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Purpose: Examine associations between whether participants' were matched to their preferred financial incentive design and behavioral goal adherence in a weight management intervention. Design: Secondary quantitative analysis incorporating qualitative survey data. Setting: Primary care clinics in socioeconomically disadvantaged communities in New York City and Los Angeles. Subjects: 668 participants (mean age 47.7 years, 81.0% female, 72.6% Hispanic) with obesity were enrolled in the Financial Incentives foR Weight Reduction (FIReWoRk) intervention. Measures: We explored qualitatively participant's reasons for hypothetically choosing a behavioral goal-directed vs a weight loss outcome-based financial incentive program. Additionally, behavioral adherence to different goals was collected at the 6-month timepoint, categorized by match to preferred financial incentive design. Analysis: Logistic regression was used to examine if participants with certain demographic and higher psychosocial factors were more likely to choose goal-directed over outcome-based incentives. Additionally, logistic regression was used to test for associations between preference and behavioral adherence, using incentive type as an interaction term. Results: 60.2% of participants preferred the goal-directed incentive, with the majority stating that it was more structured. Married participants were more likely to prefer goal-directed incentives (OR = 1.57, CI = 1.06-2.33, P =.025). Moderation analysis revealed that participants who preferred goal-directed and were matched to goal-directed had greater rates of behavioral adherence for program attendance and self-weighing, but not dietary tracking and physical activity tracking, compared to those who preferred outcome-based and were matched to outcome-based. Conclusion: Receiving one's preferred incentive design may not play a strong role in behavioral goal adherence during financially incentivized weight loss interventions. [ABSTRACT FROM AUTHOR]

Research has shown that financially incentivizing sustainable behaviors may undermine individuals' conformity to pro-environmental social norms, but it remains unclear why and when such a crowding out effect occurs. Using data from a quasi-experiment in Quzhou, China, this study has tested crowding out in a local incentive program for household recycling and evaluated the causal mechanisms and boundary conditions of crowding out. The reward program reduced residents' inclination to conform to their neighbors' recycling behaviors and persuasion, which was driven by the lowering of the first- and second-order beliefs underlying norm conformity. The crowding out effect and pathways were particularly salient among people with high levels of environmental self-identity or community social embeddedness. Moreover, framing the incentivized behavior in an environmentally beneficial way could not mitigate crowding out. Overall, the results contribute to refined theories of crowding out and have important implications for the design of environmental policies. [ABSTRACT FROM AUTHOR]

The article discusses the use of financial incentives to promote healthy lifestyles, particularly focusing on obesity. Studies have shown that financial incentives can motivate weight loss and healthier choices, but long-term sustainability and outcomes remain uncertain. The effectiveness of financial incentives in managing obesity is promising, but questions about fairness, sustainability, and long-term impact need further exploration. The article highlights the need for a holistic approach that combines financial incentives with education and support to address the complex issue of obesity. [Extracted from the article]

Context Methods Findings Conclusions Policy Points What are the facilitators and barriers of physician group participation in a performance‐based financial incentive program aimed at improving equity of care by patient race and ethnicity? Launching financial incentives to improve racial equity has required extensive organizational change management for participating physician groups, including major investments to improve quality management systems. Carefully designing financial incentives to encourage equity improvement while managing unintended consequences, and considering physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors have been central to prepare physician groups for financial incentives to improve equity of care. Given the major investments required of physician groups to prepare for financial incentives that reward equity improvement, alignment of equity of care measure specifications and reporting requirements across payers could facilitate physician group engagement. Evidence about how baseline physician group capabilities, including the maturity of their quality management systems, impact equity improvement may help health plans prioritize and target their investments to advance equity of care by patient race and ethnicity. What are the facilitators and barriers of physician group participation in a performance‐based financial incentive program aimed at improving equity of care by patient race and ethnicity? Launching financial incentives to improve racial equity has required extensive organizational change management for participating physician groups, including major investments to improve quality management systems. Carefully designing financial incentives to encourage equity improvement while managing unintended consequences, and considering physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors have been central to prepare physician groups for financial incentives to improve equity of care. Given the major investments required of physician groups to prepare for financial incentives that reward equity improvement, alignment of equity of care measure specifications and reporting requirements across payers could facilitate physician group engagement. Evidence about how baseline physician group capabilities, including the maturity of their quality management systems, impact equity improvement may help health plans prioritize and target their investments to advance equity of care by patient race and ethnicity. Blue Cross Blue Shield of Massachusetts (BCBSMA), a large commercial health insurer, is using financial incentives to advance equity of care by patient race and ethnicity. Understanding experiences of this payer and its contracted physician groups can inform efforts elsewhere. We qualitatively assess physician groups’ barriers and facilitators of planning and implementing BCBSMA's financial incentives to improve equity of ambulatory care quality by patient race and ethnicity.Key informant interviews (n = 44) of the physician group, BCBSMA, and external stakeholders were conducted, equity initiative meetings were observed, and documents were analyzed to identify barriers and facilitators of designing and preparing for financial incentives to advance racial equity. Physician group experiences of preparing for and responding to financial incentives for equity improvement were assessed.Analyses revealed 1) the central importance of valid and reliable equity performance measurement and carefully designed equity improvement incentives for physician group buy‐in, 2) that prior to implementing financial incentives for equity improvement, physician groups needed to improve their quality management systems and the accuracy and completeness of patient race and ethnicity data, and 3) physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors were central to consider to plan for physician group financial incentives to improve racial equity.Given the major infrastructure investments and organizational change management resources required of physician groups to participate in a financial incentive program designed to reward equity improvement, alignment of equity measurement and performance requirements across payers would facilitate physician groups’ engagement in efforts to improve quality of care for racial and ethnic minority patients. [ABSTRACT FROM AUTHOR]

Introduction Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research and qualitative approach to culturally adapt a smoking cessation intervention with ANAI families. Aims and Methods We conducted individual, semistructured telephone interviews with 12 ANAI adults who smoke, 12 adult family members, and 13 Alaska Tribal Health System stakeholders statewide between November 2022 and March 2023. Through content analysis, we explored intervention receptivity, incentive preferences, culturally aligned recruitment and intervention messaging, and future implementation needs. Results Participants were receptive to the intervention. Involving a family member was viewed as novel and aligned with ANAI cultural values of commitment to community and familial interdependence. Major themes included choosing a family member who is supportive and understanding, keeping materials positive and encouraging, and offering cash and noncash incentives for family members to choose (eg, fuel, groceries, activities). Participants indicated that messaging should emphasize family collaboration and that cessation resources and support tips should be provided. Stakeholders also reinforced that program materials should encourage the use of other existing evidence-based cessation therapies (eg, nicotine replacement, counseling). Conclusions Adaptations, grounded in ANAI cultural strengths, were made to the intervention and recruitment materials based on participant feedback. Next steps include a beta-test for feasibility and a randomized controlled trial for efficacy. Implications This is the first study to design and adapt a financial incentives intervention promoting smoking cessation among ANAI peoples and the first to involve the family system. Feedback from this formative work was used to develop a meaningful family-level incentive structure with ANAI people who smoke and family members and ensure intervention messaging is supportive and culturally aligned. The results provide qualitative knowledge that can inform future family-based interventions with ANAI communities, including our planned randomized controlled trial of the intervention. [ABSTRACT FROM AUTHOR]

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring. [ABSTRACT FROM AUTHOR]

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Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early‐ to mid‐2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non‐incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two‐stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended‐fee‐for‐service (FFS), 1388 blended‐capitation models, and 1164 interprofessional team‐based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation‐based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended‐FFS‐based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team‐based practices. [ABSTRACT FROM AUTHOR]

This paper investigates how investment funds behave in line with European Union (EU)'s Sustainable Finance Disclosure Regulation (SFDR). The SFDR requires investment funds to take a clear position with respect to sustainability objectives, aiming at addressing the threats of greenwashing. However, we still do not know whether investment funds are managed accordingly. We frame our study within the organizational category theory, using Morningstar Direct data to analyze the category of investment funds declaring sustainability objectives – SFDR Article 9– and a control group with no sustainability objectives – SFDR Article 6. We assess how investment managers are financially incentivized to achieve either sustainability or financial objectives. The analysis evidences unexpected results: investment funds that self-select into opposite categories have incentives to behave similarly from both the financial and sustainability perspectives. Our results show that European investment funds hardly distinguish the attributes of sustainability meanings across opposite categories, reflecting category fuzziness. [ABSTRACT FROM AUTHOR]

Methods: Web of Science, Cochrane library and PubMed were systematically searched up to January 2024 to identify studies examining the impact of financial incentives on diabetes management in patients. Studies were evaluated based on the robustness of their methodology, participant numbers, and quality scores. The Cochrane risk-of-bias tool was applied for randomized controlled trials, while the Newcastle–Ottawa Scale was used for non-randomized controlled trials to assess study quality. Due to the heterogeneity of the included studies, a narrative synthesis approach was utilized. Results: In the study, we included 12 published research studies. Five studies investigated the influence of financial incentives on patient behavior, all demonstrating a significant positive impact on behaviors such as blood glucose monitoring, medication adherence, and physical activity. 10 studies analyzed the impact of financial incentives on HbA1c levels in diabetes patients. Among them, 5 studies reported that financial incentives could improve HbA1c levels through longitudinal historical comparisons. The other 5 studies did not find significant improvements compared to the control group. Three studies explored long-term effects, two studies targeting the adolescent population had no impact, and one study targeting adults had a positive impact. Conclusions: In summary, this review found that financial incentives can positively influence patient behavior and enhance compliance, but their impact on HbA1c levels is inconsistent. Financial incentives may help adult patients maintain behavior even after the withdrawal of incentives. [ABSTRACT FROM AUTHOR]

Background: Stimulant‐related overdoses have increased dramatically, with almost 50% of overdoses in the United States now involving stimulants. Additionally, harm‐reduction approaches are increasingly seen as key to reducing the negative impact of substance use. Contingency management (CM), the provision of financial incentives for abstinence, is the most effective treatment for stimulant use disorder, but historically has not been widely implemented. Many recent, large‐scale implementation efforts have relied upon foundational CM protocols that may not sufficiently account for recent increases in the prevalence and lethality of stimulant use nor the growing preference for harm reduction versus abstinence‐only frameworks. Argument: We argue the need to (1) consider whether and how CM protocols might be modified to address rising stimulant use and harm reduction frameworks and (2) make CM widely accessible so that it can reduce population‐level stimulant use while ensuring that it is delivered with fidelity to its basic principles. Proposed changes include changing CM reinforcement schedules to emphasize treatment engagement and reductions in use in addition to abstinence, changing guidelines on the duration of and re‐engagement in CM, investing in research on virtual CM, incentivizing providers and health systems to deliver CM, making it easier to purchase and use point‐of‐care drug screens, using direct‐to‐consumer marketing to increase demand for CM and adapting CM to the community in which it is being implemented. Conclusions: Our proposed modifications to contingency management (CM) protocols and accessibility may more effectively address rising stimulant use and align CM more closely with harm‐reduction frameworks. Given the urgent need to reduce overdose deaths, developing and testing modified CM protocols may need to rely upon methods other than randomized controlled trials. Efforts to disseminate CM widely to reduce population‐level stimulant use must be balanced with the need to maintain fidelity to CM's basic principles. [ABSTRACT FROM AUTHOR]

Introduction Poor retention in clinical trials can impact on statistical power, reliability, validity, and generalizability of findings and is a particular challenge in smoking cessation studies. In online trials with automated follow-up mechanisms, poor response also increases the resource need for manual follow-up. This study compared two financial incentives on response rates at 6 months follow up, in an online, automated smoking cessation feasibility trial of a cessation smartphone app (Quit Sense). Aims and Methods A study within a trial (SWAT), embedded within a host randomized controlled trial. Host trial participants were randomized 1:1 to receive either a £10 or £20 voucher incentive, for completing the 6-month questionnaire. Stratification for randomization to the SWAT was by minimization to ensure an even split of host trial arm participants and by 6-week response rate. Outcome measures were: Questionnaire completion rate, time to completion, number of completers requiring manual follow-up, and completeness of responses. Results Two hundred and four participants were randomized to the SWAT. The £20 and £10 incentives did not differ in completion rate at 6 months (79% vs. 74%; p  = .362) but did reduce the proportion of participants requiring manual follow-up (46% vs. 62%; p  = .018) and the median completion time (7 days vs. 15 days; p  = .008). Measure response completeness rates were higher among £20 incentive participants, though differences were small for the host trial's primary smoking outcome. Conclusions Benefits to using relatively modest increases in incentive for online smoking cessation trials include more rapid completion of follow-up questionnaires and reduced manual follow-up. Implications A modest increase in incentive (from £10 to £20) to promote the completion of follow-up questionnaires in online smoking cessation trials may not increase overall response rates but could lead to more rapid data collection, a reduced need for manual follow-up and reduced missing data among those who initiate completing a questionnaire. Such an improvement may help to reduce bias, increase validity and generalizability, and improve statistical power in smoking cessation trials. Trial Registration Host trial ISRCTN12326962, SWAT repository store ID 164. [ABSTRACT FROM AUTHOR]

Affordable housing is among the biggest policy challenges facing cities worldwide. Treating New York City as a case study, this paper reviews a multifaceted toolkit to combat the housing crisis. Specifically, the analysis focuses on how the government incentivises real estate developers to build affordable housing, with both financial incentives such as tax abatements, tax credits and loans funded by tax-exempt bonds and non-financial means such as zoning regulations. The study demonstrates both the successes achieved by New York City and the unintended consequences that emerged from these interventions, and the research argues that beyond financial and economic considerations, long-range spatial planning factors play a pivotal role in the formulation of effective affordable housing policies. The research underscores the need for policy makers globally to take a holistic approach and integrate various elements of city growth to address the intricate challenges posed by housing crises in urban environments. [ABSTRACT FROM AUTHOR]

Abstract Methods Web of Science, Cochrane library and PubMed were systematically searched up to January 2024 to identify studies examining the impact of financial incentives on diabetes management in patients. Studies were evaluated based on the robustness of their methodology, participant numbers, and quality scores. The Cochrane risk-of-bias tool was applied for randomized controlled trials, while the Newcastle–Ottawa Scale was used for non-randomized controlled trials to assess study quality. Due to the heterogeneity of the included studies, a narrative synthesis approach was utilized. Results In the study, we included 12 published research studies. Five studies investigated the influence of financial incentives on patient behavior, all demonstrating a significant positive impact on behaviors such as blood glucose monitoring, medication adherence, and physical activity. 10 studies analyzed the impact of financial incentives on HbA1c levels in diabetes patients. Among them, 5 studies reported that financial incentives could improve HbA1c levels through longitudinal historical comparisons. The other 5 studies did not find significant improvements compared to the control group. Three studies explored long-term effects, two studies targeting the adolescent population had no impact, and one study targeting adults had a positive impact. Conclusions In summary, this review found that financial incentives can positively influence patient behavior and enhance compliance, but their impact on HbA1c levels is inconsistent. Financial incentives may help adult patients maintain behavior even after the withdrawal of incentives.

The paper analyzes how programs offering financial rewards for losing weight should be adapted to individuals' preferences. Specifically, we highlight the conditions under which demanding and highly remunerative programs or—conversely—easily achievable but less remunerative programs should be proposed. We show that financial incentives are more likely to encourage efforts to lose weight if the level of difficulty of the objective and the reward in case of success increase with: 1) the degree of risk seeking; 2) the degree of cross-prudence in quality of life. This suggests that individuals should be offered a weight loss program tailored to their preferences towards risk and correlation. [ABSTRACT FROM AUTHOR]

In the current economic context, characterized by rapid changes, we are faced with the need to have financing programs that are adapted to the current needs of entrepreneurs in Romania, that provide adequate financial support for the development and growth of existing businesses, but also for support­ing start-ups. These programs should consider the national strategy for smart specialization, the specif­ics of different economic sectors and offer concrete and effective solutions to overcome the obstacles encountered by entrepreneurs in accessing funds.

The energy transition towards an economic model based on energy from renewable sources is considered a priority of strategic importance for the development of the European Union and Italy. In this context, Renewable Energy Communities (RECs) represent an opportunity to accelerate the decarbonisation process, to increase energy self-consumption and to replace centralised and hierarchical power plants with distributed and collaborative ones. This study aims to analyse how decarbonisation objectives are incorporated into national and regional regulatory and financial instruments that support the establishment of RECs. Starting from the comparison between the characteristics of REC and those of other energy community models with respect to a plurality of spheres (specifically, environmental, legal, economic-financial, technical, social and administrative spheres), the study provides a systematised framework of the advantages/disadvantages that influence the decision to invest in setting up a REC, and identifies the main critical issues that must be differentially addressed by the promoters, depending on whether they are public or private actors, assessing them through a system of nomenclators obtained following a focus group of experts. Furthermore, the analysis of regulations and available data on active RECs showed that Local Administrations play a central role in the dissemination of RECs, but also that the implementation of a sustainable and inclusive energy transition in the territories is hindered by a low level of social participation due to lack of knowledge of the benefits provided by RECs as well as actual difficulties for citizens to access REC projects, especially in their role as promoters.

Innovation and investment development a key factor that will influence the recovery and development of enterprises in the post-war period. Investments in innovations can become a source of economic growth after the war, which will stimulate the creation of new jobs, and increase the productivity and competitiveness of enterprises, which will contribute to the development of all sectors of the economy. Thus, the study aimed to identify the main problems and opportunities for investment and innovative business development in the country in the post-war period. Theoretical research methods such as generalisation, statistical analysis, in particular, data aggregation and sample grouping, and analysis of development indices were used to achieve this goal. The study, based on the analysis of key factors, substantiated the relationship between investment and innovation, as well as between investment opportunities and financial results of business entities. Several key issues that hinder the innovation and investment development of enterprises in Ukraine and will have an impact in the future were identified and analysed in detail using statistical data, including the lack of financial resources, lack of proper infrastructure, problems with human resources, and corruption, which significantly affects Ukraine’s position in certain international investment ratings, resulting in difficulties in attracting foreign capital. It was established that all the above problems were significantly escalated as a result of the war. The features of innovative activity of enterprises in the conditions of war were studied and the main directions of support required by business in this area were formed. The necessity of comprehensive state support to stimulate the innovation and investment development of enterprises in the post-war period was substantiated. The results of the study can be used by public authorities, business entities and the scientific community dealing with the issues of innovation and investment activities of enterprises

Abstract Background Untreated hepatitis C virus (HCV) infection can result in cirrhosis and hepatocellular cancer. Direct-acting antiviral (DAA) therapies are highly effective and have few side effects compared to older interferon-based therapy. Despite the Australian government providing subsidised and unrestricted access to DAA therapy for chronic HCV infection, uptake has not been sufficient to meet the global target of eliminating HCV as a public health threat by 2030. This study will offer people with HCV financial incentives of varying values in order to evaluate its effect on initiation of DAA therapy in primary care. Methods Australian adults (18 years or older) who self-report as having current untreated HCV infection can register to participate via an automated SMS-based system. Following self-screening for eligibility, registrants are offered a financial incentive of randomised value (AUD 0 to 1000) to initiate DAA therapy. Study treatment navigators contact registrants who have consented to be contacted, to complete eligibility assessment, outline the study procedures (including the requirement for participants to consult a primary care provider), obtain consent, and finalise enrolment. Enrolled participants receive their offered incentive on provision of evidence of DAA therapy initiation within 12 weeks of registration (primary endpoint). Balanced randomisation is used across the incentive range until the first analysis, after which response-adaptive randomisation will be used to update the assignment probabilities. For the primary analysis, a Bayesian 4-parameter EMAX model will be used to estimate the dose–response curve and contrast treatment initiation at each incentive value against the control arm (AUD 0). Specified secondary statistical and economic analyses will evaluate the effect of incentives on adherence to DAA therapy, virological response, and cost-effectiveness. Discussion This project seeks to gain an understanding of the dose–response relationship between incentive value and DAA treatment initiation, while maximising the number of people treated for HCV within fixed budget and time constraints. In doing so, we hope to offer policy-relevant recommendation(s) for the use of financial incentives as a pragmatic, efficient, and cost-effective approach to achieving elimination of HCV from Australia. Trial registration ANZCTR (anzctr.org.au), Identifier ACTRN12623000024640, Registered 11 January 2023 ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384923&isReview=true ).

Carpooling is one solution to help reduce the negative externalities of solo driving. The aim of this study is to analyze the effect of incentives on solo drivers’ intention to carpool. A questionnaire survey was carried out among 1,329 participants, including 590 (38.39%) residents of the Paris metropolitan area who use a car to get to work. Modal choice estimates were modeled using multinomial logit and binomial logit econometric models for car drivers only. First, we analyzed the effect of non-financial incentives, such as nudges and trust in others during the carpooling trip. Second, we analyzed the effect of the combination of nudges with employer subsidies for sustainable mobility on the intention to carpool as a driver or passenger for the home-to-work (or home-to-school) commute. The results show that people aged 18–49, employees, and those with higher levels of education are more receptive to behavioral interventions such as nudges. Applying nudges in isolation is more effective at encouraging carpooling for commuting than combining nudges with employers’ subsidies for sustainable mobility. [ABSTRACT FROM AUTHOR]

Background and aims: Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC). Design, setting and participants: This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum. Interventions: Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence ('3-month incentives'); or (iii) UC plus '3-month incentives' plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence ('12-month incentives'). Measurements: Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance. Secondary outcomes: self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum. Findings: Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46-3.96), P = 0.001; 12 months versus UC 1.67 (1.04-2.70), P = 0.035; 3 months versus UC 0.69 (0.41-1.17), P = 0.174. Bayes factors indicated that for 12- month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis. Conclusions: This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care. [ABSTRACT FROM AUTHOR]

Aims Background Methods Results Conclusion Implications for nursing practice and policy To investigate how nursing students’ professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate.There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines.Using a cross‐sectional design, third‐ and fourth‐year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self‐report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance‐based structural equation modeling) were used to analyze data.The emerging model demonstrated acceptable model fit indices. Nursing students’ professional identity (β = 0.18, p = 0.043) and financial incentives (β = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (β = –0.12, p = 0.038) and clinical learning environment perception (β = –0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate.Nursing students’ professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate.This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses’ migration policies. [ABSTRACT FROM AUTHOR]

Despite the existence of anti-corruption whistleblowing laws, Zimbabwe's public service has suffered from maladministration, corrupt politicians, "mediators" and businesses, malpractice and irregularities for a long time. This article, employing grounded theory within a qualitative research paradigm, discusses a study which draws on eight interviews and found that whistleblowers lack state protection because state institutions do not have the political will to protect them. These realities are associated with: 1) state organisation capacity and success, or lack of it, in whistleblower protection in the public sector; 2) the significance of legislative and regulatory measures that encourage citizens to become whistleblowers as a key deterrent against corruption; 3) the lack of operationalisation of whistleblower protection within public organisations; 4) the possibility of creative intervention strategies and tactics that would increase the role and success of whistleblowing initiatives and actions; and 5) future financial incentives in laws and regulations that could encourage whistleblowing. [ABSTRACT FROM AUTHOR]

Ongoing quality improvement (QI) processes in the authors' department include the insertion of a Kellgren-Lawrence (KL) osteoarthritis grading template in knee radiography reports to decrease unnecessary MRI. However, uniform adoption of this grading system is lacking. Department-wide financial incentives were instituted to improve compliance with QI metrics. The purpose of this study was to evaluate the effect of a financial incentive on KL grading system use and to compare compliance rates of musculoskeletal (MSK) radiologists with those of general radiologists who were not financially incentivized to use KL grading. Percentages of all knee radiography reports containing KL grading with standardized follow-up recommendations were determined by querying the departmental radiology database before and after the introduction of the new quality-based financial incentive. Preincentive compliance rates for MSK and general radiologists were compared with an adoption period and two separate 6-month postincentive periods. In total, 52,673 reports were retrospectively analyzed for KL grading use (41,670 reports interpreted by MSK radiologists and 11,003 interpreted by general radiologists). Increase in compliance was greatest among MSK radiologists' reports during the incentivized adoption period (from 36.1% to 53.2%). This improvement was sustained among MSK radiologists and averaged 62.7% during the most recently studied postimplementation period. A lesser degree of improvement in compliance was observed in nonincentivized general radiologists' reports (from 19.3% to 27.5%); during the postimplementation follow-up period, their compliance decreased to 26.5%. The introduction of a financial incentive resulted in significantly increased adoption of QI practices with sustained improvement among incentivized MSK radiologists compared with nonincentivized general radiologists. [Display omitted] [ABSTRACT FROM AUTHOR]

The main objective of this study is to find out the financial incentive factors behind employee motivation, especially in financial institutions in, Pakistan. Salary, housing allowance, and medical insurance were independent variables, and employee motivation was dependent. The sample size was 300, only collected from 190 financial institutions in Pakistan. Questionnaires collect primary data via Google Forms. We used a random sampling method for sample selection. Correlation analysis suggests that all variables have a strong positive correlation (r>0.70)--regression analysis is used to check the effect of financial incentives on employee motivation. The findings suggested that salary, housing allowance, and medical insurance have positive statistical significance (p<0.05) on employee motivation. This research supports that all organizations should focus on financial rewards to employees' motivations for better organizational performance. [ABSTRACT FROM AUTHOR]

Non-linear reimbursement contracts in healthcare have been increasingly used to quantify providers' responses to financial incentives. In the present research, we utilize a large one-off increase in the reimbursement of rehabilitation care to assess to what extent providers are willing to modify their treating behavior to maximize profits. In order to disincentivize the use of short inpatient stays for rehabilitation care, Dutch policy-makers have instated a two-part stepwise tariff-schedule. A lower tariff-schedule is applied for short hospital stays (≤ 14 days), while a higher tariff-schedule is utilized for longer treatments. Switching from one schedule to the other at day 15 of inpatient care leads to a sudden and large increase in tariffs. We show that, for most care-types, patients are seldom treated in an inpatient setting for less than 15 days, while the majority of patients are discharged after the threshold. Therefore, we conclude that the financial incentive at day 15 leads to considerable distortions in treatment. However, instead of discharging all patients at the threshold point where marginal tariffs are maximized, providers tend to continue treatment indicating altruistic behavior. As healthcare payment systems move away from piecewise reimbursement (e.g., fee-for-service arrangements), and services are increasingly 'lumped' together into e.g., DRGs and bundled payments, the likelihood of such discontinuities in tariff-schedules radically increases. Our research illustrates how such discontinuities in reimbursements can lead to distortions in the amount of healthcare provided contributing to the debate on optimal healthcare contracting design. [ABSTRACT FROM AUTHOR]

This document provides a list of references for research articles on the adoption and willingness to pay for electric vehicles (EVs). The articles cover a range of topics including consumer preferences, factors influencing adoption, policy implications, and the role of knowledge and incentives. The research is conducted in different countries and utilizes various theoretical frameworks. These articles offer valuable insights into the factors that influence consumers' decisions to adopt EVs and their willingness to pay for them. [Extracted from the article]

The study aims to investigate the impact of financial incentives and workplace environment on employee work motivation. Individually, the study examines the impact of work allowances, employee wages, organisational culture, and internal communication on employee motivation to work in an organisation. The research employed a survey research design. The population of the study focused on the employees of Paradise Estate Management Company. A total of 79 respondents were selected from a pool of 120 employees in the organisation. The questionnaires were administered and distributed to respondents through Google Form. Multiple regression analysis was adopted to test the different hypotheses. The findings indicate that employee motivation is influenced by various factors within the work environment. These include internal communication and organisational culture, as well as financial incentives such as employee wages and work allowances. [ABSTRACT FROM AUTHOR]

Although researchers have tried to explain why individuals are unwilling to sort waste, few studies focus on whether and how ego-depletion can inhibit an individual from separating waste. Here, we investigate the effectiveness of financial incentives in mitigating the impact of ego-depletion, a phenomenon triggered by demanding tasks that subsequently impair task performance. Experiment 1 revealed that when participants were involved in a task that expended substantial effort and energy in an initial task, they were more likely to discontinue a subsequent waste sorting task. Experiment 2, however, demonstrated a significant shift when financial incentives were introduced. Even in states of high depletion, the promise of financial rewards substantially increased participants' perseverance in waste sorting. These findings not only reveal the influence of ego-depletion as a barrier to effective waste sorting but also highlight the practical potential for policymakers and environmental practitioners to motivate individuals through appropriate incentives. By addressing psychological factors (i.e., ego-depletion) and integrating incentives, this research contributes to more sustainable waste management practices. [ABSTRACT FROM AUTHOR]

Background: Untreated hepatitis C virus (HCV) infection can result in cirrhosis and hepatocellular cancer. Direct-acting antiviral (DAA) therapies are highly effective and have few side effects compared to older interferon-based therapy. Despite the Australian government providing subsidised and unrestricted access to DAA therapy for chronic HCV infection, uptake has not been sufficient to meet the global target of eliminating HCV as a public health threat by 2030. This study will offer people with HCV financial incentives of varying values in order to evaluate its effect on initiation of DAA therapy in primary care. Methods: Australian adults (18 years or older) who self-report as having current untreated HCV infection can register to participate via an automated SMS-based system. Following self-screening for eligibility, registrants are offered a financial incentive of randomised value (AUD 0 to 1000) to initiate DAA therapy. Study treatment navigators contact registrants who have consented to be contacted, to complete eligibility assessment, outline the study procedures (including the requirement for participants to consult a primary care provider), obtain consent, and finalise enrolment. Enrolled participants receive their offered incentive on provision of evidence of DAA therapy initiation within 12 weeks of registration (primary endpoint). Balanced randomisation is used across the incentive range until the first analysis, after which response-adaptive randomisation will be used to update the assignment probabilities. For the primary analysis, a Bayesian 4-parameter EMAX model will be used to estimate the dose–response curve and contrast treatment initiation at each incentive value against the control arm (AUD 0). Specified secondary statistical and economic analyses will evaluate the effect of incentives on adherence to DAA therapy, virological response, and cost-effectiveness. Discussion: This project seeks to gain an understanding of the dose–response relationship between incentive value and DAA treatment initiation, while maximising the number of people treated for HCV within fixed budget and time constraints. In doing so, we hope to offer policy-relevant recommendation(s) for the use of financial incentives as a pragmatic, efficient, and cost-effective approach to achieving elimination of HCV from Australia. Trial registration: ANZCTR (anzctr.org.au), Identifier ACTRN12623000024640, Registered 11 January 2023 (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384923&isReview=true). [ABSTRACT FROM AUTHOR]

Tuberculosis (TB), caused by Mycobacterium tuberculosis, has been a persistent global health challenge for thousands of years, known historically by various names and often romanticized in 19th-century literature. Despite advancements in medical science, TB remains a significant issue, particularly in economically disadvantaged regions like Romania, which has one of the highest TB mortality rates in the European Union. The disease's ability to remain latent and become active when the immune system is weakened contributes to its persistence and danger. Adherence to TB treatment is crucial for controlling the disease and preventing the development of drug resistance. Factors affecting adherence include socio-economic status, education, access to healthcare, and social support. Financial incentives have been shown to improve treatment adherence among vulnerable populations, suggesting that addressing economic barriers is essential for effective TB control. This study explores the socio-historical context of TB and evaluates the effectiveness of financial incentives in improving treatment adherence, especially for multidrug-resistant (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). Moreover, a quantitative analysis was performed on MDR-TB and XDR-TB patients in order to achieve a comprehensive grasp on the interaction between financial incentives and adherence to treatment. This article highlights the importance of a patient-centered approach in TB treatment, incorporating psychological and social support to enhance adherence. More precisely, the combination of socio-historical and quantitative analyses pinpoints the fact that improving living conditions and providing financial aid are vital components in the battle against TB. [ABSTRACT FROM AUTHOR]

We develop a general norm-dependent utility function with disutility for actions that are inferior or superior to a norm. We test its validity by assessing the moderating role of norm sensitivity in explaining responses to peer influences in a budget reporting experiment. Managers become less honest after seeing a less honest peer (the rotten apple effect) and more honest after seeing a more honest peer (the sterling example effect). We measure the sensitivity to social norms by the Maintaining Norms Schema score generated from the responses to the Defining Issue Test-2 moral reasoning questionnaire. We find that (1) the sterling example effect is significantly increased in an individual's sensitivity to social norms and (2) the rotten apple effect does not vary significantly with an individual's sensitivity to social norms. Our evidence supports inclusion of a disutility component for actions that are inferior to the norm in representations of personal preferences. JEL Classifications: C72, D03; J44; M41; M55. [ABSTRACT FROM AUTHOR]

Purpose of review: Lottery incentives are an innovative approach to encouraging HIV prevention, treatment initiation, and adherence behaviours. This paper reviews the latest research on lottery incentives' impact on HIV-related services, and their effectiveness for motivating behaviours to improve HIV service engagement and HIV health outcomes. Recent findings: Our review of ten articles, related to lottery incentives, published between 2018 and 2023 (inclusive) shows that lottery incentives have promise for promoting HIV-related target behaviours. The review highlights that lottery incentives may be better for affecting simpler behaviours, rather than more complex ones, such as voluntary medical male circumcision. This review recommends tailoring lottery incentives, ensuring contextual-relevance, to improve the impact on HIV-related services. Summary: Lottery incentives offer tools for improving uptake of HIV-related services. The success of lottery incentives appears to be mediated by context, the value and nature of the incentives, and the complexity of the target behaviour. [ABSTRACT FROM AUTHOR]

The article suggests the use of methods of implementation science to close the research-to-practice gaps between the evidence for contingency management (CM) and ability of patients to access treatment of addiction. Recommendations to close the gap and implement behavioral interventions include the Implementation Research Logic Model. Emphasis is given on the need to implement CM in resource-constrained organizations and health systems.

Abstract Background Structured Problem Solving (SPS) is a patient-centered approach to promoting behavior change that relies on productive collaboration between coaches and participants and reinforces participant autonomy. We aimed to describe the design, implementation, and assessment of SPS in the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized trial. Methods In the PUSH trial, individuals with a history of urinary stone disease and low urine output were randomized to control versus a multicomponent intervention including SPS that was designed to promote fluid consumption and thereby prevent recurrent stones. We provide details specifically about training and fidelity assessment of the SPS coaches. We report on implementation experiences related to SPS during the initial conduct of the trial. Results With training and fidelity assessment, coaches in the PUSH trial applied SPS to help participants overcome barriers to fluid consumption. In some cases, coaches faced implementation barriers such as variable participant engagement that required tailoring their work with specific participants. The coaches also faced challenges including balancing rapport with problem solving, and role clarity for the coaches. Conclusions We adapted SPS to the setting of kidney stone prevention and overcame challenges in implementation, such as variable patient engagement. Tools from the PUSH trial may be useful to apply to other health behavior change settings in nephrology and other areas of clinical care. Trial registration ClinicalTrials.gov Identifier NCT03244189.

Background: Structured Problem Solving (SPS) is a patient-centered approach to promoting behavior change that relies on productive collaboration between coaches and participants and reinforces participant autonomy. We aimed to describe the design, implementation, and assessment of SPS in the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized trial. Methods: In the PUSH trial, individuals with a history of urinary stone disease and low urine output were randomized to control versus a multicomponent intervention including SPS that was designed to promote fluid consumption and thereby prevent recurrent stones. We provide details specifically about training and fidelity assessment of the SPS coaches. We report on implementation experiences related to SPS during the initial conduct of the trial. Results: With training and fidelity assessment, coaches in the PUSH trial applied SPS to help participants overcome barriers to fluid consumption. In some cases, coaches faced implementation barriers such as variable participant engagement that required tailoring their work with specific participants. The coaches also faced challenges including balancing rapport with problem solving, and role clarity for the coaches. Conclusions: We adapted SPS to the setting of kidney stone prevention and overcame challenges in implementation, such as variable patient engagement. Tools from the PUSH trial may be useful to apply to other health behavior change settings in nephrology and other areas of clinical care. Trial registration: ClinicalTrials.gov Identifier NCT03244189. [ABSTRACT FROM AUTHOR]

Introduction. This study aims to evaluate the impact of a new financing policy (25% bonus) on the centralization of radical surgical procedures for cancer treatment in high-volume hospitals in Poland. It builds on existing research that demonstrates a positive correlation between treatment outcomes and the volume of patients managed at a center, extending to various cancer types and treatment modalities including both surgical and non-surgical approaches. Material and methods. Reimbursement data was collected about all radical surgery procedures related to cancer treatment funded from public sources in Poland in 2019-2022. Hospitals were clustered in three groups: 1) high-volume, 2) “close to” high-volume, and 3) low-volume hospitals. To assess the maximum number of providers in each type of cancer surgery, the volume procedures for low-volume hospitals was recalculated. Results. In the years 2018-2022, over 450 hospitals provided radical surgery services in the 13 cancer groups studied. This value changed slightly during the period under study. In almost half of the analyzed cancer groups, the number of low-volume hospitals is increasing. An increasing number of hospitals are providing services below the thresholds. At the same time, across almost all studied groups, the number of high-volume hospitals also increased. Analysis of the distribution of services by clusters proves the gradual concentration of the market. The share of radical surgery services provided by low-volume hospitals decreased from 39% in 2019 to 35% in 2022. The share of services provided in high-volume hospitals increased gradually from 49% to 57% (highest for prostate, kidney and thyroid cancers). Conclusions. The financial model providing additional revenue for high-volume hospitals with additional requirements regarding the treatment process, as well as having no required minimal volume of procedures, induced the centralization of radical oncology surgery only insignificantly. [ABSTRACT FROM AUTHOR]

Background: Understanding the effectiveness of novel models of care in community-based settings is critical to achieving hepatitis C elimination. We conducted an evaluation of a hepatitis C model of care with financial incentives that aimed to improve engagement across the hepatitis C cascade of care at a sexual health service in Cairns, Australia. Methods: Between March 2020 and May 2021, financial incentives were embedded into an established person-centred hepatitis C model of care at Cairns Sexual Health Service. Clients of the Service who self-reported experiences of injecting drugs were offered an AUD 20 cash incentive for hepatitis C testing, treatment initiation, treatment completion, and test for cure. Descriptive statistics were used to describe retention in hepatitis C care in the incentivised model. They were compared to the standard of care offered in the 11 months prior to intervention. Results: A total of 121 clients received financial incentives for hepatitis C testing (antibody or RNA). Twenty-eight clients were hepatitis C RNA positive, of whom 92% (24/28) commenced treatment, 75% (21/28) completed treatment, and 68% (19/28) achieved a sustained virological response (SVR). There were improvements in the proportion of clients diagnosed with hepatitis C who commenced treatment (86% vs. 75%), completed treatment (75% vs. 40%), and achieved SVR (68% vs. 17%) compared to the pre-intervention comparison period. Conclusions: In this study, financial incentives improved engagement and retention in hepatitis C care for people who inject drugs in a model of care that incorporated a person-centred and flexible approach. [ABSTRACT FROM AUTHOR]

Background: Urologists practicing in single‐specialty groups with ownership in radiation vaults are more likely to treat men with prostate cancer. The effect of divestment of vault ownership on treatment patterns is unclear. Methods: A 20% sample of national Medicare claims was used to perform a retrospective cohort study of men with prostate cancer diagnosed between 2010 and 2019. Urology practices were categorized by radiation vault ownership as nonowners, continuous owners, and divested owners. The primary outcome was use of local treatment, and the secondary outcome was use of intensity‐modulated radiation therapy (IMRT). A difference‐in‐differences framework was used to measure the effect of divestment on outcomes compared to continuous owners. Subgroup analyses assessed outcomes by noncancer mortality risk (high [>50%] vs. low [≤50%]). Results: Among 72 urology practices that owned radiation vaults, six divested during the study. Divestment led to a decrease in treatment compared with those managed at continuously owning practices (difference‐in‐differences estimate, −13%; p =.03). The use of IMRT decreased, but this was not statistically significant (difference‐in‐differences estimate, −10%; p =.13). In men with a high noncancer mortality risk, treatment (difference‐in‐differences estimate, −28%; p <.001) and use of IMRT (difference‐in‐differences estimate, −27%; p <.001) decreased after divestment. Conclusions: Urology group divestment from radiation vault ownership led to a decrease in prostate cancer treatment. This decrease was most pronounced in men who had a high noncancer mortality risk. This has important implications for health care reform by suggesting that payment programs that encourage constraints on utilization, when appropriate, may be effective in reducing overtreatment. Urology group divestment from radiation vault ownership led to a decrease in prostate cancer treatment. This effect was most pronounced in men with high noncancer mortality risk in the 10 years after diagnosis—those least likely to benefit from treatment. These findings lend support to the causal relationship between financial incentives and physician behavior. [ABSTRACT FROM AUTHOR]

Introduction: In South Africa, the HIV care cascade remains suboptimal. We investigated the impact of small conditional financial incentives (CFIs) and male‐targeted HIV‐specific decision‐support application (EPIC‐HIV) on the HIV care cascade. Methods: In 2018, in uMkhanyakude district, 45 communities were randomly assigned to one of four arms: (i) CFI for home‐based HIV testing and linkage to care within 6 weeks (R50 [US$3] food voucher each); (ii) EPIC‐HIV which are based on self‐determination theory; (iii) both CFI and EPIC‐HIV; and (iv) standard of care. EPIC‐HIV consisted of two components: EPIC‐HIV 1, provided to men through a tablet before home‐based HIV testing, and EPIC‐HIV 2, offered 1 month later to men who tested positive but had not yet linked to care. Linking HITS trial data to national antiretroviral treatment (ART) programme data and HIV surveillance programme data, we estimated HIV status awareness after the HITS trial implementation, ART status 3 month after the trial and viral load suppression 1 year later. Analysis included all known individuals living with HIV in the study area including those who did not participated in the HITS trial. Results: Among the 33,778 residents in the study area, 2763 men and 7266 women were identified as living with HIV by the end of the intervention period and included in the analysis. After the intervention, awareness of HIV‐positive status was higher in the CFI arms compared to non‐CFI arms (men: 793/908 [87.3%] vs. 1574/1855 [84.9%], RR = 1.03 [95% CI: 0.99−1.07]; women: 2259/2421 [93.3%] vs. 4439/4845 [91.6%], RR = 1.02 [95% CI: 1.00−1.04]). Three months after the intervention, no differences were found for linkage to ART between arms. One year after the intervention, only 1829 viral test results were retrieved. Viral suppression was higher but not significant in the EPIC‐HIV intervention arms among men (65/99 [65.7%] vs. 182/308 [59.1%], RR = 1.11 [95% CI: 0.88−1.40]). Conclusions: Small CFIs can contribute to achieve the first step of the HIV care cascade. However, neither CFIs nor EPIC‐HIV was sufficient to increase the number of people on ART. Additional evidence is needed to confirm the impact of EPIC‐HIV on viral suppression. [ABSTRACT FROM AUTHOR]

Entertainment-education has been touted as a potent delivery channel for health education campaigns. Yet, there is little evidence of its causal effects. This paper aims to fill the gap in the literature by using a field experiment in India to study two questions on the efficacy of health entertainment-education. First, can health entertainment-education, particularly through films that show role models and draw on emotions, lead to lasting, positive change in health knowledge and behavior? Second, can financial incentives for ex-post health literacy boost the effectiveness of health entertainment-education? The results show that health entertainment-education successfully increased health knowledge (e.g. knowledge about cleanliness and hygiene) by 16 percent. These gains persist almost one year later, although there were no observed impacts on health behaviors. Further, financial incentives do not appear to have any effects. These insights contribute to our knowledge of what works for health education in low-income settings, so that future education campaigns can be crafted with more meaningful impact. [ABSTRACT FROM AUTHOR]