Small Monetary Incentives for Digital Cognitive Training Adherence in Community-Dwelling Older Adults

Effect of Small Monetary Incentives on Adherence to Digital Cognitive Training Among Community-Dwelling Older Adults: A Randomized Controlled Trial

This study aims to find out whether small daily monetary rewards can help older adults living in the community to regularly complete digital cognitive training. Cognitive training is a promising way to maintain or improve memory and thinking skills in older adults, but many people find it hard to keep training every day. Small rewards, such as a few cents or one yuan per day, have been shown to encourage healthy behaviors in other areas. However, it is not clear whether such rewards are effective for cognitive training.

The investigators plan to enroll 110 adults aged 60 years or older who can use a smartphone. Participants will be randomly assigned to one of four groups: a control group that receives no money, and three groups that can earn up to 0.2, 0.5, or 1 yuan per day for completing daily cognitive training tasks. The training takes about 15-20 minutes per day and is done through a mobile app. The study lasts 12 weeks with training, followed by 4 weeks without rewards to see if participants continue training.

The main question is whether the groups that receive money complete more training days than the control group. The investigators will also examine whether higher rewards lead to better adherence, whether cognitive function improves, and whether the effects differ by income level. This study may provide a low-cost way to help older adults stay engaged in cognitive training and reduce the risk of cognitive decline.

Study Overview

• Status: Not yet recruiting
• Conditions: Cognitive Decline; Dementia Prevention
• Intervention / Treatment: Behavioral: Digital cognitive training; Behavioral: Monetary incentive 0.2 CNY/day; Behavioral: Monetary incentive 0.5 CNY/day; Behavioral: Monetary incentive 1 CNY/day

Detailed Description

Background:

Cognitive decline and dementia are major public health challenges in China. Digital cognitive training has been shown to improve or maintain cognitive function in older adults, but effectiveness depends heavily on adherence. Real-world adherence to cognitive training among community-dwelling older adults is often low. Small monetary incentives have been effective in promoting other health behaviors, such as physical activity and medication adherence, but evidence in the context of cognitive training is scarce, especially in China.

Objective:

The primary objective is to examine whether small daily monetary incentives can increase adherence to digital cognitive training among community-dwelling older adults. Secondary objectives include: (1) exploring the dose-response relationship between incentive amount (0, 0.2, 0.5, 1 yuan/day) and adherence; (2) evaluating the effect of the incentive program on cognitive function (MoCA and DiaMem); (3) assessing whether the effect differs by income level; and (4) observing whether training behavior is maintained after incentives are withdrawn.

Study Design:

This is a prospective, randomized, parallel-group, superiority trial with a multi-dose exploratory component. A total of 110 participants aged ≥60 years will be recruited from communities in Beijing and Yangcheng County, Shanxi Province. Participants will be stratified by personal monthly income (≥1000 yuan vs. <1000 yuan) and randomized in a 2:1:1:1 ratio to four groups: control (0 yuan/day, n=44), 0.2 yuan/day (n=22), 0.5 yuan/day (n=22), and 1 yuan/day (n=22).

Procedures:

After a 1-week run-in period to familiarize participants with the app, eligible participants will be randomized. The intervention period lasts 12 weeks (Weeks 2-13). All participants will be asked to complete daily cognitive training tasks using a mobile app ("Memory Fitness Coach") for about 15-20 minutes per day. The app automatically adjusts task difficulty to maintain approximately 80% accuracy. Participants in the incentive groups will receive a daily reward based on accuracy, up to the maximum amount for the assigned group (0.2, 0.5, or 1 yuan/day). Rewards are credited to the app account daily and can be withdrawn at any time. The control group receives no monetary reward.

After the 12-week intervention, a post-intervention assessment will be conducted (Week 14), including cognitive tests (MoCA and DiaMem). Then, incentives will be stopped, and a 4-week follow-up period (Weeks 14-17) will observe whether participants continue training.

Outcomes:

The primary outcome is the completion rate of cognitive training during the 12-week intervention period, defined as the number of days with all prescribed tasks completed divided by 84 days. Secondary outcomes include: stage-specific completion and participation rates; mean daily number of training tasks; weekly trends in training tasks; changes in MoCA and DiaMem scores from baseline to post-intervention; proportion of participants achieving high adherence (≥80%); recruitment rate; run-in completion rate; retention rate; researcher time input; and adverse events.

Data Analysis:

Primary analysis will follow the intention-to-treat principle. The primary outcome will be compared between the combined incentive groups and the control group using ANCOVA, adjusting for age, education, baseline MoCA score, and income stratum. Dose-response trends will be assessed using the Jonckheere-Terpstra test. Cognitive changes will be analyzed with ANCOVA. Linear mixed models will be used to analyze weekly trends in training tasks. Subgroup analysis will examine the interaction between intervention and income stratum. Missing baseline covariates will be handled by multiple imputation.

Expected Significance:

If effective, this study will provide evidence for a low-cost, scalable intervention to improve adherence to digital cognitive training in community-dwelling older adults, potentially informing public health policies and insurance coverage for preventive cognitive health services.

• Study Type: Interventional
• Enrollment (Estimated): 110
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yanjun Ma, PhD; Phone Number: +86 18811511126; Email: myj@xwhosp.org

Study Locations

• China
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100053
      • Xuanwu Hospital, Capital Medical University
      • Contact: Yanjun Ma, PhD; Phone Number: +86 18811511126; Email: myj@xwhosp.org
    • Beijing, Beijing Municipality, China, 100053
      • Baizhifang Street Community, Xicheng District
      • Contact: Yanjun Ma, PhD; Phone Number: +86 18811511126; Email: myj@xwhosp.org
    • Beijing, Beijing Municipality, China, 100053
      • Niujie Street Community, Xicheng District
      • Contact: Yanjun Ma, PhD; Phone Number: +86 18811511126; Email: myj@xwhosp.org
  • Shanxi
    • Yangcheng, Shanxi, China, 048100
      • Fengcheng Town, Yangcheng County
      • Contact: Yanjun Ma, PhD; Phone Number: +86 18811511126; Email: myj@xwhosp.org
    • Yangcheng, Shanxi, China, 048100
      • Yanli Town, Yangcheng County
      • Contact: Yanjun Ma, PhD; Phone Number: +86 18811511126; Email: myj@xwhosp.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Aged ≥60 years, either sex.
• Owns and routinely uses a smartphone.
• Willing to sign written informed consent.

Exclusion Criteria:

• Visual impairment that cannot be corrected to read training content on a smartphone screen.
• Hearing impairment that cannot be corrected to hear prompts from the training app.
• Severe upper-limb dysfunction preventing stable holding or operation of a smartphone.
• Unable to independently complete cognitive training after on-site instruction by researchers.
• Plans to move away from the local area or be away for a long period within the next 14 weeks, which may interrupt study participation.
• Concurrent participation in another cognitive intervention study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control (0 CNY/day); Participants receive digital cognitive training only, with no monetary incentive. They are asked to complete daily cognitive training tasks using the mobile app for about 15-20 minutes per day during the 12-week intervention period. Training completion is recorded automatically by the app.	Behavioral: Digital cognitive training; Participants complete daily cognitive training tasks via a mobile application ("Memory Fitness Coach," developed by Changsha Wuwangwo Education Technology Co., Ltd.) for approximately 15-20 minutes per day. The tasks target attention, memory, executive function, and processing speed. Task difficulty is automatically adjusted to maintain an accuracy level of approximately 80%. Training is performed at home using the participant's own smartphone. All participants, including those in the control group, receive this intervention during Weeks 2-13.
Experimental: 0.2 CNY/day; Participants receive digital cognitive training plus a daily monetary incentive of up to 0.2 CNY. After completing all prescribed daily training tasks, they earn a reward proportional to their accuracy (e.g., 0.2 CNY × accuracy). Rewards are credited daily to the app account and can be withdrawn at any time.	Behavioral: Digital cognitive training; Participants complete daily cognitive training tasks via a mobile application ("Memory Fitness Coach," developed by Changsha Wuwangwo Education Technology Co., Ltd.) for approximately 15-20 minutes per day. The tasks target attention, memory, executive function, and processing speed. Task difficulty is automatically adjusted to maintain an accuracy level of approximately 80%. Training is performed at home using the participant's own smartphone. All participants, including those in the control group, receive this intervention during Weeks 2-13.; Behavioral: Monetary incentive 0.2 CNY/day; Participants in this arm receive the same digital cognitive training as the control group, plus a daily monetary reward of up to 0.2 CNY after completing the daily cognitive training session. The actual reward is proportional to accuracy (e.g., 0.2 CNY × accuracy). Rewards are credited daily to the app account and can be withdrawn at any time. This incentive is provided only during the 12-week intervention period (Weeks 2-13).
Experimental: 0.5 CNY/day; Participants receive digital cognitive training plus a daily monetary incentive of up to 0.5 CNY. After completing all prescribed daily training tasks, they earn a reward proportional to their accuracy (e.g., 0.5 CNY × accuracy). Rewards are credited daily to the app account and can be withdrawn at any time.	Behavioral: Digital cognitive training; Participants complete daily cognitive training tasks via a mobile application ("Memory Fitness Coach," developed by Changsha Wuwangwo Education Technology Co., Ltd.) for approximately 15-20 minutes per day. The tasks target attention, memory, executive function, and processing speed. Task difficulty is automatically adjusted to maintain an accuracy level of approximately 80%. Training is performed at home using the participant's own smartphone. All participants, including those in the control group, receive this intervention during Weeks 2-13.; Behavioral: Monetary incentive 0.5 CNY/day; Participants in this arm receive the same digital cognitive training as the control group, plus a daily monetary reward of up to 0.5 CNY after completing the daily cognitive training session. The actual reward is proportional to accuracy (e.g., 0.5 CNY × accuracy). Rewards are credited daily to the app account and can be withdrawn at any time. This incentive is provided only during the 12-week intervention period (Weeks 2-13).
Experimental: 1 CNY/day; Participants receive digital cognitive training plus a daily monetary incentive of up to 1 CNY. After completing all prescribed daily training tasks, they earn a reward proportional to their accuracy (e.g., 1 CNY × accuracy). Rewards are credited daily to the app account and can be withdrawn at any time.	Behavioral: Digital cognitive training; Participants complete daily cognitive training tasks via a mobile application ("Memory Fitness Coach," developed by Changsha Wuwangwo Education Technology Co., Ltd.) for approximately 15-20 minutes per day. The tasks target attention, memory, executive function, and processing speed. Task difficulty is automatically adjusted to maintain an accuracy level of approximately 80%. Training is performed at home using the participant's own smartphone. All participants, including those in the control group, receive this intervention during Weeks 2-13.; Behavioral: Monetary incentive 1 CNY/day; Participants in this arm receive the same digital cognitive training as the control group, plus a daily monetary reward of up to 1 CNY after completing the daily cognitive training session. The actual reward is proportional to accuracy (e.g., 1 CNY × accuracy). Rewards are credited daily to the app account and can be withdrawn at any time. This incentive is provided only during the 12-week intervention period (Weeks 2-13).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence Rate to Digital Cognitive Training During the Intervention Period	The primary outcome is the completion rate of digital cognitive training during the 12-week intervention period (Weeks 2-13, 84 days). Completion rate is defined as the number of days on which all prescribed training tasks were completed divided by 84 days, multiplied by 100%. Participants who withdraw or do not train on a given day are counted as non-adherent, with the denominator remaining 84 days. The primary comparison is between the combined incentive groups and the control group.	Weeks 2-13 (84 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stage-Specific Completion Rate of Digital Cognitive Training	Completion rate calculated separately for the run-in period (Week 1, 7 days), intervention period (Weeks 2-13, 84 days), and follow-up period (Weeks 14-17, 28 days). For each stage, completion rate = number of days with all prescribed tasks completed / total days in that stage × 100%.	Week 1; Weeks 2-13; Weeks 14-17
Stage-Specific Participation Rate	Participation rate calculated separately for the run-in, intervention, and follow-up periods. Participation rate = number of days with APP login and at least 1 completed training task / total days in that stage × 100%. This distinguishes "starting training" from "completing all tasks".	Week 1; Weeks 2-13; Weeks 14-17
Mean Daily Number of Training Tasks Completed	Average number of training tasks completed per day during the run-in, intervention, and follow-up periods, recorded automatically by the APP. This reflects training dose.	Week 1; Weeks 2-13; Weeks 14-17
Weekly Trend in Mean Daily Training Tasks	Weekly average number of daily training tasks from Week 1 to Week 17, analyzed using a linear mixed model to assess changes over time and differences between groups. Used to evaluate whether incentive effects decay and how training behavior changes after incentive withdrawal.	Weeks 1-17 (weekly)
Change in Montreal Cognitive Assessment (MoCA) Score	Change in MoCA total score from baseline to post-intervention (Week 14). MoCA score ranges from 0 to 30, with higher scores indicating better cognitive function. Administered on-site by trained researchers using a standardized protocol.	Baseline; Week 14
Change in DiaMem Score	Change in DiaMem score from baseline to post-intervention (Week 14). DiaMem score is the mean of three tests (one on-site and two home-based), ranging from 0 to 100. Higher scores indicate better cognitive function.	Baseline; Week 14
Proportion of Participants Achieving High Adherence (≥80%)	Proportion of participants in each group with an intervention-period completion rate ≥80%. Numerator: number of participants with completion rate ≥80%; denominator: number of randomized participants who did not withdraw informed consent.	Weeks 2-13
Recruitment Rate	Proportion of older adults in the target community who actively contacted the researcher, underwent preliminary screening, signed informed consent, and successfully downloaded the cognitive training APP. Numerator: number of such participants; denominator: total number of age-eligible (≥60 years) smartphone-using older adults in the community during the same period.	Recruitment period
Run-in Completion Rate	Proportion of participants who passed the 1-week run-in and could independently complete at least 2 days of cognitive training. Numerator: number of such participants; denominator: all participants who signed informed consent and downloaded the APP.	End of Week 1
Retention Rate	Proportion of participants who completed the 12-week intervention and received the final assessment. Completion of the 12-week intervention is defined as completing at least 1 day of training in each of the 12 weeks. Numerator: number completing and assessed; denominator: total randomized participants.	Week 14 (end of 12-week intervention)
Researcher Time Input per Participant	Total time in minutes spent by researchers on training, answering questions, active contact, and data verification for each participant from enrollment to the end of the intervention period. Used for cost estimation.	From enrollment to end of intervention (Week 13)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Adverse Events	Number and proportion of participants experiencing adverse events during the study period. Serious adverse events will be reported promptly to the ethics committee.	Throughout the study (up to Week 17)
User Experience Assessed by the Short Version of the User Experience Questionnaire (UEQ-S)	User experience with the digital cognitive training app will be assessed at the post-intervention assessment (Week 14) using the Short Version of the User Experience Questionnaire (UEQ-S). The UEQ-S contains 8 items rated on a 7-point semantic differential scale and yields two subscale scores, pragmatic quality and hedonic quality, as well as an overall user experience score. Higher scores indicate more positive user experience. The UEQ-S will be used as an indicator of participant acceptance of and user experience with the training app. Open-ended feedback on the training program and incentive scheme may be collected separately.	Week 14

Collaborators and Investigators

• Sponsor: Xuanwu Hospital, Beijing
• Collaborators: Changsha Wuwangwo Education Technology Co., Ltd., Changsha, Hunan, China

Study record dates

Study Major Dates

• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): September 30, 2027

Study Registration Dates

• First Submitted: October 16, 2026
• First Submitted That Met QC Criteria: October 28, 2026
• First Posted (Actual): November 3, 2026

Study Record Updates

• Last Update Posted (Actual): November 3, 2026
• Last Update Submitted That Met QC Criteria: October 28, 2026
• Last Verified: October 1, 2026

More Information

Terms related to this study

• Keywords: Adherence; cognitive function; MoCA; behavioral economics; financial incentives; community-dwelling older adults; dementia prevention; small monetary incentives; digital cognitive training; DiaMem
• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: 2026_motivate_01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

Individual participant data (IPD) will not be shared because this study involves community-dwelling older adults and includes personal information and app-based behavioral data collected under informed consent that does not permit public data sharing. Ethical restrictions and participant privacy also prevent sharing. De-identified summary results will be published through academic papers and trial registry results.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No