151
|
Losina E, Yang HY, Deshpande BR, Katz JN, Collins JE. Physical activity and unplanned illness-related work absenteeism: Data from an employee wellness program. PLoS One 2017; 12:e0176872. [PMID: 28472084 PMCID: PMC5417546 DOI: 10.1371/journal.pone.0176872] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Illness-related absenteeism is a major threat to work productivity. Our objective was to assess the relationship between physical activity and unplanned illness-related absenteeism from work. METHODS We implemented physical activity program for sedentary non-clinician employees of a tertiary medical center. Financial rewards were available for reaching accelerometer-measured ambulatory physical activity goals over a 24-week period. We categorized participants into three groups based on mean levels of physical activity: low (0-74 min/week), medium (75-149 min/week) and meeting CDC guidelines (≥150 min/week). We built a multivariable Poisson regression model to evaluate the relationship between physical activity and rates of unplanned illness-related absenteeism. RESULTS The sample consisted of 292 employees who participated in the program. Their mean age was 38 years (SD 11), 83% were female, and 38% were obese. Over the 24 intervention weeks, participants engaged in a mean of 90 min/week (SD 74) of physical activity and missed a mean of 14 hours of work (SD 38) due to illness. Unplanned absenteeism due to illness was associated with physical activity. As compared to the group meeting CDC guidelines, in multivariable analyses those in the medium physical activity group had a 2.4 (95% CI 1.3-4.5) fold higher rate of illness-related absenteeism and those in the lowest physical activity group had a 3.5 (95% CI 1.7-7.2) fold higher rate of illness-related absenteeism. DISCUSSION Less physical activity was associated with more illness-related absenteeism. Workforce-based interventions to increase physical activity may thus be a promising vehicle to reduce unplanned illness-related absenteeism.
Collapse
Affiliation(s)
- Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Heidi Y. Yang
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Bhushan R. Deshpande
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
152
|
Harkins KA, Kullgren JT, Bellamy SL, Karlawish J, Glanz K. A Trial of Financial and Social Incentives to Increase Older Adults' Walking. Am J Prev Med 2017; 52:e123-e130. [PMID: 28062271 DOI: 10.1016/j.amepre.2016.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/21/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults' motivation to become active. This study tested the effects of financial incentives, donations to charity, and the combined effects of both interventions on older adults' uptake and retention of increased levels of walking. STUDY DESIGN RCT comparing three interventions to control. Data collection occurred from 2012 to 2013. Analyses were conducted in 2013-2016. PARTICIPANTS Ninety-four adults aged ≥65 years from Philadelphia-area retirement communities. INTERVENTION All participants received digital pedometers, walking goals of a 50% increase in daily steps, and weekly feedback on goal attainment. Participants were randomized to one of four groups: (1) Control: received weekly feedback only; (2) Financial Incentives: received payment of $20 each week walking goals were met; (3) Social Goals: received donation of $20 to a charity of choice each week walking goals were met; and (4) Combined: received $20 each week walking goals were met that could be received by participant, donated to a charity of choice, or divided between the participant and charity. MAIN OUTCOME MEASURES Mean proportion of days walking goals were met during the 16-week intervention and 4-week follow-up period. RESULTS After adjusting for baseline walking, the proportion of days step goals were met during the 16-week intervention period was higher in all intervention groups versus controls (relative risk, 3.71; 95% CI=1.37, 10.01). During the 4-week follow up period, the proportion of days step goals were met did not differ in intervention groups compared to control (relative risk, 2.91; 95% CI=0.62, 13.64). CONCLUSIONS Incentive schemes that use donations to a charity of choice, personal financial incentives, or a combination of the two can each increase older adults' initial uptake of increased levels of walking. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01643538.
Collapse
Affiliation(s)
- Kristin A Harkins
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey T Kullgren
- VA Center for Clinical Management Research and University of Michigan Medical School, Ann Arbor, Michigan
| | - Scarlett L Bellamy
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jason Karlawish
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Glanz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
153
|
Dallery J, Raiff BR, Kim SJ, Marsch LA, Stitzer M, Grabinski MJ. Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial. Addiction 2017; 112:875-883. [PMID: 27923264 PMCID: PMC5382065 DOI: 10.1111/add.13715] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/30/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers. DESIGN Randomized controlled trial with 3- and 6-month follow-ups. SETTING United States. PARTICIPANTS Smokers (n = 94) from 26 states were enrolled (mean age 36, 56% female). INTERVENTION AND COMPARATOR Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. MEASURES The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0-100-mm visual analog scale. FINDINGS Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6-12.3], but not at the 3- (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6-4.4) or 6- (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7-5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1-4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6-3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = -10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. CONCLUSIONS A contingency management/financial incentive program delivered via the internet improved short-term abstinence rates compared with an internet program without the incentives.
Collapse
Affiliation(s)
- Jesse Dallery
- University of Florida, Gainesville, FL, National Development and Research Institutes, New York, NY
| | | | | | | | - Maxine Stitzer
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | |
Collapse
|
154
|
Adams MA, Hurley JC, Todd M, Bhuiyan N, Jarrett CL, Tucker WJ, Hollingshead KE, Angadi SS. Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to increase adults' physical activity. BMC Public Health 2017; 17:286. [PMID: 28356097 PMCID: PMC5372290 DOI: 10.1186/s12889-017-4197-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background Emerging interventions that rely on and harness variability in behavior to adapt to individual performance over time may outperform interventions that prescribe static goals (e.g., 10,000 steps/day). The purpose of this factorial trial was to compare adaptive vs. static goal setting and immediate vs. delayed, non-contingent financial rewards for increasing free-living physical activity (PA). Methods A 4-month 2 × 2 factorial randomized controlled trial tested main effects for goal setting (adaptive vs. static goals) and rewards (immediate vs. delayed) and interactions between factors to increase steps/day as measured by a Fitbit Zip. Moderate-to-vigorous PA (MVPA) minutes/day was examined as a secondary outcome. Results Participants (N = 96) were mainly female (77%), aged 41 ± 9.5 years, and all were insufficiently active and overweight/obese (mean BMI = 34.1 ± 6.2). Participants across all groups increased by 2389 steps/day on average from baseline to intervention phase (p < .001). Participants receiving static goals showed a stronger increase in steps per day from baseline phase to intervention phase (2630 steps/day) than those receiving adaptive goals (2149 steps/day; difference = 482 steps/day, p = .095). Participants receiving immediate rewards showed stronger improvement (2762 step/day increase) from baseline to intervention phase than those receiving delayed rewards (2016 steps/day increase; difference = 746 steps/day, p = .009). However, the adaptive goals group showed a slower decrease in steps/day from the beginning of the intervention phase to the end of the intervention phase (i.e. less than half the rate) compared to the static goals group (−7.7 steps vs. -18.3 steps each day; difference = 10.7 steps/day, p < .001) resulting in better improvements for the adaptive goals group by study end. Rate of change over the intervention phase did not differ between reward groups. Significant goal phase x goal setting x reward interactions were observed. Conclusions Adaptive goals outperformed static goals (i.e., 10,000 steps) over a 4-month period. Small immediate rewards outperformed larger, delayed rewards. Adaptive goals with either immediate or delayed rewards should be preferred for promoting PA. Trial Registration ClinicalTrials.gov ID: NCT02053259 registered prospectively on January 31, 2014.
Collapse
Affiliation(s)
- Marc A Adams
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA. .,Global Institute of Sustainability (GIOS), Arizona State University, Tempe, AZ, 85287, USA.
| | - Jane C Hurley
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Michael Todd
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA.,College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85004, USA
| | - Nishat Bhuiyan
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Catherine L Jarrett
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Wesley J Tucker
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Kevin E Hollingshead
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| | - Siddhartha S Angadi
- College of Health Solutions, Arizona State University, 425 North 5th Street (MC9020), Phoenix, AZ, 85004, USA
| |
Collapse
|
155
|
Kranker K. The Efficacy of Using Financial Incentives to Change Unhealthy Behaviors Among a Rural Chronically Ill and Uninsured Population. Am J Health Promot 2017; 32:301-311. [PMID: 28279086 DOI: 10.1177/0890117117696621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To measure the effects of weight loss, medication compliance, and physical activity financial incentives delivered by health providers to uninsured patients. DESIGN Full factorial (orthogonal) randomized design. SETTING Primary care clinic in rural Mississippi. PARTICIPANTS A total of 544 uninsured adult patients with diabetes or hypertension. All patients were enrolled in the clinic's care management program. INTERVENTION Patients randomly received 0, 1, 2, or 3 financial incentives. Incentives for weight loss, medication compliance, and physical activity were awarded quarterly over 1 year. MEASURES Weight loss, medication compliance, physical activity, and 6 clinical measures related to diabetes and hypertension. ANALYSIS Cross-section and panel data regression models were used to compare outcomes for those who received incentives to those who did not receive incentives and to measure interaction effects. RESULTS Effects of the weight loss incentive were positive but statistically insignificant (-3.7 lb; P = .106), while medication compliance was high in both the treatment and control groups (+2.37 percentage points; P = .411), and physical activity take-up was very limited. Effects on clinical outcomes, as well as interaction effects between incentives, were mixed and generally statistically insignificant. CONCLUSION This study found little to no evidence that these financial incentives had beneficial effects on the incentivized behaviors in this setting. Likewise, the study found no effects on clinical outcomes nor any systematic evidence of interaction effects between 2 and 3 incentives.
Collapse
Affiliation(s)
- Keith Kranker
- 1 Mathematica Policy Research Inc, Princeton, NJ, USA
| |
Collapse
|
156
|
Zivin K, Sen A, Plegue MA, Maciejewski ML, Segar ML, AuYoung M, Miller EM, Janney CA, Zulman DM, Richardson CR. Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees. Am J Prev Med 2017; 52:347-352. [PMID: 27866825 DOI: 10.1016/j.amepre.2016.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/22/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. METHODS This nonrandomized comparative effectiveness study evaluated changes in healthcare costs for participants in two incentivized programs, an Internet-mediated pedometer-based walking program (WalkingSpree, n=7,594) and an in-person weight-loss program (Weight Watchers, n=5,764). The primary outcome was the change in total healthcare costs from the baseline year to the year after program participation. Data were collected from 2009 to 2011 and the analysis was done in 2014-2015. RESULTS After 1 year, unadjusted mean costs decreased in both programs, with larger decreases for Weight Watchers participants than WalkingSpree participants (-$1,055.39 vs -$577.10, p=0.019). This difference was driven by higher rates of women in Weight Watchers, higher baseline total costs among women, and a greater decrease in costs for women in Weight Watchers (-$1,037.60 vs -$388.50, p=0.014). After adjustment for baseline costs, there were no differences by program or gender. CONCLUSIONS Comparable cost reductions in both programs suggest that employers may want to offer more than one choice of incentivized wellness program with monitoring to meet the diverse needs of employees.
Collapse
Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Ananda Sen
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michelle L Segar
- Sport, Health, Activity Research and Policy (SHARP) Center, University of Michigan, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
| | - Mona AuYoung
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Erin M Miller
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Carol A Janney
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Michigan State University College of Human Medicine, Midland, Michigan
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; Division of General Medical Disciplines, Stanford University, Stanford, California
| | - Caroline R Richardson
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| |
Collapse
|
157
|
Employer and Employee Opinions About Workplace Health Promotion (Wellness) Programs. J Occup Environ Med 2017; 59:256-263. [DOI: 10.1097/jom.0000000000000946] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
158
|
Sullivan AN, Lachman ME. Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity. Front Public Health 2017; 4:289. [PMID: 28123997 PMCID: PMC5225122 DOI: 10.3389/fpubh.2016.00289] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
Physical activity is closely linked with health and well-being; however, many Americans do not engage in regular exercise. Older adults and those with low socioeconomic status are especially at risk for poor health, largely due to their sedentary lifestyles. Fitness technology, including trackers and smartphone applications (apps), has become increasingly popular for measuring and encouraging physical activity in recent years. However, many questions remain regarding the effectiveness of this technology for promoting behavior change. Behavior change techniques such as goal setting, feedback, rewards, and social factors are often included in fitness technology. However, it is not clear which components are most effective and which are actually being used by consumers. We discuss additional strategies not typically included in fitness technology devices or apps that are promising for engaging inactive, vulnerable populations. These include action planning, restructuring negative attitudes, enhancing environmental conditions, and identifying other barriers to regular physical activity. We consider which strategies are most conducive to motivating behavior change among sedentary adults. Overall, fitness technology has the potential to significantly impact public health, research, and policies. We suggest ways in which app developers and behavior change experts can collaborate to develop successful apps. Advances are still needed to help inactive individuals determine how, when, where, and with whom they can increase their physical activity.
Collapse
|
159
|
Weinstock J, Farney MR, Elrod NM, Henderson CE, Weiss EP. Exercise as an Adjunctive Treatment for Substance Use Disorders: Rationale and Intervention Description. J Subst Abuse Treat 2017; 72:40-47. [PMID: 27666958 PMCID: PMC5289308 DOI: 10.1016/j.jsat.2016.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/25/2016] [Accepted: 09/04/2016] [Indexed: 11/26/2022]
Abstract
Substance use disorders (SUDs) are maladaptive patterns of substance use that are associated with psychiatric comorbidity, unhealthy lifestyle choices, and high rates of relapse. Exercise is associated with a wide range of acute and long-term benefits for both mental and physical health and is presently being investigated as a promising adjunctive treatment for SUD. Despite positive effects of regular physical activity on treatment outcomes and risk factors for relapse, low adherence and high attrition rates limit the benefits derived from exercise interventions. Lack of motivation is one of many perceived barriers to initiating exercise that contributes to poor adherence to interventions. In the present article, we describe the protocol for a novel, integrated exercise intervention that combines motivational interviewing (MI), a client-centered approach designed to enhance intrinsic motivation and resolve ambivalence toward change, and contingency management (CM), a behavioral treatment that provides monetary incentives for the completion of target behaviors. The protocol seeks to address the challenges surrounding initiation and maintenance of an exercise program at a level consistent with public health guidelines, particularly for sedentary patients. We conclude with considerations for the implementation of the intervention in SUD specific clinics.
Collapse
|
160
|
Mitchell M, White L, Oh P, Kwan M, Gove P, Leahey T, Faulkner G. Examining Incentives to Promote Physical Activity Maintenance Among Hospital Employees Not Achieving 10,000 Daily Steps: A Web-Based Randomized Controlled Trial Protocol. JMIR Res Protoc 2016; 5:e231. [PMID: 27956377 PMCID: PMC5187449 DOI: 10.2196/resprot.6285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/13/2016] [Accepted: 10/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The economic burden of physical inactivity in Canada is estimated at Can $6.8 billion (US $5 billion) per year. Employers bear a substantial proportion of the economic costs, as they pay more for inactive workers in health care and other organizational costs. In response, many Canadian employers offer wellness programs, though these are often underutilized. While financial health incentives have been proposed as one way of increasing participation, their longer term effects (ie postintervention effects) are not clear. OBJECTIVE The objective of this paper is to outline the methodology for a randomized control trial (RCT) examining the longer term impact of an existing physical activity promotion program that is enhanced by adding guaranteed rewards (Can $1 [US $0.74] per day step goal met) in a lower active hospital employee population (less than 10,000 steps per day). METHODS A 12-week, parallel-arm RCT (with a 12-week postintervention follow-up) will be employed. Employees using Change4Life (a fully automated, incentive-based wellness program) and accumulating fewer than 10,000 steps per day at baseline (weeks 1 to 2) will be randomly allocated (1:1) to standard care (wellness program, accelerometer) or an intervention group (standard care plus guaranteed incentives). All study participants will be asked to wear the accelerometer and synchronize it to Change4Life daily, although only intervention group participants will receive guaranteed incentives for reaching tailored daily step count goals (Can $1 [US $0.74] per day; weeks 3 to 12). The primary study outcome will be mean proportion of participant-days step goal reached during the postintervention follow-up period (week 24). Mean proportion of participant-days step goal reached during the intervention period (week 12) will be a secondary outcome. RESULTS Enrollment for the study will be completed in February 2017. Data analysis will commence in September 2017. Study results are to be published in the winter of 2018. CONCLUSIONS This protocol was designed to examine the impact of guaranteed rewards on physical activity maintenance in lower active hospital employees. CLINICALTRIAL ClinicalTrials.gov NCT02638675; https://clinicaltrials.gov/ct2/show/NCT0 2638675 (Archived by WebCite at http://www.webcitation.org/6g4pvZvhW).
Collapse
Affiliation(s)
- Marc Mitchell
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Lauren White
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Matthew Kwan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Peter Gove
- Green Shield Canada Inc, Toronto, ON, Canada
| | - Tricia Leahey
- University of Connecticut, Storrs, CT, United States
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
161
|
Weinstock J, Petry NM, Pescatello LS, Henderson CE. Sedentary college student drinkers can start exercising and reduce drinking after intervention. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:791-801. [PMID: 27669095 PMCID: PMC5687258 DOI: 10.1037/adb0000207] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavy drinking by college students is exceedingly harmful to the individuals and to the overall college environment. Current interventions to reduce drinking and negative consequences are infrequently utilized. This randomized clinical trial examined an alternative approach that sought to increase exercise behavior, a substance free activity, in sedentary heavy drinking college students. Participants (N = 70) were randomized to an 8-week exercise intervention: (a) motivational interviewing plus weekly exercise contracting (MI + EC) or (b) motivational interviewing and weekly contingency management for exercise (MI + CM). Follow-up evaluations occurred at posttreatment (2 months) and 6 months post baseline. Participants in both interventions significantly increased exercise frequency initially, and the MI + CM participants exercised significantly more than the MI + EC intervention participants during the intervention period (d = 1.70). Exercise behavior decreased during the follow-up period in both groups. Significant reductions in drinking behaviors and consequences were noted over time, but were not related to changes in exercise or the interventions (ds ≤ 0.01). This study underscores the complex nature of promoting 1 specific health behavior change with the goal of changing another. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - Nancy M Petry
- Department of Medicine, University of Connecticut Health Center
| | | | | |
Collapse
|
162
|
Gopalan A, Paramanund J, Shaw PA, Patel D, Friedman J, Brophy C, Buttenheim AM, Troxel AB, Asch DA, Volpp KG. Randomised controlled trial of alternative messages to increase enrolment in a healthy food programme among individuals with diabetes. BMJ Open 2016; 6:e012009. [PMID: 27903559 PMCID: PMC5168560 DOI: 10.1136/bmjopen-2016-012009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We compared the effectiveness of diabetes-focused messaging strategies at increasing enrolment in a healthy food programme among adults with diabetes. METHODS Vitality is a multifaceted wellness benefit available to members of Discovery Health, a South Africa-based health insurer. One of the largest Vitality programmes is HealthyFood (HF), an incentive-based programme designed to encourage healthier diets by providing up to 25% cashback on healthy food purchases. We randomised adults with type 2 diabetes to 1 of 5 arms: (1) control, (2) a diabetes-specific message, (3) a message with a recommendation of HF written from the perspective of a HF member with diabetes, (4) a message containing a physician's recommendation of HF, or (5) the diabetes-specific message from arm 2 paired with an 'enhanced active choice'(EAC). In an EAC, readers are asked to make an immediate choice (in this case, to enrol or not enrol); the pros and cons associated with the preferred and non-preferred options are highlighted. HF enrolment was assessed 1 month following the first emailed message. RESULTS We randomised 3906 members. After excluding those who enrolled in HF or departed from the Vitality programme before the first intervention email, 3665 (94%) were included in a modified intent-to-treat analysis. All 4 experimental arms had significantly higher HF enrolment rates compared with control (p<0.0001 for all comparisons). When comparing experimental arms, the diabetes-specific message with the EAC had a significantly higher enrolment rate (12.6%) than the diabetes-specific message alone (7.6%, p=0.0016). CONCLUSIONS Messages focused on diabetes were effective at increasing enrolment in a healthy food programme. The addition of a framed active choice to a message significantly raised enrolment rates in this population. These findings suggest that simple, low-cost interventions can enhance enrolment in health promoting programmes and also be pragmatically tested within those programmes. TRIAL REGISTRATION NUMBER NCT02462057.
Collapse
Affiliation(s)
- A Gopalan
- Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - P A Shaw
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D Patel
- Discovery Vitality, Johannesburg, South Africa
| | - J Friedman
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Brophy
- Vitality USA, New York, New York, USA
| | - A M Buttenheim
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Community and Family Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - A B Troxel
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - D A Asch
- Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K G Volpp
- Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
163
|
Weinstock J, Petry NM. Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults. Ann Intern Med 2016; 165:599. [PMID: 27750317 PMCID: PMC5503470 DOI: 10.7326/l16-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jeremiah Weinstock
- From Saint Louis University, St. Louis, Missouri, and University of Connecticut Health Center, Farmington, Connecticut
| | - Nancy M Petry
- From Saint Louis University, St. Louis, Missouri, and University of Connecticut Health Center, Farmington, Connecticut
| |
Collapse
|
164
|
Kowatsch T, Kramer JN, Kehr F, Wahle F, Elser N, Fleisch E. Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e181. [PMID: 27624645 PMCID: PMC5039333 DOI: 10.2196/resprot.6089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/12/2016] [Accepted: 08/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research has so far benefited from the use of pedometers in physical activity interventions. However, when public health institutions (eg, insurance companies) implement pedometer-based interventions in practice, people may refrain from participating due to privacy concerns. This might greatly limit the applicability of such interventions. Financial incentives have been successfully used to influence both health behavior and privacy concerns, and may thus have a beneficial effect on the acceptance of pedometer-based interventions. OBJECTIVE This paper presents the design and baseline characteristics of a cluster-randomized controlled trial that seeks to examine the effect of financial incentives on the acceptance of and adherence to a pedometer-based physical activity intervention offered by a health insurance company. METHODS More than 18,000 customers of a large Swiss health insurance company were allocated to a financial incentive, a charitable incentive, or a control group and invited to participate in a health prevention program. Participants used a pedometer to track their daily physical activity over the course of 6 months. A Web-based questionnaire was administered at the beginning and at the end of the intervention and additional data was provided by the insurance company. The primary outcome of the study will be the participation rate, secondary outcomes will be adherence to the prevention program, physical activity, and health status of the participants among others. RESULTS Baseline characteristics indicate that residence of participants, baseline physical activity, and subjective health should be used as covariates in the statistical analysis of the secondary outcomes of the study. CONCLUSIONS This is the first study in western cultures testing the effectiveness of financial incentives with regard to a pedometer-based health intervention offered by a large health insurer to their customers. Given that the incentives prove to be effective, this study provides the basis for powerful health prevention programs of public health institutions that are easy to implement and can reach large numbers of people in need.
Collapse
Affiliation(s)
- Tobias Kowatsch
- Institute of Technology Management (ITEM), University of St Gallen, St. Gallen, Switzerland.
| | | | | | | | | | | |
Collapse
|
165
|
|
166
|
Mitchell MS, Oh PI. Capsule Commentary on Misra-Hebert et al., Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis. J Gen Intern Med 2016; 31:926. [PMID: 27114359 PMCID: PMC4945573 DOI: 10.1007/s11606-016-3716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marc S Mitchell
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada.
| | - Paul I Oh
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada
| |
Collapse
|
167
|
Terry PE, Pshock J, O'Donnell MP, Cawley J, Karen H, Whitsel L, Calitz C, Fonarow GC, Terry P. The Art of Health Promotion ideas for improving health outcomes. Am J Health Promot 2016; 30:475. [PMID: 27445328 DOI: 10.1177/0890117116658726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paul E Terry
- HERO: The Health Enhancement Research OrganizationEditor, The Art of Health Promotion
| | | | | | | | | | | | | | | | | |
Collapse
|
168
|
Walk Long and Prosper: What Is the Optimal Way to Help People Achieve Their Goals? J Gen Intern Med 2016; 31:712-3. [PMID: 27114356 PMCID: PMC4907962 DOI: 10.1007/s11606-016-3709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
169
|
van der Swaluw K, Lambooij MS, Mathijssen JJP, Schipper M, Zeelenberg M, Polder JJ, Prast HM. Design and protocol of the weight loss lottery- a cluster randomized trial. Contemp Clin Trials 2016; 49:109-15. [PMID: 27346173 DOI: 10.1016/j.cct.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 12/17/2022]
Abstract
People often intend to exercise but find it difficult to attend their gyms on a regular basis. At times, people seek and accept deadlines with consequences to realize their own goals (i.e. commitment devices). The aim of our cluster randomized controlled trial is to test whether a lottery-based commitment device can promote regular gym attendance. The winners of the lottery always get feedback on the outcome but can only claim their prize if they attended their gyms on a regular basis. In this paper we present the design and baseline characteristics of a three-arm trial which is performed with 163 overweight participants in six in-company fitness centers in the Netherlands.
Collapse
Affiliation(s)
- Koen van der Swaluw
- Tilburg University, Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE Tilburg, The Netherlands.
| | - Mattijs S Lambooij
- National Institute of Public Health and the Environment (RIVM), Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Jolanda J P Mathijssen
- Tilburg University, Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Maarten Schipper
- National Institute of Public Health and the Environment (RIVM), Department of Statistics, Informatics and Modelling, Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Marcel Zeelenberg
- Tilburg University, Department of Social Psychology, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Johan J Polder
- Tilburg University, Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE Tilburg, The Netherlands; National Institute of Public Health and the Environment (RIVM), Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Henriëtte M Prast
- Tilburg University, Department of Finance, Tilburg School of Economics and Management, PO Box 90153, 5000 LE Tilburg, The Netherlands
| |
Collapse
|