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Tailored Adherence Incentives for Childhood Asthma Medications: A Randomized Clinical Trial
Chén C Kenyon1,2,3, William O Quarshie4, Rui Xiao3
1PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Financial incentives improved inhaled asthma medication adherence in children, but the effect faded after the intervention ended. This highlights the temporary impact of financial incentives on medication adherence.
Area of Science:
- Pediatric Health
- Clinical Trials
- Health Disparities
Background:
- Differential adherence to preventive medications contributes to racial disparities in childhood asthma.
- Targeting adherence is crucial for improving asthma outcomes in minority children.
Purpose of the Study:
- To assess the impact of a financial incentive-enhanced intervention on adherence to inhaled asthma preventive medication.
- To evaluate this intervention in a high-risk, predominantly racially minoritized pediatric cohort.
Main Methods:
- A randomized clinical trial involving children aged 5-12 with persistent asthma.
- Intervention included daily text reminders, weekly feedback, and financial incentives for medication adherence.
- Adherence was monitored using electronic inhaler sensors over a 7-month period (3-month intervention, 3-month observation).
Main Results:
- The full intervention group showed a 15-percentage point higher adherence compared to the active control group during the intervention period.
- No significant differences in adherence were observed between groups during the 3-month observation phase after the intervention ceased.
- The study included 106 children, with 82% identifying as non-Hispanic Black.
Conclusions:
- Financial incentive-enhanced mobile health interventions can temporarily improve inhaled preventive medication adherence in children.
- The positive effects on adherence did not persist after the intervention components were removed.
- Findings suggest that while incentives can boost adherence, their long-term impact requires further investigation.
Importance:
Differential adherence to efficacious preventive medications is one potentially modifiable driver of racial disparities in childhood asthma outcomes.
Objective:
To determine the effect of a financial incentive-enhanced intervention on adherence to inhaled asthma preventive medication in a high-risk, predominantly racially minoritized cohort of children with asthma.
Design, Setting, And Participants:
This was a randomized clinical trial conducted from September 2019 through June 2022 at a large mid-Atlantic pediatric health system in the US. Children were eligible if they were between 5 and 12 years old, prescribed a preventive inhaler for daily use, and had at least 2 asthma exacerbations requiring systemic steroids in the preceding year. Data were analyzed from December 2022 to December 2024.
Intervention:
Inhaled medication use was monitored using electronic inhaler sensors over a 7-month period. Families who completed a 1-month run-in interval were randomized to 1 of 3 arms for a 3-month experiment interval: (1) daily text message medication reminders, weekly adherence feedback, and gain-framed, financial incentives of up to $1 per day (full intervention); (2) daily text message medication reminders and weekly adherence feedback (hybrid intervention); or (3) no reminders, feedback, or incentives (active control). Medication adherence monitoring then continued for a 3-month observation interval, where all arms reverted to active control conditions.
Main Outcomes And Measures:
The primary outcome was adherence to inhaled maintenance medication during the experiment; secondary outcomes included adherence during the observation phase. The study was powered to detect a difference in average monthly adherence between the full intervention and active control condition.
Results:
Of the 106 children randomized, 99 had at least 1 month of monitoring data (56 male [57%] and 43 female [43%]; mean [SD] age, 8.0 [2.3] years). Most participants (81 [82%]) identified as non-Hispanic Black and demographic and clinical characteristics were similar across study arms. During the experiment interval, participants receiving the full intervention had a 15-percentage point (95% CI, 2-29 percentage points) higher inhaled maintenance medication adherence compared with participants in the active control. There was no evidence of adherence differences in the observation interval.
Conclusion And Relevance:
While a financial incentive-enhanced mobile health intervention led to higher inhaled preventive medication adherence as compared with the active control group, there was no evidence for enduring effect after the intervention components ceased, consistent with other studies that include financial incentives to encourage behavior change.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03907410.
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