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| Applications of Contingency Management to Support Healthy Behaviors |
| Sunday, May 29, 2022 |
| 3:00 PM–4:50 PM |
| Meeting Level 1; Room 154 |
| Area: BPN/CBM; Domain: Applied Research |
| Chair: Matthew Novak (Johns Hopkins University School of Medicine) |
| Discussant: Bethany R. Raiff (Rowan University) |
| CE Instructor: Matthew Novak, Ph.D. |
| Abstract: More than half of adults in the United States are living with a chronic health condition. Many chronic diseases can be prevented, delayed, or alleviated with healthy behavior changes, such as increased physical activity or treatment engagement. Unfortunately, consequences for these healthy behaviors are often delayed and uncertain, whereas consequences for competing behaviors (e.g., sedentary behavior) are often immediate and probable. Contingency management interventions, which arrange for the direct and immediate reinforcement of therapeutically important target behaviors, have been highly effective in promoting a wide range of health behaviors in diverse populations. This symposium will cover recent applications of contingency management in the prevention and treatment of chronic health conditions. Specific topics include sedentary behavior reduction, cardiac rehabilitation treatment engagement, self-management of type 1 diabetes, and HIV viral load suppression. Taken together, this symposium will offer an overview of applications of behavior analysis to address a variety of chronic health conditions. |
| Instruction Level: Intermediate |
| Keyword(s): contingency management, health, incentives, technology |
| Target Audience: Intermediate: Audience members should have a basic understanding of behavioral principles and research methodology |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) identify and define health promoting behaviors and outcomes; (2) discuss key features of contingency management interventions; and (3) discuss recent applications of contingency management to promote healthy behavior change. |
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| Technology-Based Contingency Management for Walking to Prevent Prolonged Periods of Workday Sitting |
| TYLER ERATH (University of Vermont), Florence D. DiGennaro Reed (University of Kansas) |
| Abstract: Sedentary behavior is an emerging public health issue. Frequent, brief bouts of walking are recommended by experts to reduce the health risks correlated with physical inactivity and prolonged sedentary periods. The purpose of the current study was to extend the literature by evaluating a technology-based contingency management intervention that reinforced frequent, brief bouts of walking to decrease prolonged periods of sitting during the workday. The packaged intervention was implemented with individuals with primarily sedentary job responsibilities and consisted of a contingency contract with monetary incentives, goal setting, textual prompts, and performance feedback. The intervention was effective in increasing the number of physically active hourly intervals (i.e., hours with > 249 steps) to the preset goal for four participants, thereby disrupting prolonged periods of sedentary time. For two participants, the intervention did not meaningfully increase bouts of walking. Implications of these findings will be discussed along with directions for future research. |
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Contingency Management to Promote Cardiac Rehabilitation Participation Among Patients With Medicaid |
| DIANN GAALEMA (University of Vermont) |
| Abstract: Cardiac rehabilitation (CR) is a secondary prevention program available to those who have suffered a serious cardiac event or have certain chronic cardiovascular conditions. CR has the highest level of evidence of efficacy (1A), as participation in CR is associated with significant reductions in morbidity and mortality. However, not all eligible patients attend CR, and participation is particularly low among patients with lower socio-economic status, such as those insured through Medicaid. In a series of studies, we have examined whether the provision of incentives (cash or gift cards) following successful completion of CR sessions, improves CR attendance among those with Medicaid. In the current study the efficacy of incentives is being compared to providing a case-manager, to help facilitate entry into and adherence to CR. 136 patients (of a goal of 200) have been randomized 1:2:2:2 to usual care or to one of the three intervention conditions: incentives alone, case-management alone, or incentives combined with case management. The primary outcome is number of CR sessions completed out of a possible 36. Mean numbers of sessions completed thus far by condition is: usual care 15, case management only 13, incentives only 20, case management and incentives 24. |
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| Contingency Management to Improve Self-Management of Type 1 Diabetes |
| MOLLY A ANDERSON (Geisel School of Medicine), Catherine Stanger (Giesel School of Medicine at Dartmouth College) |
| Abstract: Individuals who have type 1 diabetes (T1D) often struggle with adherence to the complex daily behavior regimen. A study using contingency management (CM) to reinforce blood glucose monitoring for adolescents (ages 13–17) with T1D found the intervention resulted in improved A1c levels that sustained 6 months following intervention (Stanger et al., 2018). The current analysis characterizes the patterns of response to CM. N = 26 participants completed all 25 intervention weeks. The daily goal was to check blood glucose >5 times/day. Phases were: Baseline (2 weeks) — $10 weekly for uploading glucometer; Shaping (5 weeks) — escalating schedule from $10 to $30 for meeting goal +1 day from previous week/$5 bonus for exceeding goal; Maintenance (4 weeks) — $30 weekly for meeting goal >5 days/$5 bonus for >5 days; Fading (14 weeks) — same as maintenance with delays to incentive delivery (paid in weeks 13, 16, 20, and 25). Most participants consistently met weekly goals in all phases (n = 12). Other patterns: loss of gains during fading (n = 9), improved performance after shaping (n = 2), and never consistently met goals (n = 3). Overall, youth responded well to CM, and some may benefit from a slower incentive fading period. |
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| Financial Incentives for Suppression of Viral Load in People Living With HIV |
| MATTHEW NOVAK (Johns Hopkins University School of Medicine), August F. Holtyn (Johns Hopkins University School of Medicine), Forrest Toegel (Northern Michigan University), Andrew Rodewald (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University) |
| Abstract: Consistent use of antiretroviral medications by adults living with HIV can suppress plasma HIV-1 RNA (viral load) to undetectable levels (<200 copies/mL), which is essential for ending the HIV/AIDS epidemic. This study assessed long-term maintenance and post-intervention effects of financial incentives for suppressing HIV viral load. Adults with detectable viral loads (N=102) were randomly assigned to Usual Care Control or Incentive groups. Incentive participants earned up to $10 per day for 2 years for providing blood samples that showed either reduced or undetectable viral loads. Viral loads for all participants were assessed from blood samples collected every 3 months during the 2-year intervention evaluation period. During the intervention, Incentive participants provided a significantly higher percentage of blood samples with undetectable viral loads than Usual Care Control participants (70.4% vs. 42.5%, respectively). Post-intervention effects on viral load were assessed from blood samples collected 6 and 12 months after the intervention was discontinued. Post intervention, the difference in viral load between Incentive and Usual Care Control groups was not statistically significant (53.8% vs. 45.0%). These findings suggest that financial incentives can produce large and sustained improvements in viral load in people living with HIV, but only while the intervention is in effect. |
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