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The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya

Author

Listed:
  • Thirumurthy, Harsha
  • Masters, Samuel H
  • Rao, Samwel
  • Murray, Kate
  • Prasad, Ram
  • Zivin, Joshua G
  • Omanga, Eunice
  • Agot, Kawango

Abstract

Background Effective demand creation strategies are needed to increase uptake of medical male circumcision and reduce new HIV infections in eastern and southern Africa. Building on insights from behavioral economics, we assessed whether providing compensation for opportunity costs of time or lottery-based rewards can increase male circumcision uptake in Kenya. Methods Uncircumcised men aged 21-39 years were randomized in 1:1:1 ratio to 2 intervention groups or a control group. One intervention group was offered compensation of US $12.50 conditional on circumcision uptake. Compensation was provided in the form of food vouchers. A second intervention group was offered the opportunity to participate in a lottery with high-value prizes on undergoing circumcision. The primary outcome was circumcision uptake within 3 months. Results Among 903 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). Logistic regression analysis showed that compared with the control group, the fixed compensation group had significantly higher circumcision uptake [adjusted odds ratio 7.1; 95% CI: 2.4 to 20.8]. The lottery-based rewards group did not have significantly higher circumcision uptake than the control group (adjusted odds ratio 2.5; 95% CI: 0.8 to 8.1). Conclusions Providing compensation was effective in increasing circumcision uptake among men over a short period. The results are consistent with studies showing that such interventions can modify health behaviors by addressing economic barriers and behavioral biases in decision making. Contrary to findings from studies of other health behaviors, lottery-based rewards did not significantly increase circumcision uptake. Trial registration Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107.

Suggested Citation

  • Thirumurthy, Harsha & Masters, Samuel H & Rao, Samwel & Murray, Kate & Prasad, Ram & Zivin, Joshua G & Omanga, Eunice & Agot, Kawango, 2016. "The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya," University of California at San Diego, Economics Working Paper Series qt2c75x3fk, Department of Economics, UC San Diego.
    • Handle: RePEc:cdl:ucsdec:qt2c75x3fk
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    Cited by:

    1. Thomas, Ranjeeta & Galizzi, Matteo M. & Moorhouse, Louisa & Nyamukapa, Constance & Hallett, Timothy B., 2024. "Do risk, time and prosocial preferences predict risky sexual behaviour of youths in a low-income, high-risk setting?," Journal of Health Economics, Elsevier, vol. 93(C).
    2. Barber, Andrew & West, Jeremy, 2022. "Conditional cash lotteries increase COVID-19 vaccination rates," Journal of Health Economics, Elsevier, vol. 81(C).
    3. Wilson, Nicholas, 2021. "Why is ageing associated with lower adoption of new technologies? Evidence from voluntary medical male circumcision and a structural model," The Journal of the Economics of Ageing, Elsevier, vol. 19(C).
    4. Friedman, Willa & Wilson, Nicholas, 2022. "Can nudging overcome procrastinating on preventive health investments?," Economics & Human Biology, Elsevier, vol. 45(C).

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