Food Allergy Management for Adolescents Using Behavioral Incentives: A Randomized Trial

OBJECTIVE: We sought to evaluate the use of behavioral economics approaches to promote the 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 = .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: Textmessage nudges alone were unsuccessful at promoting EAI-carrying but text message nudges combinedwithmodest financial incentives almost doubled EAI-carriage rates among thosewho received the intervention comparedwith 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 toadolescents at all times shouldbe implemented.

Automated summary

This study examined the use of behavioral economics approaches to promote the carrying of epinephrine auto-injectors (EAIs) among adolescents with food allergies. Results showed that frequent text message nudges or frequent text message nudges plus modest financial incentives increased the likelihood of carrying EAIs compared to usual care. However, even with the intervention, adolescents with food allergies carried their EAI less than 50% of the time.