Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups

Abstract

BackgroundThere is evidence that financial incentive interventions, which include both financial rewards and also penalties, are effective in encouraging healthy behaviours. However, concerns about the acceptability of such interventions remain. We report on focus groups with a cross-section of adults from North East England exploring their acceptance of financial incentive interventions for encouraging healthy behaviours amongst adults. Such information should help guide the design and development of acceptable, and effective, financial incentive interventions.MethodsEight focus groups with a total of 74 adults were conducted between November 2013 and January 2014 in Newcastle upon Tyne, UK. Focus groups lasted approximately 60 minutes and explored factors that made financial incentives acceptable and unacceptable to participants, together with discussions on preferred formats for financial incentives. Verbatim transcripts were thematically coded and analysed in Nvivo 10.ResultsParticipants largely distrusted health promoting financial incentives, with a concern that individuals may abuse such schemes. There was, however, evidence that health promoting financial incentives may be more acceptable if they are fair to all recipients and members of the public; if they are closely monitored and evaluated; if they are shown to be effective and cost-effective; and if clear health education is provided alongside health promoting financial incentives. There was also a preference for positive rewards rather than negative penalties, and for shopping vouchers rather than cash incentives.ConclusionsThis qualitative empirical research has highlighted clear suggestions on how to design health promoting financial incentives to maximise acceptability to the general public. It will also be important to determine the acceptability of health promoting financial incentives in a range of stakeholders, and in particular, those who fund such schemes, and policy-makers who are likely to be involved with the design, implementation and evaluation of health promoting financial incentive schemes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1409-y) contains supplementary material, which is available to authorized users.

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

“…[94][95][96][97] However, this was not a strong finding in the current work. The systematic review was not able to draw generalisable conclusions concerning effectiveness, but did find some instances in which financial incentives were effective at encouraging uptake.…”

“…Findings from both stakeholder groups provide strong support for previous research, where a variety of stakeholders across a range of clinical and public health settings have described health-promoting financial incentives as coercive, divisive and akin to bribery. 49,50,91,[93][94][95][96] However, unlike previous work in other settings, in which stakeholders have challenged the potential effectiveness of health promoting financial incentives in general (sometimes as a way of avoiding discussion of acceptability altogether), [93][94][95][96] there was, overall, an acceptance that financial incentives could be effective in encouraging the uptake of preschool vaccinations for some parents. A more detailed understanding of what aspects of acceptability of health-promoting financial incentives are common across all settings and which are context-specific -as well as what determines context-specific differenceswould be helpful.…”

“…This appears to be a common phenomenon in qualitative work on the acceptability of health-promoting financial incentives. 96,97 It is not clear exactly what this reflects: perhaps that participants dislike the idea of incentives so much that they would rather not talk about them, or perhaps that they dislike them but find it hard to articulate specifically why, choosing instead to move the conversation to easier ground. Furthermore, many of the alternative approaches to maximising vaccination uptake proposed by participants reflect existing guidance and good practice 11 and known attitudes of parents to vaccination.…”

“…Cost-effectiveness may be particularly salient when considering financial incentives because of the explicit financial element in the intervention. 96 As identified in the systematic review, the cost-effectiveness of financial incentive and quasi-mandatory interventions has been very poorly studied and is not yet known. However, previous research indicates that the great majority of public health interventions meet NICE's criteria for cost-effectiveness.…”

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data

“…37 Among the general population, however, there is a suggestion of some mistrust of financial incentives as a means of promoting healthy behaviour. 38 The evaluation was restricted to Scotland based on the use of routinely collected data for the following reasons. First, data are available at a national level for the approximately 56,000 deliveries per year.…”