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Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study
  1. Stefan Priebe1,
  2. Julia Sinclair2,
  3. Alexandra Burton1,
  4. Stamatina Marougka1,
  5. John Larsen3,
  6. Mike Firn4,
  7. Richard Ashcroft5
  1. 1Queen Mary University of London, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, UK
  2. 2Division of Clinical Neurosciences, Royal South Hants Hospital, Southampton, UK
  3. 3Rethink, London, UK
  4. 4South West London & St George's Mental Health NHS Trust, Springfield University Hospital, London, UK
  5. 5Queen Mary University of London, London, UK
  1. Correspondence to Dr Stefan Priebe, Professor of Social and Community Psychiatry, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Glen Road, London E13 8SP, UK; s.priebe{at}


Background Offering financial incentives to achieve medication adherence in patients with severe mental illness is controversial.

Aims To explore the views of different stakeholders on the ethical acceptability of the practice.

Method Focus group study consisting of 25 groups with different stakeholders.

Results Eleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) ‘problems requiring clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion.

Conclusions The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies.

  • Medication adherence
  • qualitative research
  • focus groups
  • financial incentives
  • applied and professional ethics
  • philosophy of the health professions
  • behaviour modification

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  • Access to data: All authors had full access to all focus group transcriptions from the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was funded by the Wellcome Trust (grant reference: 081433/Z/06/Z). The funding body was not involved in the study design, in the collection, analysis and interpretation of the data, in the writing of the report or in the decision to submit the article for publication. All researchers were independent from the funding body.

  • Competing interests SP, MF and RA are members of a research team that has been granted funding by the NIHR Health Technology Assessment Programme to conduct a randomised controlled trial on the effectiveness of financial incentives to improve adherence to anti-psychotic maintenance medication in non-adherent patients. Beyond this, there are no direct conflicts of interest relating to any authors and the contents of this work.

  • Ethics approval The study was approved by East London and the City Research Ethics Committee 3 (07/H0705/81). The study was later extended to Hampshire Partnership NHS Trust services and ethical approval was given by Southampton and South West Hampshire Research Ethics Committee (A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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