Associations Between Language Proficiency, Insurance Status, and Compensation Redemption in Adolescents With Mild Traumatic Brain Injury

Patient compensation is an important tool to enhance enrollment of participants in clinical research. The association between compensation redemption and socioeconomic factors, however, is not well-studied, particularly in pediatric study cohorts. Our objective was to identify key variables associated with redemption of research compensation in a multicenter study of adolescents with mild traumatic brain injuries (TBIs).

We performed a secondary analysis within an ongoing multicenter observational study. Enrolled participants were emailed digital gift card codes after completing baseline surveys, followed by subsequent gift card codes for additional surveys completed after 1 week, 1 month, and 3 months. Our primary outcome was the redemption rate ratio, defined as the number of redemptions per transactions created. We used Poisson regression models with log-transformed transaction counts as offset terms to account for varying exposure periods and estimated associations between redemption rates and demographic and clinical characteristics. These included age, race, ethnicity, sex, area deprivation index, initial Glasgow Coma Scale score, and exposure to adverse childhood experiences.

We included 353 participants in our analysis. Participants with Spanish-speaking parents had significantly lower gift card redemption rates (rate ratio [RR] 0.58; 95% CI, 0.45–0.74; p < 0.001). Participants without health insurance also had lower redemption rates (RR 0.71; 95% CI, 0.52-0.95, p = 0.03). Demographic and clinical characteristics were not significantly associated with the redemption rate.

In this study of adolescents with mild TBIs, having Spanish-speaking parents and lacking health insurance were independently associated with lower gift card redemption rates. Digital gift card remuneration, while widely used in research, may inadvertently disadvantage participants facing structural or linguistic barrier