The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship

Nadine Reid; Daniel Buchman; Rebecca Brown; Cheryl Pedersen; Nicole Kozloff; Vicky Stergiopoulos

doi:10.1007/s10488-022-01217-y

The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship

Adm Policy Ment Health. 2022 Nov;49(6):1060-1071. doi: 10.1007/s10488-022-01217-y. Epub 2022 Sep 8.

Authors

Nadine Reid^{1

2}, Daniel Buchman^{1

3

4

5}, Rebecca Brown⁶, Cheryl Pedersen⁶, Nicole Kozloff^{1

2

7}, Vicky Stergiopoulos^{8

9

10

11}

Affiliations

¹ Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada.
³ Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada.
⁴ Joint Centre for Bioethics, University of Toronto, 155 College St, M5T 1P8, Toronto, ON, Canada.
⁵ Krembil Research Institute, University Health Network, 60 Leonard Ave, M5T 0S8, Toronto, ON, Canada.
⁶ MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada.
⁷ Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada.
⁸ Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada. vicky.stergiopoulos@camh.ca.
⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada. vicky.stergiopoulos@camh.ca.
¹⁰ MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada. vicky.stergiopoulos@camh.ca.
¹¹ Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada. vicky.stergiopoulos@camh.ca.

PMID: 36071341
DOI: 10.1007/s10488-022-01217-y

Abstract

Purpose: Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness.

Methods: As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis.

Results: Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged.

Conclusion: Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.

Keywords: Financial incentives; acceptability; homelessness; mental illness; qualitative.

Publication types

Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Authorship
Humans
Ill-Housed Persons*
Mental Disorders* / therapy
Motivation
Qualitative Research

Grants and funding

143259/CIHR/Canada