Financial Interventions Research Articles

Interventions for cold homes: a rapid review of the health impacts.

Cold homes are associated with an increased risk of adverse health outcomes for older people. To mitigate this risk, homes need to be heated to an appropriate temperature. This review aims to identify interventions designed to improve heating and temperatures within homes and summarize its impact on health, health service utilization and cost effectiveness. A rapid review was conducted. Studies assessing the effects of structural, financial, or behavioural interventions designed to improve home temperatures of residents aged 18+ years were eligible. Searches were carried out in four databases. A search for grey literature, and backward and forward citation searching were performed. Data were summarized in a narrative synthesis and mapped using EPPI-Reviewer and EPPI-Mapper software. Eighteen studies reported across 19 publications were included. Structural interventions were associated with better mental health and quality of life, a reduction in health service utilization, and improvements in satisfaction with internal home temperature, social interactions and financial difficulties. The impact on physical health outcomes varied by age, gender and long-term conditions. Evidence about the impact of behavioural interventions was inconsistent. Structural improvements to increase home temperatures may offer the potential to improve some aspects of health. However, the impact on physical health, including which groups are most likely to benefit, is unclear. Key gaps include the lack of evidence about the impact of financial interventions, and the impact of all types of interventions, on quality of life, mortality and costs.

Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective.

We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers. We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions. We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs. Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.

Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial

IntroductionThere is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation...

Developing Inclusive Models of Value Chain Financing

Abstract This paper presents a framework for designing external financial intervention mechanisms in the form of partnership agreements between financial institutions and different economic participants involved in the farm machinery supply chain. The scope of these partnership agreements is to facilitate small farmers’ access to loans when purchasing agricultural equipment. The research methodology and research results are drawn from desk and field research conducted on the emerging agricultural market. Several inclusive conceptual models of financing mechanisms based on business relationships between financial institutions, small farmers and either the suppliers of agricultural equipment or buyers of agricultural outputs are presented.

Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers.

Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains:psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. NCT05876325.

Professional Women’s Perceptions of Financial Well-Being in a Patrifocal Culture

This qualitative study explored the perception of financial well-being among 30 professional women belonging to the middle to upper class in India through a series of in-depth one-to-one interviews. The major dimensions of financial well-being revealed from the narratives were financial adequacy, financial security, having control over one’s finances, being independent, and having a balance in life. The findings were explained based on psychological theories on human motivation. This study improves the present state of knowledge about the financial well-being of women by providing fresh insights into their perspectives, its key driving factors, and the key issues that are critical to their financial futures. The information can be used to develop effective financial intervention strategies and policies to improve financial well-being that target the specific needs of women in an emerging country context.

Abstract 2240: An exploratory study of financial toxicity intervention components preferred by cancer survivors

Abstract Background: Despite growing research on financial toxicity (FT) in cancer survivors, few studies have examined cancer survivors’ preferences for FT interventions. Understanding cancer survivors’ preferences for specific intervention components may facilitate the development and implementation of such interventions, potentially reducing the financial burden of cancer treatment. Purpose: The current work is an exploratory study of cancer survivors’ FT intervention component preferences. Methods: Adult survivors (N=105) of colorectal cancer (CRC; n=55) or non-Hodgkin lymphoma (NHL; n=50) from three tertiary care centers self-reported demographic characteristics (gender, race, income, employment status, insurance), clinical characteristics (comorbidities), psychosocial characteristics (PROMIS Global Health scale for mental health, Brief Health Literacy Screen scale, eHealth Literacy Scale), financial impact of cancer (the 11-item comprehensive score for financial toxicity COST scale, and life-altering and care-altering coping strategy scales), and preferences for FT intervention components. Intervention preferences were assessed through survey items on intervention timing and specific content. We employed descriptive statistics to assess overall preferences, and unadjusted linear regression and ANOVAs to identify demographic, clinical, psychosocial and financial predictors of intervention preferences. Results: In terms of timing, 79% of participants favored initiating a FT intervention before treatment compared to during or after treatment. The majority of participants (57%) were interested in at least one FT intervention component. In terms of specific components, participants were most interested in help understanding out-of-pocket costs and insurance (49%), help applying for financial assistance (39%), financial education (32%), and help communicating with the treatment team (32%). Participants were less interested in online tools to manage cancer-related expenses (27%), finance-related stress management (25%), and budgeting (20%). Predictors of overall interest (i.e., number of components endorsed) were: having high FT (B=.413, p=&amp;lt;.001), adopting life-altering coping behaviors (B=.374, p=&amp;lt;.001), using care-altering coping behaviors (B=.241, p=.014), being a non-White survivor (B=.219, p=.024), and having poorer mental health (B=-.280, p=.004). Conclusions: Cancer survivors may prefer FT interventions offered before treatment, and providing guidance on out-of-pocket costs and insurance. FT interventions may be particularly desired by those who experience greater financial toxicity, life and care-altering costs, are a racial/ethnic minority, or have poorer mental health, suggesting potential priority groups and target outcomes for intervention development. Citation Format: Maisha Huq, Claire Conley, Heather Derry-Vick, Amanda Khoudary, Lia Sorgen, Osairys Billini, Thomas Gunning, Conor Luck, Shreya Kaushik, Vanessa Hurley, John Marshall, Benjamin Weinberg, Anteneh Tesfaye, Andrew Ip, Arnold Potosky, Marc D. Schwartz. An exploratory study of financial toxicity intervention components preferred by cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2240.

The acceptability of behavioural interventions in financial decision-making

Abstract Financial policymakers increasingly rely on behavioural insights to protect the interests of consumers. However, little is known about how citizens feel about interventions designed to nudge their financial behaviour. Most literature on the acceptability of behavioural interventions focuses on the health domain. To address this gap, we present the results of an experiment on the acceptability of seven financial behavioural interventions (N = 684, members of a panel of the Dutch Authority for the Financial Markets). We investigate the role of the agent implementing the intervention (policymaker versus financial company) and perceived effectiveness in relation to the acceptability of these interventions. The acceptability of behavioural interventions in financial decision-making appears to be lower than the acceptability levels found in previous studies. We find no effect of the agent on acceptability. Perceived effectiveness is strongly correlated with acceptability, but only perceived effectiveness in influencing one's own decisions has a consistently positive relationship with acceptability. Perceived effectiveness in influencing others' decisions has either no, a positive, or a negative relationship with acceptability. These results highlight that acceptability appears to be at least partly domain-specific and show that we have only just begun understanding the acceptability of behavioural interventions and its drivers.

Mechanisms for realizing the ecological products value: Green finance intervention and support

The essence of ecological product value is the rational development and utilization of natural ecological and environmental resources, which are converted into social attributes or economic value. An accurate assessment of the value of ecological products is a prerequisite for realizing their economic value. However, few studies have measured the interaction mechanism between green finance and ecological products value. This study measured the ecological products value at the city level in China from 2010 to 2021, based on the dynamic equivalent moderator model. A spatial panel data model was used to analyze the spatial pattern and dynamic evolution of ecological products value and identify their driving factors. The ecological products value in China showed an increasing trend from 2010 to 2021, and there were obvious spatial correlations between regions. Green finance significantly contributes to the realization of ecological products value, and robust estimation results can still be obtained after controlling for endogeneity. Meanwhile, the role of green finance has a spatial spillover effect. This study provides a new research perspective for correctly assessing ecological products value and studying the role of green finance in realizing ecological products value.

Evaluation of a financial incentive intervention on malaria prevalence among the residents in Lake Victoria basin, Kenya: study protocol for a cluster-randomized controlled trial

BackgroundIn the Lake Victoria basin of western Kenya, malaria remains highly endemic despite high coverage of interventions such as mass distribution of long-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) programs, and improvement of availability and accessibility of rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACT) at community healthcare facilities. We hypothesize that one major cause of the residual transmission is the lack of motivation among residents for malaria prevention and early treatment.MethodsThis study will aim to develop a demand-side policy tool to encourage local residents’ active malaria prevention and early treatment-seeking behaviors. We examine the causal impact of a financial incentive intervention complemented with malaria education to residents in malaria-prone areas. A cluster-randomized controlled trial is designed to assess the effect of the financial incentive intervention on reducing malaria prevalence in residents of Suba South in Homa Bay County, Kenya. The intervention includes two components. The first component is the introduction of a financial incentive scheme tied to negative RDT results for malaria infection among the target population. This study is an attempt to promote behavioral changes in the residents by providing them with monetary incentives. The project has two different forms of incentive schemes. One is a conditional cash transfer (CCT) that offers a small reward (200 Ksh) for non-infected subjects during the follow-up survey, and the other is a lottery incentive scheme (LIS) that gives a lottery with a 10% chance of winning a large reward (2000 Ksh) instead of the small reward. The second component is a knowledge enhancement with animated tablet-based malaria educational material (EDU) developed by the research team. It complements the incentive scheme by providing the appropriate knowledge to the residents for malaria elimination. We evaluate the intervention’s impact on the residents’ malaria prevalence using a cluster-randomized control trial.DiscussionA policy tool to encourage active malaria prevention and early treatment to residents in Suba South, examined in this trial, may benefit other malaria-endemic counties and be incorporated as part of Kenya’s national malaria elimination strategy.Trial registrationUMIN000047728. Registered on 29th July 2022.

Qualitative study of perceptions of factors contributing to success or failure among participants in a US weight loss trial of financial incentives and environmental change strategies

BackgroundThe use of financial incentives and environmental change strategies to encourage health behaviour change is increasingly prevalent. However, the experiences of participants in incentive interventions are not well characterised. Examination...

Good while it lasted? Estimating the long-term and withdrawal effects of results-based financing in Malawi on maternal care utilisation using routine data

ObjectivesThis study aimed to evaluate the effect of introduction and subsequent withdrawal of the Results-based Financing for Maternal and Newborn Health Initiative (RBF4MNH) in Malawi on utilisation of facility-based childbirths,...

A proactive financial navigation intervention in patients with newly diagnosed gastric and gastroesophageal junction adenocarcinoma

PurposeMany cancer patients and caregivers experience financial hardship, leading to poor outcomes. Gastric and gastroesophageal junction (GEJ) cancer patients are particularly at risk for financial hardship given the intensity of treatment. This pilot randomized study among gastric/GEJ cancer patients and caregivers tested a proactive financial navigation (FN) intervention to obtain a signal of efficacy to inform a larger, more rigorous randomized study.MethodsWe tested a 3-month proactive FN intervention among gastric/GEJ cancer patients and caregivers compared to usual care. Caregiver participation was optional. The primary endpoint was incidence of financial hardship, defined as follows: accrual of debt, income decline of ≥ 20%, or taking loans to pay for treatment. Data from participant surveys and documentation by partner organizations delivering the FN intervention was analyzed and outcomes were compared between study arms.ResultsNineteen patients and 12 caregivers consented. Primary FN resources provided included insurance navigation, budget planning, and help with out-of-pocket medical expenses. Usual care patients were more likely to experience financial hardship (50% vs 40%) and declines in quality of life (37.5% vs 0%) compared to intervention patients. Caregivers in both arms reported increased financial stress and poorer quality of life over the study period.ConclusionsProactive financial navigation has potentially positive impacts on financial hardship and quality of life for cancer patients and more large-scale randomized interventions should be conducted to rigorously explore the impact of similar interventions. Interventions that have the potential to lessen caregiver financial stress and burden need further exploration.Trial registrationTRN: NCT03986502, June 14, 2019.

Lay healthcare worker financial toxicity intervention: a pilot financial toxicity screening and referral program.

Financial toxicity is a source of significant distress for patients with urologic cancers, yet few studies have addressed financial burden in this patient population. We developed a financial toxicity screening program using a lay health worker (LHW) and social worker (SW) to assess and mitigate financial toxicity in a single academic medical clinic. As part of a quality improvement project, the LHW screened all newly diagnosed patients with advanced stages of prostate, kidney, or urothelial cancer for financial burden using three COST tool questions and referred patients who had significant financial burden to an SW who provided personalized recommendations. The primary outcome was feasibility defined as 80% of patients with financial burden completing the SW consult. Secondary outcomes were patient satisfaction, change in COST Tool responses, and qualitative assessment of financial resources utilized. The LHW screened a total of 185 patients for financial toxicity; 82% (n = 152) were male, 65% (n = 120) White, and 75% (n = 139) reported annual household income >$100,000 US Dollars; 60% (n = 114) had prostate cancer. A total of 18 (9.7%) participants screened positive for significant financial burden and were referred to the SW for consultation. All participants (100%) completed and reported satisfaction with the SW consultation and had 0.83 mean lower scores on the COST Tool post-intervention assessment compared to pre-intervention (95% confidence interval [0.26, 1.41]). This multidisciplinary financial toxicity intervention using an LHW and SW was feasible, acceptable, and associated with reduced financial burden among patients with advanced stages of urologic cancers. Future work should evaluate the effect of this intervention among cancer patients in diverse settings.

Systematic Review of Financial Interventions for Adults Experiencing Behavioral Health Conditions.

The authors reviewed the literature on finance-based interventions used to improve clinical and psychosocial outcomes among adults experiencing mental disorders, substance use disorders, or both. A systematic review of the peer-reviewed literature, published from 1900 to 2022, was conducted. Only studies with participants with a mental disorder or a substance use disorder, a structured finance-based intervention or program, a quantitative dependent variable in a behavioral health outcomes domain, and a defined research design were included. Studies were rated with a quality assessment tool, and overall evidence (levels I-VII) for the outcomes was rated. In total, 544 articles were identified, screened for eligibility, and reduced to 55 articles. These articles were rated by two independent raters, and 18 articles were ultimately included. Of these 18 articles, four reported findings of randomized controlled trials (RCTs), one conducted a secondary analysis of an RCT, and the remaining articles were observational studies. The most studied intervention was representative payeeship, which reduced substance use and enhanced money management, showing the strongest evidence for improving outcomes among adults with behavioral health conditions. Weaker evidence suggested that financial education and assistance interventions could improve health care utilization and other psychosocial outcomes among individuals with mental or substance use disorders. Level II-V evidence indicates that finance-based interventions can improve outcomes among adults experiencing behavioral health conditions. Further research is needed to assess the impact of interventions beyond representative payee programs on objectively measured outcomes.

A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya.

ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years, made possible by publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to overconsumption. We test an innovative, scalable strategy to target ACT-subsidies to clients with a confirmatory diagnosis. We supported malaria testing(mRDTs) in 39 medicine outlets in western Kenya, randomized to three study arms; control arm offering subsidized mRDT testing (0.4USD), client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully-subsidized) ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions, resulting in targeting of ACTs to confirmed malaria cases- 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates(RD = 0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients(RD = 0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. This uncertainty undermines our ability to definitively conclude that client-directed subsidies are not effective for improving testing and appropriate treatment. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain. Trial registration: ClinicalTrials.gov NCT04428307.

Occupational and asset adjustments in Tamil Nadu, India: The role of a finance and rebuilding program

Financial inclusion is important for long-term recovery from natural disaster-driven losses when access to safety nets or informal assistance fades away. We examine how an intervention promoting access to finance has altered primary occupations and asset accumulation among smallholders affected by the 2004 tsunami in Tamil Nadu, India, 16 years after the initial event. We show that the program increased professional jobs as a primary occupation by 38 percent while reducing household chores as a primary occupation by 7 percent. These impacts may have been driven by increased access to loans and improved social capital facilitated by the program. Our results suggest that access to financial interventions can help adaptation and resilience-building through adjusting occupations and asset accumulation in the long run.

Educational Resource Needs and Access to Tertiary Education among People with Disability in Bayelsa State

The paper investigated educational resource needs and access to tertiary education among people with disability in Bayelsa State. Three research questions were raised and three hypotheses tested in the study. Mixed method approach was adopted in the study while 165 respondents consisting 160 persons with disability, four Deans of Student Affairs and an executive of Joint National Association of Persons with Disabilities (JONAPWD) in Bayelsa State were sampled for the study using multistage sampling technique. Respondents were selected from within and outside four randomly selected tertiary institutions namely; Bayelsa Medical University (Yenagoa LGA), Federal University Otuoke (Ogbia LGA), Niger Delta University (Southern Ijaw LGA) and Isaac Jasper Boro College of Education (Sagbama LGA). Instruments used for data collection were questionnaire for the persons with disability as well as Focus Group Discussion while five Key Informant Interviews (KIIs)was conducted with the other respondents. Data collected quantitatively were analyzed using descriptive statistics such as mean, standard deviation and t-test while the qualitative data was analyzed using content and thematic analysis. The finding of the study indicated that financial resource, policy intervention and assistive technology were the priority educational resource need of the respondents. Inaccessibility to tertiary education has implication on the employment prospects and human rights of the respondents and this can only be corrected through appropriate policies, better infrastructure among other strategies. There were differences between the opinion of students and non-students on the issues interrogated. It was recommended that the government should collaborate with school administrators to create a fund for persons with disability who wish to acquire tertiary education across all spheres.

A Review of SNAP Nutritional Incentive Programs

There are over 40 million Americans in the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamps Program. Despite this program attempting to eliminate food insecurity for people 130% below the poverty line, it does little to prevent nutrition related health disparities between SNAP participants and people who are more financially stable. Nearly every state has nutrition incentive programs attempting to address these nutritional health disparities that SNAP does not address. To synthesize a literature review of several of these programs, a search was conducted in PubMed, PubAg, and Google Scholar databases using terms such as “SNAP” and “nutritional incentive program,” along with date restrictions for 2013 or later. This search resulted in a total of 54 articles, however only 35 were used following screening. Included articles were screened first by abstract and then article content to determine relevancy. The literature suggests that programs address nutritional health disparities by providing financial interventions for SNAP participants to make nutritionally conscious decisions about the food they purchase and consume. There were three categories of interventions that were suggested by the literature: incentives, discounts, and restrictions. Regardless of the intervention, each of these categories of intervention were praised by SNAP participants. Participants were able to purchase and consume more fruits and vegetables, focus on nutrition, and financially support local farmers markets and supermarkets. This review discusses these different interventions to allow for new or existing programs to be developed to best address nutritional health disparities using scholarly evidence.

Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review.

Over the past few decades, the world has witnessed considerable progress in women's, children's and adolescents' health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs). This scoping review was conducted following Joanna Briggs Institute (JBI) guidance for conducting such reviews as well as the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for reporting scoping reviews. We searched Medline, PubMed, EMBASE and the World Health Organization's (WHO) Global Index Medicus, and relevant websites. The selection process was conducted in duplicate and independently. Out of 26 355 citations identified from electronic databases, relevant website searches and stakeholders' consultations, 413 studies were included in the final review. Conditional cash transfers (CCTs) (22.3%), health insurance (21.4%), user fee exemptions (18.1%) and vouchers (16.9%) were the most reported financial interventions and measures. The majority were targeted at women (57%) and children (21%) with others targeting adolescents (2.7%) and newborns (0.7%). The findings highlighted that CCTs, voucher programs and various insurance schemes can improve the utilization of maternal and child health services for the poor and the disadvantaged, and improve mortality and morbidity rates. However, multiple implementation challenges impact the effectiveness of these programmes. Some studies suggested that financial interventions alone would not be sufficient to achieve equity in health coverage among those of a lower income and those residing in remote regions. This review provides evidence on financing interventions to address the health needs of the most vulnerable communities. It can be used to inform the design of equitable health financing policies and health system reform efforts that are essential to moving towards universal health coverage (UHC). By also unveiling the knowledge gaps, it can be used to inform future research on financing interventions and measures to improve equity when addressing WCAH in LMICs.