Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis

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Abstract

Objectives

Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behavior, (b) incentive value and attainment certainty, (c) recipients' deprivation level.

Methods

Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviors at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints.

Results

Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behavior-change, with effects sustained until 18 months from baseline (OR: 1.53, 95% CI 1.05–2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21–3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22–3.85), but only at > 6–12 months from baseline. Other assessed variables did not independently modify effects at any time-point.

Conclusions

Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal.

Highlights

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Sustained changes in health behaviours would reduce non-communicable disease burden.
•

Personal financial incentives can change habitual health-behaviours.
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Personal financial incentives may help reduce health inequalities.
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The impact of financial incentives is not sustained long after incentive removal.
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The role of financial incentives in reducing disease burden is potentially limited.

Related collections

Most cited references 56

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Financial incentive-based approaches for weight loss: a randomized trial.

Kevin Volpp, Leslie John, Andrea B Troxel … (2008)

Identifying effective obesity treatment is both a clinical challenge and a public health priority due to the health consequences of obesity. To determine whether common decision errors identified by behavioral economists such as prospect theory, loss aversion, and regret could be used to design an effective weight loss intervention. Fifty-seven healthy participants aged 30-70 years with a body mass index of 30-40 were randomized to 3 weight loss plans: monthly weigh-ins, a lottery incentive program, or a deposit contract that allowed for participant matching, with a weight loss goal of 1 lb (0.45 kg) a week for 16 weeks. Participants were recruited May-August 2007 at the Philadelphia VA Medical Center in Pennsylvania and were followed up through June 2008. Weight loss after 16 weeks. The incentive groups lost significantly more weight than the control group (mean, 3.9 lb). Compared with the control group, the lottery group lost a mean of 13.1 lb (95% confidence interval [CI] of the difference in means, 1.95-16.40; P = .02) and the deposit contract group lost a mean of 14.0 lb (95% CI of the difference in means, 3.69-16.43; P = .006). About half of those in both incentive groups met the 16-lb target weight loss: 47.4% (95% CI, 24.5%-71.1%) in the deposit contract group and 52.6% (95% CI, 28.9%-75.6%) in the lottery group, whereas 10.5% (95% CI, 1.3%-33.1%; P = .01) in the control group met the 16-lb target. Although the net weight loss between enrollment in the study and at the end of 7 months was larger in the incentive groups (9.2 lb; t = 1.21; 95% CI, -3.20 to 12.66; P = .23, in the lottery group and 6.2 lb; t = 0.52; 95% CI, -5.17 to 8.75; P = .61 in the deposit contract group) than in the control group (4.4 lb), these differences were not statistically significant. However, incentive participants weighed significantly less at 7 months than at the study start (P = .01 for the lottery group; P = .03 for the deposit contract group) whereas controls did not. The use of economic incentives produced significant weight loss during the 16 weeks of intervention that was not fully sustained. The longer-term use of incentives should be evaluated. clinicaltrials.gov Identifier: NCT00520611.

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Article: not found

Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.

Koon Teo, Stephanie Ounpuu, Steven Hawken … (2006)

Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke (SHS) worldwide. We did a standardised case-control study of acute myocardial infarction (AMI) with 27,089 participants in 52 countries (12,461 cases, 14,637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers. Current smoking was associated with a greater risk of non-fatal AMI (odds ratio [OR] 2.95, 95% CI 2.77-3.14, p 21 h per week). Young male current smokers had the highest population attributable risk (58.3%; 95% CI 55.0-61.6) and older women the lowest (6.2%, 4.1-9.2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15.4% (12.1-19.3). Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.

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A randomized, controlled trial of financial incentives for smoking cessation.

Kevin Volpp, Andrea B Troxel, Mark Pauly … (2009)

Smoking is the leading preventable cause of premature death in the United States. Previous studies of financial incentives for smoking cessation in work settings have not shown that such incentives have significant effects on cessation rates, but these studies have had limited power, and the incentives used may have been insufficient. We randomly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs (442 employees) or to receive information about programs plus financial incentives (436 employees). The financial incentives were $100 for completion of a smoking-cessation program, $250 for cessation of smoking within 6 months after study enrollment, as confirmed by a biochemical test, and $400 for abstinence for an additional 6 months after the initial cessation, as confirmed by a biochemical test. Individual participants were stratified according to work site, heavy or nonheavy smoking, and income. The primary end point was smoking cessation 9 or 12 months after enrollment, depending on whether initial cessation was reported at 3 or 6 months. Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs. The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment (14.7% vs. 5.0%, P<0.001) and 15 or 18 months after enrollment (9.4% vs. 3.6%, P<0.001). Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program (15.4% vs. 5.4%, P<0.001), completion of a smoking-cessation program (10.8% vs. 2.5%, P<0.001), and smoking cessation within the first 6 months after enrollment (20.9% vs. 11.8%, P<0.001). In this study of employees of one large company, financial incentives for smoking cessation significantly increased the rates of smoking cessation. (ClinicalTrials.gov number, NCT00128375.) 2009 Massachusetts Medical Society

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Author and article information

Contributors

Eleni Mantzari

Florian Vogt

Ian Shemilt

Yinghui Wei

Julian P.T. Higgins

Theresa M. Marteau

Journal

Journal ID (nlm-ta): Prev Med

Journal ID (iso-abbrev): Prev Med

Title: Preventive Medicine

Publisher: Academic Press

ISSN (Print): 0091-7435

ISSN (Electronic): 1096-0260

Publication date PMC-release: 1 June 2015

Publication date (Print): June 2015

Volume: 75

Pages: 75-85

Affiliations

[a ]Health Psychology Section, King's College London, London, UK

[b ]Institute of Pharmaceutical Science, King's College London, London, UK

[c ]Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK

[d ]MRC Clinical Trials Unit Hub for Trials Methodology Research, MRC Clinical Trials Unit, London, UK

[e ]School of Social and Community Medicine, University of Bristol, Bristol UK

[f ]Centre for Reviews and Dissemination, University of York, York, UK

Author notes

[* ]Corresponding author at: Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK. tm388@ 123456medschl.cam.ac.uk

[1]

Present address: Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK.

[2]

Present address: School of Computing and Mathematics, Plymouth University, UK.

Article

Publisher ID: S0091-7435(15)00072-9

DOI: 10.1016/j.ypmed.2015.03.001

PMC ID: 4728181

PubMed ID: 25843244

SO-VID: c93974d4-daf3-4b8d-b375-cf149db27bed

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis

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Abstract

Objectives

Methods

Results

Conclusions

Highlights

Related collections

Jiangsu Journal of Preventive Medicine

Most cited references 56

Financial incentive-based approaches for weight loss: a randomized trial.

Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.

A randomized, controlled trial of financial incentives for smoking cessation.

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