Patient attitudes about financial incentives for diabetes self-management: A survey

Table 1 Overview of survey questions

Survey question themes
Three most difficult and three easiest diabetes self-management tasks:
Tracking health parameters
Choosing foods
Adapting medications or insulin
Affording healthcare
Adjusting meds and diet around unexpected events
Perceived challenges for living with diabetes (detailed in Table 2)
Perceived helpfulness of incentives for motivating healthier behaviors:
Cash rewards (weekly, monthly or yearly)
Tangible rewards, e.g., vouchers (weekly, monthly or yearly)
Decrease in future insurance premium
Non-financial rewards (badges, stars)
Social support (sharing with friends)
Self-reward (setting money aside for a self-set goal)
Potential sources of funding for the rewards (employer, insurance, self-paid)
Estimated amount needed to lose weight and keep it off for a year:
To lose 5 lb
To lose 15 lb

Table 2 Challenges of diabetes self-management behaviors

Behavior	n (%)
Having to structure my daily routine around diabetes management	77 (50.3)
Coping with the impact of diabetes on my social relationships	64 (41.8)
Thinking about diabetes all the time	74 (48.4)
Having insufficient support from family and/or friends	52 (34.0)
Having insufficient support from my workplace	51 (33.3)
Seeing how other people think of me	88 (57.5)
Having to change what I eat	49 (32.0)
Understanding the relationships between glucose, diet and exercise	72 (47.1)
Overall mean	65.9 (43.1)

For the score, each behavior was rated 0 to 3 points (total of 0 to 24 points).

Table 3 Participant characteristics by type of diabetes

Diabetes	Type 1	Type 21	P-value
Value	17 (11.1)	136 (88.9)
Female	6 (35.3)	71 (52.2)	0.20
Age (x)	39.6 ± 3.5	44.8 ± 1.3	0.18
United States. region			0.06
West	1 (5.9)	26 (19.1)
Midwest	4 (23.5)	29 (21.3)
Northeast	9 (52.9)	30 (22.1)
South	3 (17.6)	51 (37.5)
Hispanic	1 (7.6)	13 (9.3)	0.80
White race	14 (84.7)	120 (88.9)	0.14
Education (highest attained level)			0.98
High school	8 (47.1)	61 (44.9)
College	5 (29.4)	40 (29.4)
Graduate school	4 (23.5)	35 (25.7)
Income > $50000/yr	7 (42.9)	72 (52.9)	0.45
Current smoker	4 (21.8)	32 (23.5)	0.87
Smartphone user	14 (80.6)	53 (38.8)	0.005

¹Limited to white and black race. Data are expressed as mean ± SD or n (%).

Table 4 Effect of behavior score on the 3 types of rewards

Score	OR financial incentive (95%CI)	P-value	OR non-financial incentive (95%CI)	P-value	OR self-reward (95%CI)	P-value
Score	0.82 (0.72-0.93)	0.002	1.06 (1.01-1.10)	0.01	1.00 (0.96-1.04)	0.98
Score adjusted for age	0.82 (0.72-0.93)	0.002	1.06 (1.01-1.11)	0.01	1.00 (0.96-1.05)	0.94
Score adjusted for weight loss motivation1	0.83 (0.73-0.95)	0.005	1.07 (1.02-1.11)	0.006	1.01 (0.96-1.05)	0.75

¹Estimated amount needed to lose 5 lb and maintain it for a year.