@article {Gopalane012009, author = {A Gopalan and J Paramanund and P A Shaw and D Patel and J Friedman and C Brophy and A M Buttenheim and A B Troxel and D A Asch and K G Volpp}, title = {Randomised controlled trial of alternative messages to increase enrolment in a healthy food programme among individuals with diabetes}, volume = {6}, number = {11}, elocation-id = {e012009}, year = {2016}, doi = {10.1136/bmjopen-2016-012009}, publisher = {British Medical Journal Publishing Group}, abstract = {Objectives We compared the effectiveness of diabetes-focused messaging strategies at increasing enrolment in a healthy food programme among adults with diabetes.Methods Vitality is a multifaceted wellness benefit available to members of Discovery Health, a South Africa-based health insurer. One of the largest Vitality programmes is HealthyFood (HF), an incentive-based programme designed to encourage healthier diets by providing up to 25\% cashback on healthy food purchases. We randomised adults with type 2 diabetes to 1 of 5 arms: (1) control, (2) a diabetes-specific message, (3) a message with a recommendation of HF written from the perspective of a HF member with diabetes, (4) a message containing a physician{\textquoteright}s recommendation of HF, or (5) the diabetes-specific message from arm 2 paired with an {\textquoteleft}enhanced active choice{\textquoteright}(EAC). In an EAC, readers are asked to make an immediate choice (in this case, to enrol or not enrol); the pros and cons associated with the preferred and non-preferred options are highlighted. HF enrolment was assessed 1 month following the first emailed message.Results We randomised 3906 members. After excluding those who enrolled in HF or departed from the Vitality programme before the first intervention email, 3665 (94\%) were included in a modified intent-to-treat analysis. All 4 experimental arms had significantly higher HF enrolment rates compared with control (p\<0.0001 for all comparisons). When comparing experimental arms, the diabetes-specific message with the EAC had a significantly higher enrolment rate (12.6\%) than the diabetes-specific message alone (7.6\%, p=0.0016).Conclusions Messages focused on diabetes were effective at increasing enrolment in a healthy food programme. The addition of a framed active choice to a message significantly raised enrolment rates in this population. These findings suggest that simple, low-cost interventions can enhance enrolment in health promoting programmes and also be pragmatically tested within those programmes.Trial registration number NCT02462057.}, issn = {2044-6055}, URL = {https://bmjopen.bmj.com/content/6/11/e012009}, eprint = {https://bmjopen.bmj.com/content/6/11/e012009.full.pdf}, journal = {BMJ Open} }