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 .