Trial reportPloS one2018
Do incentives undermine intrinsic motivation? Increases in intrinsic motivation within an incentive-based intervention for people living with HIV in Tanzania.
Trial report in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Effects of economic interventions on pediatric and adolescent HIV care outcomes: a systematic review.AIDS care · 2024Pooled it
- Demand creation for HIV testing services: A systematic review and meta-analysis.PLoS medicine · 2023Pooled it
- Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico.The European journal of health economics : HEPAC : health economics in prevention and care · 2025Trial
- Impact of financial incentives on viral suppression among adults initiating HIV treatment in Tanzania: a hybrid effectiveness-implementation trial.The lancet. HIV · 2024Trial
- Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda.Journal of health economics · 2021Trial
- Habit formation in support of antiretroviral medication adherence in clinic-enrolled HIV-infected adults: a qualitative assessment using free-listing and unstructured interviewing in Kampala, Uganda.AIDS research and therapy · 2020Trial
- Impact of a Patient-Centered Behavioral Economics Intervention on Hypertension Control in a Highly Disadvantaged Population: a Randomized Trial.Journal of general internal medicine · 2020Trial
- Incentive-based interventions to improve HIV prevention and care continuum: a global systematic review and meta-analysis.EClinicalMedicine · 2026Article
- Article
- Article
- We must invest in behavioural economics for the HIV response.Nature human behaviour · 2023Article
- Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review.Current HIV/AIDS reports · 2022Article
- Measuring patient engagement with HIV care in sub-Saharan Africa: a scoping study.Journal of the International AIDS Society · 2022Review
- Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya.PLOS global public health · 2022Article
- iSAY (incentives for South African youth): Stated preferences of young people living with HIV.Social science & medicine (1982) · 2020Article
- Spending money to make change: Association of methamphetamine abstinence and voucher spending among contingency management pilot participants in South Africa.Journal of substance abuse treatment · 2020Article
- Bridging the Efficacy-Effectiveness Gap in HIV Programs: Lessons From Economics.Journal of acquired immune deficiency syndromes (1999) · 2019Review
- Conditional economic incentives to improve HIV prevention and treatment in low-income and middle-income countries.The lancet. HIV · 2019Review
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundCash and in-kind incentives can improve health outcomes in various settings; however, there is concern that incentives may 'crowd out' intrinsic motivation to engage in beneficial behaviors. We examined this hypothesis in a randomized trial of food and cash incentives for people living with HIV infection in Tanzania.
methodsWe analyzed data from 469 individuals randomized to one of three study arms: standard of care, short-term cash transfers, or short-term food assistance. Eligible participants were: 1) ≥18 years old; 2) HIV-infected; 3) food insecure; and 4) initiated antiretroviral therapy (ART) ≤90 days before the study. Food or cash transfers, valued at ~$11 per month and conditional on attending clinic visits, were provided for ≤6 months. Intrinsic motivation was measured at baseline, 6, and 12 months using the autonomous motivation section of the Treatment Self-Regulation Questionnaire (TSRQ). We compared the change in TSRQ score from baseline to 6 and 12 months and the change within study arms.
resultsThe mean intrinsic motivation score was 2.79 at baseline (range: 1-3), 2.91 at 6 months (range: 1-3), and 2.95 at 12 months (range: 2-3), which was 6 months after the incentives had ended. Among all patients, the intrinsic motivation score increased by 0.13 points at 6 months (95% CI (0.09, 0.17), Cohen's d = 0.29) and 0.19 points at 12 months (95% CI (0.14, 0.24), Cohen's d = 0.49). Intrinsic motivation also increased within each study group at 6 months: 0.15 points in the food arm (95% CI (0.09, 0.21), Cohen's d = 0.37), 0.11 points in the cash arm (95% CI (0.05, 0.18), Cohen's d = 0.25), and 0.08 points in the comparison arm (95% CI (-0.03, 0.19), Cohen's d = 0.21); findings were similar at 12 months. Increases in motivation were statistically similar between arms at 6 and 12 months.
conclusionIntrinsic motivation for ART adherence increased significantly both overall and within the food and cash incentive arms, even after the incentive period was over. Increases in motivation did not differ by study group. These results suggest that incentive interventions for treatment adherence should not be withheld due to concerns of crowding out intrinsic motivation.
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