Designing financial incentives for health behaviour change: a mixed-methods case study of weight loss in men with obesity

Abstract

Aim Designing financial incentives for health behaviour change requires choices across several domains, including value (the size of the incentive), frequency of incentives, and direction (gain or loss). However, the rationale underlying complex incentive design is infrequently reported. Transparent reporting is important if we want to understand and improve the incentive development process. This paper describes a mixed methods approach for designing financial incentives for health behaviour change which involves stakeholders throughout the design process. Subject and methods The mixed methods approach focuses on incentives for weight loss for men with obesity living in areas with high levels of disadvantage. The approach involves: (a) using an existing framework to identify all domains of a financial incentive scheme for which choices need to be made, deciding what criteria are relevant (such as effectiveness, acceptability and uptake) and making choices on each domain on the basis of the criteria; (b) conducting a survey of target population preferences to inform choices for domains and to design the incentive scheme; and (c) making final decisions at a stakeholder consensus workshop. Results The approach was implemented and an incentive scheme for weight loss for men living with obesity was developed. Qualitative interview data from men receiving the incentives in a feasibility trial endorses our approach. Conclusion This paper demonstrates that a mixed methods approach with stakeholder involvement can be used to design financial incentives for health behaviour change such as weight loss. Trial registration number NCT03040518. Date: 2 February 2017.

Text Messages With Financial Incentives for Men With Obesity

“…Providing participants with cash that they could retain if they met study goals may have facilitated enrollment of participants with lower incomes, in contrast to deposit contract financial incentives where participants risk losing their own money . Including men with obesity living in disadvantaged areas in making decisions about the design of the incentives, number of assessments, goals, and text messages may have contributed to the effectiveness of the text messaging with the financial incentives intervention. A meta-analysis recommended 12 in-person contacts for individual or group behavioral weight-management interventions .…”

“…Text messages and financial incentives were developed with feedback from potentially eligible men and health care clinicians and were designed to promote inclusivity, sustainability, minimal effort from participants and clinical staff, and to have a low risk of harm …”