Asthma is the most common chronic disease in children, with symptoms usually developing before age 5. The condition highly impacts young Black children, who are twice as likely to have asthma and face higher hospitalization and death rates than white children.
A key issue for many Black families is medication adherence, or following prescribed treatment plans. Studies reveal that Black adolescents have significantly lower asthma medication adherence than white adolescents due to barriers like income, insurance, and pharmacy access.
A recent study published in JAMA Pediatrics investigated whether financial incentives could improve medication adherence among children with high-risk asthma.
How financial incentives can improve asthma control
The study, led by Chén C. Kenyon, MD, MSHP, tested whether a financial incentive-enhanced intervention could improve medication adherence and health outcomes for children with high-risk asthma.
The randomized clinical trial was conducted from September 2019 to June 2022, involving 106 predominantly Black children aged 5-12. Researchers monitored inhaled medication use through sensors over seven months. Families who completed a 1-month run-in period were randomized to one of three groups:
- Full intervention: Daily text medication reminders, weekly adherence feedback, and financial incentives of up to $1 daily.
- Hybrid intervention: Daily text medication reminders and weekly adherence feedback, without incentives.
- Active control: No reminders, feedback, or incentives.
Participants in the full intervention had 15 percentage points higher medication adherence than those in the active control group. However, adherence quickly returned to baseline levels when the intervention concluded.
“Improved adherence did not meet a high enough threshold to result in changes in asthma control or health care utilization from baseline,” says Davene R. Wright, PhD, of Harvard Medical School and colleagues in an accompanying editorial. “Therefore, it is not surprising that intrinsic motivation did not appear to be activated.”
The role of incentives in increasing Black participation in clinical trials
Financial incentives, such as gift cards, have been shown to increase participation in clinical trials and improve adherence to medical interventions.
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A 2024 study published in JAMA Network found that a $25 gift card incentive increased a parent’s willingness to enroll their Black children into a clinical trial. Interestingly, the study revealed that monetary incentives may override mistrust in the healthcare system when enrolling in a study.
This suggests that monetary incentives can motivate participation even in distrust. Similarly, the asthma study revealed that financial incentives led to better medication adherence, highlighting the importance of targeted incentives to improve health outcomes for Black children.
What do these findings mean for asthma management in Black children?
Kenyon’s and Johnson’s findings provide valuable insights into how financial incentives can improve medication adherence and increase Black participation in clinical trials. However, further research is needed to assess the long-term impact of these incentives on health outcomes.
“More research is needed on the impact of incentives on health-related quality of life, how incentives are actually used, the value of incentives that would motivate participants, the impact of incentives on intrinsic motivation, and the cost-effectiveness of financial incentive interventions,” says Dr. Wright and colleagues.
Why it matters
Improving asthma control in Black children is essential for reducing hospitalization and death rates. Financial incentives like $1 per day or a $25 gift card offer promising approaches to overcoming barriers like income and healthcare access. By making adherence to asthma medication more feasible, these incentives can help close healthcare gaps and reduce disparities. However, further research is needed to refine these approaches for lasting impact in minority populations.
“As with many behavioral interventions, incentives are, therefore, not typically meant for long-term use,” explains Dr. Wright and colleagues. “Incentives are likely most effective when the immediate rewards help individuals to align their actions with their true underlying preferences.”
