Coupling Financial Incentives with Direct Mail in Population-Based Practice: A Randomized Trial of Mammography Promotion.
TL;DR: Experimental evidence is offered on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.
Abstract: Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.
Citations
More filters
01 Jan 2016
TL;DR: Thank you very much for downloading health behavior and health education theory research and practice, maybe you have knowledge that, people have search numerous times for their favorite readings like this, but end up in harmful downloads.
Abstract: Thank you very much for downloading health behavior and health education theory research and practice. Maybe you have knowledge that, people have search numerous times for their favorite readings like this health behavior and health education theory research and practice, but end up in harmful downloads. Rather than enjoying a good book with a cup of tea in the afternoon, instead they cope with some harmful virus inside their desktop computer.
903 citations
TL;DR: To usefully inform public health policy and investment decisions, there needs to be greater application of economic evaluation to understand the cost-effectiveness of alternative implementation efforts.
43 citations
TL;DR: It is shown that fairly moderate levels of incentive payments for treatment engagement and abstinence increased very low-income smokers' engagement and success in smoking cessation treatment.
37 citations
TL;DR: Interventions focused on social determinants of health to improve breast, cervical, and colorectal cancer screening appear to be cost-effective for underserved, vulnerable populations in the United States.
Abstract: Importance Screening for breast, cervical, and colorectal cancers in the United States has remained below the Healthy People 2020 goals, with evidence indicating that persistent screening disparities still exist The US Department of Health and Human Services has emphasized cross-sectoral collaboration in aligning social determinants of health with public health and medical services Examining the economics of intervening through these novel methods in the realm of cancer screening can inform program planners, health care providers, implementers, and policy makers Objective To conduct a systematic review of economic evaluations of interventions leveraging social determinants of health to improve screening for breast, cervical, and colorectal cancer to guide implementation Evidence Review A systematic literature search for economic evidence was performed in MEDLINE, Embase, PsycINFO, Cochrane Library, Global Health, Scopus, Academic Search Complete, Business Source Complete, EconLit, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Education Resources Information Center), and Sociological Abstracts from January 1, 2004, to November 25, 2019 Included studies intervened on social determinants of health to improve breast, cervical, and colorectal cancer screening in the United States and reported intervention cost, incremental cost per additional person screened, and/or incremental cost per quality-adjusted life-year (QALY) Risk of bias was assessed along with qualitative assessment of quality to ensure complete reporting of economic measures, data sources, and analytic methods In addition, included studies with modeled outcomes had to define structural elements and sources for input parameters, distinguish between programmatic and literature-derived data, and assess uncertainty Findings Thirty unique articles with 94 706 real and 421 million simulated participants satisfied our inclusion criteria and were included in the analysis The median intervention cost per participant was $12387 (interquartile interval [IQI], $2444-$31319; 34 estimates) The median incremental cost per additional person screened was $25037 (IQI, $4467-$60938; 17 estimates) Studies that modeled final economic outcomes had a median incremental cost per person of $12296 (IQI, $4696-$12480; 5 estimates), a median incremental screening rate of 15% (IQI, 14%-20%; 5 estimates), and a median incremental QALY per person of 004 years (IQI, 0006-006 year; 5 estimates) The median incremental cost per QALY gained of $312000 (IQI, $78259-$33 60000; 5 estimates) was lower than $50 000, an established, conservative threshold of cost-effectiveness Conclusions and Relevance Interventions focused on social determinants of health to improve breast, cervical, and colorectal cancer screening appear to be cost-effective for underserved, vulnerable populations in the United States The increased screening rates were associated with earlier diagnosis and treatment and in improved health outcomes with significant gains in QALYs These findings represent the latest economic evidence to guide implementation of these interventions, which serve the dual purpose of enhancing health equity and economic efficiency
24 citations
TL;DR: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening and may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance.
Abstract: Background: Despite lower cancer screening rates and survival rates in the Medicaid population compared with those with private insurance, there is a dearth of population-based, evidence-based interventions targeting Medicaid clients to address this problem.Methods: This study reports results of a population-based randomized controlled trial (RCT) among all individuals enrolled in Minnesota's Medicaid program who were overdue for breast cancer (n = 22,113) and/or colorectal cancer (n = 94,294) screening. Individuals were randomized to intervention or control groups. The intervention group received persuasive and innovative direct mail materials coupled with a $20 incentive for using their Medicaid benefit to get screened. Direct mail materials provided a phone number to a call center staffed by patient navigators who addressed barriers and scheduled appointments via three-way calls. The control group received the intervention 15 months later. Primary outcomes were completion of mammography or colonoscopy within 12 weeks of the intervention. Billing claims served as evidence of screening.Results: Multivariate logistic regression showed significant differences for both breast cancer (P < 0.001) and colorectal cancer (P < 0.01). The odds of receiving a mammogram for the treatment group were significantly higher than the control group [OR = 1.30; 95% confidence interval (95% CI) = 1.16-1.46], and the treatment group was more likely to receive a colonoscopy than the control group (OR = 1.12; 95% CI = 1.04-1.21).Conclusions: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening.Impact: These findings may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance. Cancer Epidemiol Biomarkers Prev; 27(9); 1047-56. ©2018 AACR.
19 citations
Cites background or methods or result from "Coupling Financial Incentives with ..."
...Even though previous research has shown that direct mail's efficacy is improved by adding incentives and/or patient navigation (18, 25), it is important to note that this multicomponent study was not designed to determine the relative contribution of each component....
[...]
...We have previously demonstrated that a multicomponent intervention (25, 26) composed of direct mail coupled with financial incentives and a centralized patient navigator-staffed call center (27, 28) can increase mammography and is scalable (25, 26, 29)....
[...]
...When considered in conjunction with prior research (25, 26), this approach shows promise for increasing cancer screening in public health insurance programs....
[...]
...Mailers were designed on the basis of previous research (25, 26)....
[...]
...Only one targeted an unscreened population (25), but the accuracy of screening status was limited because the time between determination of screening status and the mailed intervention was more than a year, whereas in the current study, screening status was up-to-date within weeks of the mailing....
[...]
References
More filters
TL;DR: The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of about 1,024,400 deaths from cancer, which can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket.
Abstract: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. A total of 1,638,910 new cancer cases and 577,190 deaths from cancer are projected to occur in the United States in 2012. During the most recent 5 years for which there are data (2004-2008), overall cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.6% per year in women. Over the past 10 years of available data (1999-2008), cancer death rates have declined by more than 1% per year in men and women of every racial/ethnic group with the exception of American Indians/Alaska Natives, among whom rates have remained stable. The most rapid declines in death rates occurred among African American and Hispanic men (2.4% and 2.3% per year, respectively). Death rates continue to decline for all 4 major cancer sites (lung, colorectum, breast, and prostate), with lung cancer accounting for almost 40% of the total decline in men and breast cancer accounting for 34% of the total decline in women. The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of about 1,024,400 deaths from cancer. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket.
10,630 citations
TL;DR: The meta-analysis suggests that strong fear appeals produce high levels of perceived severity and susceptibility, and are more persuasive than low or weak fear appeals, and the results indicate that fear appeals motivate adaptive danger control actions such as message acceptance and maladaptive fear control actionssuch as defensive avoidance or reactance.
Abstract: The fear appeal literature is examined in a comprehensive synthesis using meta-analytical techniques. The meta-analysis suggests that strong fear appeals produce high levels of perceived severity and susceptibility, and are more persuasive than low or weak fear appeals. The results also indicate that fear appeals motivate adaptive danger control actions such as message acceptance and maladaptive fear control actions such as defensive avoidance or reactance. It appears that strong fear appeals and high-efficacy messages produce the greatest behavior change, whereas strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses. Future directions and practical implications are provided.
2,700 citations
"Coupling Financial Incentives with ..." refers background or methods in this paper
...The mailers used a loss-frame message (see Rothman & Salovey, 1997), and this was coupled with a high-efficacy message (see Witte & Allen, 2000)....
[...]
...Fear at WESTERN MICHIGAN UNIVERSITY on June 5, 2016heb.sagepub.comDownloaded from appeal or loss-frame messages coupled with clearly stated and achievable steps—a high-efficacy message—are most effective for promoting preventive behaviors (Witte & Allen, 2000)....
[...]
2,281 citations
"Coupling Financial Incentives with ..." refers background in this paper
...However, some of the behavioral mechanisms influenced by incentive-based programs have been shown to have far-reaching and consistent effects regardless of the demographic characteristics of the populations within which programs are implemented (see, e.g., Thaler & Sunstein, 2009)....
[...]
01 Jan 1996
1,930 citations
TL;DR: The authors discuss the cognitive and affective processes that may mediate the influence of framed information on judgment and behavior and the relative effectiveness of gain-framing or loss-framed appeals.
Abstract: Health-relevant communications can be framed in terms of the benefits (gains) or costs (losses) associated with a particular behavior, and the framing of such persuasive messages influences health decision making. Although to ask people to consider a health issue in terms of associated costs is considered an effective way to motivate behavior, empirical findings are inconsistent. In evaluating the effectiveness of framed health messages, investigators must appreciate the context in which health-related decisions are made. The influence of framed information on decision making is contingent on people, first, internalizing the advocated frame and, then, on the degree to which performing a health behavior is perceived as risky. The relative effectiveness of gain-framed or loss-framed appeals depends, in part, on whether a behavior serves an illness-detecting or a health-affirming function. Finally, the authors discuss the cognitive and affective processes that may mediate the influence of framed information on judgment and behavior.
1,750 citations
"Coupling Financial Incentives with ..." refers background or methods in this paper
...The mailers used a loss-frame message (see Rothman & Salovey, 1997), and this was coupled with a high-efficacy message (see Witte & Allen, 2000)....
[...]
...Loss-frame messages are meant to inform an individual that certain behaviors can lead to unhealthy outcomes, and this type of message frame is effective for promoting cancer screening (Rothman & Salovey, 1997)....
[...]