Monetary Incentives and Intrinsic Motivation to Sustain Hypertension Control
2 other identifiers
interventional
207
1 country
2
Brief Summary
Despite unequivocal proof that tight control of blood pressure with antihypertensive medication can prevent hypertensive complications-including strokes, myocardial infarcts, heart failure, end-stage renal disease, and death- blood pressure remains uncontrolled in the majority of individuals with hypertension. We propose a novel patient-centered intervention that combines monetary incentives and a social psychological intervention to help patients sustain blood pressure control once incentives are no longer offered by strengthening intrinsic motivation to control blood pressure among two vulnerable populations: African Americans, who suffer disproportionately from hypertension, and Mexican Americans, who have the lowest hypertension control rates of any demographic group in the United States. If the intervention is successful, it could be adapted as a set of tools to apply in clinical practice to improve outcomes of a range of chronic diseases, by maximizing the motivation of patients to optimize their treatment.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for not_applicable hypertension
Started Aug 2011
Typical duration for not_applicable hypertension
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
July 25, 2011
CompletedFirst Posted
Study publicly available on registry
July 26, 2011
CompletedStudy Start
First participant enrolled
August 1, 2011
CompletedPrimary Completion
Last participant's last visit for primary outcome
September 1, 2012
CompletedStudy Completion
Last participant's last visit for all outcomes
September 1, 2013
CompletedMarch 10, 2015
March 1, 2015
1.1 years
July 25, 2011
March 7, 2015
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Change in and normalization of BP
12 months
Secondary Outcomes (1)
Acceptability of the intervention and subjects' views regarding its impact.
12 months
Study Arms (2)
Control Subjects
NO INTERVENTIONReceive educational materials and a home BP monitor.
Intervention Subjects
EXPERIMENTALReceive educational materials and a home BP monitor, as well as monetary incentives tied to amount of improvement in BP from baseline and a personalized intervention to internalize motivation for BP control. Monthly monetary incentives will cease after 6 months.
Interventions
Subjects will receive a payment of $2 per mm. drop in BP from the baseline value at each follow-up visit. If a subject reaches their target BP, they will receive a minimum of $30 each time to motivate continued participation in the study and reinforce continued improvement relative to baseline BP. Lottery incentives will be added to motivate attainment of intermediate goals. For remembering to do certain actions that assist in the management of their BP, the subject will receive one entry into a lottery with an expected value of $3 per ticket. For the lottery payment, the subject will be given 3 chances to randomly select a card that may or may not show a winning monetary prize.
A)Subjects will complete an additional component to the baseline questionnaire that probes systematically for areas of experience that currently are of importance to them. Their answers will help to identify patients' intrinsic motivations for controlling their BP. B)Answers to this component will be analyzed to characterize a role self-identity that will be used by study personnel to frame their interactions with the subject for the remainder of the study. C) Role identity will be kept highly salient throughout the study by using identity primes that remind the individual that improving blood pressure levels is an important responsibility associated with that role.
Eligibility Criteria
You may qualify if:
- Adults aged 18 or older who are receiving ongoing medical care at the clinic (one or more routine visits in the year prior to the visit during the study enrollment period at which their blood pressure is found to be abnormal), are capable of giving consent, and live at a fixed address.
- Must state that they intend to continue to receive care in the clinic.
- Measured BP is greater than 140mm systolic or 90mm diastolic (or 130/80 respectively for "high risk" subjects with: diabetes, established coronary artery disease, prior cardiovascular event, left ventricular hypertrophy by ECG, chronic kidney disease, or diagnosed heart failure).
You may not qualify if:
- Those whose BP's have returned to normal 1-2 weeks after the original obtained average reading.
- Children, prisoners, institutionalized individuals, or pregnant women.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
St. John's Well Child and Family Center Compton W.M. Keck Foundation Clinic Building
Los Angeles, California, 90007, United States
St. John's Well Child and Family Center Dr. Louis C. Frayser Clinic
Los Angeles, California, 90037, United States
Related Publications (1)
Shapiro MF, Shu SB, Goldstein NJ, Victor RG, Fox CR, Tseng CH, Vangala S, Mogler BK, Reed SB, Villa E, Escarce JJ. Impact of a Patient-Centered Behavioral Economics Intervention on Hypertension Control in a Highly Disadvantaged Population: a Randomized Trial. J Gen Intern Med. 2020 Jan;35(1):70-78. doi: 10.1007/s11606-019-05269-z. Epub 2019 Sep 12.
PMID: 31515735DERIVED
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Martin F. Shapiro, MD
University of California, Los Angeles
- STUDY DIRECTOR
José J. Escarce, MD, Ph.D
University of California, Los Angeles
- STUDY DIRECTOR
Craig R. Fox, Ph.D.
University of California, Los Angeles
- STUDY DIRECTOR
Noah J. Goldstein, Ph.D.
University of California, Los Angeles
- STUDY DIRECTOR
Honghu Liu, Ph.D.
University of California, Los Angeles
- STUDY DIRECTOR
Suzanne B. Shu, Ph.D., MBA
University of California, Los Angeles
- STUDY DIRECTOR
Ronald G. Victor, MD
Cedars-Sinai Medical Center for Hypertension
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Professor of Medicine
Study Record Dates
First Submitted
July 25, 2011
First Posted
July 26, 2011
Study Start
August 1, 2011
Primary Completion
September 1, 2012
Study Completion
September 1, 2013
Last Updated
March 10, 2015
Record last verified: 2015-03