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Assessment of Parents' Preferences for Incentives to Promote Engagement in Family-Based Childhood Obesity Treatment
Davene R Wright1,2, Brian E Saelens1,2,3, Angela Fontes4
1Department of Pediatrics, University of Washington School of Medicine, Seattle.
Insights
Parents prefer higher incentives for childhood obesity treatment, but are willing to accept lower amounts for shared goals and guaranteed payments. These preferences may not align with established treatment best practices.
Area of Science:
- Pediatric obesity treatment
- Behavioral economics
- Health psychology
Background:
- Family-based treatment (FBT) is a recommended approach for childhood obesity.
- High attrition rates in FBT limit its effectiveness.
- Extrinsic incentives have shown success in improving adult health behaviors.
Purpose of the Study:
- To investigate parents' preferences for incentive programs designed to improve engagement in FBT for childhood obesity.
- To identify key attributes of incentives that influence parental motivation.
Main Methods:
- A nationally representative web-based survey was conducted with parents of children (6-17 years) with obesity.
- A discrete choice experiment assessed preferences for incentive attributes: monetary value, payment structure, goal, and recipient.
- Hierarchical Bayesian modeling and linear regressions analyzed preference data.
Main Results:
- Parents preferred higher monetary incentives, but accepted lower values when incentives were gain-framed and involved both parent and child participation.
- Incentivizing physical activity was preferred over weight loss or dietary monitoring.
- A strong preference for guaranteed payments over lottery-based incentives was observed.
Conclusions:
- Parental preferences for FBT incentives may not align with established best practices or behavioral economic principles.
- Further research, such as randomized clinical trials, is needed to determine if aligning incentives with stated preferences or best practices maximizes engagement and behavior change.
Importance:
Family-based treatment (FBT) is recommended for childhood obesity, but even when sought, attrition is high. Extrinsic incentives, which have been effective for improving adult health, could improve FBT engagement.
Objective:
To assess parents' preferences for FBT incentives.
Design, Setting, And Participants:
Survey study of parents of children aged 6 to 17 years with obesity (body mass index in ≥95th percentile for age and sex). Parents' preferences for FBT incentive program attributes were assessed in a discrete choice experiment conducted using a nationally representative, web-based survey in March 2018. Attributes included (1) the monetary value of the incentive, (2) the payment structure, (3) the goal being incentivized, and (4) the person(s) being incentivized. A fractional factorial design was used to create a set of profiles representing hypothetical FBT incentives. Parents were presented with 10 pairs of profiles and asked which would most motivate them in FBT. Parents were also asked about preferences between a small, guaranteed incentive and a lottery for a large incentive. Analyses used a hierarchical Bayesian model and linear regressions.
Main Outcomes And Measures:
Parents' preference for different incentive program attributes and levels.
Results:
The nationally representative survey had a 41.4% eligibility rate (n = 339) and a 89.7% completion rate (n = 304). A total of 53.3% of respondents (weighted percentage) were non-Hispanic white, 42.6% had an annual household income less than $50 000, and 28.3% had a bachelor's degree. Parents preferred higher incentives, although they were willing to accept lower-value incentives if both the parent and the child (vs the child alone) were required to meet the goal (mean difference [MD], -$108; 95% CI, -$132 to -$84), if the incentive used a gain-framed vs loss-framed payment structure (MD, -$72; 95% CI, -$85 to -$59), and if physical activity goals were incentivized over weight loss (MD, -$63; 95% CI, -$82 to -$44) or dietary monitoring (MD, -$5; 95% CI, -$1 to $28). Only 20.6% of parents preferred a lottery over a guaranteed payment. Preferences did not vary among demographic or health subgroups.
Conclusions And Relevance:
In this study, parent-stated preferences did not align with FBT best practices or behavioral economic theory. A randomized clinical trial could examine whether aligning incentives with preferences or best practices would maximize FBT engagement and behavior change.