Financial Incentives for Alzheimer's Prevention

(FIND-AD Trial)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Southern California

Disqualifiers: Below age 50, Dementia diagnosis

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine whether sending messages, with or without financial incentives, encourages more people to join an online Alzheimer's prevention study. Participants will be divided into three groups: one will receive messages only, another will get messages with a chance to win a prize, and the third will receive a small monetary incentive. The trial seeks individuals aged 50 or older who are patients at Contra Costa Regional Medical Center or its affiliated clinics and can read in English or Spanish. As an unphased study, this trial offers a unique opportunity to contribute to innovative research in Alzheimer's prevention.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that using money to encourage study participation is generally safe. Studies have found that offering financial rewards does not cause harm and helps attract more participants from diverse backgrounds. No reports have linked negative effects directly to receiving these incentives. This aligns with the common use of financial incentives in research without causing problems. Therefore, those considering joining a trial with financial incentives can feel confident in the safety of these methods. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using financial incentives for Alzheimer's prevention because this approach focuses on motivating individuals to engage in preventive behaviors, which is quite different from traditional treatments that often involve medications or therapies targeting symptoms. The trial explores how offering small monetary rewards or a chance to win a prize can encourage people to adopt habits that might reduce Alzheimer's risk. This innovative method could potentially lead to more sustainable, lifestyle-based prevention strategies, making it a unique and accessible complement to existing pharmaceutical options.

What evidence suggests that this trial's treatments could be effective for increasing enrollment in the Alzheimer Prevention Trials Webstudy?

This trial will compare different financial incentives to encourage participation in Alzheimer's prevention research. Research has shown that offering money can increase participation in health studies. For example, one study found that a small reward, like $25, encouraged more people from different backgrounds to participate. In this trial, participants in the "Small Incentive" arm will receive a one-time monetary incentive. Another study found that even a prize drawing can motivate more people to sign up. Participants in the "Prize Incentive" arm will have the opportunity to win a prize through a drawing. These incentives aim to attract a wider variety of participants, especially from communities that might not usually join. These methods have successfully brought more diverse groups into health research programs. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for individuals aged 50 or older who are patients at Contra Costa Regional Medical Center and its affiliated health centers. Participants must be literate in English or Spanish. The study aims to recruit a diverse group of people into an online Alzheimer's disease registry.

Inclusion Criteria

I am 50 years old or older.

I can read and understand either English or Spanish.

You are a patient registered at CCRMC or its associated health centers.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Enrollment

Participants are enrolled into the APT Webstudy and randomized into different arms with or without financial incentives

2 weeks

Fully remote

Cognitive Assessment

Participants complete cognitive assessments using the Cognitive Function Instrument and/or Cogstate Brief Battery

2 weeks

Quarterly remote assessments

Follow-up

Participants are monitored for enrollment status and completion of cognitive assessments

Annual

What Are the Treatments Tested in This Trial?

Interventions

• Financial Incentives
• Message

Trial Overview

The study is testing if sending messages with financial incentives, such as small cash rewards or prize drawings, can increase enrollment in the APT Webstudy—a remote cognitive testing program—compared to just sending messages without incentives.

How Is the Trial Designed?

Group I: Small Incentive Experimental Treatment 1 Intervention

16,000 participants will be randomized to Arm 2 where a small one-time monetary incentive is offered.

Group II: Prize Incentive Experimental Treatment 1 Intervention

16,000 participants will be randomized to Arm 3 where an opportunity based incentive (or a drawing with a prize) with a single winner will be offered.

Group III: Messaging Only Active Control 1 Intervention

16,000 participants will be randomized to Arm 1 where no monetary incentive is offered.

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

American Heart Association

Collaborator

Trials

352

Recruited

6,196,000+

Schaeffer Center for Health Policy & Economics

Collaborator

Trials

1

Recruited

48,000+

Alzheimer's Therapeutic Research Institute

Collaborator

Trials

18

Recruited

58,400+

Published Research Related to This Trial

Financial incentive programs aimed at changing health-related behaviors may not be suitable for older adults due to their unique cognitive and emotional characteristics, such as changes in emotional regulation and decision-making preferences.

To be effective, these programs should be designed with the specific needs and decision-making styles of older adults in mind, which could enhance their impact and economic success in improving health outcomes for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Challenges and opportunities for developing and implementing incentives to improve health-related behaviors in older adults. Klein, E., Karlawish, J.[2021]

A systematic review of 15 studies found that explicit financial incentives aimed at promoting health among older adults produced mixed results in changing health-related behaviors, indicating that their effectiveness may vary significantly.

Qualitative findings revealed that older individuals often have limited trust in financial incentives for health promotion, suggesting that the design of these incentive systems is critical for their acceptance and success.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review. Tambor, M., Pavlova, M., Golinowska, S., et al.[2018]

Home visits significantly increased the willingness of study partners to allow their relatives with Alzheimer's disease to participate in clinical trials, with predicted participation rising from 17% to 27% when home visits were included.

Combining home visits with low risk and a higher chance of receiving the active treatment could boost willingness to participate to 60%, highlighting the importance of reducing travel hassles in recruiting participants, especially those with more severe Alzheimer's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How redesigning AD clinical trials might increase study partners' willingness to participate. Karlawish, J., Cary, MS., Rubright, J., et al.[2022]

Despite ongoing efforts, no primary prevention trial has successfully delayed the onset of Alzheimer's disease (AD), highlighting the challenges in this area of research.

Future trials must focus on safety, tolerability, long-term follow-up, and effective recruitment strategies to improve the chances of success in preventing AD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevention of Alzheimer disease. Thal, LJ.[2019]

Disclosing Alzheimer's disease risk has traditionally been discouraged due to the limited predictive value of tests and concerns about psychological harm, but interest in risk information is growing, especially with the rise of direct-to-consumer genetic tests.

Research indicates that individuals seeking Alzheimer's risk information through formal education and counseling generally find it beneficial and do not report negative effects, suggesting a potential shift in how risk information could be communicated.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Estimating and disclosing the risk of developing Alzheimer's disease: challenges, controversies and future directions. Roberts, JS., Tersegno, SM.[2021]

Financial incentives can be a promising strategy to encourage healthy behaviors in children, but their design must consider factors like intrinsic motivation and ethical implications, as well as the child's developmental stage.

Current research indicates that immediate, small incentives may be more effective than delayed, larger ones for promoting behaviors like healthy eating, but there is no clear advantage of loss-framed incentives over gain-framed ones in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. Kenyon, CC., Flaherty, C., Floyd, GC., et al.[2023]

A study involving 1,917 patients showed that while 62% of those with prescription drug coverage were enrolled in incentive-based pharmacy plans, many were unaware of their out-of-pocket costs during doctor visits, with 54% reporting they were 'never' or only 'sometimes' aware.

Patients in plans with no copayments were less likely to discuss out-of-pocket costs with their physicians compared to those in incentive-based plans, indicating that lack of awareness and communication may reduce the effectiveness of financial incentives in guiding treatment decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of pharmacy benefit design on patient-physician communication about costs. Shrank, WH., Fox, SA., Kirk, A., et al.[2021]

A review of Medicaid incentive programs revealed mixed effectiveness, with only about half of the available credits claimed in Florida, indicating potential issues with understanding or attractiveness of the incentives.

In contrast, Idaho's program successfully increased the number of children receiving timely well-child visits, suggesting that well-designed incentives can lead to positive health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved. Blumenthal, KJ., Saulsgiver, KA., Norton, L., et al.[2022]

In a study of 35 randomized controlled trials, financial incentives (FIs) based on behavioral-economic principles, particularly deposit contracts, were found to be the most effective in promoting healthy diet, weight control, and physical activity, significantly increasing goal achievement compared to no incentives.

While both deposit and lottery-based incentives improved physical activity levels during the intervention, only the deposit incentive maintained its effectiveness in the follow-up period, suggesting that behavioral insights can enhance the long-term impact of financial incentives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. Boonmanunt, S., Pattanaprateep, O., Ongphiphadhanakul, B., et al.[2023]

In a study involving 132 older volunteers, the method of informing participants about amyloid PET scan results (blinded vs. transparent enrollment) did not affect their willingness to participate in a preclinical Alzheimer's disease trial.

Participants prioritized study risks and the need for a study partner over the disclosure of biomarker results, suggesting that requiring biomarker enrollment criteria may not hinder recruitment for Alzheimer's trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disclosure of amyloid status is not a barrier to recruitment in preclinical Alzheimer's disease clinical trials. Grill, JD., Zhou, Y., Elashoff, D., et al.[2023]

A survey of 422 older adults in a dementia prevention trial revealed high overall satisfaction with participation, particularly favoring staff-administered interviews over automated methods.

Participants were primarily motivated by altruism and expressed a desire for more human interaction, feedback on their performance, and less repetitiveness in assessments, suggesting that future trials should focus on enhancing these aspects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial. Sano, M., Egelko, S., Zhu, CW., et al.[2022]

Financial incentives can be effective in changing healthcare professional practices, particularly in improving processes of care and prescribing costs, but the evidence is limited and has serious methodological flaws.

There is no conclusive evidence that financial incentives positively impact patient outcomes, highlighting the need for more comprehensive and rigorous studies in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Flodgren, G., Eccles, MP., Shepperd, S., et al.[2022]

Health care systems can enhance value for money by implementing both financial and non-financial incentive structures to improve performance and reduce financial barriers for providers.

There is no one-size-fits-all approach to incentives in health care; their effectiveness varies based on specific circumstances, and careful design involving stakeholders is crucial for success.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing performance of health care services within economic constraints: working towards improved incentive structures. Custers, T., Klazinga, NS., Brown, AD.[2019]

Changing financial rewards can influence healthcare behavior, but simply increasing payments for quality does not guarantee better health outcomes, as evidenced by mixed research results.

Financial incentives must be carefully designed to avoid unintended consequences, such as focusing on low-risk patients or undermining intrinsic motivation, and should be evaluated for their effectiveness compared to other quality improvement strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paying hospitals for quality: can we buy better care? Hall, JP., van Gool, KC.[2019]

Citations

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RESULTS Of 44 844 patients invited to the APT Webstudy, the mean (SD) age was 64.7 (10.1) years,. 25 447 (56.8%) were women, 25 044 (55.8%) ...

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Effectiveness and Ethics of Incentives for Research ...

This trial examines whether incentives improve enrollment in real randomized clinical trials or serve as undue or unjust inducements.