Financial Incentives Help Teens Manage Chronic Illness


How best to incentivize teens to monitor and maintain their health? A new study investigates. GARO/PHANIE/Canopy/Getty Images

How do you get a teenager to do something? Oh really? Because it's notoriously difficult. One solution, though, is to simply pay them. Some parents pay kids for getting good grades, some shell out cash for mowing the lawn ... we teach capitalism early around here, and it shows.

But what if you need your kid to just take care of herself and not die? Well, turns out it might help to offer a financial incentive in those cases, too.

A new study published in JAMA Pediatrics suggests that, at least with teens diagnosed with Type 1 diabetes, financially incentivizing the daily monitoring of blood sugars can help them take charge of their health during adolescence, when self care tends to go off the rails.

Of course, there's more than just checking blood glucose levels that goes into managing Type 1 diabetes: you have to eat well, exercise, give yourself the right amount of insulin at the right times. Neglecting the daily maintenance of the disease could result in some trips to the hospital, or even death. So, how does one help a kid make the transition to taking care of their diabetes independently in adulthood when all they want to do in their adolescence is ignore their disease altogether? The answer might be, a little bit of money.

Financial incentives have been successful in helping adults with chronic disease establish good management regimens, but not much research has been done in younger people. Over the course of three months, the researchers conducting this new study examined the effect of small financial incentives on the overall disease management of 90 study participants, aged 14-20, with poorly managed Type 1 diabetes. They tracked the blood sugars and how many times the participant checked them with a wireless glucose monitor. The participants were each given $60 in a virtual account at the beginning of each month. During that month, each day the participant didn't meet their goals for checking and maintaining their target blood glucose levels, $2 was deducted from the account. The research team found that when the $60 monthly stipend was on the line, the participants were three times more likely to achieve their daily glucose monitoring goals than the control group.

But what happens when a financial incentive is taken away? After the three-month intervention, the researchers tracked both the incentive and control groups for an additional three months, and found that once money was no longer part of the equation, adherence to monitoring goals declined in both groups, although those who had previously been given money for managing their diabetes continued to meet their check goals 50 percent of the time, where those in the control group met their goals only 18.9 percent of the time (that's a decrease of 15.3 percent in the incentive group and 8.7 percent in the control group).

"Young people are often financially dependent on others, such as their parents, making financial incentives an attractive option for encouraging them to become more engaged in their own health as they move into adulthood," said lead author Dr. Charlene Wong, an assistant professor of pediatrics at the Duke University School of Medicine in a press release. "Our results showed that offering a small monthly financial incentive significantly improved daily glucose monitoring, and suggests similar financial incentives could also be an effective way to improve management of other chronic health conditions in youth, such as medication adherence in those who have received transplants or have asthma."



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