PURPOSE: To test the role of financial incentives to motivate engagement in diabetes prevention programs (DPPs).
DESIGN: Minnesota, Montana, and New York randomized 3 different approaches to providing incentives: incentivizing class attendance and weight loss (all states), class attendance only (NY), and weight loss only (NY). We used New York to test how different approaches to providing incentives influence DPP completion and attendance.
SETTING: Health-care facilities and local young men's Christian association.
PARTICIPANTS: Eight hundred thirty one Medicaid enrollees in Minnesota, 204 in Montana, and 560 in New York. Intervention Measure: Impact of the financial incentives on DPP program completion rates. We measured completion of DPP classes in 2 ways: completing 9 or more or 16 or more DPP classes.
ANALYSIS: Multivariate logistic model to compare completion of DPP classes between participants randomized into receiving financial incentives and controls.
RESULTS: Receipt of incentives was associated with higher odds at attending 9 or more classes (odds ratio [OR]: 2.2; P < .01) in Minnesota, Montana (OR: 2.2; P < .05), and New York (OR: 1.9; P < .01) as well as attending 16 or more classes in Minnesota (OR: 3.1; P < .01), Montana (OR: 2.1; P < .01), and New York (OR: 2.9; P < .01). In New York, individuals paid to attend classes attended more classes than individuals paid based on results only.
CONCLUSION: Among Medicaid beneficiaries, financial incentives improve DPP class attendance.