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General

Study Overview

Title:

Optimizing the use of economic incentives to increase male circumcision demand: a randomized trial to compare fixed and lottery-based incentives

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-530e60df56107

Initial Registration Date:

02/26/2014

Last Update Date:

03/11/2016

Study Status:

Completed

Change History for Status

Changed On	Previous Value
03/11/2016	In Development

Location(s):

Kenya

Abstract:

The proposed study will use a randomized design to test the effect of two distinct economic interventions to increase demand for voluntary medical male circumcision (VMMC) in Kenya. One intervention will offer men a small fixed incentive to come for circumcision; it is based on the finding that transportation and opportunity costs associated with undergoing the procedure are barriers to VMMC uptake in Kenya. Another intervention will offer a lottery-based incentive to come for circumcision; it will be based on the rationale that small probabilities of winning high-value items may motivate individuals to take action to a greater extent than small, fixed incentives. By comparing these two interventions to each other and to a control group receiving a very small, nominal fixed incentive to come for VMMC, we will assess whether economic incentives are effective in promoting VMMC uptake as well as what types of economic incentives are most effective. The results of this research will offer insights on ways to increase VMMC uptake and provide scientific evidence on the relative effectiveness of direct incentives vs. lottery-based incentives for achieving changes in health behaviors.

Registration Citation:

Thirumurthy, H. and Agot, K., 2014. Optimizing the use of economic incentives to increase male circumcision demand: a randomized trial to compare fixed and lottery-based incentives. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie019

Categories:

Health, Nutrition, and Population

Additional Keywords:

Male circumcision, HIV prevention

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

Harsha Thirumurthy

Affiliation:

University of North Carolina at Chapel Hill

Name of Second PI:

Kawango Agot

Affiliation:

Impact Research and Development Organization

Study Sponsor

Name:

International Initiative for Impact Evaluation (3ie)

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

Impact Research and Development Organization

Type of Organization:

NGO (local) or other civil society organization

Location:

Kenya

Intervention

Intervention Overview

Intervention:

This study will use individual-level random assignment to test whether offering lottery-based incentives or fixed incentives can increase circumcision uptake. Study participants will be uncircumcised men and will be visited at their homes or workplaces and informed about the study. They will then be randomly assigned to receive either a scratch card for a lottery with high-value prizes (lottery-based incentive); a food voucher of about KES 1,000 (US$ 12) (fixed incentive); or a food voucher of about KES 50 (US$ 0.60) (control group) if they come for circumcision. The lottery will be implemented by offering men scratch cards that will reveal whether any prizes have been won, and the food vouchers will be valid at a network of local shops. In all cases, men will be required to come to one of the IRDO clinics and undergo the circumcision procedure in order to receive the incentive. The study will test the relative effectiveness of using lottery-based incentives versus fixed incentives in increasing demand for voluntary male circumcision.

Private Intervention Details:

Theory of Change:

Multiple Treatment Arms Evaluated?

Yes

Implementing Agency

Name of Organization:

Impact Research and Development Organization

Type of Organization:

NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:

International Initiative for Impact Evaluation (3ie)

Type of Organization:

Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?

No

Start Date:

03/01/2014

End Date:

09/30/2014

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

A simple chi-squared test will be used to compare the proportion of men who undergo circumcision in each intervention group compared to the control group and compared with one another. We will conduct further analyses using multivariate logistic regression that control for characteristics of individuals. The outcome variable in the logistic regression will be uptake of VMMC within 3 months of randomization.

Private Details of Evaluation Approach:

Outcomes (Endpoints):

The primary outcome is the uptake of VMMC within 3 months after enrollment and randomization. There will be two secondary outcomes. First, we will examine the amount of time that elapsed between the offer of the incentive and uptake of VMMC. Second, we will examine whether people who exhibit high risk behaviors will be more likely to utilize the lottery based incentives than those who do not exhibit that behavior.

Unit of Analysis:

Individual

Hypotheses:

Our primary hypothesis is that uptake of circumcision will be higher in the lottery incentive group and the fixed incentive group than in the control group. Second, we hypothesize that uptake of circumcision will be higher in the lottery incentive group than the fixed incentive group. Third, we hypothesize that participants who exhibit high risk behaviors will be more likely to utilize the lottery based incentives than those who do not exhibit that behavior.

Unit of Intervention or Assignment:

Individuals

Number of Clusters in Sample:

Number of Individuals in Sample:

900 men

Size of Treatment, Control, or Comparison Subsamples:

300 in control arm, 300 in fixed incentive arm, 300 in lottery arm

Supplementary Files

Analysis Plan:

Other Documents:

Data

Outcomes Data

Description:

We will conduct a baseline household survey at the time of enrollment. Following enrollment we will monitor the participating health facilities for 3 months to see if the enrolled participants uptake voluntary medical male circumcision.

Data Already Collected?

No

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 1: Data for measuring impacts have not been collected

Completion

Completion Overview

Intervention Completion Date:

12/10/2014

Data Collection Completion Date:

12/10/2014

Unit of Analysis:

Individual

Clusters in Final Sample:

None

Total Observations in Final Sample:

909

Size of Treatment, Control, or Comparison Subsamples:

Control (n=299) Fixed compensation (n=308) Lottery-based rewards (n=302)

Findings

Preliminary Report:

No

Preliminary Report URL:

Summary of Findings:

Results: Among 909 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). Unadjusted modified Poisson regression analysis showed that compared to the control group, the fixed compensation group had significantly higher circumcision uptake (relative risk (RR) 6.3; 95% CI 2.2-17.9). The lottery-based rewards group did not significantly higher circumcision uptake than the control group (RR 2.5; 95% CI 0.8-7.8).

Paper:

No

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

No--Data not expected to be available

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Yes

Survey Instrument Links or Contact:

Email contact (harsha@unc.edu)

Program Files:

Yes

Program Files Links or Contact:

Email contact (harsha@unc.edu)

External Link:

External Link Description:

Description of Changes:

None

Study Stopped

Date:

Reason: