This #TalkClinicalTrials blog explores why it’s time to reject gift cards as incentives in research. While gift cards remain a common choice, evidence and participant feedback show that cash is not only preferred but also supports participant autonomy, demonstrates trust, affirms equity, and conveys solidarity. It’s time for researchers, ethics boards, and institutions to rethink long-standing practices and prioritize compensation approaches that better serve participants.
Written by Alexandra Kubica, Ben Evans-Durán, Daniel Z. Buchman, and Aaron M. Orkin.
Incentives for participation in public health research are used as compensation or a gesture of appreciation for participants’ time and contribution to science. How we compensate research participants, especially those from structurally disadvantaged communities, carries ethical, methodological, and public health implications.
While gift cards are perhaps the most common incentive, mounting evidence and participant feedback show that cash is not only preferred but also helps to preserve participant autonomy, demonstrate trust, affirm equity, and convey solidarity. Researchers, ethics boards, and institutions need to rethink long-standing practices. It is time to stop the use of gift cards in research.
Why Do Gift Cards Remain So Common?
Despite widespread recognition among both researchers and participants that cash is preferable, gift cards remain common in part because of:
- Administrative Convenience: Easy purchasing and financial processes.
- Perceived Safety: Viewed as less risky for staff to carry and distribute.
- Ethical Values: The mistaken belief that gift cards discourage recipients from using funds on substances or stigmatized behaviors.
- Institutional Habit: Longstanding use has normalized gift cards despite their limitations.
Convenience for researchers should not outweigh financial freedom for participants. As we examine more closely, cash provides important benefits that gift cards cannot.
Cash Restores Autonomy
Gift cards restrict spending to settings with fewer options and high costs, like fast food chains or coffee shops, limiting participants’ ability to choose how they meet their needs.
Key autonomy considerations:
- Gift cards force people to pay more for the same things available elsewhere for less.
- When gift cards don’t cover the total cost of a desirable item, participants are pressured to spend their own money to complete the purchase.
- Some choose not to participate in research altogether when gift cards are used as compensation.
In contrast, cash affirms that participants are capable decision-makers. Researchers can demonstrate trust by affirming participants’ economic independence, and enabling individuals to spend their resources on groceries, rent, transportation, or anything else they choose.
Cash Reduces Stigma
Gift cards have conventionally been used to control how participants spend incentives, based on assumptions that some individuals may use cash for “undesirable” purposes. This approach is:
- Paternalistic: It assumes participants cannot be trusted to make decisions.
- Stigmatizing: It reinforces social biases, especially against people who use drugs or live in poverty.
- Uninformed: Studies show that cash recipients generally use funds for essentials like household needs, bills, and transportation.
Regardless of the amount of money provided, participants should feel respected to meaningfully engage in research. Cash incentives go further to build the intended respectful relationship with participants.
Cash Affirms Equity
When staff enjoy stable salaries for conducting research while participants receive a gift card for the same encounter, it widens power imbalances.
Equity benefits of cash:
- Acknowledges research participation as work.
- Recognizes the opportunity cost of participation, especially for those experiencing material poverty.
- Reduces power imbalances that separate researchers from participants.
Gift cards may result in fewer participants from structurally disadvantaged groups who rely on research incentives as income. Cash may therefore help to amplify perspectives from marginalized groups and convey solidarity in compensation for participant contributions.
Financial and Health Implications
In contrast, cash retains its full purchasing power and has direct health implications. When participants can choose to pay for medication, food, or housing; researchers not only compensate, but invest in participants’ health.
From a systems perspective, gift cards redirect scarce research dollars to specific retailers, offering no added value or partnership. Those retailers benefit even when the gift cards are not used.
A small research incentive will not itself lift someone out of poverty, but it does provide more financial opportunities than a gift card of the same value.
Comparing Cash vs Gift Cards in Research
| Cash | Gift Cards | |
| Administration | More paperwork, but manageable with systems in place | Easier to procure and justify |
| Autonomy | Full financial freedom | Spending limited to often high-cost retailers |
| Stigma | Values participants as informed decision makers | Implies mistrust and attempts to control spending |
| Equity | Recognizes participants’ contributions as labor | May result in less participation from structurally disadvantaged groups |
| Health Benefits | Can support basic needs (housing, transit, food) | May not align with urgent health needs |
| Financial Impacts | Full dollar value retained | Unnecessarily provides research funds to retailers |
Regulations and Policy
To protect the important role that cash plays in the lives of communities facing vulnerabilities, policies for better cash management need to be created. Currently there are no requirements to justify the type of incentive provided or vendor choice for gift cards to research ethics boards. Ethics boards should review the choice of incentives used in research, especially when it has implications on autonomy, equity, and respectful engagement.
Recommendations
- Advocate for policy shifts within institutions.
- Collaborate with finance departments to enable safe, trackable cash distribution.
- Listen to community partners and prioritize their compensation needs.
- Inform ethics boards of the unintended harms of gift card incentives.
Conclusion
Gift cards may be convenient, but convenience should not be the foundation of ethical research. Cash incentives offer tangible benefits, they respect autonomy, reduce stigma, and affirm the value of participant contributions.
Let’s move beyond outdated norms and center our practices around the people we serve.
To explore this issue further, please consider reading the full paper: Advocating for cash incentives instead of gift cards in public health research: Dollars over donuts