26 September 2021

By Jasmine Hine, PhD student with Asthma UK Centre of Applied Research (AUKCAR) at Imperial College London

Adherence to inhaled asthma medications in adolescents is poor. Interventions to date often improve short-term adherence, but this rarely translates into sustained behaviour change or significant improvements in clinical outcomes (better asthma control or reduced asthma attacks and hospital admissions for example). So, how can we best encourage adolescents to take their medication to see these benefits long-term?

Incentives are a behavioural strategy used in various settings to target an individual’s motivations to engage in a specific behaviour – they are actually very effective and seem to be everywhere we look!

For example:

• Companies offer employee ‘pay for performance’ schemes or bonuses dependent upon performance.
• Schools offer various reward systems like sticker or point charts for children dependent upon behaviour or work ethic.
• Retail companies offer customers a free prize draw entry dependent upon experience feedback form completion.
• Health insurance companies offer customers cost-reduced fitness accessories dependent upon physical activity levels.

It is often an adolescent’s beliefs or motivations to take their medication that impedes good adherence – they could be feeling well and believe they don’t need it, they could be with friends and be embarrassed to take it, or they could have concerns for the side-effects of it (although sometimes they do simply forget to take their medication too!). The use of incentives in this instance may be useful to challenge these motivations and beliefs to successfully improve their adherence.

Incentives of monetary value seem to be appealing to adolescents, yet not everyone agrees with this concept: are we just ‘bribing’ adolescents to do something they should be doing already? Is better health not incentive enough? Will everyone want asthma if they’re getting paid? There is a lot to consider. Financial incentives, however, can meet the demands of adolescents having very different interests (e.g., they could buy whatever they want – within reason! – with the money they earn) and can also act as a reminder to take medication (e.g., the last thing they would want to do is miss a dose and reduce the amount of money earned). This suggests that the concept is worth exploring, at least in the short-term.

I am conducting some research to explore the use of incentives in adolescents with asthma to hopefully answer some questions that the discussion above sets out, including whether their use will be effective at improving longer-term adherence and clinical outcomes.

The protocol development and ethics application are underway for a pilot randomised controlled trial that will aim to recruit approximately 50 adolescents (aged 11-18 years old) who will be randomised to receive electronic reminders (control group) or electronic reminders and financial incentives dependent upon adherence (intervention) across a 3-month period.

Data collection, including adherence and asthma control, will be conducted at baseline, 3-months (post-intervention) and 6-months (follow-up). It is hopeful the clinical trial will start in early 2022.

See more from #AskAboutAsthma 2021