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Almeida FA, You W, Harden SM, Blackman KCA, Davy BM, Glasgow RE, Hill JL, Linnan LA, Wall SS, Yenerall J, Zoellner JM, Estabrooks PA. Effectiveness of a worksite-based weight loss randomized controlled trial: the worksite study. Obesity (Silver Spring) 2015; 23:737-45. [PMID: 25678325 PMCID: PMC4380658 DOI: 10.1002/oby.20899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the effectiveness of an individually targeted Internet-based intervention with monetary incentives (INCENT) at reducing weight of overweight and obese employees when compared with a less-intensive intervention (Livin' My Weigh [LMW]) 6 months after program initiation. METHODS Twenty-eight worksites were randomly assigned to either INCENT or LMW conditions. Both programs used evidence-based strategies to support weight loss. INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and on-site educational sessions. Generalized linear mixed models were conducted for weight change from baseline to 6 months post-program and using an intention-to-treat analysis to include all participants with baseline weight measurements. RESULTS Across 28 worksites, 1,790 employees (M = 47 years of age; 79% Caucasian; 74% women) participated. Participants lost an average of 2.27 lbs (P < 0.001) with a BMI decrease of 0.36 kg/m(2) (P < 0.001) and 1.30 lbs (P < 0.01) with a BMI decrease of 0.20 kg/m(2) (P < 0.01) in INCENT and LMW, respectively. The differences between INCENT and LMW in weight loss and BMI reduction were not statistically significant. CONCLUSIONS This study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites.
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Affiliation(s)
- Fabio A. Almeida
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Wen You
- Fralin Translational Obesity Research Center, Virginia Tech
- Virginia Tech, Department of Agriculture and Applied Economics
| | | | | | - Brenda M. Davy
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | | | - Jennie L. Hill
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Laura A. Linnan
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
| | - Sarah S. Wall
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | | | - Jamie M. Zoellner
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Paul A. Estabrooks
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
- Carilion Clinic, Department of Family and Community Medicine
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Harvey JR, Ogden DE. Obesity treatment in disadvantaged population groups: where do we stand and what can we do? Prev Med 2014; 68:71-5. [PMID: 24878585 PMCID: PMC4452994 DOI: 10.1016/j.ypmed.2014.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 01/14/2023]
Abstract
Obesity is now the second leading cause of death and disease in the United States leading to health care expenditures exceeding $147 billion dollars. The socioeconomically disadvantaged and racial/ethnic minority groups are at significantly increased risk for obesity. Despite this, low income and minority individuals are underrepresented in the current obesity treatment literature. Additionally, weight loss outcomes for these high risk groups are well below what is typically produced in standard, well-controlled behavioral interventions and reach and access to treatment is often limited. The use of telecommunications technology may provide a solution to this dilemma by expanding dissemination and allowing for dynamic tailoring. Further gains may be achieved with the use of material incentives to enhance uptake of new behaviors. Regardless of what novel strategies are deployed, the need for further research to improve the health disparities associated with obesity in disadvantaged groups is critical. The purpose of this manuscript is to review the weight loss intervention literature that has targeted socioeconomically disadvantaged and racial/ethnic minority populations with an eye toward understanding outcomes, current limitations, areas for improvement and need for further research.
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Affiliation(s)
- Jean R Harvey
- University of Vermont, Department of Nutrition and Food Sciences, USA; University of Vermont, Vermont Center on Behavior and Health, USA.
| | - Doris E Ogden
- University of Vermont, Department of Nutrition and Food Sciences, USA
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Hui-Callahan BC, Luder HR, Frede SM. Impact of the pay-for-performance-for-patients program for diabetes management. J Am Pharm Assoc (2003) 2014; 53:644-7. [PMID: 24185432 DOI: 10.1331/japha.2013.12220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether patients with diabetes who used a financial rewards program in a grocery chain pharmacy had increased rates of self-reported healthy behaviors, to measure the impact of the program on glycosylated hemoglobin (A1C), and to measure the impact of the program on grocery store sales. METHODS This prospective study took place at one location of a grocery chain pharmacy in Cincinnati, OH. Adult patients with diabetes on at least one diabetes medication were eligible to participate. Participants received a $5 incentive for each weeklong behavior log completed and reviewed with the pharmacist, who provided counseling on improving healthy behaviors. Change in self-reported healthy behaviors, A1C, grocery store expenditure, and program satisfaction were measured. RESULTS During the 12-week study, 25 patients enrolled in the program. A total of 13 participants completed the poststudy survey and reported increased rates of self-monitoring of blood glucose and blood pressure and increased exercise frequency. Differences in A1C and grocery store expenditures were unable to be detected. Satisfaction with the pay-for-performance-for-patients (P4P4P) program was favorable (8.6 on a 10-point scale). CONCLUSION Participants given small, frequent financial incentives had increased frequency of healthy behaviors and were satisfied with the P4P4P program.
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Purnell JQ, Gernes R, Stein R, Sherraden MS, Knoblock-Hahn A. A systematic review of financial incentives for dietary behavior change. J Acad Nutr Diet 2014; 114:1023-1035. [PMID: 24836967 DOI: 10.1016/j.jand.2014.03.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/13/2014] [Indexed: 01/22/2023]
Abstract
In light of the obesity epidemic, there is growing interest in the use of financial incentives for dietary behavior change. Previous reviews of the literature have focused on randomized controlled trials and found mixed results. The purpose of this systematic review is to update and expand on previous reviews by considering a broader range of study designs, including randomized controlled trials, quasi-experimental, observational, and simulation studies testing the use of financial incentives to change dietary behavior and to inform both dietetic practice and research. The review was guided by theoretical consideration of the type of incentive used based on the principles of operant conditioning. There was further examination of whether studies were carried out with an institutional focus. Studies published between 2006 and 2012 were selected for review, and data were extracted regarding study population, intervention design, outcome measures, study duration and follow-up, and key findings. Twelve studies meeting selection criteria were reviewed, with 11 finding a positive association between incentives and dietary behavior change in the short term. All studies pointed to more specific information on the type, timing, and magnitude of incentives needed to motivate individuals to change behavior, the types of incentives and disincentives most likely to affect the behavior of various socioeconomic groups, and promising approaches for potential policy and practice innovations. Limitations of the studies are noted, including the lack of theoretical guidance in the selection of incentive structures and the absence of basic experimental data. Future research should consider these factors, even as policy makers and practitioners continue to experiment with this potentially useful approach to addressing obesity.
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Gardner CD, Whitsel LP, Thorndike AN, Marrow MW, Otten JJ, Foster GD, Carson JAS, Johnson RK. Food-and-beverage environment and procurement policies for healthier work environments. Nutr Rev 2014; 72:390-410. [DOI: 10.1111/nure.12116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Anne N Thorndike
- Department of Medicine; Massachusetts General Hospital; Boston Massachusetts USA
| | - Mary W Marrow
- Public Health Law Center; William Mitchell College of Law; Saint Paul Minnesota USA
| | - Jennifer J Otten
- Department of Health Services; School of Public Health; University of Washington; Seattle Washington USA
| | - Gary D Foster
- Departments of Medicine, Public Health, and Psychiatry; Temple University; Philadelphia Pennsylvania USA
| | - Jo Ann S Carson
- Department of Clinical Nutrition; University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Rachel K Johnson
- Department of Nutrition and Food Sciences; University of Vermont; Burlington Vermont USA
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Mendis K, Forster T, Paxton K, Hyland K, Yelverton J, McLean R, Canalese J, Brown A, Steinbeck K. Large and forgotten in rural Australia: assessment, attitudes and possible approaches to losing weight in young adult males. BMC Public Health 2014; 14:243. [PMID: 24612872 PMCID: PMC4008138 DOI: 10.1186/1471-2458-14-243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young Adult Males (YAMs) in rural Australia are poorly studied with respect to overweight and obesity. Firstly, we explored the feasibility of recruiting 17-25 year old YAMs to obtain baseline data on overweight and obesity rates, socio-demographics, nutrition, exercise and mobile phone usage. Secondly, we explored the views of YAMs with a waist measurement over 94 cm about using mobile phone text messages to promote weight loss and incentives to promote healthy lifestyles. METHODS A two-staged, mixed-methods approach was used to study obesity and overweight issues in Dubbo, a regional city in New South Wales, Australia. In Phase I, socio-demographic, health behaviour and mobile phone usage data were collected using a questionnaire and anthropometric data collected by direct measurement. In Phase II, YAMs' views were explored by focus group discussion using a semi-structured questionnaire. RESULTS Phase I (145 participants): mean Body Mass Index (BMI) 25.06±5.01; mean waist circumference 87.4±15.4 cm. In total, 39.3% were obese (12.4%) or overweight (26.9%) and 24.1% had an increased risk of metabolic complications associated with obesity. 135 (93.1%) owned a mobile phone and sent on average 17±25 text messages per day and received 18±24. Phase II (30 participants): YAMs acknowledged that overweight and obesity was a growing societal concern with many health related implications, but didn't feel this was something that affected them personally at this stage of their lives. Motivation was therefore an issue. YAMs admitted that they would only be concerned about losing weight if something drastic occurred in their lives. Text messages would encourage and motivate them to adopt a healthy lifestyle if they were individually tailored. Gym memberships, not cash payments, seem to be the most favoured incentive. CONCLUSION There is a clear need for an effective health promotion strategy for the almost 40% overweight or obese Dubbo YAMs. The high rate of text message usage makes it feasible to recruit YAMs for a prospective study in which personalized text messages are used to promote healthy behaviours. It may be important to target motivation specifically in any weight-related intervention in this group with incentives such as gym membership vouchers.
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Affiliation(s)
- Kumara Mendis
- School of Rural Health, University of Sydney, Dubbo, Australia
- Bathurst Rural Clinical School, School of Medicine, University of Western Sydney, Bathurst, Australia
| | - Tanya Forster
- School of Rural Health, University of Sydney, Dubbo, Australia
| | - Karen Paxton
- School of Rural Health, University of Sydney, Dubbo, Australia
| | - Karen Hyland
- School of Rural Health, University of Sydney, Dubbo, Australia
| | | | - Rick McLean
- School of Rural Health, University of Sydney, Dubbo, Australia
| | - Joseph Canalese
- School of Rural Health, University of Sydney, Dubbo, Australia
| | - Anthony Brown
- School of Rural Health, University of Sydney, Dubbo, Australia
| | - Katharine Steinbeck
- Sydney Medical School, University of Sydney, Sydney, Australia
- Discipline of Paediatrics & Child Health, Children’s Hospital, Westmead, Australia
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Farooqui MA, Tan YT, Bilger M, Finkelstein EA. Effects of financial incentives on motivating physical activity among older adults: results from a discrete choice experiment. BMC Public Health 2014; 14:141. [PMID: 24512102 PMCID: PMC3933254 DOI: 10.1186/1471-2458-14-141] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 02/04/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is extensive evidence that regular physical activity confers numerous health benefits. Despite this, high rates of physical inactivity prevail among older adults. This study aimed to ascertain if incentives could be effective in motivating physical activity through improving uptake of walking programs, either with or without an enrolment fee to cover corresponding costs. METHODS A discrete-choice conjoint survey was fielded to a national sample of older adults in Singapore. Each respondent was given ten pairs of hypothetical walking programs and asked to choose the option they preferred. Each option varied along several dimensions, including the level and type (cash, voucher, or health savings credit) of incentive and an enrolment fee. For each option, they were asked how likely they would be to join their preferred program. A random utility model (RUM) was used to analyze the responses. RESULTS Results suggest that a free 6-month program with a $500 cash incentive would generate enrolment rates of 58.5%; charging $50 to enroll lowers this to 55.7%. In terms of incentive type, cash payments were the most preferred incentive but not significantly different from supermarket vouchers. Both were preferred to health savings credits and sporting goods vouchers. Concerns of adverse selection were minimal because those who were inactive represented at least 72% of new participants for any offered program(s) and were the majority. CONCLUSIONS Study results demonstrate the potential for even modest incentives to increase program uptake among inactive older adults. Moreover, although cash was the most preferred option, supermarket vouchers, which could potentially be purchased at a discount, were a close alternative. Results also suggest that an enrolment fee is a viable option to offset the costs of incentives as it has only minimal impact on participation.
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Affiliation(s)
| | | | | | - Eric A Finkelstein
- Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
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Abstract
Purpose To evaluate the effect of financial incentive in a diabetes prevention weight loss program at worksites. Design Group-level randomized intervention study. Setting Four long-term care facilities, randomly assigned to “incentive-IG” or “non incentive-NIG” groups. Participants Ninety-nine employees, all overweight or obese (BMI= mean 34.8±7.4 kg/m2) and at risk for type 2 diabetes. Intervention A 16 week weight loss program (diabetes prevention program) with a 3 month follow up. IG could either choose a "standard incentive" to receive cash award when achieving the projected weight loss or to participate in a "standard plus deposit incentive" to get additional money matched with their deposit for projected weight loss. All of the participants received a one-hour consultation for a healthy weight loss at the beginning. Measures Weight-loss, diabetes risk score (DRS), and cardiovascular risk outcomes. Analyses Linear and logistic regressions for completed cases with adjustments for clustering effect at group level. Results IG lost on average more pounds (p=0.027), reduced BMI (p=0.04), and reduced in DRS (p=0.011) compared to NIG at week 16. At the 12-week follow-up period, those in IG plus deposit subgroup had twice the odds (OR=2.2, p=0.042) and those in the standard IG had three times the odds of achieving weight loss goals than NIG; those in the IG plus deposit group reduced DRS by 0.4 (p=0.045). Conclusion Monetary incentives appear to be effective in reducing weight and diabetes risk.
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Affiliation(s)
- Pouran D Faghri
- Department of Allied Health Sciences/Health Promotion, University of Connecticut, USA
| | - Rui Li
- Division of Diabetes Translation, Centers for Disease Control and Prevention, USA
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Cawley J. The Affordable Care Act permits greater financial rewards for weight loss: a good idea in principle, but many practical concerns remain. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2014; 33:810-820. [PMID: 24988654 DOI: 10.1002/pam.21767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Patient Protection and Affordable Care Act of 2010 (ACA) increased the maximum rewards that group health insurance plans (including employers who self-insure) may offer in their wellness programs, with the goal of incentivizing healthy behaviors such as weight loss among the obese and smoking cessation. In this essay, I describe the history and intention of such programs, and make the following three points: (1) In principle, incentivizing healthy behavior can reduce external costs and help people with time-inconsistent preferences stick to their resolutions; (2) there are problems with the design of this portion of the ACA that will limit its effectiveness in achieving these goals; and (3) financial rewards for healthy behaviors have a mixed record to date, and thus many practical design features need to be resolved to improve the effectiveness of such programs.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management, and the Department of Economics, and Institute for Health Economics, Health Behaviors and Disparities at Cornell University, 2312 MVR Hall, Ithaca, NY 14853, USA.
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Cawley J. Incentives for wellness: tackling issues of effectiveness, biology, scope, and cost shifting. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2014; 33:826-832. [PMID: 24988656 DOI: 10.1002/pam.21768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Morgan Downey raises several interesting issues in his essay. We agree on several points, for example, that current regulations are "really quite porous," with the result that enrollees will be able to get the rewards even if they do not alter their health behaviors. There are also several areas of disagreement that merit further discussion, and I focus on those in this essay. To provide context, my position is that financial incentives for healthy behavior can improve social welfare by internalizing the external costs of risky behaviors and help people with time-inconsistent preferences to adhere to a healthier lifestyle. To achieve the goal of increasing social welfare, the penalties for risky health behaviors should be set equal to the external costs. The design of the rewards (in terms of their frequency, salience, and the amount of loss aversion they invoke) may be critical in determining their effectiveness.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management, and the Department of Economics, and the Institute for Health Economics, Health Behaviors and Disparities at Cornell University, 2312 MVR Hall, Ithaca, NY 14853, USA.
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Adams MA, Sallis JF, Norman GJ, Hovell MF, Hekler EB, Perata E. An adaptive physical activity intervention for overweight adults: a randomized controlled trial. PLoS One 2013; 8:e82901. [PMID: 24349392 PMCID: PMC3857300 DOI: 10.1371/journal.pone.0082901] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 11/04/2013] [Indexed: 01/01/2023] Open
Abstract
Background Physical activity (PA) interventions typically include components or doses that are static across participants. Adaptive interventions are dynamic; components or doses change in response to short-term variations in participant's performance. Emerging theory and technologies make adaptive goal setting and feedback interventions feasible. Objective To test an adaptive intervention for PA based on Operant and Behavior Economic principles and a percentile-based algorithm. The adaptive intervention was hypothesized to result in greater increases in steps per day than the static intervention. Methods Participants (N = 20) were randomized to one of two 6-month treatments: 1) static intervention (SI) or 2) adaptive intervention (AI). Inactive overweight adults (85% women, M = 36.9±9.2 years, 35% non-white) in both groups received a pedometer, email and text message communication, brief health information, and biweekly motivational prompts. The AI group received daily step goals that adjusted up and down based on the percentile-rank algorithm and micro-incentives for goal attainment. This algorithm adjusted goals based on a moving window; an approach that responded to each individual's performance and ensured goals were always challenging but within participants' abilities. The SI group received a static 10,000 steps/day goal with incentives linked to uploading the pedometer's data. Results A random-effects repeated-measures model accounted for 180 repeated measures and autocorrelation. After adjusting for covariates, the treatment phase showed greater steps/day relative to the baseline phase (p<.001) and a group by study phase interaction was observed (p = .017). The SI group increased by 1,598 steps/day on average between baseline and treatment while the AI group increased by 2,728 steps/day on average between baseline and treatment; a significant between-group difference of 1,130 steps/day (Cohen's d = .74). Conclusions The adaptive intervention outperformed the static intervention for increasing PA. The adaptive goal and feedback algorithm is a “behavior change technology” that could be incorporated into mHealth technologies and scaled to reach large populations. Trial Registration ClinicalTrials.gov NCT01793064
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Affiliation(s)
- Marc A. Adams
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona, United States of America
- Graduate School of Public Health, San Diego State University, San Diego, California, United States of America
- * E-mail:
| | - James F. Sallis
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, California, United States of America
- Department of Psychology, San Diego State University, San Diego, California, United States of America
| | - Gregory J. Norman
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, California, United States of America
| | - Melbourne F. Hovell
- Graduate School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Eric B. Hekler
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona, United States of America
| | - Elyse Perata
- College of Education and Allied Studies, California State University East Bay, Hayward, California, United States of America
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Sumida Y, Yoshikawa T, Tanaka S, Taketani H, Kanemasa K, Nishimura T, Yamaguchi K, Mitsuyoshi H, Yasui K, Minami M, Naito Y, Itoh Y. The 'donations for decreased ALT (D4D)' prosocial behavior incentive scheme for NAFLD patients. J Public Health (Oxf) 2013; 36:629-34. [PMID: 24099735 DOI: 10.1093/pubmed/fdt098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physicians often experience difficulties in motivating patients with non-alcoholic fatty liver disease (NAFLD) to undergo lifestyle changes. The aim of this study is to examine whether 'Donations for Decreased alanine aminotransferase (ALT)' (D4D) prosocial behavior incentive can serve as an effective intrinsic motivational factor in comparison with conventional dietary and exercise intervention alone for NAFLD patients. METHODS Twenty-five NAFLD patients with elevated ALT were randomly assigned to a control group that received conventional dietary and exercise intervention alone, or a donation group whereby, as an incentive, we would make a monetary donation to the United Nations World Food Programme (WFP) based on the decrease in their ALT levels achieved over 12 weeks, in addition to receiving control intervention. In a donation group, we would donate US$1 to the WFP for every 1 IU/l of decrease in their ALT levels. RESULTS There were no differences of pre-treatment clinical characteristics between the two groups. Significant reductions of ALT levels were achieved only in a donation group, although post-treatment ALT levels were not different between the two groups. These patients raised a total of $316 for the WFP. CONCLUSIONS Promoting patients' intrinsic motivation by incorporating 'D4D' prosocial behavior incentive into conventional dietary and exercise intervention may provide a means to improve NAFLD.
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Affiliation(s)
- Yoshio Sumida
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Saiyu Tanaka
- Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Hiroyoshi Taketani
- Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Kazuyuki Kanemasa
- Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Tekeshi Nishimura
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kanji Yamaguchi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hironori Mitsuyoshi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohichiroh Yasui
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahito Minami
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Cawley J, Price JA. A case study of a workplace wellness program that offers financial incentives for weight loss. JOURNAL OF HEALTH ECONOMICS 2013; 32:794-803. [PMID: 23787373 DOI: 10.1016/j.jhealeco.2013.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 06/02/2023]
Abstract
Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This paper examines the outcomes of 2635 workers across 24 worksites who were offered financial incentives for weight loss that took various forms, including fixed payments and forfeitable bonds. We document extremely high attrition and modest weight loss associated with the financial incentives in this program, which contrasts with the better outcomes associated with pilot programs. We conclude by offering suggestions, motivated by behavioral economics, for increasing the effectiveness of financial incentives for weight loss.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management, Cornell University, United States; Department of Economics, Cornell University, United States.
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An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr 2013; 16:1215-28. [PMID: 23122423 PMCID: PMC3898771 DOI: 10.1017/s1368980012004715] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/19/2012] [Accepted: 09/13/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption. DESIGN Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria. SETTING Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants. SUBJECTS Interventions enrolled various population subgroups such as school/ university students, metropolitan transit workers and low-income women. RESULTS All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment. CONCLUSIONS Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.
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Affiliation(s)
- Ruopeng An
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407, USA.
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Lunze K, Paasche-Orlow MK. Financial incentives for healthy behavior: ethical safeguards for behavioral economics. Am J Prev Med 2013; 44:659-65. [PMID: 23683984 DOI: 10.1016/j.amepre.2013.01.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/24/2012] [Accepted: 01/31/2013] [Indexed: 11/26/2022]
Abstract
Economic incentives to promote healthy behavior are becoming increasingly common and have been suggested as an approach to decreasing healthcare costs. Ethical concerns about programs with such incentives are that they may contribute to inequities, be coercive, interfere with therapeutic relationships, undermine personal responsibility for health, and decrease social solidarity. Additionally, they may be a source of stigma or discrimination, promote dependence, and be unfair for those already engaged in targeted health behaviors or those who cannot fulfill the incentivized behaviors. Incentive programs need to incorporate appropriate safeguards to monitor these risks and support fairness in offering economic incentives to promote healthy behavior.
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Affiliation(s)
- Karsten Lunze
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Drury VB, Saw SM, Finkelstein E, Wong TY, Tay PKC. A New Community-Based Outdoor Intervention to Increase Physical Activity in Singapore Children: Findings from Focus Groups. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n5p225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Myopia is a significant public health problem in Singapore with estimates that more than 50% of the population is affected by it by the time of adulthood. Childhood obesity is also increasing and has been linked to long-term health problems. Recent studies have found that Singaporean children in Primary 1 spend less than 3 hours a day outdoors which is less than children in other countries. Physical activity has been shown to be protective against obesity and recently, there has been some evidence to suggest that time spent outdoors may reduce the prevalence and severity of myopia. This study aims to explore the barriers and enablers to children in Singapore participating in outdoor activities. Materials and Methods: Qualitative data, gathered from focus group discussions was thematically analysed against the PRECEDE component of the PRECEDE-PROCEED model which provided a conceptual framework for examining factors relevant to children participating in an outdoor activity intervention. A total of 31 people participated in 4 focus groups held over a 6-month period. Results: This feasibility study was exploratory in nature but provided valuable information concerning barriers and enablers to participation. Data informed the development of a larger study. Conclusion: Results indicated that families preferred structured activities such as orienteering and a choice of weekend attendance days and times.
Key words: Myopia, Physical activity, Qualitative research, Singapore
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Affiliation(s)
- Vicki B Drury
- Faculty of Health Sciences, School of Nursing and Midwifery University, Australia
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Tien Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter KC Tay
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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A theoretically grounded systematic review of material incentives for weight loss: implications for interventions. Ann Behav Med 2013; 44:375-88. [PMID: 22907712 DOI: 10.1007/s12160-012-9403-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Providing material incentives for weight loss is a class of intervention strategies that has received considerable attention; however, the effectiveness of this class of strategies is uncertain. Attending to distinctions among incentive strategies may clarify our understanding of prior work and inform the design of future interventions. PURPOSE A theoretical framework is proposed that distinguishes between four classes of incentive strategies and is used to organize randomized controlled trials of material incentives for weight loss. METHODS A systematic literature review was conducted. RESULTS Findings were mixed with regards to the overall efficacy of material incentives for weight loss. Three of the four proposed incentive categories are represented in the literature. Heterogeneous methods were used across studies rendering comparisons between studies difficult. CONCLUSIONS Definitive conclusions about the usefulness of material incentives for weight loss could not be drawn. A theoretically grounded approach to designing and testing incentive strategies is encouraged.
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Kullgren JT, Troxel AB, Loewenstein G, Asch DA, Norton LA, Wesby L, Tao Y, Zhu J, Volpp KG. Individual- versus group-based financial incentives for weight loss: a randomized, controlled trial. Ann Intern Med 2013; 158:505-14. [PMID: 23546562 PMCID: PMC3994977 DOI: 10.7326/0003-4819-158-7-201304020-00002] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Data on the effectiveness of employer-sponsored financial incentives for employee weight loss are limited. OBJECTIVE To test the effectiveness of 2 financial incentive designs for promoting weight loss among obese employees. DESIGN Randomized, controlled trial. (ClinicalTrials.gov: NCT01208350) SETTING Children's Hospital of Philadelphia. PARTICIPANTS 105 employees with a body mass index between 30 and 40 kg/m2. INTERVENTION 24 weeks of monthly weigh-ins (control group; n = 35); individual incentive, designed as $100 per person per month for meeting or exceeding weight-loss goals (n = 35); and group incentive, designed as $500 per month split among participants within groups of 5 who met or exceeded weight-loss goals (n = 35). MEASUREMENTS Weight loss after 24 weeks (primary outcome) and 36 weeks and changes in behavioral mediators of weight loss (secondary outcomes). RESULTS Group-incentive participants lost more weight than control participants (mean between-group difference, 4.4 kg [95% CI, 2.0 to 6.7 kg]; P < 0.001) and individual-incentive participants (mean between-group difference, 3.2 kg [CI, 0.9 to 5.5 kg]; P = 0.008). Twelve weeks after incentives ended and after adjustment for 3-group comparisons, group-incentive participants maintained greater weight loss than control group participants (mean between-group difference, 2.9 kg [CI, 0.5 to 5.3 kg]; P = 0.016) but not greater than individual-incentive participants (mean between-group difference, 2.7 kg [CI, 0.4 to 5.0 kg]; P = 0.024). LIMITATION Single employer and short follow-up. CONCLUSION A group-based financial incentive was more effective than an individual incentive and monthly weigh-ins at promoting weight loss among obese employees at 24 weeks. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Jeffrey T Kullgren
- Veterans Affairs Center forClinical Management Research, Veterans Affairs Ann Arbor HealthcareSystem, Ann Arbor, MI 48113-0170, USA.
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Abstract
Abstract
We present a generally applicable theory of focusing based on the hypothesis that a person focuses more on, and hence overweights, attributes in which her options differ more. Our model predicts that the decision maker is too prone to choose options with concentrated advantages relative to alternatives, but maximizes utility when the advantages and disadvantages of alternatives are equally concentrated. Applying our model to intertemporal choice, these results predict that a person exhibits present bias and time inconsistency when—such as in lifestyle choices and other widely invoked applications of hyperbolic discounting—the future effect of a current decision is distributed over many dates, and the effects of multiple decisions accumulate. But unlike in previous models, in our theory (1) present bias is lower when the costs of current misbehavior are less dispersed, helping explain why people respond more to monetary incentives than to health concerns in harmful consumption; and (2) time inconsistency is lower when a person commits to fewer decisions with accumulating effects in her ex ante choice. In addition, a person does not fully maximize welfare even when making decisions ex ante: (3) she commits to too much of an activity—for example, exercise or work—that is beneficial overall; and (4) makes “future-biased” commitments when—such as in preparing for a big event—the benefit of many periods’ effort is concentrated in a single goal.
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Abstract
This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30 years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of incentives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit.
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Affiliation(s)
- Robert W Jeffery
- Division of Epidemiology and Community Health, Obesity Prevention Center, University of Minnesota School of Public Health, 1300 South 2nd Street, Minneapolis, MN 55454, USA.
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Allan C, Radley A, Williams B. Paying the price for an incentive: An exploratory study of smokers’ reasons for failing to complete an incentive based smoking cessation scheme. J Health Serv Res Policy 2012; 17:212-8. [DOI: 10.1258/jhsrp.2012.011084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: In 2009, one Scottish region launched a smoking cessation programme offering a weekly financial incentive of £12.50 over a 12-week period. However, a significant proportion of registered participants dropped out of the programme, some even failing to collect the financial reward they were owed. We explore reasons for disengagement and failure to re-engage within this group. Method: Individuals (n =14) were interviewed in depth. Transcripts from recorded interviews formed the dataset and were analysed using the “Framework” method. Results: Incentives appeared to introduce a potential change/reversal in the felt contractual relationship between service provider and client: the client was now the provider and being paid to quit. This led to an increased sense of obligation towards the service, and enhanced feelings of failure, guilt and shame post-relapse, and reluctance to continue engagement or re-engagement. Other service factors promoting disengagement included issues of practical delivery through location, timing, administrative burden and incentive preference. Conclusion: The future design of incentive-based schemes should be cognisant of the potential impact on the client-professional relationship. Increasing the value of the incentive may overcome clients’ antipathy towards bureaucracy and monitoring, but may simultaneously exacerbate the sense of failure and resultant stigma associated with relapse. It may be more cost-effective to reduce barriers/costs such as inconvenience, lack of privacy, timing and embarrassment of association of attendance at the pharmacy with methadone use. Alternatively, risks may be managed by reframing weekly rewards as three separate month-long stages, increasing a sense of achievement that a particular stage has been achieved before any relapse.
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Tsai AG, Felton S, Hill JO, Atherly AJ. A randomized pilot trial of a full subsidy vs. a partial subsidy for obesity treatment. Obesity (Silver Spring) 2012; 20:1838-43. [PMID: 21720426 DOI: 10.1038/oby.2011.193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intensive obesity treatment is mandated by federal health care reform but is costly. A partial subsidy for obesity treatment could lower the cost of treatment, without reducing its efficacy. This study sought to test whether a partial subsidy for obesity treatment would be feasible, as compared to a fully subsidized intervention. The study was a pilot randomized trial. Participants (n = 50) were primary care patients with obesity and at least one comorbid condition (diabetes, hypertension, dyslipidemia, or obstructive sleep apnea). Each participant received eight weight loss counseling visits as well as portion-controlled foods for weight loss. Participants were randomized to full subsidy or partial subsidy (2 vs. 1 meal per day provided). The primary outcome was weight change after 4 months. Secondary outcomes included changes in blood pressure, waist circumference, and health-related quality of life. Participants in the full and partial subsidy groups lost 5.9 and 5.3 kg, equivalent to 5.3% and 5.1% of initial weight, respectively (P = 0.71). Changes in secondary outcomes were similar in the two groups. A partial subsidy was feasible and induced a clinically similar amount of weight loss, compared to a full subsidy. Large-scale testing of economic incentives for weight control is merited given the federal mandate to offer weight loss counseling to obese patients.
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Affiliation(s)
- Adam G Tsai
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
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Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA, Jacobs DR, Kraus WE, Kris-Etherton PM, Krummel DA, Popkin BM, Whitsel LP, Zakai NA. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 2012; 126:1514-63. [PMID: 22907934 DOI: 10.1161/cir.0b013e318260a20b] [Citation(s) in RCA: 412] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. METHODS AND RESULTS For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. CONCLUSIONS This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.
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Abstract
OBJECTIVE To evaluate the cost-effectiveness ratios of a nursing home-based incentivized Behavioral Weight Management Program (BWMP) from the employer's perspective. METHODS Seventy-two overweight and obese health care workers completed the BWMP (n = 35 incentivized; n = 37 nonincentivized). Weight change outcomes were compared for the pre- (0) and postintervention (28 weeks) follow-up periods within and between sites. Comprehensive estimates of BWMP direct program costs and avoided costs of absenteeism and productivity improvements were estimated to evaluate a business case. RESULTS There was a significant difference (P = 0.01) between the average per-participant weight change between incentivized sites (-7.4 lb) and nonincentivized sites (-2.2 lb). The cost-effectiveness ratios per pound of weight loss were $25.5 and $58.1, respectively. CONCLUSIONS In general, incentivized BWMPs were more cost effective. To generate a business case, enhancement in productivity becomes a critical factor and future research needs to investigate it further.
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Vojta D, De Sa J, Prospect T, Stevens S. Effective interventions for stemming the growing crisis of diabetes and prediabetes: a national payer's perspective. Health Aff (Millwood) 2012; 31:20-6. [PMID: 22232090 DOI: 10.1377/hlthaff.2011.0327] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Between a fifth and a third of US adults will have diabetes by midcentury, up from one in ten now, according to a government estimate. We project that over the next decade, around 40 million adults could have diabetes and 100 million could be diagnosed with its clinical precursor, prediabetes. Related health care spending could reach $512 billion annually in 2021. Evidence-based interventions can curb diabetes and its clinical complications, but little has been done to implement them on a wide scale. What's needed, among other measures, are new risk-assessment methods to identify subpopulations that will benefit most; the enrollment of consumers in new care models that support and encourage lifestyle change; partnerships with pharmacists, nurses, and health coaches; and new programs in Medicare and Medicaid that encourage patient engagement and lifestyle change.
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Affiliation(s)
- Deneen Vojta
- UnitedHealth Diabetes Prevention and Control Alliance, Minnetonka, Minnesota, USA.
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Abstract
Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be significantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for achieving evidence-based health goals. These rewards would be in the form of discounts towards co-payments for doctor's visits, procedures, and medications, thereby potentially reducing cost and compliance issues. A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program. Offering incentives to patients for reaching health goals has the potential to foster a stronger partnership between doctors and patients and improve health outcomes.
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Affiliation(s)
- Joanne Wu
- Northwest Primary Care, 7015 SE 22nd Ave., Portland, OR 97202, USA.
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77
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Galizzi MM. Label, nudge or tax? A review of health policies for risky behaviours. J Public Health Res 2012; 1:14-21. [PMID: 25170442 PMCID: PMC4140317 DOI: 10.4081/jphr.2012.e5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/27/2011] [Indexed: 11/23/2022] Open
Abstract
This work proposes a critical, non systematic, review of the three main lines of health policy interventions to deal with risky behaviours, such as over-eating, smoking, sedentary lives, and excess alcohol drinking, namely: i) the release of information on health risks and consequences; ii) the use of incentives; and iii) direct policy intervention in markets, through regulation and taxation. First, the health and economic impact of the risky behaviours epidemics are briefly described. Then a critical review follows on the evidence existing on the effectiveness of each type of intervention. The review will also highlight the public health approach staying beyond each type of policy on risky behaviours and critically consider them within the context of more general health and social policy interventions.
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Affiliation(s)
- Matteo M Galizzi
- Centre for the Study of Incentives in Health, The London School of Economics, UK
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Jensen JD, Hartmann H, de Mul A, Schuit A, Brug J. Economic incentives and nutritional behavior of children in the school setting: a systematic review. Nutr Rev 2012; 69:660-74. [PMID: 22029832 DOI: 10.1111/j.1753-4887.2011.00422.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the present review was to examine the existing literature on the effectiveness of economic incentives for producing sound nutritional behavior in schools. Studies published in the English-language literature that included baseline and/or outcome data regarding food and beverage intake of schoolchildren were eligible for inclusion. A systematic search of the literature was conducted to identify relevant primary studies and relevant systematic reviews of primary studies. Altogether, 3,472 research publications were identified in the systematic search, of which 50 papers were retrieved. Of these, 30 publications representing 28 studies fulfilled the criteria for inclusion. The studies addressing price incentives suggest that such incentives are effective for altering consumption in the school setting. Other types of economic incentives have been included in combined intervention schemes, but the inclusion of other intervention elements makes it difficult to draw conclusions about the effectiveness of the economic incentive instruments per se in these studies.
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Affiliation(s)
- Jørgen Dejgård Jensen
- Institute of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark.
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79
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Crane MM, Tate DF, Finkelstein EA, Linnan LA. Motivation for participating in a weight loss program and financial incentives: an analysis from a randomized trial. J Obes 2012; 2012:290589. [PMID: 22577524 PMCID: PMC3345232 DOI: 10.1155/2012/290589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/20/2012] [Accepted: 02/12/2012] [Indexed: 11/24/2022] Open
Abstract
This analysis investigated if changes in autonomous or controlled motivation for participation in a weight loss program differed between individuals offered a financial incentive for weight loss compared to individuals not offered an incentive. Additionally, the same relationships were tested among those who lost weight and either received or did not receive an incentive. This analysis used data from a year-long randomized worksite weight loss program that randomly assigned employees in each worksite to either a low-intensity weight loss program or the same program plus small financial incentives for weight loss ($5.00 per percentage of initial weight lost). There were no differences in changes between groups on motivation during the study, however, increases in autonomous motivation were consistently associated with greater weight losses. This suggests that the small incentives used in this program did not lead to increases in controlled motivation nor did they undermine autonomous motivation. Future studies are needed to evaluate the magnitude and timing of incentives to more fully understand the relationship between incentives and motivation.
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Affiliation(s)
- Melissa M. Crane
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, Campus Box 7294, Chapel Hill, NC 27514, USA
- *Melissa M. Crane:
| | - Deborah F. Tate
- Departments of Health Behavior and Nutrition, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, Campus Box 7294, Chapel Hill, NC 27514, USA
| | | | - Laura A. Linnan
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, Campus Box 7294, Chapel Hill, NC 27514, USA
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Reisinger HS, Brackett RH, Buzza CD, Páez MBW, Gourley R, Weg MWV, Christensen AJ, Kaboli PJ. "All the money in the world …" patient perspectives regarding the influence of financial incentives. Health Serv Res 2011; 46:1986-2004. [PMID: 21689098 DOI: 10.1111/j.1475-6773.2011.01287.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze patient perspectives of the use of financial incentives in a hypertension intervention. Study Setting. Twelve Veterans Affairs primary care clinics over a 9-month period. STUDY DESIGN Qualitative semistructured interviews conducted with 54 hypertensive veterans participating in an intervention to promote guideline-consistent therapy. Intervention components included an intervention letter requesting patients talk with their providers, an offer of U.S.$20 to bring in the letter to their provider, and a health educator phone call. DATA COLLECTION METHODS Semistructured interviews were conducted. Transcripts were coded for thematic content. The financial incentive theme was then subcoded for more detailed analysis. PRINCIPLE FINDINGS Most participants (n=48; 88.9 percent) stated the incentive had (or would have) no effect on their decision to initiate a discussion with their provider. Some participants articulated reservations about the effectiveness and/or appropriateness of financial incentives in health care decisions; however, a few expressed the opinion that there may be some potential benefits to the use of financial incentives if they encourage patients to be active in their health care. CONCLUSION The findings of this study raise questions about the appropriateness and unintended consequences of employing patient-directed financial incentives in health care settings.
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Affiliation(s)
- Heather Schacht Reisinger
- The Center for Comprehensive Access and Delivery Research and Evaluation-CADRE, the Iowa City VA Medical Center, Iowa City, IA, USA.
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Relton C, Strong M, Li J. The 'Pounds for Pounds' weight loss financial incentive scheme: an evaluation of a pilot in NHS Eastern and Coastal Kent. J Public Health (Oxf) 2011; 33:536-42. [DOI: 10.1093/pubmed/fdr030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cawley J, Ruhm CJ. The Economics of Risky Health Behaviors11We thank the editors of this Handbook, Pedro Pita Barros, Tom McGuire, and Mark Pauly, for their feedback and helpful guidance. We also thank the other authors in this volume for their valuable feedback and comments at the Authors’ Conference, and we are grateful to Abigail Friedman for transcribing the comments at that conference. HANDBOOK OF HEALTH ECONOMICS 2011. [DOI: 10.1016/b978-0-444-53592-4.00003-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Why are Financial Incentives not Effective at Influencing Some Smokers to Quit? Results of a Process Evaluation of a Worksite Trial Assessing the Efficacy of Financial Incentives for Smoking Cessation. J Occup Environ Med 2011; 53:62-7. [DOI: 10.1097/jom.0b013e31820061d7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Archer WR, Batan MC, Buchanan LR, Soler RE, Ramsey DC, Kirchhofer A, Reyes M. Promising Practices for the Prevention and Control of Obesity in the Worksite. Am J Health Promot 2011. [DOI: 10.4278/ajhp.080926-lit-220] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To identify worksite practices that show promise for promoting employee weight loss. Data Source. The following electronic databases were searched from January 1, 1966, through December 31, 2005: CARL Uncover (via Ingenta), CDP, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Library, CRISP, Dissertation Abstracts, EMBASE, ERIC, Health Canada, INFORM (part of ABI/INFORM Proquest), LocatorPlus, New York Academy of Medicine, Ovid MEDLINE, SPORTDiscus, PapersFirst, PsycINFO, PubMed, and TRIP. Study Inclusion and Exclusion Criteria. Included studies were published in English, conducted at a worksite, designed for adults (aged ≥18 years), and reported weight-related outcomes. Data Extraction. Data were extracted using an online abstraction form. Data Synthesis. Studies were evaluated on the basis of study design suitability quality of execution, sample size, and effect size. Changes in weight-related outcomes were used to assess effectiveness. Results. The following six promising practices were identified: enhanced access to opportunities for physical activity combined with health education, exercise prescriptions alone, multicomponent educational practices, weight loss competitions and incentives, behavioral practices with incentives, and behavioral practices without incentives. Conclusions. These practices will help employers and employees select programs that show promise for controlling and preventing obesity. (Am J Health Promot 2011;25[3]:e12–e26.)
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Affiliation(s)
- W. Roodly Archer
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Marilyn C. Batan
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Leigh Ramsey Buchanan
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Robin E. Soler
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - David C. Ramsey
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Ardine Kirchhofer
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
| | - Michele Reyes
- W. Roodly Archer, PhD, and David C. Ramsey, MPH, CHES, were with McKing Consulting Corporation, Atlanta, Georgia. Marilyn C. Batan, MPH; Leigh Ramsey Buchanan, PhD; Robin E. Soler, PhD; and Michele Reyes, PhD, are with the Centers for Disease Control and Prevention, Atlanta, Georgia. Ardine Kirchhofer, PhD, is with Youth Leadership for Global Health, Inc, Atlanta, Georgia
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85
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Madison KM, Volpp KG, Halpern SD. The law, policy, and ethics of employers' use of financial incentives to improve health. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2011; 39:450-468. [PMID: 21871042 DOI: 10.1111/j.1748-720x.2011.00614.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Patient Protection and Affordable Care Act (ACA) turns to a nontraditional mechanism to improve public health: employer-provided financial incentives for healthy behaviors. Critics raise questions about incentive programs' effectiveness, employer involvement, and potential discrimination. We support incentive program development despite these concerns. The ACA sets the stage for a broad-based research and implementation agenda through which we can learn to structure incentive programs to not only promote public health but also address prevalent concerns.
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Affiliation(s)
- Kristin M Madison
- Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
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86
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Halpern SD, Madison KM, Volpp KG. Patients as mercenaries?: the ethics of using financial incentives in the war on unhealthy behaviors. Circ Cardiovasc Qual Outcomes 2010; 2:514-6. [PMID: 20031885 DOI: 10.1161/circoutcomes.109.871855] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Scott D Halpern
- Center for Health Incentives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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87
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Carnethon M, Whitsel LP, Franklin BA, Kris-Etherton P, Milani R, Pratt CA, Wagner GR. Worksite wellness programs for cardiovascular disease prevention: a policy statement from the American Heart Association. Circulation 2009; 120:1725-41. [PMID: 19794121 DOI: 10.1161/circulationaha.109.192653] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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88
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Pearson SD, Lieber SR. Financial penalties for the unhealthy? Ethical guidelines for holding employees responsible for their health. Health Aff (Millwood) 2009; 28:845-52. [PMID: 19414897 DOI: 10.1377/hlthaff.28.3.845] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As health care costs continue to rise, an increasing number of self-insured employers are using financial rewards or penalties to promote healthy behavior and control costs. These incentive programs have triggered a backlash from those concerned that holding employees responsible for their health, particularly through the use of penalties, violates individual liberties and discriminates against the unhealthy. This paper offers an ethical analysis of employee health incentive programs and presents an argument for a set of conditions under which penalties can be used in an ethical and responsible way to contain health care costs and encourage healthy behavior among employees.
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Affiliation(s)
- Steven D Pearson
- National Institutes of Health (NIH) Clinical Center Department of Bioethics in Bethesda, Maryland, USA.
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89
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Donaldson JM, Normand MP. Using goal setting, self-monitoring, and feedback to increase calorie expenditure in obese adults. BEHAVIORAL INTERVENTIONS 2009. [DOI: 10.1002/bin.277] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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90
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Weiner BJ, Lewis MA, Linnan LA. Using organization theory to understand the determinants of effective implementation of worksite health promotion programs. HEALTH EDUCATION RESEARCH 2009; 24:292-305. [PMID: 18469319 DOI: 10.1093/her/cyn019] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.
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Affiliation(s)
- Bryan J Weiner
- Department of Health Policy.dministration, CB 7411, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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91
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Brown DS, Finkelstein EA, Brown DR, Buchner DM, Johnson FR. Estimating older adults' preferences for walking programs via conjoint analysis. Am J Prev Med 2009; 36:201-7.e4. [PMID: 19215845 DOI: 10.1016/j.amepre.2008.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 08/19/2008] [Accepted: 10/27/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical inactivity is a major driver of costly health problems, especially in older adults. Structured walking programs are one approach for increasing physical activity, although there is little information about how the characteristics of these programs influence their effectiveness. It was hypothesized that cash incentives would increase acceptability and effectiveness while a group participation requirement would place a net burden on participants. METHODS To measure preferences for specific characteristics of walking programs (i.e., minutes per day, days per week, organized or individual/informal group, cash incentive) and the likelihood of participation, a conjoint-analysis survey of 501 inactive adults aged >or=50 years was conducted in October 2006. Data were analyzed in 2007-2008. RESULTS The most-preferred program was three 20-minute walks per week. Respondents had a strong preference for programs conducted outside of a formal group setting. Offering an incentive of $9 in cash per week ($468 per year) increased predicted participation by 31%. CONCLUSIONS The results suggest that the characteristics of walking programs, such as whether they involve participation in a formal group, substantially influence their perceived acceptability and the likelihood of participation. The results also suggest that, independent of other program attributes, modest financial incentives increase the likelihood of program participation by sedentary older adults, and thus are a potential means to increase the effectiveness of walking programs.
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Affiliation(s)
- Derek S Brown
- Research Triangle Institute, Research Triangle Park, North Carolina, USA.
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92
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Volpp KG, Pauly MV, Loewenstein G, Bangsberg D. P4P4P: an agenda for research on pay-for-performance for patients. Health Aff (Millwood) 2009; 28:206-14. [PMID: 19124872 PMCID: PMC3507539 DOI: 10.1377/hlthaff.28.1.206] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Unhealthy behavior is a major cause of poor health outcomes and high health care costs. In this paper we describe an agenda for research to guide broader use of patient-targeted financial incentives, either in conjunction with provider-targeted financial incentives (pay-for-performance, or P4P) or in clinical contexts where provider-targeted approaches are unlikely to be effective. We discuss evidence of proven effectiveness and limitations of the existing evidence, reasons for underuse of these approaches, and options for achieving wider use. Patient-targeted incentives have great potential, and systematic testing will help determine how they can best be used to improve population health.
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Affiliation(s)
- Kevin G Volpp
- Center for Health Incentives, Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, USA.
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93
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Volpp KG, John LK, Troxel AB, Norton L, Fassbender J, Loewenstein G. Financial incentive-based approaches for weight loss: a randomized trial. JAMA 2008; 300:2631-7. [PMID: 19066383 PMCID: PMC3583583 DOI: 10.1001/jama.2008.804] [Citation(s) in RCA: 520] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Identifying effective obesity treatment is both a clinical challenge and a public health priority due to the health consequences of obesity. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS 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. MAIN OUTCOME MEASURES Weight loss after 16 weeks. RESULTS 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. CONCLUSIONS 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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00520611.
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Affiliation(s)
- Kevin G Volpp
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA.
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94
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Authors’ Response. J Occup Environ Med 2008. [DOI: 10.1097/jom.0b013e31818bc43d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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95
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Long JA, Helweg-Larsen M, Volpp KG. Patient opinions regarding 'pay for performance for patients'. J Gen Intern Med 2008; 23:1647-52. [PMID: 18663540 PMCID: PMC2533373 DOI: 10.1007/s11606-008-0739-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 06/05/2008] [Accepted: 06/27/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown. OBJECTIVE To assess patients' opinion of the acceptability of P4P4P. DESIGN Cross-sectional self-administered survey. PARTICIPANTS Patients in waiting rooms in two university-based primary care clinics. MEASUREMENTS Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes. RESULTS Respondents were split on whether P4P4P is desirable. Thirty-six to 42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41-44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts. CONCLUSIONS Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance.
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Affiliation(s)
- Judith A Long
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, PA, USA.
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96
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Lightfoot JT. Commentary on viewpoint: Perspective on the future use of genomics in exercise prescription. J Appl Physiol (1985) 2008; 104:1249. [PMID: 18385304 DOI: 10.1152/japplphysiol.00014.2008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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97
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Allison DB, Downey M, Atkinson RL, Billington CJ, Bray GA, Eckel RH, Finkelstein EA, Jensen MD, Tremblay A. Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity (Silver Spring) 2008; 16:1161-77. [PMID: 18464753 DOI: 10.1038/oby.2008.231] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- David B Allison
- Department of Biostatistics and Clinical Nutrition Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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