Alternative Incentive Research Articles

Sustainability and Innovation in Green Energy: Biomass As A Renewable Energy Alternative

Objective: The objective of this research was to analyze the role of biomass as a renewable energy alternative. Methodology: To do so, an integrative literature review was carried out by surveying articles in the SciELO, Web Of Science and Google Academic databases. During the search, specific keywords and AND and OR search descriptors were used. As an inclusion criterion, only Brazilian scientific articles were selected, in Portuguese, available in full, free of charge and published between the years 2020 and 2023. Results and analysis of the data: As a result, it was found that the energy use of solid urban waste (MSW) in Brazil offers environmental, health and social benefits, in spite of not having sufficient potential to sustain the expansion of the country's electricity supply in the long term. Relevant public policies, such as the National Policy on Solid Waste (PNRS) and the Alternative Energy Incentive Program (PROINFA), are crucial, but the lack of clarity in the joint implementation makes it difficult to replicate initiatives. The management of MSW is the responsibility of municipalities, while energy planning is the responsibility of the Union, and the absence of clear guidelines and specific funding contributes to limited results. Projects such as those of ASJA and FURNAS show progress, but the greater dissemination of these projects requires integrated public policies and a normative framework that aligns the efforts of various actors to maximize the efficiency and benefits of using MSW in power generation. Conclusion: In conclusion, the energy use of solid urban waste (MSW) in Brazil offers environmental and social benefits, but is not sufficient to expand the supply of electricity in the long term. Existing public policies are important, but their effectiveness is limited by the lack of clarity in implementation and by the division of responsibilities between municipalities and the Union. Projects such as those of ASJA and FURNAS show progress, but greater dissemination and effectiveness require integrated public policies and a normative framework that aligns the efforts of the various players to optimize the use of MSW in power generation.

<b>The Crossroad between Intellectual Property and Clinical Trials: Balancing Incentives for Innovation w</b>ith Access to Healthcare

The interplay between intellectual property rights (IPRs) and clinical trials presents a complex challenge in the realm of healthcare innovation. This paper examines the critical role of IPRs, particularly patents, in incentivizing pharmaceutical research and development while simultaneously addressing their implications for access to essential medicines, especially in low- and middle-income countries (LMICs). We explore the phases of clinical trials that underpin medical advancements and highlight the significant financial and temporal investments required for drug development. The discussion also delves into the tensions created by monopolistic pricing, data exclusivity, and evergreening practices that hinder equitable access to healthcare. Through a review of international agreements like the TRIPS Agreement and case studies on HIV/AIDS, hepatitis C treatments, and COVID-19 vaccines, we illustrate the urgent need for policy reforms and alternative incentive models, including prize funds, patent pools, and tiered pricing strategies. Our findings underscore the necessity for a balanced approach that fosters innovation while ensuring that life-saving medications are accessible to all populations. Ultimately, this paper calls for collaborative efforts among governments, international organizations, and the private sector to create an equitable healthcare landscape that prioritizes public health needs without stifling innovation.

From risk to reward: Japan’s potential for health and economic improvements

This study examines the relationship between risky consumption behaviors, non-communicable diseases (NCDs), and socioeconomic costs in Japan using the Preventable Risk Integrated ModEl (PRIME). We assess the potential impact of healthier lifestyle choices on NCD incidences and costs in 2019. Japan's rising healthcare expenditures threaten its economic future. Excessive intake of salt, tobacco, and alcohol, along with insufficient fiber and fruit consumption, significantly contribute to high NCD rates. Our analysis shows that healthier behaviors could have prevented 564,000 NCD cases, potentially saving $35 billion in health costs and economic losses in 2019. We consider scenarios where smokers switch to heated tobacco products (HTPs), applying conservative risk reduction estimates. Higher risk reduction levels could triple smoking-attributable savings. Projecting these savings over ten years would increase economic benefits tenfold. The study emphasizes the need for comprehensive public health strategies promoting healthier lifestyles. Targeted interventions, such as stricter regulation of high-risk products and incentives for healthier alternatives, could reduce NCD incidences and healthcare costs. While PRIME provides valuable insights, further research is needed to refine our understanding of risk factor-disease relationships.

Incentivization in centrally managed systems: Inconsistencies resolution

In centrally managed systems (CMSs), the need for incentivization systems at the local management level is crucial to optimize overall performance. Three alternative incentive systems have emerged within the centralized resource allocation (CRA) framework, aiming to measure the contribution of decision-making units (DMUs) in CMSs. However, we identify inconsistencies within these approaches and present them through illustrative examples. First, existing methods may struggle to effectively distinguish between CRA-efficient and CRA-inefficient DMUs, potentially resulting in inappropriate penalties or rewards for some the DMUs. Second, they may encounter difficulty in differentiating among CRA-efficient DMUs, especially when dealing with non-extreme DMUs or masked data within the dataset. Third, these methods may lack precision in measuring the impact of non-extreme CRA-efficient DMUs on overall performance. To address these limitations, we first highlight certain misconceptions related to individual efficiency within CMSs in the existing literature. Subsequently, we establish a fundamental characterization of individual efficient DMUs by outlining necessary and sufficient conditions for categorizing a DMU as CRA-efficient. For the second and third limitations, we adopt an endogenous perspective to quantify the influence of each CRA-efficient DMU. This involves calculating the maximum potential contribution of the DMU under evaluation in constructing the projection points of other DMUs. Furthermore, we propose a new method to handle masked data well in differentiating among CRA-efficient DMUs. We show the validity and applicability of our approaches using a real dataset.

Tax Incentives for Economic Growth in the Russian Far East: Broad vs. Targeted Stimuli

The purpose of this study is to justify the choice of tax incentive policy instruments aimed at the economic development of the Russian Far East, which is facing acute demographic and environmental problems. To model the dynamics of the region’s real economic system, this study employed a mathematical model based on actual data from 2010 to 2021, covering economic, technological, and socio-ecological aspects. Using the versatile AnyLogic 8.0 platform for agent-based and system dynamics modeling, experiments on alternative tax incentive policy options involving both broad tax incentives and targeted economic development measures were conducted. Specifically, a 50% investment tax deduction for residents in special economic zones in the Russian Far East was implemented. The experimental results show that, despite comparable population dynamics, targeted stimulation of growth poles through public-private partnership programs outperforms broad tax incentives for economic entities in the Russian Far East. This is evident in higher economic growth rates in the region, particularly during the experimental period, except for 2040–2050, where adverse demographic trends constrain growth in both scenarios. The theoretical significance of the application of this method has shown that it allows us to obtain new significant results in the subject area of research due to the consideration of the complex interaction of factors of influence both at the micro- and macro-level, primarily behavioral factors that are fundamentally important for understanding the action of taxes. The practical implications of this study lie in defining the parameters of tax policy to target and stimulate growth poles in regions serving as hubs for generating and disseminating new technologies. The planned perspective is to encourage population growth and ensure sustained economic development in Russia’s Far East. It is advisable to explore comprehensive tax and budgetary regulations that simultaneously address economic, socio-demographic, and environmental issues in the region. Doi: 10.28991/ESJ-2024-08-03-021 Full Text: PDF

Distributional justice, effectiveness, and costs of current and alternative solar PV incentive schemes in Switzerland

Like many other countries, Switzerland offers various incentives to promote residential solar PV, but not all households have equal access to them. Using a microsimulation approach based on merged data from the Swiss Household Budget Survey and Household Energy Demand Survey, we evaluate the current Swiss incentive scheme in terms of how equally the internal rates of return of PV installations, the amounts of obtainable incentives, and the saving months to accumulate the investment are distributed across households. The current, regionally heterogeneous scheme is then compared with alternative, nationally uniform designs based on the required public spending, effectiveness in promoting profitable and affordable PV, and distributional equality. The current scheme leads to a large disparity in the economic profitability of installations and incentive amounts obtainable across various socio-demographics. Larger, the highest-income, and rural households can obtain more incentives and install more profitable PV systems. Lower-income households must save the longest to install PV. Incentive schemes with a nationally uniform investment grant or a feed-in tariff threshold could offer a good alternative to the current scheme in terms of justice, public spending, and effectiveness. The insights on heterogeneous versus uniform PV incentives and the developed methodology could be transferred elsewhere.

The effect of a financial incentive on COVID-19 vaccination uptake, and predictors of uptake, in people experiencing homelessness: A randomized controlled trial

People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable.This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured ‘on-time’ at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated.Eighty-six people consented to participate, and 43 were randomly allocated to each of the ‘incentive’ and ‘no incentive’ groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, −9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, –2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001).Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness.

The influence of pricing interventions in food choices on Brazil: An agent-based modelling approach

This study introduces an agent-based model (ABM) to analyse beef consumption trends in Brazil from 2017 to 2020. The ABM assesses the influence of price changes, specifically a rise in beef prices, on consumption behaviours and their diverse impacts across income groups. By integrating demographic and socioeconomic factors, the model replicates beef consumption decisions within Brazil. Findings show that consumer preferences are highly responsive to beef prices, with consumption decreasing as prices increase. A 60 % price increase due to a US$ 42/tCO2e tax could potentially reduce beef consumption by 55 %, cutting livestock-related greenhouse gas emissions by 53 % in Brazil. However, this tax would disproportionately affect lower-income individuals, worsening social inequality. To address potential food insecurity and ensure adequate nutrition for all, the consequences of food price interventions must be considered. Additional measures, such as tax incentives for plant-based alternatives, should be adopted to encourage suitable dietary choices. By thoughtfully assessing pricing intervention impacts, policymakers can support climate change mitigation, promote reduced meat consumption, and ensure fair access to nutritious food. This research improves our understanding of dietary decisions, the efficacy of pricing interventions, and their implications for affordability and social equality, with relevance beyond Brazil to nations facing similar challenges.

Space Utilization Policy in Payakumbuh City to Support The Public Transportation

The strategy that might be applied to increase the use of public transportation is to apply space utilization incentives and disincentives. Incentives and disincentives for space use contain elements of regulation and control that are accommodating to various actual changes that occur in cities. The stages of this research are: : 1) distribution of questionnaires, 2) ranking of Alternative Incentives and Disincentives with Likert scale. The formulation of incentives and disincentives for space utilization that are predicted to increase the use of public transportation, Alternative incentives sequentially are: 1) Policy for subsidizing public transportation fares, 2) Policy for Rejuvenating Public Transport Fleet, 3) Improving infrastructure and supporting facilities for the use of public transportation, and for Disincentives: 1) Progressive Tax Implementation Policy on vehicle ownership, 2) Mandatory garage policy for prospective owners of private vehicles. The results of this study can be used as input for the Payakumbuh City government in making decisions related to spatial planning and transportation and further research needs to be done on alternative incentives and disincentives that have been formulated.

Incentives as a Driving Force for Scholarly Activity in General Surgery Training: Survey of Program Directors and our Institution's Experience.

Scholarly activity in a few of the domains is required for both residents and faculty per Accreditation Council for Graduate Medical Education's Common Program Requirements. Increased burden in clinical activities and economic changes in the health care environment have created new challenges, which have negatively affected faculty and residents to participate in scholarly activity. Various avenues are being sought which might help in improving the scholarly activity in an institution by providing dedicated time, salaried positions, grants, paid conferences, and financial incentives. A survey was sent to program directors of surgery residency programs in 2020 to evaluate the impact of financial incentives on scholarly activity. Data was analyzed on SPSS 20, and descriptive statistics using frequencies and percentages were done. Out of 230 surveys sent, 80 (35%) program directors responded (35%). 52 (65%) of respondents were from university hospitals and 28 (35%) were from community hospitals. Both the faculty and residents were required to publish in 56 (70%) of the institutions surveyed. 59 (73.7%) considered a PubMed publication as a scholarly activity. Only 9 (11%) programs were supportive of residents being involved in research activities that had a designated rotation. 48 (60%) respondents stated that residents and faculty would be more likely to pursue research endeavors if they were provided some form of financial incentive, but only 9 (11%) had some sort of incentive program in place. Given the results of the survey, there is a need to seek uniform, acceptable, and sustainable alternative incentive programs to help promote and increase the scholarly activity of residents and faculty.

PERHITUNGAN NILAI EKONOMI SUMBERDAYA TERUMBU KARANG BERDASARKAN WILLINGNESS TO DONATE (WTD) WISATAWAN BAHARI DI TAMAN NASIONAL KARIMUNJAWA

Karimunjawa National Park (TNKJ) as one of the seven marine national parks is priority for marine management. Ecosystems that contribute a lot of indirect value is coral reef ecosystems. Its utilization for marine tourism activities has enormous potential but is also vulnerable to damage. Calculation of economic value is carried out as basic information on tourist willingness in terms of coral reef conservation through a Willingness to Donate (WTD) that it can be used as one of the inputs for sustainable management. The research was conducted in the main waters of the TNKJ marine tourism utilization zone in August-September 2017. Tourist data collection was carried out through structured questionnaire with 45 selected respondents. The results show tourists who use coral reef ecosystems snorkel as many as 4755 people peryear and 853 people dive peryear in an area of ​​886,302.7841 m2. The average WTD for snorkeling tourists is IDR206,250 and IDR87,500 for diving tourists. The total cost of rehabilitation of coral reefs per year is IDR1,055,356,250 per year. The resulting value can be used as a reference for the cost of repairing damaged ecosystems, responsible marine tourism activities and as an alternative priority incentive for coral reef conservation activities in TNKJ.

What incentives encourage local communities to collect and upload mosquito sound data by using smartphones? A mixed methods study in Tanzania

BackgroundTo detect and identify mosquitoes using their characteristic high-pitched sound, we have developed a smartphone application, known as the ‘HumBug sensor’, that records the acoustic signature of this sound, along with the time and location. This data is then sent remotely to a server where algorithms identify the species according to their distinctive acoustic signature. Whilst this system works well, a key question that remains is what mechanisms will lead to effective uptake and use of this mosquito survey tool? We addressed this question by working with local communities in rural Tanzania and providing three alternative incentives: money only, short message service (SMS) reminders and money, and SMS reminders only. We also had a control group with no incentive.MethodsA multi-site, quantitative empirical study was conducted in four villages in Tanzania from April to August 2021. Consenting participants (n = 148) were recruited and placed into one of the three intervention arms: monetary incentives only; SMS reminders with monetary incentives; and SMS reminders only. There was also a control group (no intervention). To test effectiveness of the mechanisms, the number of audio uploads to the server of the four trial groups on their specific dates were compared. Qualitative focus group discussions and feedback surveys were also conducted to explore participants’ perspectives on their participation in the study and to capture their experiences of using the HumBug sensor.ResultsQualitative data analysis revealed that for many participants (37 out of 81), the main motivation expressed was to learn more about the types of mosquitoes present in their houses. Results from the quantitative empirical study indicate that the participants in the ‘control’ group switched on their HumBug sensors more over the 14-week period (8 out of 14 weeks) when compared to those belonging to the ‘SMS reminders and monetary incentives’ trial group. These findings are statistically significant (p < 0.05 or p > 0.95 under a two-sided z-test), revealing that the provision of monetary incentives and sending SMS reminders did not appear to encourage greater number of audio uploads when compared to the control.ConclusionsKnowledge on the presence of harmful mosquitoes was the strongest motive for local communities to collect and upload mosquito sound data via the HumBug sensor in rural Tanzania. This finding suggests that most efforts should be made to improve flow of real-time information back to the communities on types and risks associated with mosquitoes present in their houses.

Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania.

Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania. Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children. All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8%) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95% confidence interval Tsh 2,523-3,610; 1 USD∼Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children. Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness. NCT03252288.

Socialism, Farming, and Resistance: How Cuban Socialism is Beating the Embargo

Beginning as a small assignment which ought to have taken two days, it soon ballooned into a three month project looking at the Cuban political system and the farming sector’s role in developing not only Socialist theory, but Socialism in practice. As the collapse of Cuban Socialism has been expected for the past four decades by Western scholars and lawmakers, this very same inevitability has perplexed its proponents as it continues to not occur. Cuba has been under embargo by the United States for over sixty years now, and its tremendous pressure on the Socialist government has been exacerbated by the COVID-19 pandemic and hurricane Ian. One ought to ask the question, then, how Cuba remains so resilient after the collapse of the USSR. Although not a conclusive reason as to why Socialism remains prevalent in Cuba, this essay looks at one aspect of this new Cuban Socialism and its successes -- that being its farming systems. By looking at the roles polycultural cropping and alternative incentive schemes play in Cuba, I conclude that they both play a vital role in the development and reinforcement of Socialism in the island nation.

Incentivized user-based relocation strategies for moderating supply–demand dynamics in one-way car-sharing services

One-way car-sharing services have drawn much attention in recent years in transportation research and practice. The flexible operating scheme stimulates patronage but causes unbalanced distributions of the shared cars and consequently low utilization of the services. In light of the empirical evidence that users are willing to cooperate with the operators for relocations, this paper formulates the supply–demand dynamics of shared cars under four user-based relocation strategies, including a naive one without incentive and three alternatives with incentives. We formulate the triggering conditions and travel disutilities responding to the incentive-based strategies based on the concept of load-space–time paths. To systematically assess the effects of the strategies, we propose an incentive-based boundedly rational dynamic user equilibrium (IBR-DUE) model in a multimodal transportation system. A cluster-based column generation algorithm is developed to solve the IBR-DUE model without path enumeration in a space–time supernetwork. Numerical examples demonstrate that the alternative drop-off incentive outperforms other strategies and can improve the utilization and service rates about 2 times on average.

CEO Compensation Incentives and Playing It Safe: Evidence from FAS 123R

AbstractThis article uses FAS 123R regulation to examine how reduction in CEO compensation incentives affects managerial “playing it safe” behavior. Using proxies reflecting deliberate managerial efforts to change firm risk, difference-in-difference tests show that affected firms drastically reduce both systematic and idiosyncratic risks, leading to an 8% decline in total firm risk. These reductions in risk are achieved by shifting to safer, but low-Q, segments while closing the riskier ones, without significant changes in investment levels. Our findings suggest that decrease in risk-taking incentives provided by option compensation, when not compensated for by alternative incentives or governance mechanisms, exacerbates risk-related agency problem.

Blockchain-based tokenization and its impact on plastic bottle supply chains

Over the past few decades, industrial plastic production has been experiencing exceptional growth. The durability, lightness, stability, and low cost of conventional plastic materials are clear benefits that explain their popularity and application variety. However, these advantages are offset by complex after-use processes in which post-consumer plastic waste is either recycled, used for energy recovery, or dumped in landfills, where it breaks down into harmful microplastics. In practice, existing approaches to incentivize end-consumers for the proper collection of plastic bottle waste pose certain barriers and weaknesses. In this study, we propose blockchain-based tokenization as an alternative incentive system and investigate its impact on plastic bottle supply chains (SC). Together with industry partners, including Coca-Cola HBC, we first developed a process model of a circular plastic bottle SC based on blockchain tokenization and then implemented it in an empirical pilot study. Here, we tested different token-based incentives (i.e., donations, lottery tickets, and gamification) for their attractiveness among end-consumers to enhance collection efforts of plastic bottles. We then developed a system dynamics model where we used empirical data from the pilot study to analyze the impact of incentivization via blockchain-based tokenization on a circular plastic bottle SC. The insights from the pilot study demonstrate the practical and technical feasibility of such a novel incentivization approach when implemented in a real-world setting. It was also found that token-based incentives for social purposes are most suitable for stimulating end-consumers for proper plastic bottle recycling. Furthermore, the results show the positive effects of the proposed system in terms of reduced virgin material delivery and higher collection fractions of plastic bottles.

Investment versus Output Subsidies: Implications of Alternative Incentives for Wind Energy

This paper examines the choice between subsidizing investment or output to promote socially desirable production. We exploit a natural experiment in which wind farm developers could choose an investment or an output subsidy to estimate the impact of these policy instruments on productivity. Using instrumental variables and matching estimators, we find that wind farms claiming the investment subsidy produced 10 to 12 percent less power than wind farms claiming the output subsidy, and that this effect reflects subsidy incentives rather than selection. Introducing investment subsidies caused the Federal government to spend 14 percent more per unit of output from wind farms.

New development: Increasing vaccination uptake in repeated Covid 19 vaccination mandates

IMPACT Some countries are still struggling to vaccinate residents against Covid 19 despite the wide availability of vaccines. This situation becomes more complex when considering the possible need for regular booster shots. Repeated vaccine mandates that impose fines on vaccine refusers may increase vaccination uptake. However, the uptake may not be sufficient to lift all Covid 19 restrictions. This article recommends that policy-makers consider an alternative financial incentive system that relies on rewards in addition to fines. Theoretical and empirical evidence suggests that a combination can yield a stronger response than using rewards or fines alone.

Participant retention in a fully remote trial of digital psychotherapy: Comparison of incentive types.

Numerous studies have found that long term retention is very low in remote clinical studies (>4 weeks) and to date there is limited information on the best methods to ensure retention. The ability to retain participants in the completion of key assessments periods is critical to all clinical research, and to date little is known as to what methods are best to encourage participant retention. To study incentive-based retention methods we randomized 215 US adults (18+ years) who agreed to participate in a sequential, multiple assignment randomized trial to either high monetary incentive (HMI, $125 USD) and combined low monetary incentive ($75 USD) plus alternative incentive (LMAI). Participants were asked to complete daily and weekly surveys for a total of 12 weeks, which included a tailoring assessment around week 5 to determine who should be stepped up and rerandomized to one of two augmentation conditions. Key assessment points were weeks 5 and 12. There was no difference in participant retention at week 5 (tailoring event), with approximately 75% of the sample completing the week-5 survey. By week 10, the HMI condition retained approximately 70% of the sample, compared to 60% of the LMAI group. By week 12, all differences were attenuated. Differences in completed measures were not significant between groups. At the end of the study, participants were asked the impressions of the incentive condition they were assigned and asked for suggestions for improving engagement. There were no significant differences between conditions on ratings of the fairness of compensation, study satisfaction, or study burden, but study burden, intrinsic motivation and incentive fairness did influence participation. Men were also more likely to drop out of the study than women. Qualitative analysis from both groups found the following engagement suggestions: desire for feedback on survey responses and an interest in automated sharing of individual survey responses with study therapists to assist in treatment. Participants in the LMAI arm indicated that the alternative incentives were engaging and motivating. In sum, while we were able to increase engagement above what is typical for such study, more research is needed to truly improve long term retention in remote trials.