Diabetes, Diet, Incentives, Messaging
Conditions
Brief summary
The Vitality HealthyFood benefit is a three-tiered incentive program designed to encourage healthier food choices amongst members of Discovery Health's Vitality program. Once enrolled in the benefit, participating members can receive 10%, 15%, or 25% cash-back on the healthy foods they purchase at selected grocers. And, while overall enrollment in the program is high, there is particular interest in increasing enrollment in the benefit amongst Vitality members with diabetes. One presumed barrier to enrollment in the benefit amongst members with diabetes is a misperception of the particular relevance of the benefit and healthier food choices for their personal health. Improved messaging regarding the HealthyFood benefit and its particular salience for individuals with diabetes may be an effective means of increasing activation of the benefit in this population. The proposed study will be a collaboration between Discovery Health/Vitality and researchers at the Perelman School of Medicine at the University of Pennsylvania. In the proposed RCT, Vitality members with diabetes will be randomised to different types of messages regarding the HealthyFood benefit. The investigators will then compare the effectiveness of these different messaging strategies at increasing activation of the HealthyFood benefit amongst Vitality members with diabetes.
Interventions
OTHEREmail message regarding the HealthyFood benefit
Sponsors
Discovery Health
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Adults over age 18 2. Vitality health members who have not yet enrolled in the Vitality HealthyFood benefit 3. Diagnosis of type 2 diabetes (based on registration for chronic benefits for type 2 diabetes) 4. Have registered on to Discovery Health/Vitality website in the past (marker of Internet access and availability of email address)
Exclusion criteria
* Anyone who does not meet above criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Enrollment in 10% Level of Benefit | One month from initial emailed messages | Rates of enrolment in 10% cash-back level (the most basic level, requires online activation only) of the HealthyFood Benefit amongst members with diabetes |
Participant flow
Pre-assignment details
5467 individuals were eligible in 1/2015. This sample was identified months before randomization to allow individuals time to learn about HF from other sources and enrol if interested. Prior to randomization, we excluded participants who joined HF of left Vitality since identification. This is why the initial and randomized samples are unequal.
Participants by arm
| Arm | Count |
|---|---|
| Control Arm This arm will represent current practice. This group will receive no contact from the research team. They may receive information regarding the benefit from the Vitality marketing team during the intervention period and can enroll in the benefit at any time during the study period. | 737 |
| Diabetes-specific This group will receive a message which simply cites the two specific benefits of the eating more healthy foods for individuals with diabetes. This message contains a link to start the enrolment process.
Email message regarding the HealthyFood benefit | 753 |
| Experience of Another Member This group will receive a message that includes a quote from the perspective of a Vitality member with diabetes who uses the HealthyFood benefit. Given the need to standardise message content across study arms, the quote was written by the study team and not an actual member. The quote emphasizes the positive impact the benefit has had for the member-both the financial benefit, as well as the two specific diabetes health benefits.
Email message regarding the HealthyFood benefit | 766 |
| Input From a Diabetes Expert This group will receive a message that includes a quote from a South African physician who specializes in diabetes. The quote emphasises the financial benefit and the two specific diabetes health benefits of the HealthyFood program included in the other messages. It concludes with the doctor's recommendation of the benefit for all individuals with diabetes.
Email message regarding the HealthyFood benefit | 701 |
| Enhanced Active Choice This group will receive a message whose first portion is identical to those in the diabetes-specific message group. The second portion of the message differs in that instead of just asking recipients to click on the provided link if interested, the message asks people to choose and click on one of following possible responses:
1. Yes! I want to active the HealthyFood benefit and get up to 25% cash back on the healthy food I buy at Pick n Pay or Woolworths
2. No, I'd prefer not to activate and continue paying full price for my healthy food purchases
Email message regarding the HealthyFood benefit | 708 |
| Total | 3,665 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Overall Study | Joined HealthyFood Before Intervention | 22 | 13 | 23 | 16 | 17 |
| Overall Study | Left Vitality | 32 | 27 | 23 | 35 | 33 |
Baseline characteristics
| Characteristic | Control Arm | Diabetes-specific | Experience of Another Member | Input From a Diabetes Expert | Enhanced Active Choice | Total |
|---|---|---|---|---|---|---|
| Age, Continuous | 55.9 years STANDARD_DEVIATION 10.9 | 55.2 years STANDARD_DEVIATION 10.7 | 55 years STANDARD_DEVIATION 10.8 | 55.4 years STANDARD_DEVIATION 10 | 56 years STANDARD_DEVIATION 10.6 | 55.4 years STANDARD_DEVIATION 10.6 |
| Sex/Gender, Customized Female | 145 Participants | 152 Participants | 152 Participants | 134 Participants | 146 Participants | 729 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 737 | 0 / 753 | 0 / 766 | 0 / 701 | 0 / 708 |
| serious Total, serious adverse events | 0 / 737 | 0 / 753 | 0 / 766 | 0 / 701 | 0 / 708 |
Outcome results
Primary
Enrollment in 10% Level of Benefit
Rates of enrolment in 10% cash-back level (the most basic level, requires online activation only) of the HealthyFood Benefit amongst members with diabetes
Time frame: One month from initial emailed messages
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control Arm | Enrollment in 10% Level of Benefit | 7 Participants |
| Diabetes-specific | Enrollment in 10% Level of Benefit | 57 Participants |
| Experience of Another Member | Enrollment in 10% Level of Benefit | 76 Participants |
| Input From a Diabetes Expert | Enrollment in 10% Level of Benefit | 48 Participants |
| Enhanced Active Choice | Enrollment in 10% Level of Benefit | 89 Participants |
p-value: <0.0001Fisher Exact