Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda
Abstract Background Few studies have explored how economic incentives influence behavioral outcomes. This study aimed to identify pathways of action of an incentives-based intervention to increase men’s participation in HIV testing. Methods The qualitative study was embedded in a randomized-controll...
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-019-8073-6 |
| _version_ | 1818662240096616448 |
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| author | Alex Ndyabakira Monica Getahun Ambrose Byamukama Devy Emperador Stella Kabageni Kara Marson Dalsone Kwarisiima Gabriel Chamie Harsha Thirumurthy Diane Havlir Moses R. Kamya Carol S. Camlin |
| author_facet | Alex Ndyabakira Monica Getahun Ambrose Byamukama Devy Emperador Stella Kabageni Kara Marson Dalsone Kwarisiima Gabriel Chamie Harsha Thirumurthy Diane Havlir Moses R. Kamya Carol S. Camlin |
| author_sort | Alex Ndyabakira |
| collection | DOAJ |
| description | Abstract Background Few studies have explored how economic incentives influence behavioral outcomes. This study aimed to identify pathways of action of an incentives-based intervention to increase men’s participation in HIV testing. Methods The qualitative study was embedded in a randomized-controlled trial that compared effectiveness of gain-framed, loss-framed and lottery-based incentives to increase HIV testing among men. Following testing at a community health campaign, 60 in-depth interviews were conducted with men systematically sampled on the basis of age, incentive group, and campaign attendance. Data were coded deductively and inductively for thematic content analysis. Results Incentives addressed men’s structural, interpersonal and individual-level barriers to testing: offered at convenient locations, incentives offset costs of testing, in lost wages, which are exacerbated when livelihoods required mobility. Interpersonal barriers included anticipated stigma/fear of disclosure, social obligations, and negative peer influences. Providing incentives in public settings provided “social proof” that prizes could be won, and facilitated social support and positive norms by promoting testing with trusted others. Incentives had little influence when men appraised prize values to be low, disbelieved they would win a prize, or were already intrinsically motivated to test. Yet, incentives provided a behavioral ‘cue to action’ for many men who perceived themselves to be susceptible to HIV and perceived HIV disease to be severe, acting as secondary motivator for testing that “sweetened the deal”. Conclusion Incentives can be an important ‘lever’ to promote men’s healthy behaviors in resource-poor settings. HIV testing in convenient, public settings, when paired with incentives, provides multiple pathways to stimulate men’s testing uptake. Trial registration Registered with ClinicalTrials.gov on 08/10/2016, ID: NCT02890459. The first participant was enrolled on 11th April 2016. |
| first_indexed | 2024-12-17T04:57:48Z |
| format | Article |
| id | doaj.art-1b2eda0ba7314a899b95a8c73f3d0699 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-17T04:57:48Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-1b2eda0ba7314a899b95a8c73f3d06992022-12-21T22:02:39ZengBMCBMC Public Health1471-24582019-12-011911910.1186/s12889-019-8073-6Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural UgandaAlex Ndyabakira0Monica Getahun1Ambrose Byamukama2Devy Emperador3Stella Kabageni4Kara Marson5Dalsone Kwarisiima6Gabriel Chamie7Harsha Thirumurthy8Diane Havlir9Moses R. Kamya10Carol S. Camlin11Infectious Diseases Research CollaborationDepartment of Obstetrics, Gynecology & Reproductive Sciences, University of California San FranciscoInfectious Diseases Research CollaborationDepartment of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San FranciscoInfectious Diseases Research CollaborationDepartment of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San FranciscoInfectious Diseases Research CollaborationDepartment of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San FranciscoDivision of Health Policy, Perelman School of Medicine, University of PennsylvaniaDepartment of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San FranciscoSchool of Medicine, College of Health Sciences, Makerere UniversityDepartment of Obstetrics, Gynecology & Reproductive Sciences, University of California San FranciscoAbstract Background Few studies have explored how economic incentives influence behavioral outcomes. This study aimed to identify pathways of action of an incentives-based intervention to increase men’s participation in HIV testing. Methods The qualitative study was embedded in a randomized-controlled trial that compared effectiveness of gain-framed, loss-framed and lottery-based incentives to increase HIV testing among men. Following testing at a community health campaign, 60 in-depth interviews were conducted with men systematically sampled on the basis of age, incentive group, and campaign attendance. Data were coded deductively and inductively for thematic content analysis. Results Incentives addressed men’s structural, interpersonal and individual-level barriers to testing: offered at convenient locations, incentives offset costs of testing, in lost wages, which are exacerbated when livelihoods required mobility. Interpersonal barriers included anticipated stigma/fear of disclosure, social obligations, and negative peer influences. Providing incentives in public settings provided “social proof” that prizes could be won, and facilitated social support and positive norms by promoting testing with trusted others. Incentives had little influence when men appraised prize values to be low, disbelieved they would win a prize, or were already intrinsically motivated to test. Yet, incentives provided a behavioral ‘cue to action’ for many men who perceived themselves to be susceptible to HIV and perceived HIV disease to be severe, acting as secondary motivator for testing that “sweetened the deal”. Conclusion Incentives can be an important ‘lever’ to promote men’s healthy behaviors in resource-poor settings. HIV testing in convenient, public settings, when paired with incentives, provides multiple pathways to stimulate men’s testing uptake. Trial registration Registered with ClinicalTrials.gov on 08/10/2016, ID: NCT02890459. The first participant was enrolled on 11th April 2016.https://doi.org/10.1186/s12889-019-8073-6HIV testingMenEconomic incentivesLotteryLoss aversionSub Saharan Africa |
| spellingShingle | Alex Ndyabakira Monica Getahun Ambrose Byamukama Devy Emperador Stella Kabageni Kara Marson Dalsone Kwarisiima Gabriel Chamie Harsha Thirumurthy Diane Havlir Moses R. Kamya Carol S. Camlin Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda BMC Public Health HIV testing Men Economic incentives Lottery Loss aversion Sub Saharan Africa |
| title | Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda |
| title_full | Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda |
| title_fullStr | Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda |
| title_full_unstemmed | Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda |
| title_short | Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda |
| title_sort | leveraging incentives to increase hiv testing uptake among men qualitative insights from rural uganda |
| topic | HIV testing Men Economic incentives Lottery Loss aversion Sub Saharan Africa |
| url | https://doi.org/10.1186/s12889-019-8073-6 |
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