A Randomized, Controlled Trial of Lottery-Based Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults

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

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.

TRIAL REGISTRATION

This study is registered at www.isrctn.com ISRCTN24436134.

Gamification Use and Design in Popular Health and Fitness Mobile Applications

PURPOSE

To evaluate the presence of gamification in popular mobile applications and whether principles from behavioral economics were incorporated in the design.

DESIGN

The top 50 ranked free health and fitness applications were downloaded. Gamification elements were predetermined through literature review, and applications were evaluated for their presence.

SETTING

App Store by Apple Inc.

MEASURES

Presence of gamification, type of game element, and use of behavioral economic principles.

ANALYSIS

We classified the types and frequencies of targeted behaviors and features of gamification. Use of behavioral economic principles focused on designing rewards or points using loss aversion (allocated upfront and could be lost), variable reinforcement (not allocated constantly), and probability inflation (using drawings or lottery designs).

RESULTS

Gamification was used by 64% of mobile applications. Most applications that included gamification (97%) targeted behaviors related to physical activity and weight loss. Applications focused on other areas such as reproductive health, meditation, and sleep used gamification less often (11%). Game elements used most commonly included goal setting (78%), social influences (78%), and challenges (63%), while less common elements included points (6%) and levels (3%). No applications incorporated behavioral economics principles specified in the study.

CONCLUSIONS

Gamification was commonly used by popular health and fitness mobile applications, but none used the specified behavioral economic principles to design rewards or points. Mobile applications could potentially improve their use if their design better leveraged principles from behavioral economics.