# Leveraging Contingency Management to Encourage Online Brain Training Among Economically Disadvantaged Seniors: A Pilot Study

## TL;DR

This pilot study explored using rewards to encourage low-income seniors to do online brain training, but found low participation due to technology and literacy barriers.

## Contribution

The study is novel in applying contingency management to online cognitive training in economically disadvantaged seniors.

## Key findings

- Only 2% of enrolled seniors sustained regular participation in the brain training program.
- Barriers included confusing materials, limited technology access, and low digital literacy.
- Non-CM costs for technical support were four times higher than CM-related expenses.

## Abstract

This pilot study evaluated the feasibility of using contingency management (CM) to encourage economically disadvantaged seniors to participate in an online brain training program. Of 100 residents at a Housing Authority apartment complex, 11 initially enrolled, incentivized by monetary rewards. Despite multiple follow-up events, only 2% continued to engage regularly in weekly exercises. Participation was limited by several barriers, including confusing flyer language, limited access to technology, and low digital literacy. Additionally, non-CM costs, such as providing technical resources and on-site support, were found to be four times higher than CM-related expenses. These findings suggest that while CM is a promising incentive, substantial additional investments are needed to sustain engagement. With a modest 2% sustained participation rate, the study highlights significant socioeconomic and technological challenges. However, if these barriers are addressed through integrated support systems and digital infrastructure investments, CM-based interventions could potentially reach and benefit hundreds of thousands of the estimated 6-8 million economically disadvantaged older adults nationwide. Overall, the findings underscore the need for comprehensive interventions that combine incentives, access to technology, and consistent technical support to promote cognitive health in underserved aging populations.