Veterans’ Donations of Research Incentives to Fellow Veterans

Donna M Zulman; Mayuree Rao; Cindie Slightam; Liberty Greene; Matthew L Maciejewski

doi:10.1001/jamanetworkopen.2025.20307

. 2025 Jul 14;8(7):e2520307. doi: 10.1001/jamanetworkopen.2025.20307

Veterans’ Donations of Research Incentives to Fellow Veterans

Donna M Zulman ^1,^2,^✉, Mayuree Rao ^3,⁴, Cindie Slightam ¹, Liberty Greene ^1,², Matthew L Maciejewski ^5,^6,⁷

¹Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California

²Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California

³Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington

⁴Department of Medicine, University of Washington, Seattle

⁵Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina

⁶Department of Population Health Sciences, Duke University, Durham, North Carolina

⁷Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina

Accepted for Publication: May 6, 2025.

Published: July 14, 2025. doi:10.1001/jamanetworkopen.2025.20307

^✉

Corresponding Author: Donna M. Zulman, MD, MS, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025 (donna.zulman@va.gov).

Author Contributions: Drs Zulman and Maciejewski had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zulman, Rao, Maciejewski.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Zulman, Maciejewski.

Critical review of the manuscript for important intellectual content: Rao, Slightam, Greene, Maciejewski.

Statistical analysis: Greene.

Obtained funding: Zulman, Maciejewski.

Administrative, technical, or material support: Slightam, Maciejewski.

Supervision: Maciejewski.

Conflict of Interest Disclosures: Drs Zulman, Rao, and Maciejewski reported grants from the US Department of Veterans Affairs (Health Systems Research). No other disclosures were reported.

Funding/Support: Funding for this work was provided by the US Department of Veterans Affairs (VA HSR IIR 20-114, RCS 10-391).

Role of the Funder/Sponsor: The funding organization did not have a role in the conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication. This study was reviewed and approved by the VA Central Institutional Review Board (Protocol #1733647).

Disclaimer: Views expressed do not represent the views of the US Department of Veterans Affairs or the United States government.

Data Sharing Statement: See the Supplement.

Additional Contributions: We greatly appreciate the project management support provided by Camila Chaudhary, MPH, from VA Palo Alto Health Care System’s Center for Innovation to Implementation. We are also grateful to the veterans who participated in this study, and the veteran engagement groups that provided feedback during study development: Durham VA Health Care System’s Veteran Research Engagement Panel, Seattle VA Medical Center’s Veteran Engagement Group, VA Palo Alto Health Care System’s Older Adult Veteran and Family Advisory Sub-Committee, and VA Women’s Health Research Network’s Women’s Improvement Network.

^✉

Corresponding author.

PMCID: PMC12260992 PMID: 40658422

Abstract

This survey study examines using monetary donations to veteran-serving organizations as an incentive for research participation among US veterans.

Introduction

After serving their country, US veterans often continue public service by volunteering to participate in Veterans Affairs (VA) research studies. Their contributions have been instrumental to numerous scientific advancements, including medical treatments for posttraumatic stress disorder, development of the implantable cardiac pacemaker, and the world’s largest genomic biorepository, the Million Veteran Program.¹

Research studies sometimes offer financial incentives to boost participation rates, but the impact can be modest.² Given that many veterans are motivated to participate in research that helps fellow veterans, we evaluated VA research participant preferences for receiving a monetary incentive or donating an equal amount to a veteran-focused service organization.

Methods

During March through June 2024, we conducted a social risks survey on a national sample of veterans, following the AAPOR guideline for survey studies. During survey development, a veteran engagement group suggested that we offer respondents the option of donating their monetary incentive to an organization that supports veterans.

The survey was administered via web and mail to a stratified national sample of 13 510 veterans who received VA primary care and/or mental health care in the previous year, with stratification by age, race and ethnicity, and sex and oversampling of small strata. After the survey, respondents were offered $10, which they could receive as cash or an Amazon e-gift card or donate to Disabled American Veterans. The survey included a 2-item measure of financial strain that queried respondents’ general financial situation and difficulty affording basic needs^3,4 and measures of self-reported race and ethnicity to enable more precise, veteran-centered characterization of these variables than is available in the VA health record. We calculated the unweighted proportion of respondents who elected to donate the monetary incentive and compared donation rates between those who did and did not endorse financial strain using a χ² test, with 2-sided P < .05 considered significant. We used Stata, version 18 to conduct analyses. The VA Central Institutional Review Board approved this study and waived informed consent as survey completion was considered consent to participate in the study.

Results

Among 3430 respondents (response rate, 25%), mean (SD) age was 61 (15.2) years; 1446 (42.2%) were women, 901 (26.3%) were Black, 834 (24.3%) were Hispanic, and 1775 (51.7%) experienced financial strain. Overall, 1720 respondents (50.2%) elected to donate their monetary incentive, 1615 (47.1%) elected to receive an e-gift card or cash, and 95 (2.8%) did not select an option. Respondents experiencing financial strain were less likely to donate their incentive than those not experiencing financial strain (690 [38.9%] vs 991 of 1590 [62.3%]; P < .001).

Discussion

Over half of the participants in this study chose to donate their research incentive, resulting in a $17 200 donation to Disabled American Veterans. This finding suggests that for many veterans, participation in this study was likely driven by a desire to contribute to research supporting fellow veterans.

Monetary incentives have historically affected survey response rates more than donation opportunities.² Guided by veteran input, we opted to offer respondents a choice. Veterans might have selected the donation option because the monetary incentive was modest; however, even among individuals facing financial strain, over one-third of participants chose to donate. Future research should examine whether similar patterns are observed in the general population.

The generosity of study participants reflects an ethos of service common among veterans and rooted in military experience. Veterans report that they are motivated to participate in research, veteran engagement groups, and national peer reviews to contribute to efforts that benefit other veterans.^5,6 Although we report unweighted results from a survey with a 25% response rate, the selection of the donation option might reflect preferences among many VA research participants because of a commitment to serving others who have served. Just as the scientific advancements achieved through veterans’ engagement in research benefit the broader population,¹ the actions of veterans in this study might inspire VA and non-VA researchers to offer donation as an incentive in future studies.

Supplement.

Data Sharing Statement

jamanetwopen-e2520307-s001.pdf^{(14.1KB, pdf)}

References

1.Hays MT. A Historical Look at the Establishment of the Department of Veterans Affairs Research & Development Program. Veterans Health Administration; 2010. [Google Scholar]
2.Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Woolf B, Perkins C. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2023;11(11):MR000008. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Board of Governors of the Federal Reserve System . Survey of household economics and decision-making. May 21, 2024. Accessed March 17, 2025. https://www.federalreserve.gov/consumerscommunities/shed.htm
4.Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation. The accountable health communities health-related social needs screening tool. Accessed March 17, 2025. https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf
5.Knight SJ, Haibach JP, Hamilton AB, et al. Veteran engagement in health services research: a conceptual model. J Gen Intern Med. 2022;37(Suppl 1):94-98. doi: 10.1007/s11606-021-07309-z [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Chavez MA, Blevins KR, Brown C, et al. The future of veteran community engagement: perspectives on engaging veterans and other stakeholders in research agenda setting. J Veterans Stud. 2022;8(2):21-35. doi: 10.21061/jvs.v8i2.360 [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement.

Data Sharing Statement

jamanetwopen-e2520307-s001.pdf^{(14.1KB, pdf)}

[zld250116r1] 1.Hays MT. A Historical Look at the Establishment of the Department of Veterans Affairs Research & Development Program. Veterans Health Administration; 2010. [Google Scholar]

[zld250116r2] 2.Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Woolf B, Perkins C. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2023;11(11):MR000008. [DOI] [PMC free article] [PubMed] [Google Scholar]

[zld250116r3] 3.Board of Governors of the Federal Reserve System . Survey of household economics and decision-making. May 21, 2024. Accessed March 17, 2025. https://www.federalreserve.gov/consumerscommunities/shed.htm

[zld250116r4] 4.Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation. The accountable health communities health-related social needs screening tool. Accessed March 17, 2025. https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf

[zld250116r5] 5.Knight SJ, Haibach JP, Hamilton AB, et al. Veteran engagement in health services research: a conceptual model. J Gen Intern Med. 2022;37(Suppl 1):94-98. doi: 10.1007/s11606-021-07309-z [DOI] [PMC free article] [PubMed] [Google Scholar]

[zld250116r6] 6.Chavez MA, Blevins KR, Brown C, et al. The future of veteran community engagement: perspectives on engaging veterans and other stakeholders in research agenda setting. J Veterans Stud. 2022;8(2):21-35. doi: 10.21061/jvs.v8i2.360 [DOI] [Google Scholar]

PERMALINK

Veterans’ Donations of Research Incentives to Fellow Veterans

Donna M Zulman, MD, MS

Mayuree Rao, MD, MS

Cindie Slightam, MPH

Liberty Greene, MS, MEd

Matthew L Maciejewski, PhD

Abstract

Introduction

Methods

Results

Discussion

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Cite

Add to Collections

PERMALINK

Veterans’ Donations of Research Incentives to Fellow Veterans

Donna M Zulman, MD, MS

Mayuree Rao, MD, MS

Cindie Slightam, MPH

Liberty Greene, MS, MEd

Matthew L Maciejewski, PhD

Abstract

Introduction

Methods

Results

Discussion

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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