title: Patient attitudes about financial incentives for diabetes self-management: A survey.
abstract: OBJECTIVE
  To study the acceptability of incentives for behavior changes in individuals with diabetes, comparing financial incentives to self-rewards and non-financial incentives.
  
  
  METHODS
  A national online survey of United States adults with diabetes was conducted in March 2013 (n = 153). This survey was designed for this study, with iterative testing and modifications in a pilot population. We measured the demographics of individuals, their interest in incentives, as well as the perceived challenge of diabetes self-management tasks, and expectations of incentives to improve diabetes self-management (financial, non-financial and self-rewards). Using an ordered logistic regression model, we assessed the association between a 32-point score of the perceived challenge of the self-management tasks and the three types of rewards.
  
  
  RESULTS
  Ninety-six percent of individuals were interested in financial incentives, 60% in non-financial incentives and 72% in self-rewards. Patients were less likely to use financial incentives when they perceived the behavior to be more challenging (odds ratio of using financial incentives of 0.82 (95%CI: 0.72-0.93) for each point of the behavior score). While the effectiveness of incentives may vary according to the perceived level of challenge of each behavior, participants did not expect to need large amounts to motivate them to modify their behavior. The expected average amounts needed to motivate a 5 lb weight loss in our population and to maintain this weight change for a year was $258 (interquartile range of $10-100) and $713 (interquartile range of $25-250) for a 15 lb weight loss. The difference in mean amount estimates for 5 lb and 15 lb weight loss was significant (P < 0.001).
  
  
  CONCLUSIONS
  Individuals with diabetes are willing to consider financial incentives to improve diabetes self-management. Future studies are needed to explore incentive programs and their effectiveness for diabetes.
authors.affiliation: Katherine S Blondon, Division of General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Blondon
keywords: Diabetes self-management; Motivation; Patient engagement; Patient incentives; Weight loss