Adolescent-Preferred financial incentives to promote type 1 diabetes Self-Care: A discrete choice experiment.

AIMS: This study aimed to quantify preferences for the characteristics of a financial incentives program that would motivate adolescent engagement in type 1 diabetes (T1D) self-care. METHOD: We performed a discrete choice experiment with 12-18 year-olds with T1D from two pediatric hospital endocrinology clinics (n = 317). We identified key attributes of incentives: (1) monthly value of the reward, (2) payment structure, and (3) difficulty of incentivized behaviors. In twelve choice questions, adolescents chose the incentive option from a pair of profiles that was more likely to motivate them to increase adherence to recommended self-care. Options presented were tailored to adolescents' T1D technology use and perceived difficulty of completing each behavior. We analyzed data using a conditional logit model. RESULTS: The value of the reward accounted for 60.8% of preferences. Adolescents were willing to accept lower value rewards when incentive payments used positive vs. negative reinforcement (-$10.88 (95% CI: -$12.60, -9.24)) and preferred higher incentives for performing hard vs. easier behaviors (+$14.92 (95% CI: +$12.66, +$17.28)). CONCLUSIONS: Stated preferences can inform intervention design. Future research will evaluate the external validity of the discrete choice experiment-informed intervention design by assessing adolescent health and behavioral outcomes in a randomized controlled trial.

Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes.

BACKGROUND: An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS: Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS: Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS: The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.

Medical interpreters and bilingual school staff: Potential disaster information conduits?

OBJECTIVES: Dissemination of trusted disaster information to limited English proficient (LEP) communities may mitigate the negative effects these higher risk communities experience in disasters. For immigrant communities, disaster messages may be perceived with skepticism, and fear of public officials may affect compliance with disaster messages. This study explores whether medical interpreters (MIs) and bilingual school staff (BSS) are already informal information sources for LEP communities, and could their connection to both public service organizations and LEP communities make them ideal efficient, trusted disaster information conduits for LEP communities. DESIGN: The authors conducted a mixed methods study, which included MI individual interviews, Latino community focus groups, an MI employer survey, and school administrator interviews. SETTING: To ensure diversity in the sample, data were collected in both Los Angeles and Seattle. RESULTS: MIs, MI employers, and schools are willing to communicate disaster information to LEP communities. MIs and BSS are connected to and share information with LEP communities. Latino LEP communities are eager for more disaster information and sources. CONCLUSIONS: The study adds to the evidence that a multipronged approach that includes collaborating with professionals linked to immigrant communities, such as MIs and BSS, could be an effective method of disaster information dissemination. Working with MIs and BSS as part of a wider dissemination strategy would promote a community-based interpersonal flow of information that would contribute to LEP community's trust in the message.

Understanding the experiences of lesbian, bisexual and trans survivors of domestic violence: a qualitative study.

OBJECTIVES: Using a participatory approach, our objectives were to understand community perspectives on domestic violence (DV) in lesbian, bisexual and trans (LBT) communities, and to assess access to and cultural appropriateness ofDVservices for LBT survivors. METHODS: We used qualitative methods and conducted focus groups and semi-structured interviews with LBT survivors of DV. RESULTS: Nearly all participants reported that the level of awareness regarding DV in their communities was limited. Survivors reported difficulty identifying their partners' behavior as abusive. Isolation was described as central to experiences of abuse, and respondents discussed a variety of isolation tactics specific to LBT communities. Isolation also contributed to difficulty seeking help. Respondents reported that they often did not access mainstream DV services due to concerns about homophobia and transphobia. To address DV in LBT communities respondents pointed to the importance of friendship and community networks, sharing information about queer DV, and holding batterers accountable for their behavior. CONCLUSIONS: LBT people face challenges identifying and responding to DV that are specific to their cultural context. Services for LBT DV survivors must be culturally appropriate and accessible. Community based solutions for addressing and preventing DV should be encouraged.

Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships.

OBJECTIVE: This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. METHODS: We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships' development. RESULTS: Activities critical in partnership development include sharing decision-making, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. CONCLUSIONS: The URC experiences suggest that CBPR can be successfully implemented in diverse settings.