Abstract
BackgroundDiabetes is an increasing public health problem in the UK and globally. Diabetic retinopathy is a microvascular complication of diabetes, and is one of the leading causes of blindness in the UK working age population. The diabetic eye screening programme in England aims to invite all people with diabetes aged 12 or over for retinal photography to screen for the presence of diabetic retinopathy. However, attendance rates are only 81 %, leaving many people at risk of preventable sight loss.MethodsThis is a three arm randomized controlled trial to investigate the impact of different types of financial incentives (based on principles from behavioral economics) on increasing attendance at diabetic eye screening appointments in London. Eligible participants will be aged 16 or over, and are those who have been invited to screening appointments annually, but who have not attended, or telephoned to rearrange an appointment, within the last 24 months.Eligible participants will be randomized to one of three conditions:Control condition (usual invitation letter)Fixed incentive condition (usual invitation letter, including a voucher for £10 if they attend their appointment)Probabilistic incentive condition (invitation letter, including a voucher for a 1 in 100 chance of winning £1000 if they attend their appointment).Participants will be sent invitation letters, and the primary outcome will be whether or not they attend their appointment. One thousand participants will be included in total, randomized with a ratio of 1.4:1:1. In order to test whether the incentive scheme has a differential impact on patients from different demographic or socio-economic groups, information will be recorded on age, gender, distance from screening center, socio-economic status and length of time since they were last screened. A cost-effectiveness analysis will also be performed.DiscussionThis study will be the first trial of financial incentives for improving uptake of diabetic eye screening. If effective, the intervention may suggest a cost-effective way to increase screening rates, thus reducing unnecessary blindness.Trial registrationISRCTN14896403, 25 February 2016
Highlights
Diabetes is an increasing public health problem in the United Kingdom (UK) and globally
This study will be the first trial of financial incentives for improving uptake of diabetic eye screening
This study is a novel, randomized controlled trial to investigate the impact of two different types of financial incentives on increasing attendance at diabetic retinopathy screening
Summary
Study population and eligibility Eligible participants will be identified from the Diabetic Eye Screening Programme (DES) prior to commencement of the study by 1st Retinal Screen Ltd (who at the time of the study were providing the DES service in the Kensington, Chelsea and Westminster Clinical Commissioning Groups in West London). Probabilistic incentive group Participants in this group will receive the standard invitation letter, including additional text and a voucher offering entry into a prize draw for a 1 in 100 chance of winning £1000 following attendance at screening. This condition was designed with an understanding of the phenomena that people overvalue small probabilities, which explains the popularity of lotteries and insurance [28]. Risk differences and risk ratios (i.e., relative risks), along with their 95 % confidence intervals, will be presented to assess whether any significant differences between groups exist This analysis will address the first two research questions of whether financial incentives, and the design of the incentive scheme have an impact on screening attendance. TMT members from 1st Retinal Screen Ltd, Imperial College London and the statistician will have access to the dataset
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