Integrating Behavioral Economics and Self-Determination Theory to Advance Patient Engagement in Diabetes Prevention
The estimated 84 million US adults with prediabetes can significantly reduce their risk of developing type 2 diabetes mellitus (T2DM) by engaging in a Diabetes Prevention Program (DPP) or using metformin. However, very few patients with prediabetes are engaged in these evidence-based strategies. One promising and scalable way to increase patient engagement in strategies to prevent T2DM would be to offer patients financial incentives for engaging in a DPP or using metformin. Such financial incentives could be made more effective by integrating insights from behavioral economics with principles of SDT. This integration could be achieved at scale by adding to incentives automated tailored messages that link incentives and T2DM prevention to people's roles, values, and strengths, thereby supporting their autonomy, competence, and relatedness. Our team of experts in T2DM prevention, behavioral economics, and SDT will conduct a 4-arm, 12-month pragmatic randomized controlled trial in which we will enroll XX employees with prediabetes who for 12 months will be randomly assigned to 1 of 4 groups: (1) financial incentives plus tailored messages based on SDT principles; (2) financial incentives alone; (3) tailored messages based on SDT principles alone; or (4) a control group. Aim 1: Compare the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles in increasing participation in a DPP or use of metformin, and in decreasing HbA1c, weight, and waist circumference. To measure the primary outcome of participation in a DPP or use of metformin we will use health plan administrative data. To measure secondary outcomes of changes in hemoglobin A1c, weight, and waist circumference we will conduct clinical assessments at baseline, 6, and 12 months. Aim 2: Identify mediators and moderators of the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. To measure mediators and moderators of intervention effectiveness we will survey participants at baseline, 6, and 12 months. Aim 3: Evaluate facilitators of and barriers to scalability, acceptability, and sustainability of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. We will use data from interviews of patients, workplace health promotion staff, and health system staff to conduct a comprehensive evaluation of program implementation and sustainability using an integration of the Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. If effective, this novel approach that leverages insights from behavioral economics and SDT could serve as a model for how employers and health care systems can partner to help at-risk patients not only prevent T2DM but also modify other behavioral risk factors for chronic disease and poor health.
National Institute of Diabetes and Digestive and Kidney Diseases
Funding Period: 9/15/2019 to 6/30/2024