Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial

Kowatsch, Tobias; Kramer, Jan-Niklas; Kehr, Flavius; Wahle, Fabian; Elser, Niklas; Fleisch, Elgar

doi:10.2196/resprot.6089

Cited by 6 publications

(6 citation statements)

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“…The design of this study is described in greater detail elsewhere. 27 Briefly, this study was conducted in cooperation with a large Swiss health insurance company that implemented a 6-month pilot initiative to promote physical activity among its insureds from July to December 2015. In June 2015, eligible insureds were randomly assigned to a type of incentive (personal financial, charity financial, or no incentive) and invited via e-mail to participate in the pilot program.…”

Section: Methodsmentioning

confidence: 99%

A Cluster-Randomized Trial on Small Incentives to Promote Physical Activity

Kramer

Tinschert

Scholz

et al. 2019

American Journal of Preventive Medicine

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Introduction: There has been limited research investigating whether small financial incentives can promote participation, behavior change, and engagement in physical activity promotion programs. This study evaluates the effects of two types of small financial incentives within a physical activity promotion program of a Swiss health insurance company. Study design: Three-arm cluster-randomized trial comparing small personal financial incentives and charity financial incentives (10 Swiss Francs, equal to US$10.40) for each month with an average step count of >10,000 steps per day to control. Insureds' federal state of residence was the unit of randomization. Data were collected in 2015 and analyses were completed in 2018. Setting/participants: German-speaking insureds of a large health insurer in Switzerland were invited. Invited insureds were aged ≥18 years, enrolled in complementary insurance plans and registered on the insurer's online platform. Main outcome measures: Primary outcome was the participation rate. Secondary outcomes were steps per day, the proportion of participant days in which >10,000 steps were achieved and non-usage attrition over the first 3 months of the program. Results: Participation rate was 5.94% in the personal financial incentive group (OR=1.96, 95% CI=1.55, 2.49) and 4.98% in the charity financial incentive group (OR=1.59, 95% CI=1.25, 2.01) compared with 3.23% in the control group. At the start of the program, the charity financial group had a 12% higher chance of walking 10,000 steps per day than the control group (OR=1.68, 95% CI=1.23, 2.30), but this effect dissipated after 3 months. Steps per day and non-usage attrition did not differ significantly between the groups. Conclusions: Small personal and charity financial incentives can increase participation in physical activity promotion programs. Incentives may need to be modified in order to prevent attrition and promote behavior change over a longer period of time.

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Section: Methodsmentioning

confidence: 99%

A Cluster-Randomized Trial on Small Incentives to Promote Physical Activity

Kramer

Tinschert

Scholz

et al. 2019

American Journal of Preventive Medicine

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“…We invited insurees via email to participate in our study. On the basis of a previous study in the same population and with a similar recruiting process [60], we expected a participation rate of approximately 3%. We initially sent the invitation email to 10,000 insurees.…”

Section: Methodsmentioning

confidence: 99%

Investigating Intervention Components and Exploring States of Receptivity for a Smartphone App to Promote Physical Activity: Protocol of a Microrandomized Trial

Kramer¹,

Künzler²,

Mishra³

et al. 2019

JMIR Res Protoc

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Background Smartphones enable the implementation of just-in-time adaptive interventions (JITAIs) that tailor the delivery of health interventions over time to user- and time-varying context characteristics. Ideally, JITAIs include effective intervention components, and delivery tailoring is based on effective moderators of intervention effects. Using machine learning techniques to infer each user’s context from smartphone sensor data is a promising approach to further enhance tailoring. Objective The primary objective of this study is to quantify main effects, interactions, and moderators of 3 intervention components of a smartphone-based intervention for physical activity. The secondary objective is the exploration of participants’ states of receptivity, that is, situations in which participants are more likely to react to intervention notifications through collection of smartphone sensor data. Methods In 2017, we developed the A ssistant to L ift your L evel of activit Y (Ally), a chatbot-based mobile health intervention for increasing physical activity that utilizes incentives, planning, and self-monitoring prompts to help participants meet personalized step goals. We used a microrandomized trial design to meet the study objectives. Insurees of a large Swiss insurance company were invited to use the Ally app over a 12-day baseline and a 6-week intervention period. Upon enrollment, participants were randomly allocated to either a financial incentive, a charity incentive, or a no incentive condition. Over the course of the intervention period, participants were repeatedly randomized on a daily basis to either receive prompts that support self-monitoring or not and on a weekly basis to receive 1 of 2 planning interventions or no planning. Participants completed a Web-based questionnaire at baseline and postintervention follow-up. Results Data collection was completed in January 2018. In total, 274 insurees (mean age 41.73 years; 57.7% [158/274] female) enrolled in the study and installed the Ally app on their smartphones. Main reasons for declining participation were having an incompatible smartphone (37/191, 19.4%) and collection of sensor data (35/191, 18.3%). Step data are available for 227 (82.8%, 227/274) participants, and smartphone sensor data are available for 247 (90.1%, 247/274) participants. Conclusions This study describes the evidence-based development of a JITAI for increasing physical activity. If components prove to be efficacious, they will be included in a revised version of the app that offers scalable promotion of physical activity at low cost. Trial Registration ClinicalTrials.gov NCT03384550; https://clinicaltrials.gov/ct2/show/NCT03384550 (Archived by WebCite at http://www.webcitation.org/74IgCiK3d) Internationa...

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“…The timing, content, and order of quizzes were the same for all individuals, other than the initial quiz timing, which will be discussed in greater detail in the Study Design section. Quizzes were developed to inform and familiarize users about self-regulatory health skills [ 32 ] or stepping stone behaviors (ie, goal setting, tracking, action planning, and barrier identification), skills that have been demonstrated in the past to promote health behaviors [ 31 ]. After completing a health quiz or health risk assessment and immediately earning incentives (US $0.04 to US $1.48 depending on the length, timing, and date of completion of the quiz), users could view relevant health information on partner websites.…”

Section: Methodsmentioning

confidence: 99%

“…In the first few weeks after its launch in 2016, Carrot underwent several important program changes, resulting in a nonexperimental observational study [ 27 ] that can be examined to shed light on factors influencing engagement. Our primary objective was to examine the impact of reducing reward size on engagement to tackle competing predictions: although previous research has suggested that the size of a financial incentive is important for sustained engagement and thus behavior change [ 28 , 29 ], which is consistent with principles of economic rationality, other research [ 30 ] and theory in consumer psychology suggest that the magnitude of the incentive may be somewhat inelastic to size [ 30 - 32 ]. The secondary objectives were to examine whether reward timing, type of reward, and health intervention content influence engagement.…”

Section: Introductionmentioning

confidence: 99%

Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study

Brower¹,

LaBarge²,

White³

et al. 2020

J Med Internet Res

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Background The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points for downloading the app, referring friends, completing educational health quizzes, and health-related behaviors with long-term objectives of increasing health knowledge and encouraging healthy behaviors. During the first 3 months after program rollout in British Columbia, a number of program design elements were adjusted, creating observed differences between groups of users with respect to the potential impact of program features on user engagement levels. Objective This study examines the impact of reducing reward size over time and explored the influence of other program features such as quiz timing, health intervention content, and type of reward program on user engagement with a mobile health (mHealth) app. Methods Participants in this longitudinal, nonexperimental observational study included British Columbia citizens who downloaded the app between March and July 2016. A regression methodology was used to examine the impact of changes to several program design features on quiz offer acceptance and engagement with this mHealth app. Results Our results, based on the longitudinal app use of 54,917 users (mean age 35, SD 13.2 years; 65.03% [35,647/54,917] female), indicated that the key drivers of the likelihood of continued user engagement, in order of greatest to least impact, were (1) type of rewards earned by users (eg, movies [+355%; P<.001], air travel [+210%; P<.001], and grocery [+140%; P<.001] relative to gas), (2) time delay between early offers (−64%; P<.001), (3) the content of the health intervention (eg, healthy eating [−10%; P<.001] vs exercise [+20%, P<.001] relative to health risk assessments), and (4) changes in the number of points offered. Our results demonstrate that reducing the number of points associated with a particular quiz by 10% only led to a 1% decrease in the likelihood of offer response (P<.001) and that each of the other design features had larger impacts on participant retention than did changes in the number of points. Conclusions The results of this study demonstrate that this program, built around the principles of behavioral economics in the form of the ongoing awarding of a small number of reward points instantly following the completion of health interventions, was able to drive significantly higher engagement levels than those demonstrated in previous literature exploring the intersection of mHealth apps and financial incentives. Previous studies have demonstrated the presence of incentive matters to user engagement; however, our results indicate that the number of points offered for these reward point–based health interventions is less important than other program design features such as the type of reward points being offered, the timing of intervention and reward offers, and the content of the health interventions in driving continued engagement by users.

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Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial

Cited by 6 publications

References 66 publications

A Cluster-Randomized Trial on Small Incentives to Promote Physical Activity

A Cluster-Randomized Trial on Small Incentives to Promote Physical Activity

Investigating Intervention Components and Exploring States of Receptivity for a Smartphone App to Promote Physical Activity: Protocol of a Microrandomized Trial

Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study

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