Monetary Incentives and Intrinsic Motivation to Sustain Hypertension Control

Summary

Despite unequivocal proof that tight control of blood pressure with antihypertensive medication can prevent hypertensive complications-including strokes, myocardial infarcts, heart failure, end-stage renal disease, and death- blood pressure remains uncontrolled in the majority of individuals with hypertension. We propose a novel patient-centered intervention that combines monetary incentives and a social psychological intervention to help patients sustain blood pressure control once incentives are no longer offered by strengthening intrinsic motivation to control blood pressure among two vulnerable populations: African Americans, who suffer disproportionately from hypertension, and Mexican Americans, who have the lowest hypertension control rates of any demographic group in the United States. If the intervention is successful, it could be adapted as a set of tools to apply in clinical practice to improve outcomes of a range of chronic diseases, by maximizing the motivation of patients to optimize their treatment.

Conditions

• Hypertension

Interventions

BEHAVIORAL

Monetary Incentives

Subjects will receive a payment of $2 per mm. drop in BP from the baseline value at each follow-up visit. If a subject reaches their target BP, they will receive a minimum of $30 each time to motivate continued participation in the study and reinforce continued improvement relative to baseline BP. Lottery incentives will be added to motivate attainment of intermediate goals. For remembering to do certain actions that assist in the management of their BP, the subject will receive one entry into a lottery with an expected value of $3 per ticket. For the lottery payment, the subject will be given 3 chances to randomly select a card that may or may not show a winning monetary prize.

BEHAVIORAL

Intrinsic Motivation

A)Subjects will complete an additional component to the baseline questionnaire that probes systematically for areas of experience that currently are of importance to them. Their answers will help to identify patients' intrinsic motivations for controlling their BP. B)Answers to this component will be analyzed to characterize a role self-identity that will be used by study personnel to frame their interactions with the subject for the remainder of the study. C) Role identity will be kept highly salient throughout the study by using identity primes that remind the individual that improving blood pressure levels is an important responsibility associated with that role.

Sponsors & Collaborators

• National Institute on Aging (NIA)

  collaborator NIH

• University of California, Los Angeles

  lead OTHER

Principal Investigators

• Martin F. Shapiro, MD · University of California, Los Angeles

• José J. Escarce, MD, Ph.D · University of California, Los Angeles

• Craig R. Fox, Ph.D. · University of California, Los Angeles

• Noah J. Goldstein, Ph.D. · University of California, Los Angeles

• Honghu Liu, Ph.D. · University of California, Los Angeles

• Suzanne B. Shu, Ph.D., MBA · University of California, Los Angeles

• Ronald G. Victor, MD · Cedars-Sinai Medical Center for Hypertension

Study Design

Allocation

RANDOMIZED

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2011-08-31

Primary Completion

2012-09-30

Completion

2013-09-30

Countries

• United States

Study Locations