Designing and using incentives to support recruitment and retention in clinical trials: a scoping review and a checklist for design

Beth Parkinson, Rachel Meacock, Matt Sutton, Eleonora Fichera, Nicola Mills, Gillian W. Shorter, Shaun Patrick Treweek, Nicola L Harman, Rebecca C. H. Brown, Kate Gillies, Peter Bower* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background
Recruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future.

Methods
The scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives.

Results
The issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base.

Conclusions
Our findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.
Original languageEnglish
Article number624
Number of pages14
JournalTrials
Volume20
Early online date9 Nov 2019
DOIs
Publication statusPublished - 9 Nov 2019

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Checklist
Motivation
Clinical Trials
Incentive Reimbursement
Health Behavior
Research

Keywords

  • recruitment
  • retention
  • trials
  • incentives
  • Incentives
  • Trials
  • Retention
  • Recruitment
  • RANDOMIZED CONTROLLED-TRIALS
  • PAYMENT
  • QUALITY
  • METAANALYSIS
  • ISSUES
  • PAY-FOR-PERFORMANCE
  • HEALTH-CARE
  • FINANCIAL INCENTIVES
  • PARTICIPATION

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Medicine (miscellaneous)

Cite this

Designing and using incentives to support recruitment and retention in clinical trials : a scoping review and a checklist for design. / Parkinson, Beth; Meacock, Rachel ; Sutton, Matt; Fichera, Eleonora; Mills, Nicola ; Shorter, Gillian W.; Treweek, Shaun Patrick; Harman, Nicola L; Brown, Rebecca C. H. ; Gillies, Kate; Bower, Peter (Corresponding Author).

In: Trials, Vol. 20, 624, 09.11.2019.

Research output: Contribution to journalArticle

Parkinson, Beth ; Meacock, Rachel ; Sutton, Matt ; Fichera, Eleonora ; Mills, Nicola ; Shorter, Gillian W. ; Treweek, Shaun Patrick ; Harman, Nicola L ; Brown, Rebecca C. H. ; Gillies, Kate ; Bower, Peter. / Designing and using incentives to support recruitment and retention in clinical trials : a scoping review and a checklist for design. In: Trials. 2019 ; Vol. 20.
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abstract = "BackgroundRecruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future.MethodsThe scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives.ResultsThe issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base.ConclusionsOur findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.",
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author = "Beth Parkinson and Rachel Meacock and Matt Sutton and Eleonora Fichera and Nicola Mills and Shorter, {Gillian W.} and Treweek, {Shaun Patrick} and Harman, {Nicola L} and Brown, {Rebecca C. H.} and Kate Gillies and Peter Bower",
note = "Acknowledgements The authors would like to thank the two anonymous reviewers for their useful comments and suggestions for additions to the manuscript. Funding The study was funded by the MRC Network of Hubs for Trials Methodology Research (MR/L004933/1-N73).",
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AU - Parkinson, Beth

AU - Meacock, Rachel

AU - Sutton, Matt

AU - Fichera, Eleonora

AU - Mills, Nicola

AU - Shorter, Gillian W.

AU - Treweek, Shaun Patrick

AU - Harman, Nicola L

AU - Brown, Rebecca C. H.

AU - Gillies, Kate

AU - Bower, Peter

N1 - Acknowledgements The authors would like to thank the two anonymous reviewers for their useful comments and suggestions for additions to the manuscript. Funding The study was funded by the MRC Network of Hubs for Trials Methodology Research (MR/L004933/1-N73).

PY - 2019/11/9

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N2 - BackgroundRecruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future.MethodsThe scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives.ResultsThe issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base.ConclusionsOur findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.

AB - BackgroundRecruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future.MethodsThe scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives.ResultsThe issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base.ConclusionsOur findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.

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