Adherence to asthma maintenance treatment for children and young people (CYP) with asthma is poor; however, behaviour change is challenging. Electronic monitoring supported by reminders are effective at improving adherence, yet this is not often sustained. Financial incentives may support these approaches to bring about longer-term changes and improved clinical outcomes for CYP. Therefore, the over-arching aim of this PhD is to explore the use of financial incentives for CYP with asthma to improve their adherence to maintenance treatment.
This PhD was completed in three projects. Project 1 was a systematic review that explored the effectiveness of financial incentives to improve asthma management behaviours. There were mixed results; however, effective financial incentive characteristics were identified. Project 2 conducted focus groups with CYP, their parents, and healthcare professionals to explore attitudes towards financial incentives. Financial incentives were acceptable, and findings were used to inform the design of the ‘Financial INcentives to improve Asthma’ (FINA) study. Project 3 implemented the FINA study, a mixed-methods pilot randomised controlled trial (RCT) of financial incentives to improve CYP adherence to maintenance treatment. After the intervention, median adherence was higher for intervention CYP (73.0%, range: 23.0%-89.0%) compared to control (56.0%, range: 7.0%-87.0%), but this did not reach significance (p=0.077). Logistical challenges were encountered, and the FINA study was not considered feasible to be conducted as a definitive trial using the current design. CYP focus groups, and parental interviews, showed concerns around financial incentive use but acceptability was more likely if their purpose is fully explained.
This PhD provides unique and important insights into the use of financial incentives in CYP with asthma. Acknowledging the small sample size, financial incentives were not effective for sustained adherence and experiences of financial incentives largely differed. Future research is needed to explore interactions between financial incentives and individual characteristics.