Financial INcentives to improve Asthma (FINA): a pilot RCT to improve medication adherence for children and young people with asthma

OBJECTIVE: To assess effectiveness and feasibility of financial incentives to improve medication adherence for children and young people (CYP) with asthma. DESIGN: Pilot randomised controlled trial measuring adherence in CYP using an electronic monitoring device (EMD) with twice-daily reminders; design supported by patient and public involvement. SETTING: CYP were recruited between 2 and 12 weeks after attendance at an emergency department (ED) following a severe asthma exacerbation. PATIENTS: CYP aged 11-17 years old with asthma, who were prescribed inhaled corticosteroids for at least 6 months prior to their exacerbation, owned their own smartphone and understood verbal and written English. INTERVENTIONS: Intervention CYP received £1 per complete morning/£1 per complete evening inhaler dose(s) for 12 weeks (max £168). Controls received usual care (with EMD and reminder use) with no financial incentives. MAIN OUTCOME MEASURES: adherence, asthma control and psychological outcomes. Feasibility assessed by recruitment, randomisation and intervention delivery indicators. RESULTS: 32 CYP (mean age: 13.4 years (±1.64, SD); 65.6% male) were enrolled; 16 randomised to intervention. After 12 weeks, those who received financial incentives had higher median adherence (73.0%, range: 23.0-89.0%), compared with control (56.0%, range: 7.0-87.0%); this did not reach significance (p=0.077). During follow-up, intervention and control adherence significantly decreased (to 39.0%, range: 0.0-72.0%, p=0.012 and 31.5%, range: 3.0-62.0%, p=0.002, respectively). Study implementation was challenging due to slow recruitment and technological issues. CONCLUSIONS: In this small pilot study, financial incentives were not effective in sustaining adherence. Improved technology is necessary for a definitive study. Future work could explore individual characteristics that contribute to successful financial incentive use in CYP. TRIAL REGISTRATION NUMBER: NCT05322044.