Financial incentives for participants in health research: when are they ethical?

Abstract

Offering financial incentives to recruit participants, retain them and promote health-related behaviours is a common practice in health research. The development of health re- search standards has given rise to a rich and long-standing debate regarding the ethical issues associated with the use of financial incentives. Some researchers argue that financial incentives compromise the integrity of the research process and its outcomes. Since financial incentives can influence decision-making, they may jeopardise the voluntariness of research participants’ consent. In particular, they argue that the use of financial incentives may lead to undue inducement, exploitation and biased enrolment of research participants. At the same time, other researchers argue that financial incentives represent a flexible tool that can be designed in ways that do not compromise scientific integrity. They highlight that financial incentives can be fair inducements for participation, a way of acknowledging participants’ time and effort, and a means to achieve diverse sample compositions. They also point out that in some situations, these incentives can enable re-search that would otherwise be unfeasible.
Defining when financial incentives might be suitable or not in health research studies is an important task ahead. It re- mains to be discussed how to weight the ethical issues at stake when offering financial incentives to influence be- haviour in implementation research, the relationship be- tween incentives and health outcomes in the context of socioeconomic disparities, and how to establish adequate incentives to influence health-related behaviours and out- comes. A public debate on financial incentives for par- ticipants in health studies will encourage the generation of better guidance for researchers, and contribute to safe- guard participants’ well-being in the creation of high-qual- ity knowledge.