Framing financial incentives to promote hypertension care among rural primary doctors in Shandong Province, China: study protocol of a randomized field trial

Abstract

Background: Managing hypertension in rural China poses significant challenges, as rural physicians often struggle to provide consistent, high-quality care. Insufficient financial incentives may explain the sub-optimal long-term treatment behavior by rural doctors. This study designs a protocol for studying better-framed financial incentives for rural physicians to manage hypertension treatment, specifically the impact of loss-framed versus gain-framed incentives in enhancing hypertension management. Methods: This protocol outlines a three-arm randomized controlled trial to be conducted in rural China. A total of 300 primary doctors, involving 1,500 hypertension patients, will be randomly assigned in a 1:1:1 ratio to two intervention groups or a control group. Financial incentives will be implemented in the two intervention groups, namely gain-framed incentives and loss-framed incentives. The trial will include a six-month intervention period followed by six months of follow-up. Changes in patients’ blood pressure (BP) values include both systolic and diastolic BP, hypertension control rates, physicians’ hypertension care performance and patient medication adherence will be measured. Data collection includes baseline information and regular blood pressure measurements. Discussion: This study will determine the effectiveness of a 6-month framing financial incentive intervention in improving doctors’ hypertension management and patients’ blood pressure control outcomes while comparing the different effects of loss framing and gain framing. Trial registration: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2300077733, Date registered: 07/11/2023.