Background: Suboptimal asthma management contributes to poor asthma control; however behaviour change is challenging. Financial incentives are a widely used behaviour change technique in healthcare, increasingly used in asthma.

Aims and Objectives: To explore the effectiveness of financial incentives at improving asthma management behaviours. The objectives were to determine overall effectiveness of financial incentives, identify characteristics of effective interventions, and to assess the impact on asthma outcomes.

Methods: A PICOS strategy was used to search electronic databases (MEDLINE, EMBASE, Global Health, PsycINFO, CINAHL, PubMed, Web of Science) and grey literature sources (NHS digital, CORE, ProQuest, clinical trials register, EU clinical trials register) in Nov 2021. Bias was assessed using ROBINS-I or RoB2. Narrative synthesis grouped studies by asthma management behaviour and financial incentives framework domain.

Results: We identified 4,129 articles; 8 met the inclusion criteria. Studies were from the US (n=7) and the UK (n=1). Asthma management behaviours included: attendance at asthma-related appointments (n=4), reduction in tobacco smoke exposure (n=1) and medication adherence (n=3). Five studies demonstrated positive behaviour change; four were significant. Features of successful interventions included positive gain and fixed financial incentives of smaller magnitude. Four studies reported clinical outcomes; none of which demonstrated significant improvements.

Conclusions: There is some evidence that financial incentives improve asthma management behaviours. The findings of this review will be used to support the analysis of the Financial INcentives to improve Asthma (FINA) pilot study.