ABSTRACT
Objective
We sought to evaluate the use of behavioral economics approaches to promote the abstract carrying of epinephrine auto-injectors (EAIs) among adolescents with food allergies. We hypothesized that adolescents who receive frequent text message nudges (Intervention 1) or frequent text message nudges plus modest financial incentives (Intervention 2) would be more likely to carry their epinephrine than members of the usual care control group.
Methods
We recruited 131 adolescents ages 15 to 19 with a food allergy and a current prescription for epinephrine to participate in a cohort multiple randomized controlled trial. Participants were randomly assigned to participate in Intervention 1, Intervention 2, or to receive usual care. The primary outcome was consistency of epinephrine-carrying, measured as the proportion of checkpoints at which a participant could successfully demonstrate they were carrying their EAI, with photo-documentation of the device.
Results
During Intervention 1, participants who received the intervention carried their EAI 28% of the time versus 38% for control group participants (P 5 .06). During Intervention 2, participations who received the intervention carried their EAI 45% of the time versus 23% for control group participants (P 5 .002).
Conclusions
Text message nudges alone were unsuccessful at promoting EAI-carrying but textmessage nudges combined with modest financial incentives almost doubled EAI-carriage rates among thos ewho received the intervention compared with the control group. However, even with the intervention, adolescents. with food allergies carried their EAI<50%of the time. Alternative strategies for making EAIs accessible to adolescents at all times should be implemented.