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Ladapo JA, Orstad SL, Wylie-Rosett J, Tseng CH, Chung UYR, Patel NR, Shu SB, Goldstein NJ, Wali S, Jay M. Cost-effectiveness of goal-directed and outcome-based financial incentives for weight loss in low-income populations: the FIReWoRk randomized clinical trial. Int J Obes (Lond) 2024; 48:231-239. [PMID: 37919433 DOI: 10.1038/s41366-023-01404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The Financial Incentives for Weight Reduction (FIReWoRk) clinical trial showed that financial incentive weight-loss strategies designed using behavioral economics were more effective than provision of weight-management resources only. We now evaluate cost-effectiveness. METHODS Cost-effectiveness analysis of a multisite randomized trial enrolling 668 participants with obesity living in low-income neighborhoods. Participants were randomized to (1) goal-directed incentives (targeting behavioral goals), (2) outcome-based incentives (targeting weight-loss), and (3) resources only, which were provided to all participants and included a 1-year commercial weight-loss program membership, wearable activity monitor, food journal, and digital scale. We assessed program costs, time costs, quality of life, weight, and incremental cost-effectiveness in dollars-per-kilogram lost. RESULTS Mean program costs at 12 months, based on weight loss program attendance, physical activity participation, food diary use, self-monitoring of weight, and incentive payments was $1271 in the goal-directed group, $1194 in the outcome-based group, and $834 in the resources-only group (difference, $437 [95% CI, 398 to 462] and $360 [95% CI, 341-363] for goal-directed or outcome-based vs resources-only, respectively; difference, $77 [95% CI, 58-130] for goal-directed vs outcome-based group). Quality of life did not differ significantly between the groups, but weight loss was substantially greater in the incentive groups (difference, 2.34 kg [95% CI, 0.53-4.14] and 1.79 kg [95% CI, -0.14 to 3.72] for goal-directed or outcome-based vs resources only, respectively; difference, 0.54 kg [95% CI, -1.29 to 2.38] for goal-directed vs outcome-based). Cost-effectiveness of incentive strategies based on program costs was $189/kg lost in the goal-directed group (95% CI, $124/kg to $383/kg) and $186/kg lost in the outcome-based group (95% CI, $113/kg to $530/kg). CONCLUSIONS Goal-directed and outcome-based financial incentives were cost-effective strategies for helping low-income individuals with obesity lose weight. Their incremental cost per kilogram lost were comparable to other weight loss interventions.
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Affiliation(s)
- Joseph A Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Un Young Rebecca Chung
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikhil R Patel
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Suzanne B Shu
- Cornell Dyson School of Applied Economics and Management, Ithaca, NY, USA
| | | | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Melanie Jay
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
- Veterans Affairs, New York Harbor, New York, NY, USA
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2
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Green L, Taddei-Allen P. Shifting paradigms: Reframing coverage of antiobesity medications for plan sponsors. J Manag Care Spec Pharm 2023; 29:564-568. [PMID: 37121250 PMCID: PMC10387974 DOI: 10.18553/jmcp.2023.29.5.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
| | - Patty Taddei-Allen
- School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL
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3
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Boonmanunt S, Pattanaprateep O, Ongphiphadhanakul B, McKay G, Attia J, Vlaev I, Thakkinstian A. Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. Ann Behav Med 2022; 57:277-287. [PMID: 36367428 PMCID: PMC10094952 DOI: 10.1093/abm/kaac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Healthy diet, weight control and physical activity to reduce obesity can be motivated by financial incentives (FI). Behavioral-economic approaches may improve the incentivization effectiveness. This study compares and ranks the effectiveness of standard and behavioral incentivization for healthy diet, weight control, and physical activity promotion.
Purpose
To investigate whether behavioral-economic insights improve incentivization effectiveness.
Methods
A systematic search of Medline and Scopus was performed from database inception to December 2020. Study characteristics, program designs, and risk ratio (RR) were extracted. A two-stage network meta-analysis pooled and ranked intervention effects.
Results
There were 35 eligible RCTs. For diet-weight control, standard FI, deposit contract (deposit), lottery-based incentive (lottery), and standard-FI + lottery increased goal achievement compared to no-FI but only deposit was statistically significant with pooled RRs and 95% confidence intervals (CI) of 1.21 (0.94, 1.56), 1.79 (1.04, 3.05), 1.45 (0.99, 2.13), and 1.73 (0.83, 3.63). For physical activity, standard-FI, deposit, and lottery significantly increased goal achievement compared to no-FI, with pooled RRs of 1.38 (1.13, 1.68), 1.63 (1.24, 2.14) and 1.43 (1.14, 1.80), respectively. In a follow-up period for physical activity, only deposit significantly increased goal achievement compared to no-FI, with pooled RRs of 1.39 (1.11, 1.73).
Conclusion
Deposit, followed by lottery, were best for motivating healthy diet, weight control and physical activity at program end. Post-intervention, deposit then standard-FI were best for motivating physical activity. Behavioral insights can improve incentivization effectiveness, although lottery-based approaches may offer only short-term benefit regarding physical activity. However, the imprecise intervention effects were major concerns.
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Affiliation(s)
- Suparee Boonmanunt
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
| | - Boonsong Ongphiphadhanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
| | - Gareth McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast , 97 Lisburn Road, Whitla Medical Building, BT9 7BL Belfast , UK
| | - John Attia
- School of Medicine and Public Health, University of Newcastle , Kookaburra Circuit, John Hunter Hospital Campus, New Lambton, NSW 2305 , Australia
- Hunter Medical Research Institute , Kookaburra Circuit, John Hunter Hospital Campus, New Lambton, NSW 2305 , Australia
| | - Ivo Vlaev
- Warwick Business School, University of Warwick , Coventry CV4 7AL , UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , 270 Rama VI Road, Pyathai, Bangkok 10400 , Thailand
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Krukowski RA, Harvey JR, Naud S, Finkelstein EA, West DS. Perspectives on the Form, Magnitude, Certainty, Target, and Frequency of Financial Incentives in a Weight Loss Program. Am J Health Promot 2022; 36:996-1004. [PMID: 35377246 PMCID: PMC10369452 DOI: 10.1177/08901171221078843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Financial incentives are a promising approach to enhance weight loss outcomes; however, little guidance exists on the optimal incentive structure. DESIGN Mixed methods. SETTING An online weight management trial, combining outcome (i.e., weight loss) and behavioral (i.e., self-weighing, dietary self-monitoring, and steps) incentives over 12 months (up to $665). SUBJECTS 116 participants who completed the incentive preference assessment at the 18-month follow-up visit. METHOD Response distributions on the form, magnitude, certainty, and target of the incentives and content analysis of the qualitative responses. RESULTS Nearly all (96.6%) participants indicated they liked receiving electronic Amazon gift cards, more so than the alternatives presented. Most participants (81.0%) thought they would have lost a similar amount of weight if the incentives were smaller. Few (18.1%) indicated they would have preferred a lottery structure, but 50.8% indicated the variable incentive schedule was beneficial during the maintenance period. Most (77.6%) felt incentives were most helpful when starting to lose weight. In both phases, most participants (85.3% and 72.4%, respectively) indicated appropriate behaviors were incentivized. Participants had mixed views on whether outcome or behavioral incentives were most motivating. CONCLUSION There was notable variation in preferences for the magnitude, duration, and timing of incentives; it will be important to examine in future research whether incentive design should be tailored to individual preferences.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, College of Medicine, 2358University of Virginia, Charlottesville, VA, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, 2092University of Vermont, Burlington, VT, USA
| | - Shelly Naud
- Biomedical Statistics, Larner College of Medicine, 2092University of Vermont, Burlington, VT, USA
| | - Eric A Finkelstein
- Duke-NUS Medical School and Duke University Global Health Institute, singapore
| | - Delia S West
- Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
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5
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Li R, Zhang Y, Cai X, Luo D, Zhou W, Long T, Zhang H, Jiang H, Li M. The nudge strategies for weight loss in adults with obesity and overweight: A systematic review and meta-analysis. Health Policy 2021; 125:1527-1535. [PMID: 34772518 DOI: 10.1016/j.healthpol.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022]
Abstract
Obesity and overweight conditions have become major health challenges worldwide. The exploration of effective weight loss strategies is essential. Nudges are currently advancing approaches that represent a new and better method for changing the behaviors of people. However, the effectiveness of nudge interventions on weight loss in overweight people who may be obese has not been synthesized in a systematic manner. In this study, a systematic literature search was performed. Only randomized controlled trials (RCTs) were considered. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated as summary statistics. In total, 25 RCTs involving a population of 5,929 individuals were included. Significant effects of the nudge strategy on weight loss (WMD: -0.96 kg, 95% CI: -1.49 to -0.43), body mass index (WMD: -0.3 kg/m2, 95% CI: -0.41 to -0.19) and waist circumference (WMD: -0.75 cm, 95% CI: -1.23 to -0.27) were observed. The subgroup analysis showed that the reduction in body weight associated with nudge interventions was significant in younger and more obese people. Moreover, the effect of nudge intervention on weight loss weakened over time. Overall, the nudge strategy can promote changes in weight loss, body mass index and waist circumference of adults, albeit at a mild magnitude and in particular types of individuals. Nudge strategies can be recommended to clinical practitioners and policy-makers to promote obesity management.
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Affiliation(s)
- Ruxue Li
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Xue Cai
- Zhongda Hospital Southeast University, Nanjing, China
| | - Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wuai Zhou
- Department of Automation, Tsinghua University, Beijing, China
| | - Tianxue Long
- School of Nursing, Peking University, Beijing, China
| | - Huijing Zhang
- School of Nursing, Peking University, Beijing, China
| | - Hua Jiang
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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Frimpong JA, Helleringer S. Strategies to increase downloads of COVID-19 exposure notification apps: A discrete choice experiment. PLoS One 2021; 16:e0258945. [PMID: 34723981 PMCID: PMC8559927 DOI: 10.1371/journal.pone.0258945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/10/2021] [Indexed: 11/18/2022] Open
Abstract
Exposure notification apps have been developed to assist in notifying individuals of recent exposures to SARS-CoV-2. However, in several countries, such apps have had limited uptake. We assessed whether strategies to increase downloads of exposure notification apps should emphasize improving the accuracy of the apps in recording contacts and exposures, strengthening privacy protections and/or offering financial incentives to potential users. In a discrete choice experiment with potential app users in the US, financial incentives were more than twice as important in decision-making about app downloads, than privacy protections, and app accuracy. The probability that a potential user would download an exposure notification app increased by 40% when offered a $100 reward to download (relative to a reference scenario in which the app is free). Financial incentives might help exposure notification apps reach uptake levels that improve the effectiveness of contact tracing programs and ultimately enhance efforts to control SARS-CoV-2. Rapid, pragmatic trials of financial incentives for app downloads in real-life settings are warranted.
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Affiliation(s)
- Jemima A. Frimpong
- Division of Social Science, Program in Social Research and Public Policy, New York University–Abu Dhabi (UAE), Abu Dhabi, United Arab Emirates
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Stéphane Helleringer
- Division of Social Science, Program in Social Research and Public Policy, New York University–Abu Dhabi (UAE), Abu Dhabi, United Arab Emirates
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7
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Voils CI, Pendergast J, Hale SL, Gierisch JM, Strawbridge EM, Levine E, McVay MA, Reed SD, Yancy WS, Shaw RJ. A randomized feasibility pilot trial of a financial incentives intervention for dietary self-monitoring and weight loss in adults with obesity. Transl Behav Med 2021; 11:954-969. [PMID: 33245118 DOI: 10.1093/tbm/ibaa102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Financial incentives could be used to improve adherence to behavioral weight loss interventions, increasing their effectiveness. This Phase IIb randomized pilot study evaluated the feasibility and acceptability of a study protocol for providing financial incentives for dietary self-monitoring and/or weight loss. Community-dwelling adults with obesity were enrolled in a 24 week, group-based weight loss program. Participants were randomized in a 2 × 2 factorial design to receive financial incentives for both dietary self-monitoring and weekly weight loss, just one, or neither. Participants could earn up to $300, evolving from fixed weekly payments to intermittent, variable payments. The notice of reward was provided by text message. The study was conducted in three successive cohorts to evaluate study procedure changes, including dietary approach, recruitment and retention strategies, text messaging, and incentives. Descriptive statistics calculated separately for each cohort described study performance relative to predefined targets for recruitment, including minority representation; retention; adherence; and weight loss. Acceptability was assessed via postintervention qualitative interviews. In Cohort 1 (n = 34), a low-carbohydrate diet was used. Recruitment, retention, adherence, and weight loss were adequate, but minority representation was not. For Cohort 2 (n = 31), employing an additional recruitment method and switching to a reduced-calorie diet yielded adequate recruitment, minority representation, retention, and adherence but less weight loss. Returning to a low-carbohydrate diet in Cohort 3 (n = 28) yielded recruitment, minority representation, retention, adherence, and weight loss similar to Cohort 2. Participant feedback informed changes to text message timing and content and incentive amount. Through successive cohorts, we optimized recruitment and retention strategies and text messaging. An adequately powered trial is warranted to evaluate the efficacy of these incentive structures for reducing weight. The trial registration number is NCT02691260.
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Affiliation(s)
- Corrine I Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Research Service, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Sarah L Hale
- School of Medicine, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | | | - Megan A McVay
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Shelby D Reed
- School of Medicine, Duke University, Durham, NC, USA
| | - William S Yancy
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, USA
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8
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Elani HW, Kawachi I, Sommers BD. Medicaid healthy behavior incentives and use of dental services. Health Serv Res 2021; 56:702-708. [PMID: 34008193 DOI: 10.1111/1475-6773.13672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/28/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine changes in access to dental care in states using Section 1115 waivers to implement healthy behavior incentive (HBI) programs in their Medicaid expansion under the ACA, compared to traditional expansion states and nonexpansion states. DATA SOURCES Behavioral Risk Factor Surveillance System from 2008 to 2018. STUDY DESIGN We used difference-in-differences analysis to compare changes in three Medicaid expansion states with HBI (Iowa, Indiana, Michigan) to traditional expansion (Minnesota, North Dakota, Ohio) and nonexpansion states (Nebraska, South Dakota, Wyoming) in the same mid-Western region of the country. The sample included 32 556 low-income adults. DATA COLLECTION/EXTRACTION METHODS NA. PRINCIPAL FINDINGS We found no significant changes in dental visits associated with HBI or traditional expansion relative to nonexpansion states. HBI expansion was associated with an increase of 2.2 percentage points in reporting a dental visit in the past year for adults in urban areas (P < 0.05) while the traditional expansion was associated with a reduction of 8.5 percentage points (P < 0.01) in utilization in rural areas relative to nonexpansion states. However, after adjustment for preexisting trends, the coefficients were no longer significant, suggesting that these differences are likely due to preexisting trends. CONCLUSIONS We did not find evidence of increased utilization of routine dental care associated with HBI programs.
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Affiliation(s)
- Hawazin W Elani
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Benjamin D Sommers
- Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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9
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Gardiner CK, Bryan AD. Randomized controlled trials of self-monitoring interventions with or without incentives for diet and exercise among individuals with overweight or obesity: Psychological and behavioural effects. Br J Health Psychol 2021; 26:1114-1134. [PMID: 33835597 DOI: 10.1111/bjhp.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 05/02/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To test the effects of three behavioural interventions (daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only) on psychological constructs and fruit and vegetable consumption or physical activity behaviour change among a sample of adults with overweight or obesity. DESIGN A pair of 3-arm longitudinal randomized controlled trials compared daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only interventions for either fruit and vegetable consumption or physical activity. METHODS Individuals reporting elevated weight status and insufficient engagement in one of the target behaviours were randomly assigned to one of three 3-week interventions. All three interventions involved daily self-monitoring of the behaviour, and two provided monetary incentives contingent upon reported behaviour. Participants completed measures of psychological constructs and reported behaviour at baseline, the end of the intervention, and two and four weeks post-intervention. RESULTS Participants across all three intervention conditions demonstrated increased engagement in the target behaviour from pre- to post-intervention and reported behaviour remained above baseline levels at both follow-up time points. Increases in reported behaviour during the intervention were associated with increases in self-efficacy, and this enhanced self-efficacy prospectively predicted sustained reported behaviour at follow-up. However, contrary to hypotheses, the incentive interventions including self-monitoring were not more efficacious than self-monitoring alone, and increased reported behaviour was not associated with enhancements in attitudes. CONCLUSIONS Self-monitoring interventions can aid behaviour change efforts, and behavioural practice during these interventions can increase self-efficacy. However, among adults with overweight or obesity who are seeking behaviour change interventions, incentive-based self-monitoring approaches may not be superior to self-monitoring alone in driving behaviour change and maintenance.
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Affiliation(s)
- Casey K Gardiner
- Department of Psychology and Neuroscience, University of Colorado Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Colorado, USA
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10
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Heise TL, Frense J, Christianson L, Seuring T. Using financial incentives to increase physical activity among employees as a strategy of workplace health promotion: protocol for a systematic review. BMJ Open 2021; 11:e042888. [PMID: 33674371 PMCID: PMC7938995 DOI: 10.1136/bmjopen-2020-042888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/25/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Shifts towards sedentary occupations in high-income countries (HIC) over the last decades and the health burden associated with physical inactivity have led to innovative strategies to promote physical activity (PA) among the working population. Financial rewards have been proposed to incentivise participation in programmes promoting PA or the achievement of PA-related goals. This review will assess (1) effects of financial incentives provided by employers to promote PA on programme adherence/compliance, PA and closely linked outcomes (eg, days of sick leave), (2) effects according to age, gender, implementation and study quality and (3) intervention costs and cost-effectiveness. METHODS AND ANALYSIS We will search for relevant studies in eight academic databases, two grey literature resources, two trial registers and on five organisational websites (oldest record/content to present). We will include (cluster) randomised controlled studies with a financial incentive to promote PA as intervention (≥1 months), conducted among employees in HIC and reporting data on at least one primary outcome in stages of screening (title/abstract, full text). To assess study quality and potential bias, we will use the revised Cochrane risk-of-bias tool (RoB 2). We will extract study data into prepiloted extraction sheets. Each task in screening, quality assessment and data extraction will be done by two authors independently. If a sufficient number of studies provide homogeneous data (ie, similar follow-up) for primary outcomes, meta-analyses will be carried out. We will report GRADE ratings to provide information on the certainty of the evidence. ETHICS AND DISSEMINATION For this review, no ethical approval will be required because only data of studies in which informed consent was obtained will be considered and analysed. The final review manuscript will be published in an Open Access journal. To ensure effective promotion of this review project, we will disseminate major findings through relevant communication channels. PROSPERO REGISTRATION NUMBER CRD42020184345.
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Affiliation(s)
- Thomas Leonhard Heise
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute for Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
| | - Jennifer Frense
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Administration, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Till Seuring
- Department of Living Conditions, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
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11
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Project Step: A Randomized Controlled Trial Investigating the Effects of Frequent Feedback and Contingent Incentives on Physical Activity. J Phys Act Health 2021; 18:247-253. [PMID: 33601334 DOI: 10.1123/jpah.2020-0198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/02/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Financial incentives and feedback on behavior offer promise for promoting physical activity. However, evidence for the effect of each of these techniques is inadequate. The present study evaluated the effects of daily versus weekly feedback and incentives contingent on reaching a daily walking goal versus noncontingent incentives in a 2 × 2 trial. METHODS Participants (N = 57) had a body mass index >25 kg/m2 and were insufficiently active. Participants received a daily walking goal that adapted weekly. RESULTS Participants receiving daily feedback increased daily steps (P = .03) more than those receiving weekly feedback. Participants receiving contingent incentives did not significantly increase steps (P = .12) more than those receiving noncontingent incentives. A trend-level effect (P = .09) suggested that there may be an interaction such that the combination of daily feedback and contingent incentives is most effective. CONCLUSIONS Results indicate that feedback is an important component of remotely delivered PA interventions and that evaluating each component of low-intensity interventions may help to improve efficacy. Moreover, results indicate that possible synergistic effects of feedback and rewards should be investigated further to help optimize interventions.
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12
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Ellis JD, Struble CA, Fodor MC, Cairncross M, Lundahl LH, Ledgerwood DM. Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther 2020; 136:103781. [PMID: 33302054 DOI: 10.1016/j.brat.2020.103781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Contingency management (CM) interventions involve providing reinforcement for engaging in a desired behavior, and have been shown to increase treatment adherence and promote abstinence in the treatment of substance use disorders. This review was conducted to systematically review the literature on the effectiveness of CM when applied to a range of medical conditions outside of substance use disorders. METHOD The authors identified a total of 24 randomized studies examining the effects of CM on four outcomes: weight change, physical activity, medication/device adherence, and viral load that were included in the qualitative summary, and 20 studies included in the meta-analysis. RESULTS CM was associated with positive outcomes for physical activity and medication/device adherence compared to control conditions. Findings with weight loss and viral load were more mixed, and evidence for publication bias was found for both outcomes. The effects of CM tend to dissipate when the contingency is removed. Heterogeneity was observed across most outcomes. LIMITATIONS AND CONCLUSIONS This review provides preliminary support for the use of CM in increasing physical activity and improving adherence to medication for chronic health conditions while reinforcement is ongoing. Future studies should examine potential moderators and identify strategies to maintain these changes over time.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, USA
| | - Cara A Struble
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Marina C Fodor
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Molly Cairncross
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Canada
| | - Leslie H Lundahl
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - David M Ledgerwood
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA.
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Scales CD, Desai AC, Harper JD, Lai HH, Maalouf NM, Reese PP, Tasian GE, Al-Khalidi HR, Kirkali Z, Wessells H. Prevention of Urinary Stones With Hydration (PUSH): Design and Rationale of a Clinical Trial. Am J Kidney Dis 2020; 77:898-906.e1. [PMID: 33212205 DOI: 10.1053/j.ajkd.2020.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/15/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although maintaining high fluid intake is an effective low-risk intervention for the secondary prevention of urinary stone disease, many patients with stones do not increase their fluid intake. STUDY DESIGN We describe the rationale and design of the Prevention of Urinary Stones With Hydration (PUSH) Study, a randomized trial of a multicomponent behavioral intervention program to increase and maintain high fluid intake. Participants are randomly assigned (1:1 ratio) to the intervention or control arm. The target sample size is 1,642 participants. SETTING & PARTICIPANTS Adults and adolescents 12 years and older with a symptomatic stone history and low urine volume are eligible. Exclusion criteria include infectious or monogenic causes of urinary stone disease and comorbid conditions precluding increased fluid intake. INTERVENTIONS All participants receive usual care and a smart water bottle with smartphone application. Participants in the intervention arm receive a fluid intake prescription and an adaptive program of behavioral interventions, including financial incentives, structured problem solving, and other automated adherence interventions. Control arm participants receive guideline-based fluid instructions. OUTCOMES The primary end point is recurrence of a symptomatic stone during 24 months of follow-up. Secondary end points include changes in radiographic stone burden, 24-hour urine output, and urinary symptoms. LIMITATIONS Periodic 24-hour urine volumes may not fully reflect daily behavior. CONCLUSIONS With its highly novel features, the PUSH Study will address an important health care problem. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03244189.
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Affiliation(s)
- Charles D Scales
- Urologic Surgery and Population Health Science, Duke Surgical Center for Outcomes Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
| | - Alana C Desai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Naim M Maalouf
- Department of Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA
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Adding Financial Incentives to Online Group-Based Behavioral Weight Control: An RCT. Am J Prev Med 2020; 59:237-246. [PMID: 32446752 PMCID: PMC8510645 DOI: 10.1016/j.amepre.2020.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Internet-delivered behavioral weight control is promising for expanding the reach and availability of weight management, but online programs produce lower weight losses than typically achieved in person. Financial incentives have been shown to increase weight losses. This study examined whether adding financial incentives for self-monitoring and achieving target weight losses increases weight losses attained in a fully online, group-based behavioral weight management program compared with the same program alone. STUDY DESIGN This study was an RCT. SETTING/PARTICIPANTS Adults with overweight and obesity (n=418; 91% female; 28% minority) were recruited from 2 clinical centers. INTERVENTION The intervention was a 24-session online group-based behavioral weight control program with weekly synchronous chat sessions (Internet-only) or the same program with weekly financial incentives for self-monitoring body weight and dietary intake daily and for achieving target weight losses at 2 and 6 months (Internet + incentives). MAIN OUTCOME MEASURES This study measured weight loss at 6 months and treatment engagement (attendance, self-monitoring of body weight, dietary intake, and physical activity). Data were collected between February 2016 and August 2018, and analyses were completed in 2019. RESULTS Participants randomized to the Internet + incentives group lost more weight (-6.4 [SD=5.5] kg) than those in the Internet-only group (-4.7 [SD=6.6] kg; p<0.01). Further, a higher proportion of the Internet + incentives group achieved ≥5% weight loss (55%) than those in the Internet-only group (40%; p<0.05). Treatment engagement was higher in the Internet + incentives condition, with greater self-monitoring of behaviors targeted by incentives, as well as higher rates of behaviors not targeted and higher self-reported physical activity. Study retention was higher among those in the Internet + incentives condition (91%) than those in the Internet-only condition (81%; p=0.003). CONCLUSIONS Adding financial incentives to a program delivered fully online increases weight losses compared with the program alone and can achieve weight losses comparable to in-person programs, offering potential for substantial geographic reach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02688621.
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15
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White JS, Ramos-Gomez F, Liu JX, Jue B, Finlayson TL, Garza JR, Crawford AH, Helman S, Santo W, Cheng J, Kahn JG, Gansky SA. Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial. PLoS One 2020; 15:e0236692. [PMID: 32730310 PMCID: PMC7392266 DOI: 10.1371/journal.pone.0236692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/10/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. DESIGN A stratified, parallel-group, three-arm individually randomized controlled pilot trial. SETTING Two Los Angeles area Early Head Start (EHS) sites. PARTICIPANTS 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. INTERVENTIONS Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. OUTCOMES Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. FINDINGS Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. CONCLUSIONS Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03862443.
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Affiliation(s)
- Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
| | - Francisco Ramos-Gomez
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jenny X. Liu
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Institute for Health and Aging, University of California San Francisco, San Francisco, California, United States of America
| | - Bonnie Jue
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Tracy L. Finlayson
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Jeremiah R. Garza
- Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Alexandra H. Crawford
- California Protons Cancer Therapy Center, University of California San Diego Health, San Diego, California, United States of America
| | - Sarit Helman
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - William Santo
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jing Cheng
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Stuart A. Gansky
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Center to Address Disparities in Children’s Oral Health, University of California San Francisco, San Francisco, California, United States of America
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, United States of America
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, United States of America
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16
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Evaluating the Feasibility, Acceptability, and Effects of Deposit Contracts With and Without Daily Feedback to Promote Physical Activity. J Phys Act Health 2020; 17:29-36. [DOI: 10.1123/jpah.2018-0589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 07/24/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022]
Abstract
Background: Despite interest in financial incentive programs, evidence regarding the feasibility, acceptability, and effectiveness of deposit contracts (ie, use of participants’ own money as a financial reward) for increasing physical activity (PA) is limited. Furthermore, evidence regarding the use of feedback within incentive programs is limited. Purpose: To evaluate: (1) the feasibility and acceptability of deposit contracts for increasing objectively measured PA and (2) the effects of deposit contracts with or without ongoing feedback on PA. Methods: Participants (n = 24) were exposed to 3 conditions (1) self-monitoring, (2) incentive, and (3) incentive with feedback in an ABACABAC design, with the order of incentive conditions counterbalanced across participants. Results: Effect sizes suggest that individuals had a modest increase in PA during the incentive conditions compared with self-monitoring. Presentation order moderated results, such that individuals exposed to incentives with feedback first performed more poorly across both incentive conditions. In addition, individuals often cited the deposit contract as a reason for not enrolling, and those who did participate reported inadequate acceptability of the incentives and feedback. Conclusions: Results suggest that while deposit contracts may engender modest increases in PA, this type of incentive may not be feasible or acceptable for promoting PA.
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17
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Inolopú J, Hilario-Huapaya N, Tantaleán-Del-Águila MA, Hurtado-Roca Y, Ugarte-Gil C. Interventions for the prevention of risk factors and incidence of type 2 diabetes in the work environment: a systematic review. Rev Saude Publica 2019; 53:101. [PMID: 31800912 PMCID: PMC6863112 DOI: 10.11606/s1518-8787.2019053001084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 03/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments.
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Affiliation(s)
- Jorge Inolopú
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Salud Pública. Lima, Perú
| | - Nélida Hilario-Huapaya
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Salud Pública. Lima, Perú
| | | | - Yamilee Hurtado-Roca
- EsSalud. Instituto de Evaluación de Tecnologías en Salud e Investigación. Lima, Perú
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Perú.,Universidad Peruana Cayetano Heredia. Facultad de Medicina. Lima, Perú
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18
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Fortunato M, Harrison J, Oon AL, Small D, Hilbert V, Rareshide C, Patel M. Remotely Monitored Gamification and Social Incentives to Improve Glycemic Control Among Adults With Uncontrolled Type 2 Diabetes (iDiabetes): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14180. [PMID: 31746765 PMCID: PMC6893558 DOI: 10.2196/14180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/26/2019] [Accepted: 07/26/2019] [Indexed: 01/02/2023] Open
Abstract
Background Type 2 diabetes is a significant cause of morbidity and mortality in the United States. Lifestyle modifications including increasing physical activity and losing weight have been demonstrated to improve glycemic control. However, most patients struggle to make these changes. Many stakeholders are interested in using gamification and social incentives to increase engagement in healthy behaviors. However, these approaches often do not appropriately leverage insights from behavioral economics that could be used to address predictable barriers to behavior change. Objective This study aimed to describe the protocol for the Influencing DIabetics to Adapt Behaviors related to Exercise and weighT by Enhancing Social incentives (iDiabetes) trial, which aimed to evaluate the effectiveness of gamification interventions that leverage insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives to improve glycemic control, promote weight loss, and increase physical activity among overweight and obese adults with type 2 diabetes. Methods We are conducting a one-year four-arm randomized controlled trial of 361 overweight and obese patients with type 2 diabetes and a glycated hemoglobin (HbA1c) level ≥8.0. Wireless weight scales and wearable devices are provided to remotely monitor weight and physical activity and transmit data to the study team. Patients are recruited by email, following which they establish a baseline measure of weight, daily step count, HbA1c level, and low-density lipoprotein cholesterol level and then repeat these measures at 6 and 12 months. The control arm receives no other interventions. Patients randomized to one of the three intervention arms are entered into a game designed using insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives. To examine predictors of strong or poor performance, participants completed validated questionnaires on a range of areas including their personality, risk preferences, and social network. Results Enrollment of 361 patients was completed in January 2019. Results are expected in 2020. Conclusions The iDiabetes trial represents a scalable model to remotely monitor the daily health behaviors of adults with type 2 diabetes. Results from this trial will help provide insights into how to improve management of patients with type 2 diabetes. Trial Registration ClinicalTrials.gov NCT02961192; https://clinicaltrials.gov/ct2/show/NCT02961192 International Registered Report Identifier (IRRID) DERR1-10.2196/14180
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Affiliation(s)
- Michael Fortunato
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States
| | - Joseph Harrison
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States
| | - Ai Leen Oon
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States
| | - Dylan Small
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States
| | - Victoria Hilbert
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States
| | - Charles Rareshide
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States
| | - Mitesh Patel
- University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, Philadelphia, PA, United States.,Crescenz Veteran Affairs Medical Center, Philadelphia, PA, United States
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19
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Husain SA, Diaz K, Schwartz JE, Parsons FE, Burg MM, Davidson KW, Kronish IM. Behavioral economics implementation: Regret lottery improves mHealth patient study adherence. Contemp Clin Trials Commun 2019; 15:100387. [PMID: 31198881 PMCID: PMC6555893 DOI: 10.1016/j.conctc.2019.100387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background Nonadherence to study protocols reduces the generalizability, validity, and statistical power of longitudinal studies. Purpose To determine whether an automated electronically-delivered regret lottery would improve adherence to an intensive mHealth self-monitoring protocol as part of a longitudinal observational study. Methods We enrolled 77 adults into a 52-week study requiring five daily ecologic momentary assessments (EMA) of stress and daily accelerometer use. We performed a pre/post single-arm study to evaluate the efficacy of a lottery intervention in improving adherence to this protocol. Midway through the study, participants were invited to enter a weekly regret lottery ($50 prize, expected value <$1) in which prize collection was contingent upon meeting adherence thresholds for the prior week. Study protocol adherence before and after lottery initiation were compared using mixed models repeated measures analysis of variance. Results 62 participants consented to lottery participation. In the 12 weeks prior to lottery initiation, weekly adherence was declining (slope −1.4%/week). The weekly per-participant probability of adherence was higher after lottery initiation when comparing the 4-week (32% pre-lottery vs 50% post-lottery, p < 0.001), 8-week (37% vs 49%, p < 0.001), and 12-week periods (39% vs 45%, p = 0.001) before and after lottery initiation. However, the rate of decline in adherence over time was unchanged. Conclusion The implementation of an automated, electronically-delivered weekly regret lottery improved adherence with an intensive self-monitoring study protocol. Regret lotteries may represent a cost-effective tool to improve adherence and reduce bias caused by dropout or nonadherence.
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Affiliation(s)
- S Ali Husain
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.,Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Keith Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.,Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, USA
| | - Faith E Parsons
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Matthew M Burg
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
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20
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Gudzune KA, Alexander E, Tseng E, Durkin N, Jerome GJ, Dalcin A, Appel LJ, Clark JM. Influence of subsidies and promotional strategies on outcomes in a beneficiary-based commercial weight-loss programme. Clin Obes 2019; 9:e12307. [PMID: 30957415 DOI: 10.1111/cob.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
To determine whether initial engagement, continued participation, and weight loss vary by subsidy and promotional strategies in a beneficiary-based, commercial weight-loss programme. We conducted a retrospective analysis of data from 2013 to 2016. Our dependent variables included initial engagement (≥1 calls; ≥2 weights), coach calls and weight change. Our independent variables were subsidy strategy (total subsidy (n = 9) vs cost sharing (n = 3)) and combination of promotional-subsidy strategies (mixed campaign + total subsidy (n = 6) vs mass media + total subsidy (n = 3)). We used logistic and linear regression analyses adjusted for beneficiary factors and clustering by organization. From 12 participating organizations, 26 068 beneficiaries registered of which 6215 initially engaged. Cost sharing was associated with significantly greater initial engagement as compared to total subsidy (OR 3.73, P < 0.001); however, no significant between-group differences existed in calls or weight change. Mass media + total subsidy group had significantly greater calls and weight loss at 12 months compared to mixed campaign + total subsidy (-2.6% vs -1.8%, P = 0.04). Cost sharing may promote greater initial engagement, although does not contribute to better participation or weight loss relative to total subsidy. If organizations elect total subsidy, then pairing this strategy with a mass media campaign may promote greater participation and weight loss among beneficiaries.
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Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eleanore Alexander
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nowella Durkin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gerald J Jerome
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Arlene Dalcin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne M Clark
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
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21
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Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review. Soc Sci Med 2019; 232:340-350. [PMID: 31129504 DOI: 10.1016/j.socscimed.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 01/27/2023]
Abstract
The rising epidemic of non-communicable diseases (NCDs) poses substantial health and economic challenges to both individuals and society. Application of incentive-based strategies based on traditional and behavioural economic theory has emerged as a potential strategy to address rising rates of NCDs. Yet, whether or not incentives truly represent a promising strategy for addressing NCDs has not been systematically addressed nor is it clear whether certain behavioural economic strategies outperform others or simply offering a cash-based incentive for meeting a goal. In this systematic review we aim to determine whether there is an evidence base for any of these strategies. Forty-eight published randomized controlled trials (70 contrasts) evaluating the effectiveness of incentive-based strategies for improvements in NCD risk-factors were reviewed. Our primary conclusion is that there is a lack of compelling evidence that incentives of any form represent a compelling NCD reduction strategy. More evidence for long-term effectiveness and cost-effectiveness is needed to justify third party funding of any incentive based strategy.
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22
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Jay M, Orstad SL, Wali S, Wylie-Rosett J, Tseng CH, Sweat V, Wittleder S, Shu SB, Goldstein NJ, Ladapo JA. Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial. BMJ Open 2019; 9:e025278. [PMID: 30962231 PMCID: PMC6500238 DOI: 10.1136/bmjopen-2018-025278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Obesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone. METHODS AND ANALYSIS We are recruiting 795 adults, aged 18-70 years with a body mass index ≥30 kg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5% to ≥5% reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months. ETHICS AND DISSEMINATION Human research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders. TRIAL REGISTRATION NUMBER NCT03157713.
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Affiliation(s)
- Melanie Jay
- Departments of Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Soma Wali
- Department of Medicine, Olive View-University of California Los Angeles (UCLA) Medical Center, Sylmar, California, USA
| | - Judith Wylie-Rosett
- Division of Health Promotion and Nutrition Research, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Victoria Sweat
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Sandra Wittleder
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Suzanne B Shu
- Anderson School of Management at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Noah J Goldstein
- Anderson School of Management at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Kurtzman GW, Day SC, Small DS, Lynch M, Zhu J, Wang W, Rareshide CAL, Patel MS. Social Incentives and Gamification to Promote Weight Loss: The LOSE IT Randomized, Controlled Trial. J Gen Intern Med 2018; 33:1669-1675. [PMID: 30003481 PMCID: PMC6153249 DOI: 10.1007/s11606-018-4552-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/25/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social networks influence obesity patterns, but interventions to leverage social incentives to promote weight loss have not been well evaluated. OBJECTIVE To test the effectiveness of gamification interventions designed using insights from behavioral economics to enhance social incentives to promote weight loss. DESIGN The Leveraging Our Social Experiences and Incentives Trial (LOSE IT) was a 36-week randomized, controlled trial with a 24-week intervention and 12-week follow-up. PARTICIPANTS One hundred and ninety-six obese adults (body mass index ≥ 30) comprising 98 two-person teams. INTERVENTIONS All participants received a wireless weight scale, used smartphones to track daily step counts, formed two-person teams with a family member or friend, and selected a weight loss goal. Teams were randomly assigned to control or one of two gamification interventions for 36 weeks that used points and levels to enhance collaborative social incentives. One of the gamification arms also had weight and step data shared regularly with each participant's primary care physician (PCP). MAIN OUTCOME MEASURES The primary outcome was weight loss at 24 weeks. Secondary outcomes included weight loss at 36 weeks. KEY RESULTS At 24 weeks, participants lost significant weight from baseline in the control arm (mean: - 3.9 lbs; 95% CI: - 6.1 to - 1.7; P < 0.001), the gamification arm (mean: - 6.6 lbs; 95% CI: - 9.4 to - 3.9; P < 0.001), and the gamification arm with PCP data sharing (mean: - 4.8 lbs; 95% CI: - 7.4 to - 2.3; P < 0.001). At 36 weeks, weight loss from baseline remained significant in the control arm (mean: - 3.5 lbs; 95% CI: - 6.1 to - 0.8; P = 0.01), the gamification arm (mean: - 6.3 lbs; 95% CI: - 9.2 to - 3.3; P < 0.001), and the gamification arm with PCP data sharing (mean: - 5.2 lbs; 95% CI: - 8.5 to - 2.0; P < 0.01). However, in the main adjusted model, there were no significant differences in weight loss between each of the intervention arms and control at either 12, 24, or 36 weeks. CONCLUSIONS Using digital health devices to track behavior with a partner led to significant weight loss through 36 weeks, but the gamification interventions were not effective at promoting weight loss when compared to control. TRIAL REGISTRATION clinicaltrials.gov Identifier: 02564445.
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Affiliation(s)
- Gregory W Kurtzman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Medicine Nudge Unit, Philadelphia, PA, USA
| | - Susan C Day
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dylan S Small
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Lynch
- Penn Medicine Nudge Unit, Philadelphia, PA, USA
| | - Jingsan Zhu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wenli Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mitesh S Patel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Medicine Nudge Unit, Philadelphia, PA, USA. .,The Wharton School, University of Pennsylvania, Philadelphia, PA, USA. .,Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
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Gong Y, Trentadue TP, Shrestha S, Losina E, Collins JE. Financial incentives for objectively-measured physical activity or weight loss in adults with chronic health conditions: A meta-analysis. PLoS One 2018; 13:e0203939. [PMID: 30252864 PMCID: PMC6156024 DOI: 10.1371/journal.pone.0203939] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We conducted a meta-analysis and systematic review of published randomized controlled trials (RCTs) to evaluate the impact of financial incentives (FI) on objectively-measured physical activity (PA) and weight loss (WL) in adults with sedentary behavior or chronic health conditions. EVIDENCE REVIEW We performed a systematic search for RCTs published in English indexed in PubMed, Embase, or Web of Science through July 27, 2017. We limited our search to RCTs that involved an FI intervention with a monetary component, objectively-measured PA or WL outcomes, samples with either sedentary lifestyles or chronic health conditions, and a comparator group that did not receive performance-contingent FI. We calculated the mean difference and standardized mean difference (SMD) for each study and used a random effects model to summarize intervention efficacy. We used the Jadad scoring tool to assess the quality of the identified articles. RESULTS We abstracted data from 11 RCTs. Two of the 11 included studies focused on PA, totaling 126 intervention and 116 control subjects. Nine RCTs evaluated the effect of FI on WL, totaling 1,799 intervention and 1,483 control subjects. The combined estimate for change in daily steps was 940 (95%CI [306-1,574]) more in PA intervention groups than in control groups and 2.36 (95%CI [1.80-2.93]) more kilograms lost by WL intervention groups compared to control groups. The overall estimated SMD for both outcomes combined was 0.395 (95%CI [0.243-0.546; p<0.001]), favoring FI interventions. CONCLUSION FI interventions are efficacious in increasing PA and WL in adults with chronic conditions or sedentary adults. Public health programs to increase PA or prevent chronic disease should consider incorporating FI to improve outcomes.
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Affiliation(s)
- Yusi Gong
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and the Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Taylor P. Trentadue
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and the Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Swastina Shrestha
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and the Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and the Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Orthopedics, Harvard Medical School, Boston, Massachusetts, United States of America
- Section of Clinical Sciences, 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
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and the Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Orthopedics, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Ananthapavan J, Peterson A, Sacks G. Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity - a systematic review. Obes Rev 2018; 19:605-613. [PMID: 29266677 DOI: 10.1111/obr.12657] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
Curbing the obesity epidemic is likely to require a suite of interventions targeting the obesogenic environment as well as individual behaviour. Evidence suggests that the effectiveness of behaviour modification programmes can be enhanced by financial incentives that immediately reward weight loss behaviour. This systematic review investigated the effectiveness of incentives with a focus on assessing the relative effectiveness of incentives that target different behaviours as well as factors of importance when implementing these programmes in real-world settings (health insurer settings). A narrative review of the academic and grey literature including a variety of study designs was undertaken. Twenty studies met inclusion criteria and were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results suggest that incentivizing weight loss is effective in the short term while the incentives are in place. There are various incentive designs, and although the relative effectiveness of each of these on weight loss is not clear, it appears that positive incentives increase the uptake into programmes and may reduce dropouts. As with other weight loss initiatives, there is a need to explore ways to maintain weight loss in the longer term - incentives for weight maintenance could play a role.
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Affiliation(s)
- J Ananthapavan
- Deakin University, Geelong, Australia, Deakin Health Economics, Centre for Population Health Research.,Deakin University, Geelong, Australia, Global Obesity Centre, Centre for Population Health Research
| | - A Peterson
- Deakin University, Geelong, Australia, Deakin Health Economics, Centre for Population Health Research
| | - G Sacks
- Deakin University, Geelong, Australia, Global Obesity Centre, Centre for Population Health Research
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Madison KM. The Risks Of Using Workplace Wellness Programs To Foster A Culture Of Health. Health Aff (Millwood) 2018; 35:2068-2074. [PMID: 27834248 DOI: 10.1377/hlthaff.2016.0729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In many respects, employers are well positioned to take a leading role in helping create a culture of health. Employers have access to many programs that could be beneficial to their employees' health. The potential for financial gains related to health improvement may motivate employers to offer these programs, and if the gains are realized, they may help finance the programs. At the same time, employers' involvement in such programs may create substantial risks. Enthusiasm about the financial and health gains that wellness programs might yield coexists with concerns about health costs shouldered by employees, the possibility of employment discrimination, and the potential for employers' invasion of employees' privacy. A fragmented regulatory regime, including a recently issued final rule under the Americans with Disabilities Act, has been created to address these concerns. Whether the regime strikes the right balance between wellness program benefits and risks remains to be determined.
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Affiliation(s)
- Kristin M Madison
- Kristin M. Madison is a professor at the School of Law and at the Bouvé College of Health Sciences, both at Northeastern University, in Boston, Massachusetts
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27
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Misra-Hebert AD, Hu B, Le PH, Rothberg MB. Effect of Health Plan Financial Incentive Offering on Employees with Prediabetes. Am J Med 2018; 131:293-299. [PMID: 29024625 PMCID: PMC7055733 DOI: 10.1016/j.amjmed.2017.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prediabetes may be improved or reversed with lifestyle interventions. A worksite wellness program offering financial incentives for participation may be effective in improving the health of employees with prediabetes. We studied the effect of employee health plan financial incentives on health outcomes for employees with prediabetes. METHODS We conducted a retrospective cohort study using electronic medical record data from January 2008 to December 2012. Our study participants were employees with prediabetes and propensity-matched non-employees with prediabetes and commercial health insurance, all receiving care within one health system. Exposures included fixed annual financial incentives for program participation and later a premium discount divided between program participation and achievement of goals. We used longitudinal linear mixed models to assess yearly changes in glycosylated hemoglobin (HbA1c), weight, and low-density lipoprotein cholesterol in employees versus non-employees. We also compared outcomes of employees by ever- versus never- program participant status. RESULTS Our study population included 1005 employees and 1005 matched non-employees. The yearly reduction in HbA1c for employees versus matched non-employees did not differ in 2008-2010 but was greater in 2010-2012, when incentives were tied to program participation as well as achievement of goals (-0.10% vs -0.08 %, respectively; P for difference in change [DIC] = .01 from 2010 to 2012). Analyses from both periods showed that employees lost more weight per year than matched non-employees (-1.85 vs -0.21 lb [1 lb=0.45 kg] from 2008 to 2010; P for DIC < .001 and -2.35 vs -0.65 lb from 2010 to 2012; P for DIC < .001). Employees who participated in disease management lost more weight than those who did not (-2.14 vs 0.79 lb yearly before 2010 and -2.82 vs -0.91 after January 1, 2010, P for DIC < .01 and < .001, respectively). CONCLUSION A worksite wellness program offering health plan financial incentives for participation and outcomes was associated with improvements in weight and HbA1c.
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Affiliation(s)
- Anita D Misra-Hebert
- Center for Value-Based Care Research, Cleveland Clinic, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Ohio.
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Ohio
| | - Phuc H Le
- Center for Value-Based Care Research, Cleveland Clinic, Ohio
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28
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Carrera M, Royer H, Stehr M, Sydnor J. Can financial incentives help people trying to establish new habits? Experimental evidence with new gym members. JOURNAL OF HEALTH ECONOMICS 2018; 58:202-214. [PMID: 29550665 PMCID: PMC5899425 DOI: 10.1016/j.jhealeco.2018.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/29/2017] [Accepted: 02/15/2018] [Indexed: 05/14/2023]
Abstract
Can financial incentives aid habit formation in people attempting to establish a positive health behavior? We provide evidence on this question from a randomized controlled trial of modest-sized incentives to attend the gym among new members of a fitness facility. Our experiment randomized 690 participants into a control group that received a $30 payment unconditionally or one of 3 incentive groups that received a payment for attending the gym at least 9 times over the first 6 weeks of membership. Two incentive treatment arms offered monetary payments of $30 and $60. The third incentive treatment, motivated by the endowment effect, offered a physical item worth $30. All three incentives had only small impacts on attendance during members' first 6 weeks and no effect on their post-incentive visit trajectories. We document substantial overconfidence among new members about their likely visits and discuss how overconfidence may undermine the effectiveness of incentive programs.
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Affiliation(s)
| | - Heather Royer
- University of California, Santa Barbara & IZA & NBER, United States
| | | | - Justin Sydnor
- University of Wisconsin, Madison & NBER, United States
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29
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Tomaszewski D, Cernohous T, Vaidyanathan R. Evaluating Patient Preferences for Different Incentive Programs to Optimize Pharmacist-Provided Patient Care Program Enrollment. J Manag Care Spec Pharm 2017; 23:1140-1147. [PMID: 29083970 PMCID: PMC10397908 DOI: 10.18553/jmcp.2017.23.11.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Employers have increased efforts to engage employees in health and wellness programs. Providing employees with incentives to participate in these programs has been shown to improve overall enrollment and engagement. One program that has had challenges with enrollment and engagement is medication therapy management (MTM). OBJECTIVES To (a) determine how individuals evaluate different financial incentives to improve participation in an MTM program and (b) measure the effect of participant characteristics on incentive preference. METHODS This study was composed of a paper-based survey administered to participants after focus group sessions. Participants included MTM-eligible beneficiaries from 2 employer groups and included MTM-naive and MTM-experienced participants. Incentive preference was measured based on 3 bipolar scales that compared 3 incentives: $100 gift certificates, $8 copay reduction for 6 months, and $100 added to paycheck. RESULTS A total of 72 participants completed the survey: 34 participants were MTM experienced, and 38 were MTM naive. Overall participant preference reporting resulted in inconsistencies. Copay reduction was preferred to a gift certificate (55.6% vs. 37.5%); money in paycheck was preferred over copay reduction (48.6% vs. 40.3%); and gift certificates were preferred over money in paycheck (56.9% vs. 22.2%). However, subgroup analysis resulted in a more consistent preference reporting, with MTM-experienced participants consistently preferring copay reduction over gift certificates (67.6% vs. 23.5%) and money in paycheck (55.9% vs. 29.4%). MTM-naive participants preferred a gift certificate over copay reduction (51.4% vs. 44.7%) and cash in paycheck (68.4% vs. 23.7%). CONCLUSIONS The results of this study suggest that gift certificates were preferred by MTM-naive participants, which supports the use of gift certificates as an incentive for MTM-naive patients to enroll in an MTM program. Conversely, the use of a copay reduction program was preferred by MTM-experienced participants, suggesting that it may be ideal for participants already enrolled in an MTM program. The results suggest the potential value of using multiple forms of incentives to attract MTM-naive and experienced beneficiaries. DISCLOSURES No outside funding supported this study. The authors have no conflicts of interest to disclose. All authors contributed to study concept and design. Cernohous and Vaidyanathan collected the data, and Tomaszewski took the lead in data interpretation, along with Cernohous. The manuscript was written and revised primarily by Tomaszewski, along with Cernohous and Vaidyanathan.
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Affiliation(s)
- Daniel Tomaszewski
- 1 Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California
| | - Tim Cernohous
- 2 University of Minnesota College of Pharmacy and Essentia Health, Duluth, Minnesota
| | - Rajiv Vaidyanathan
- 3 Department of Marketing, Labovitz School of Business and Economics, University of Minnesota, Duluth
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Chang LL, DeVore AD, Granger BB, Eapen ZJ, Ariely D, Hernandez AF. Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes. Circulation 2017; 136:765-772. [DOI: 10.1161/circulationaha.117.028380] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Leslie L. Chang
- From Duke Clinical Research Institute, Durham, NC (L.L.C., A.D.D., Z.J.E., A.F.H.); and School of Medicine (L.L.C., A.D.D., Z.J.E., A.F.H.), School of Nursing (B.B.G.), and Fuqua School of Business (D.A.), Duke University, Durham, NC
| | - Adam D. DeVore
- From Duke Clinical Research Institute, Durham, NC (L.L.C., A.D.D., Z.J.E., A.F.H.); and School of Medicine (L.L.C., A.D.D., Z.J.E., A.F.H.), School of Nursing (B.B.G.), and Fuqua School of Business (D.A.), Duke University, Durham, NC
| | - Bradi B. Granger
- From Duke Clinical Research Institute, Durham, NC (L.L.C., A.D.D., Z.J.E., A.F.H.); and School of Medicine (L.L.C., A.D.D., Z.J.E., A.F.H.), School of Nursing (B.B.G.), and Fuqua School of Business (D.A.), Duke University, Durham, NC
| | - Zubin J. Eapen
- From Duke Clinical Research Institute, Durham, NC (L.L.C., A.D.D., Z.J.E., A.F.H.); and School of Medicine (L.L.C., A.D.D., Z.J.E., A.F.H.), School of Nursing (B.B.G.), and Fuqua School of Business (D.A.), Duke University, Durham, NC
| | - Dan Ariely
- From Duke Clinical Research Institute, Durham, NC (L.L.C., A.D.D., Z.J.E., A.F.H.); and School of Medicine (L.L.C., A.D.D., Z.J.E., A.F.H.), School of Nursing (B.B.G.), and Fuqua School of Business (D.A.), Duke University, Durham, NC
| | - Adrian F. Hernandez
- From Duke Clinical Research Institute, Durham, NC (L.L.C., A.D.D., Z.J.E., A.F.H.); and School of Medicine (L.L.C., A.D.D., Z.J.E., A.F.H.), School of Nursing (B.B.G.), and Fuqua School of Business (D.A.), Duke University, Durham, NC
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Affiliation(s)
- Joseph P Newhouse
- From the Departments of Health Care Policy (J.P.N., S-L.T.N.) and Biostatistics (S.-L.T.N.), Harvard Medical School, Boston
| | - Sharon-Lise T Normand
- From the Departments of Health Care Policy (J.P.N., S-L.T.N.) and Biostatistics (S.-L.T.N.), Harvard Medical School, Boston
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32
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Yoo BK, Hasebe T, Kim M, Sasaki T, Styne DM. Pilot survey of a novel incentive to promote healthy behavior among school children and their parents. Prev Med Rep 2017; 6:286-293. [PMID: 28409091 PMCID: PMC5388936 DOI: 10.1016/j.pmedr.2017.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/08/2017] [Accepted: 03/27/2017] [Indexed: 10/26/2022] Open
Abstract
Reversing the obesity epidemic has been a persistent global public health challenge, particularly among low socioeconomic status populations and racial/ethnic minorities. We developed a novel concept of community-based incentives to approach this problem in such communities. Applying this concept, we proposed a school intervention to promote obesity prevention in the U.S. We conducted a pilot survey to explore attitudes towards this future intervention. The survey was collected as a nonprobability sample (N = 137 school-aged children (5-12 years)) in northern California in July 2013. We implemented multivariable logistic regression analyses where the dependent variable indicated the intention to participate in the future intervention. The covariates included the body mass index (BMI) based weight categories, demographics, and others. We found that the future intervention is expected to motivate generally-high-risk populations (such as children and parents who have never joined a past health-improvement program compared to those who have completed a past health-improvement program (the odds-ratio (OR) = 5.84, p < 0.05) and children with an obese/overweight parent (OR = 2.72, p < 0.05 compared to those without one)) to participate in future obesity-prevention activities. Our analyses also showed that some subgroups of high-risk populations, such as Hispanic children (OR = 0.27, p < 0.05) and children eligible for a free or reduced price meal program (OR = 0.37, p < 0.06), remain difficult to reach and need an intensive outreach activity for the future intervention. The survey indicated high interest in the future school intervention among high-risk parents who have never joined a past health-improvement program or are obese/overweight. These findings will help design and implement a future intervention.
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Affiliation(s)
- Byung-Kwang Yoo
- Department of Public Health Sciences, School of Medicine, University of California, One Shields Ave., Medical Sciences 1C, Davis, CA 95616, USA
| | - Takuya Hasebe
- Department of Public Health Sciences, School of Medicine, University of California, One Shields Ave., Medical Sciences 1C, Davis, CA 95616, USA
| | - Minchul Kim
- Department of Public Health Sciences, School of Medicine, University of California, One Shields Ave., Medical Sciences 1C, Davis, CA 95616, USA
| | | | - Dennis M. Styne
- Yocha Dehe Endowed Chair in Pediatric Endocrinology, Director of the Newborn Screening Program, University of California, Davis Children's Hospital, University of California, Davis, CA, 2521 Stockton Blvd, Sacramento, CA 95817, USA
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Mitchell M, White L, Oh P, Alter D, Leahey T, Kwan M, Faulkner G. Uptake of an Incentive-Based mHealth App: Process Evaluation of the Carrot Rewards App. JMIR Mhealth Uhealth 2017; 5:e70. [PMID: 28559224 PMCID: PMC5470010 DOI: 10.2196/mhealth.7323] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/17/2017] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Behavioral economics has stimulated renewed interest in financial health incentives worldwide. The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points (eg, movies and groceries) for downloading the app, referring friends, and completing an average of 1 to 2 educational health quizzes per week ("micro-learning"), with long-term objectives of increasing health knowledge and encouraging healthy behaviors. OBJECTIVE The main objective of this study was to evaluate uptake of a loyalty points-based mHealth app during the exclusive 3-month launch period in British Columbia (BC), Canada. The secondary aims were to describe the health and sociodemographic characteristics of users, as well as participation levels (eg, proportion of quizzes completed and friends referred). METHODS The app was promoted via loyalty program email campaigns (1.64 million emails). Number of downloads and registrations (users enter age, gender, and valid BC postal code to register) were collected. Additional sociodemographics were inferred by linking postal codes with census data at the local health area (LHA) level. Health risk assessments were also deployed. Participation levels were collected over 3 months and descriptive data were presented. RESULTS In 3 months, 67,464 individuals downloaded the app; in its first week, Carrot Rewards was the most downloaded health app in Canada. Among valid users (n=57,885; at least one quiz completed), the majority were female (62.96%; 36,446/57,885) and aged 18 to 34 years (54.34%; 31,459/57,885). More than half of the users (52.40%; 30,332/57,885) resided in LHAs where the median personal income was below the provincial average (Can $28,765). Furthermore, 64.42% (37,291/57,885) of users lived in metropolitan (ie, urban) LHAs, compared with 56.17% of the general BC population. The most prevalent risk factors were "not" meeting physical activity guidelines (72.70%; 31,765/43,692) and "not" getting the flu shot last year (67.69%; 30,286/44,739). Regarding participation, 60.05% (34,761/57,885) of users were classified as "very high" engagers (>75% quiz completion rate). CONCLUSIONS Early results suggest that loyalty points may promote mHealth app uptake. The app was downloaded by younger females especially, and BC residents from higher and lower income regions were equally represented. Loyalty points appear to have driven participation throughout the inaugural 3-month period (ie, quiz completion).
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Affiliation(s)
- Marc Mitchell
- University Health Network, Toronto, ON, Canada
- Carrot Insights Inc, Toronto, ON, Canada
| | | | - Paul Oh
- University Health Network, Toronto, ON, Canada
| | - David Alter
- University Health Network, Toronto, ON, Canada
| | - Tricia Leahey
- University of Connecticut, Storrs, CT, United States
| | | | - Guy Faulkner
- University of British Columbia, Vancouver, BC, Canada
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Holtz BE, Murray KM, Hershey DD, Dunneback JK, Cotten SR, Holmstrom AJ, Vyas A, Kaiser MK, Wood MA. Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents. JMIR Mhealth Uhealth 2017; 5:e53. [PMID: 28428167 PMCID: PMC5415658 DOI: 10.2196/mhealth.6654] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents.
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Affiliation(s)
- Bree E Holtz
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Katharine M Murray
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Denise D Hershey
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Julie K Dunneback
- Sparrow Health System, Department of Pediatric Endocrinology, Lansing, MI, United States
| | - Shelia R Cotten
- Department of Media and Information, Michigan State University, East Lansing, MI, United States
| | - Amanda J Holmstrom
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Arpita Vyas
- Department of Pediatrics, Texas Tech University, Lubbock, TX, United States
| | - Molly K Kaiser
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Michael A Wood
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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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.
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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.
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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]
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Gardiner CK, Bryan AD. Monetary Incentive Interventions Can Enhance Psychological Factors Related to Fruit and Vegetable Consumption. Ann Behav Med 2017; 51:599-609. [DOI: 10.1007/s12160-017-9882-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Affiliation(s)
- Justin S White
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94118, USA.
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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
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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]
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A Response to Proposed Equal Employment Opportunity Commission Regulations on Employer-Sponsored Health, Safety, and Well-Being Initiatives. J Occup Environ Med 2016; 58:e103-10. [PMID: 26949886 DOI: 10.1097/jom.0000000000000698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify areas of consensus in response to proposed Equal Employment Opportunity Commission Americans with Disabilities Act of 1990 and Genetic Information Nondiscrimination Act of 2008 regulations on employer-sponsored health, safety, and well-being initiatives. METHODS The consensus process included review of existing and proposed regulations, identification of key areas where consensus is needed, and a methodical consensus-building process. RESULTS Stakeholders representing employees, employers, consulting organizations, and wellness providers reached consensus around five areas, including adequate privacy notice on how medical data are collected, used, and protected; effective, equitable use of inducements that influence participation in programs; observance of reasonable alternative standards; what constitutes reasonably designed programs; and the need for greater congruence between federal agency regulations. CONCLUSION Employee health and well-being initiatives that are in accord with federal regulations are comprehensive, evidence-based, and are construed as voluntary by employees and regulators alike.
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