Financial incentives to improve medication adherence for children and young people with asthma.

<bold>Background:</bold> Adherence to maintenance treatment for children and young people (CYP) with asthma is poor; behaviour change is challenging and improvements are not often maintained. There is growing interest in financial incentives to improve CYP health behaviours. <bold>Aims and objectives:</bold> To assess effectiveness of financial incentives to improve medication adherence for CYP with asthma and feasibility of study processes. <bold>Methods:</bold> Pilot RCT that measured CYP adherence using an electronic monitoring device; all received twice-daily reminders. CYP randomised to intervention received £1 per AM/£1 per PM inhaler dose for 12-weeks (max £168). Data collection included adherence and asthma control test (ACT) score. Feasibility was assessed by recruitment and intervention delivery indicators. <bold>Results:</bold> Recruitment was challenging. 32 CYP (13.4 years (SD ±1.64); 65.6% male) were enrolled; 16 were randomised to intervention. Over half of CYP (65.6%) experienced technological issues. After 12-weeks of financial incentives, there was no significant difference in % adherence between intervention (73.0%, range: 23.0%-89.0%) and control (56.0%, range: 7.0%-87.0%), (<italic>p</italic>=0.077). There was also no significant difference in ACT (<italic>p</italic>=0.595). During 12-week follow-up of no rewards, intervention adherence significantly decreased to 39.0% (range: 0.0%-72.0%), (<italic>p</italic>=0.012). <bold>Conclusions:</bold> Financial incentives were not effective in this study for sustained adherence, although small numbers are acknowledged. Implementation of the pilot was challenging, and a definitive study is not feasible without substantial protocol changes. Future work could explore CYP characteristics that contribute to successful financial incentive use.