Effectiveness of Financial Incentives and Text Messages to Improve Health Care in Population With Moderate and High Cardiovascular Risk

Not Applicable

• Conditions: Moderate and High Cardiovascular Risk
• Interventions: Behavioral: Framing (SMS); Behavioral: Financial incentives

• Registration Number: NCT03300154
• Lead Sponsor: Institute for Clinical Effectiveness and Health Policy

Brief Summary

Cardiovascular diseases are increasing throughout the developing world and are the cause of almost 16.7 million deaths each year, of which 80% occur in low and middle-income countries. As more than three fourth of the global burden of cardiometabolic diseases are related to risk factors connected with lifestyles or behaviors, such as smoking, unhealthy eating, low physical activity, and harmful consumption of alcohol. This burden could be dramatically reduced by changing individual behaviors. This study is focused on interventions that are aimed to improve the adherence to treatment in cardiovascular disease (hypertension), based on a Behavioral Economics approach. Most of public policies targeted to tackle NCDs utilize a rational economic model of behavior. Behavioral economics, by using insights from cognitive psychology and other social sciences, has drawn a lot of attention for its potential to increase healthy behaviors. Interventions informed by BE principles seek to rearrange the social or physical environment in such a way to 'nudge' people towards healthier choices and behaviors.

Main objective: to assess whether the implementation of two strategies based on behavioral economics, that include the use of a financial incentive scheme and specific framing to beneficiaries (i.e. mobile health interventions), increase the referral, evaluation and follow-up of people with moderate and high cardiovascular risk in the public health network, compared to the usual strategy.

Design: A cluster-randomized pragmatic clinical trial will be performed. The randomization unit will be the Community Health Centers (CHC) and the intervention groups (2 arms) or control will be assigned to 9 health centers in total (3 CHC per arm).

Population: This RCT is going to be conducted in selected CHC of Salta. Nine CHC will be selected, which will be randomized: 3 centers to the control, 3 centers to framing intervention with messages and 3 centers to the intervention with incentives.

A total of 900 patients ≥ 40 years, without health coverage and with a 10-year cardiovascular risk ≥ 10% will participate in this study.

Follow up: 3 month

Detailed Description

Not available

Study Timeline

• Study Start: 2017-04-27
• Primary Completion: 2017-07-31
• Status Verified: 2017-09
• Study First Submitted: 2017-09-28
• Study First Submitted QC: 2017-10-02
• Last Update Submitted: 2017-10-02
• Study First Posted: 2017-10-03
• Last Update Posted: 2017-10-03
• Study Completion: 2017-10-23

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 917

Inclusion Criteria

• Subjects that only have public health coverage.
• Residence in the area of influence of the health centers of the study.
• Have a mobile phone for personal use.
• 10 year cardiovascular risk ≥ 10%

Exclusion Criteria

• Pregnant women.
• Immobilized people.
• Persons who do not give their informed consent.
• People planning to move in the next 3 months

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Framing (SMS)	Framing (SMS)	-
Financial incentives	Financial incentives	-

Primary Outcome Measures

Name	Time	Method
Attendance at the first medical visit	4 weeks	Proportion of patients who attended and completed the first clinical visit to the health center
Attendance at the second medical visit	8 weeks after first medical visit	Proportion of patients who attended and completed the second clinical visit to the health center

Secondary Outcome Measures

Name	Time	Method
Attendance at least one clinical visit	12 weeks	Proportion of patients who attended and completed at least one clinical visit to the health

Trial Locations

Locations (9)

CIC; 🇦🇷 Guemes, Salta, Argentina

Villa Tranquila; 🇦🇷 Guemes, Salta, Argentina

1º DE MAYO; 🇦🇷 Guemes, Salta, Argentina

Barrio Cooperativa; 🇦🇷 Guemes, Salta, Argentina

Barrio La Tablada; 🇦🇷 Guemes, Salta, Argentina

Campo Santo; 🇦🇷 Guemes, Salta, Argentina

El cruce; 🇦🇷 Guemes, Salta, Argentina

Los Olivos; 🇦🇷 Güemes, Salta, Argentina

EL BORDO; 🇦🇷 Guemes, Salta, Argentina