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. 2025 Apr 21;15(1):36.
doi: 10.1186/s13561-025-00634-7.

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

Yue Zhong  1 , Pengyang Fan  2 , Jialong Tan  1 , Elizabeth Maitland  3 , Stephen Nicholas  4   5 , Yiwei Qiao  1 , Dejian Kou  1 , Zehua Meng  1 , Jian Wang  6   7
Affiliations

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

Yue Zhong et al. Health Econ Rev. .

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.

Keywords: Financial incentives; Framing; Hypertension care; Randomized controlled trial.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Primary ethics approval has been received from the Wuhan University Human Research Ethics Committee (WHU-HSS-IRB2023014). Consent will be collected from all participants.Informed consent will be obtained from all participants, and participation will be voluntary. Participants may withdraw from the study at any time without facing any negative consequences. Personal data will be kept confidential. Findings from the study will be published in peer-reviewed journals and presented at national and international conferences. The whole study will strictly follow the ethical guidelines stipulated by the Helsinki Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
Framing financial incentive
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