The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya

Harsha Thirumurthy, Samuel H Masters, Samwel Rao, Kate Murray, Ram Prasad, Joshua Graff Zivin, Eunice Omanga and Kawango Agot

University of California at San Diego, Economics Working Paper Series from Department of Economics, UC San Diego

Abstract: BACKGROUND: Effective demand creation strategies are needed to increase uptake of medical male circumcision and reduce new HIV infections in eastern and southern Africa. Building on insights from behavioral economics, we assessed whether providing compensation for opportunity costs of time or lottery-based rewards can increase male circumcision uptake in Kenya. METHODS: Uncircumcised men aged 21-39 years were randomized in 1:1:1 ratio to 2 intervention groups or a control group. One intervention group was offered compensation of US $12.50 conditional on circumcision uptake. Compensation was provided in the form of food vouchers. A second intervention group was offered the opportunity to participate in a lottery with high-value prizes on undergoing circumcision. The primary outcome was circumcision uptake within 3 months. RESULTS: Among 903 participants enrolled, the group that received compensation of US $12.50 had the highest circumcision uptake (8.4%, 26/308), followed by the lottery-based rewards group (3.3%, 10/302), and the control group (1.3%, 4/299). Logistic regression analysis showed that compared with the control group, the fixed compensation group had significantly higher circumcision uptake [adjusted odds ratio 7.1; 95% CI: 2.4 to 20.8]. The lottery-based rewards group did not have significantly higher circumcision uptake than the control group (adjusted odds ratio 2.5; 95% CI: 0.8 to 8.1). CONCLUSIONS: Providing compensation was effective in increasing circumcision uptake among men over a short period. The results are consistent with studies showing that such interventions can modify health behaviors by addressing economic barriers and behavioral biases in decision making. Contrary to findings from studies of other health behaviors, lottery-based rewards did not significantly increase circumcision uptake. TRIAL REGISTRATION: Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107.

Keywords: 32 Biomedical and Clinical Sciences (for-2020); 3202 Clinical Sciences (for-2020); 42 Health Sciences (for-2020); Clinical Trials and Supportive Activities (rcdc); Behavioral and Social Science (rcdc); Prevention (rcdc); Clinical Research (rcdc); 3.1 Primary prevention interventions to modify behaviours or promote wellbeing (hrcs-rac); Adult (mesh); Circumcision; Male (mesh); Compensation and Redress (mesh); Humans (mesh); Kenya (mesh); Male (mesh); Reward (mesh); Young Adult (mesh); male circumcision; demand creation; economic interventions; lottery-based rewards; behavioral economics; Humans (mesh); Reward (mesh); Compensation and Redress (mesh); Adult (mesh); Kenya (mesh); Male (mesh); Circumcision; Male (mesh); Young Adult (mesh); Adult (mesh); Circumcision; Male (mesh); Compensation and Redress (mesh); Humans (mesh); Kenya (mesh); Male (mesh); Reward (mesh); Young Adult (mesh); 1103 Clinical Sciences (for); 1117 Public Health and Health Services (for); Virology (science-metrix); 3202 Clinical sciences (for-2020); 4202 Epidemiology (for-2020); 4206 Public health (for-2020) (search for similar items in EconPapers)
Date: 2016-08-15
References: View complete reference list from CitEc
Citations: View citations in EconPapers (5)

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