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Perceived ethical acceptability of financial incentives to improve diabetic eye screening attendance
  1. Hester Wadge,
  2. Colin Bicknell,
  3. Ivo Vlaev
  1. Division of Surgery, Department of Surgery and Cancer, St Mary's Hospital, London, UK
  1. Correspondence to Dr Colin Bicknell; colin.bicknell{at}


Objective To test the ethical acceptability of using financial incentives to increase diabetic retinopathy screening attendance.

Background Financial incentives could be an effective way to increase attendance at screening for diabetic retinopathy, although there can be ethical concerns about this approach.

Design Survey of people with diabetes in North West London. Those who were due to attend a screening appointment were invited to complete a questionnaire. Key demographic variables included age, gender, and deprivation.

Setting and participants A questionnaire was issued to those invited to attend screening in North West London and those who run the screening service. The questionnaire captured views on aspects of the ethical problem and different incentive types.

Main variables studied It captured views on the different dimensions of the ethical problem and different types of incentive. In order to understand how views might vary within a population, demographic variables were used to analyze the results.

Results and conclusions Vouchers were found to be the most acceptable form of incentive, significantly more so than cash payments. Most rejected the notion of targeting those who need incentivizing, preferring equality. Age was an important factor, with those aged between 40 and 64 the most optimistic about the potential benefits. Higher levels of deprivation were linked to increased acceptability scores. While some ethical concerns are strongly held among certain groups, there is also much support for the principle of incentivizing positive behaviors. This paves the way for future research into the effectiveness of incentivizing diabetic retinopathy screening attendance.

  • Behavior Modification
  • Ethics
  • Screening Strategies
  • Health Psychology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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