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Wanni Arachchige Dona S, Angeles MR, Hall N, Watts JJ, Peeters A, Hensher M. Impacts of chronic disease prevention programs implemented by private health insurers: a systematic review. BMC Health Serv Res 2021; 21:1222. [PMID: 34763676 PMCID: PMC8582197 DOI: 10.1186/s12913-021-07212-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic diseases contribute to a significant proportion (71%) of all deaths each year worldwide. Governments and other stakeholders worldwide have taken various actions to tackle the key risk factors contributing to the prevalence and impact of chronic diseases. Private health insurers (PHI) are one key stakeholders, particularly in Australian health system, and their engagement in chronic disease prevention is growing. Therefore, we investigated the impacts of chronic disease prevention interventions implemented by PHI both in Australia and internationally. METHOD We searched multiple databases (Business Source Complete, CINAHL, Global Health, Health Business Elite, Medline, PsycINFO, and Scopus) and grey literature for studies/reports published in English until September 2020 using search terms on the impacts of chronic disease prevention interventions delivered by PHIs. Two reviewers assessed the risk of bias using a quality assessment tool developed by Effective Public Healthcare Panacea Project. After data extraction, the literature was synthesised thematically based on the types of the interventions reported across studies. The study protocol was registered in PROSPERO, CRD42020145644. RESULTS Of 7789 records, 29 studies were eligible for inclusion. There were predominantly four types of interventions implemented by PHIs: Financial incentives, health coaching, wellness programs, and group medical appointments. Outcome measures across studies were varied, making it challenging to compare the difference between the effectiveness of different intervention types. Most studies reported that the impacts of interventions, such as increase in healthy eating, physical activity, and lower hospital admissions, last for a shorter term if the length of the intervention is shorter. INTERPRETATION Although it is challenging to conclude which intervention type was the most effective, it appeared that, regardless of the intervention types, PHI interventions of longer duration (at least 2 years) were more beneficial and outcomes were more sustained than those PHI interventions that lasted for a shorter period. FUNDING Primary source of funding was Geelong Medical and Hospital Benefits Association (GMHBA), an Australian private health insurer.
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Affiliation(s)
- Sithara Wanni Arachchige Dona
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Mary Rose Angeles
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Natasha Hall
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Jennifer J Watts
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Martin Hensher
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia.
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia.
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Analysis of consumers’ negative perceptions of health tracking in insurance – a value sacrifice approach. JOURNAL OF INFORMATION COMMUNICATION & ETHICS IN SOCIETY 2021. [DOI: 10.1108/jices-05-2020-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper explores and identifies customer-value-related sacrifices that consumers attach to interactive health/life insurance. This paper aims to increase understanding of why individual consumers are not willing to embrace behaviour-tracking-based insurance applications.
Design/methodology/approach
The authors analysed data from a qualitative survey of Finnish insurance consumers who were not keen on adopting interactive insurance products.
Findings
Developed through thematic analysis, the framework presented in this paper illustrates consumers’ value sacrifices on four dimensions: economic, functional, emotional and symbolic value.
Research limitations/implications
The framework and insights emerging in the study hold several implications related to increased understanding of consumers’ perceptions of insurance and to developing interactive insurance services. In addition, this work provides a promising foundation and avenues for further considerations related to digital ethics in insurance.
Originality/value
To the best of the authors’ knowledge, this paper is the first piece applying a value sacrifice perspective in studying consumers’ unwillingness to adopt interactive insurance products.
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Abstract
BACKGROUND Promotion of physical activity (PA) among populations is a global health investment. However, evidence on economic aspects of PA is sparse and scattered in low-income and middle-income countries (LMICs). OBJECTIVE The objective of this study was to summarise the available evidence on economics of PA in LMICs, identify potential target variables for policy and report gaps in the existing economic evidence alongside research recommendations. DATA SOURCES A systematic review of the electronic databases (Scopus, Web of Science and SPORTDiscus) and grey literature. STUDY ELIGIBILITY CRITERIA Cost-of-illness studies, economic evaluations, interventions and descriptive studies on economic factors associated with PA using preset eligibility criteria. STUDY APPRAISAL AND SYNTHESIS OF METHODS Screening, study selection and quality appraisal based on standard checklists performed by two reviewers with consensus of a third reviewer. Descriptive synthesis of data was performed. RESULTS The majority of the studies were from upper-middle-income countries (n=16, 88.8%) and mainly from Brazil (n=9, 50%). Only one economic evaluation study was found. The focus of the reviewed literature spanned the economic burden of physical inactivity (n=4, 22%), relationship between PA and costs (n=6, 46%) and socioeconomic determinants of PA (n=7, 39%). The findings showed a considerable economic burden due to insufficient PA, with LMICs accounting for 75% of disability-adjusted life years (DALYs) globally due to insufficient PA. Socioeconomic correlates of PA were identified, and inverse relationship of PA with the cost of chronic diseases was established. Regular PA along with drug treatment as a treatment scheme for chronic diseases showed advantages with a cost-utility ratio of US$3.21/quality-adjusted life year (QALY) compared with the drug treatment-only group (US$3.92/QALY) by the only economic evaluation conducted in the LMIC, Brazil. LIMITATIONS Meta-analysis was not performed due to heterogeneity of the studies. CONCLUSIONS AND RECOMMENDATIONS Economic evaluation studies for PA promotion interventions/strategies and local research from low-income countries are grossly inadequate. Setting economic research agenda in LMICs ought to be prioritised in those areas. PROSPERO REGISTRATION NUMBER CRD42018099856.
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Affiliation(s)
- Priyanga Diloshini Ranasinghe
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
- Ministry of Health, Nutrition, Indegenous Medicine, Colombo 10, Sri Lanka
| | - Subhash Pokhrel
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
| | - Nana Kwame Anokye
- Health Economics Research Group, Division of Global Public Health, Department of Health Sciences, Brunel University London, UB8 3PH, UK
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Development of a Tool to Increase Physical Activity among People at Risk for Diabetes in Low-Resourced Communities in Cape Town. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030865. [PMID: 32019135 PMCID: PMC7037043 DOI: 10.3390/ijerph17030865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 12/23/2022]
Abstract
Targeted lifestyle interventions, including physical activity (PA), have been proven to prevent or delay the onset of diabetes. South Africa’s unique context, complex environment and varied cultures and ethnicities require tailored interventions. Our objective was to develop a context-appropriate tool for the South African Diabetes Prevention Programme’s PA lifestyle component in order to enable people at risk of developing diabetes to adopt PA. We used mixed methods to inform the development of the tool. Descriptive analyses of baseline survey data included socio-demographics, anthropometrics, blood pressure and biochemical measurements, reported medical history, PA behaviours, and built environment information. Focus group discussions assisted in understanding perceived challenges, barriers and facilitators/opportunities to PA. A literature search on successful South African PA interventions was done, and PA experts in Cape Town were consulted. Quantitative data were analysed using the software R, version 3.4.4 and qualitative data were thematically analysed. Participants (n = 316) recruited were mostly black (54.4%) and of mixed-ancestry (44.6%); they were mainly female (80.1%), obese (75.2%), and had an haemoglobin A1c (HbA1c) above 5.7% (65.5%), with 30% having hypertension and 87% (self-reported) meeting the World Health Organisation (WHO) PA recommendation. Main barriers to PA practice were safety, cost and accessibility of sports facilities, and laziness. We included practising moderate-intensity aerobic and resistance exercises and take-home self-help materials as recommended. By combining results, we produced a targeted, practical and promotional PA booklet.
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Hajat C, Kotzen D, Stein E, Yach D. Physical activity is associated with improvements in other lifestyle behaviours. BMJ Open Sport Exerc Med 2019; 5:e000500. [PMID: 31803493 PMCID: PMC6887498 DOI: 10.1136/bmjsem-2018-000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction We tested whether physical activity (PA) engagement is subsequently associated with additional health-promoting behaviours in a large-scale, real-world programme leveraging technology and behavioural science to reward healthy lifestyle behaviours. Methods In this observational, longitudinal study, we compared participants' verified and self-reported health behaviours prior to and following their first verified engagement in PA recorded on the Vitality programme between 2014 and 2017. Results Of 34 061 participants, the mean duration in the programme was 40.1 (SD 12.6) months, and the median time until the first PA was 13.1 (SD 16.6) months, with a mean age of 42.0 (SD 11.1) years and 14 881 (43.7%) being male. Baseline weekly PA minutes were mean 62.8 (SD 129.7), 98 (SD 26.0) and 282.9 (SD 230.0) for the low, moderate and high groups, respectively. In the 12 months following the first PA, the low group increased weekly active minutes by 156% (40 (95% CI 28.6 to 51.0) to 102 (95% CI 94.5 to 109.8)); the moderate group increased weekly active minutes by 60% (85.0 (95% CI 76.4 to 93.5) to 136 (95% CI 130.2 to 141.8)); and no change was seen for the high group. Overall, individuals exhibited an increase of 26% in their weekly active minutes from an average of 130 min (95% CI 121.2 to 139.4) to 164 min (95% CI 157.5 to 169.8). Overall, fruit and vegetable daily servings increased from 2.7 (95% CI 2.6 to 2.8) to 2.9 (95% CI 2.9 to 3.0); Kessler Stress Scores decreased from 17.4 (95% CI 17.2 to 17.6) to 17.0 (95% CI 16.9 to 17.1); sedentary hours decreased from 11.3 (95% CI 11.1 to 11.5) to 10.8 (95% CI 10.7 to 11.0); alcohol consumption decreased from 1.8 (95% CI 1.7 to 2.0) to 1.6 (95% CI 1.5 to 1.7) weekly units; sleep increased with borderline significance from 7.1 (95% CI 7.06 to 7.16) to 7.2 (95% CI 7.13 to 7.20) hours/night. Conclusions PA and other health-promoting behaviours improved in parallel. PA was followed by improvements in other health-promoting behaviour.
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Affiliation(s)
- Cother Hajat
- Vitality Group, Chicago, Illinois, USA.,Public Health Institute, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Emma Stein
- School of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Gambhir SS, Ge TJ, Vermesh O, Spitler R. Toward achieving precision health. Sci Transl Med 2019; 10:10/430/eaao3612. [PMID: 29491186 DOI: 10.1126/scitranslmed.aao3612] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/08/2018] [Indexed: 01/19/2023]
Abstract
Health care systems primarily focus on patients after they present with disease, not before. The emerging field of precision health encourages disease prevention and earlier detection by monitoring health and disease based on an individual's risk. Active participation in health care can be encouraged with continuous health-monitoring devices, providing a higher-resolution picture of human health and disease. However, the development of monitoring technologies must prioritize the collection of actionable data and long-term user engagement.
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Affiliation(s)
- Sanjiv Sam Gambhir
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA 94305, USA. .,Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA 94304, USA.,Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA 94304, USA.,Department of Bioengineering and Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - T Jessie Ge
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA 94305, USA.,Precision Health and Integrated Diagnostics Center, Stanford University, Stanford, CA 94305, USA
| | - Ophir Vermesh
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ryan Spitler
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Bioengineering and Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
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Hajat C, Hasan A, Subel S, Noach A. The impact of short-term incentives on physical activity in a UK behavioural incentives programme. NPJ Digit Med 2019; 2:91. [PMID: 31531396 PMCID: PMC6746750 DOI: 10.1038/s41746-019-0164-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/12/2019] [Indexed: 11/09/2022] Open
Abstract
This observational study investigates whether the provision of ongoing short-term-incentives for verified physical activity increases and sustains levels of physical activity. We compared UK members at baseline (years 1 and 2) prior to Vitality's Active Rewards (VAR) intervention commencing (year 3) and follow-up (year 4) for verified, self-reported (encompassing additional physical activities), mortality relative risk and satisfaction with physical activity. Members were categorised into low-active, medium-active and high-active by tertiles of baseline physical activity. Of 11,881 participants, 6477(54.5%) were male, with mean age 39.7(SD 9.8) years. At follow-up, annual active days had increased by 56% overall [60.8(59.7-61.9)-94.8(93.0-96.5)]; 554% in low-active [8.5(8.3-8.7)-47.1(44.7-49.5)]; 205% in medium-active [39.8(39.4-40.2)-81.4(78.7-84.1)] and 17% in high-active members [131.7(129.9-133.5)-153.7(150.7-156.7)] (all p < 0.001). Annual weeks of attaining international physical activity recommendations increased by 19% overall [22.2(42.8%)-26.4(50.8%)] and by 316% for low-active members [4.9(9.5%)-15.5(29.8%)]. Self-reported active minutes/week increased by 45% overall [1423(139.4-145.2)-207.0(201.8-212.3)] and 712% in low-active members [20.1(19.3-21.0)-143.2(134.6-151.9)]. Happiness with exercise levels also increased from 1985(49.4%) to 3414(84.9%) members (all p < 0.001). The relative risk of mortality from a lack of physical activity reduced by 7% for low-active members [from 0.99 to 0.92], 5% for medium-active [0.94-0.89] and 3% for high-active [0.89-0.86](p < 0.001) and by 0.02% for each additional year of age (p = 0.02). This large-scale, real-world, short-term-incentives intervention led to a dramatic increase in physical activity which was sustained for, and still increasing after, two years. If applied at broader level, this approach could considerably aid progress towards WHO targets in its Global Action Plan for Physical Activity.
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Affiliation(s)
- Cother Hajat
- The Vitality Group, Chicago, IL USA
- Vitality Health, London, UK
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Forsythe AM, Venter C. Behavioral Economics, Motivating Psycho-Education Improvements: A Mobile Technology Initiative in South Africa. Front Psychol 2019; 10:1560. [PMID: 31354576 PMCID: PMC6635590 DOI: 10.3389/fpsyg.2019.01560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
Here we report on a health behavioral support project, using incentivized behavior on a mobile platform through M4JAM. This was a proof of concept study to support further developments, more specifically targeted at the management of tuberculosis and human immunodeficiency virus. The study reported here examines the impact of financial rewards and app toward improving mental health outcomes in South Africa. A total of 136 participants were recruited from a database and dichotomized into self-determined and heteronomous groups based on self-report scores. Overall the findings reported here highlight that personal financial incentives have a role in motivating behavior. The findings are discussed in light of the usefulness of an incentivized mobile platform in real-world practice to encourage mental health improvements in low- to middle-income countries.
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Affiliation(s)
- Alexandra Mary Forsythe
- Centre for Psychological Research, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Catherine Venter
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
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Pharmaceutical use according to participation in worksite wellness screening and health campaigns. Prev Med Rep 2018; 12:158-163. [PMID: 30263886 PMCID: PMC6156915 DOI: 10.1016/j.pmedr.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 08/26/2018] [Accepted: 09/09/2018] [Indexed: 01/13/2023] Open
Abstract
This study evaluated whether participation in worksite wellness screening and health campaigns influences the number and cost (USD) of pharmacy medication claims. Analyses are based on 2531 workers employed all four academic years in a large school district in the western United States, 2010–11 through 2013–14. Mean and ratio comparisons were adjusted by age, sex, year, and baseline health. Approximately 84.2% of employees participated in wellness screening and 60.1% completed one or more health campaigns. Those completing wellness screening were 1.09 (95% CI 1.06–1.13) times more likely to file a claim. Mean total cost remained near $934 (SD = $3695) over the academic years, positively associated with years of wellness screening, suggesting increased awareness of the need for medication through screening. Women were 1.02 (95% CI 1.00–1.05) times more likely than men to participate in wellness screening and had greater total pharmacy cost ($990.6 [SD = $4023.7] vs. $777.9 [SD = $2580.5], p = 0.0104). Women were 1.38 (95% CI 1.32–1.44) times more likely to complete a health campaign. Mean number of pharmacy claims was lower (9.8 vs. 10.6, p = 0.0069) in those completing at least one health campaign, suggesting greater health orientation in women. Those completing at least one health campaign were 0.96 (95% CI 0.92–0.99) times as likely to have a total cost of medication above the median, 0.94 (95% CI 0.88–1.01) as likely to have a total cost of medication above the 75th percentile, and 0.84 (0.75–0.96) times as likely to have a total cost above the 90th percentile.
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Munck B, Björklund A, Jansson I, Lundberg K, Wagman P. Adulthood transitions in health and welfare; a literature review. Nurs Open 2018; 5:254-260. [PMID: 30062017 PMCID: PMC6056437 DOI: 10.1002/nop2.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/02/2018] [Indexed: 12/03/2022] Open
Abstract
AIM The aim of the literature review was to describe how adulthood transition is used in health and welfare. DESIGN A qualitative design with a deductive approach were used. METHODS As material, 283 articles published in scientific journals, between 2011-August 2013, were selected. The search was conducted August 2013. The data were analysed and sorted in a categorization matrix. RESULTS Transition was identified as a process mainly related to the four types previously identified; developmental, situational, health-illness and organizational transitions. Another one transition was also identified, lifestyle transition.
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Affiliation(s)
- Berit Munck
- School of Health and WelfareADULT research groupJönköping UniversityJönköpingSweden
| | - Anita Björklund
- School of Health and WelfareADULT research groupJönköping UniversityJönköpingSweden
| | - Inger Jansson
- School of Health and WelfareADULT research groupJönköping UniversityJönköpingSweden
| | - Kristina Lundberg
- School of Health and WelfareADULT research groupJönköping UniversityJönköpingSweden
- Faculty of Caring science, Work Life and Social WelfarePre Hospen ‐ Centre for Prehospital ResearchUniversity of BoråsBoråsSweden
| | - Petra Wagman
- School of Health and WelfareADULT research groupJönköping UniversityJönköpingSweden
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Patel DN, Nossel C, Patricios J, Maboreke J. Bright spots, physical activity investments that work: Vitality Active Rewards-a smartphone app that incentivises programme members to be physically active. Br J Sports Med 2018; 52:1494-1496. [PMID: 29934427 DOI: 10.1136/bjsports-2018-099271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/26/2018] [Accepted: 06/10/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Deepak N Patel
- Research Division, Discovery Vitality, Sandton, South Africa
| | - Craig Nossel
- Research Division, Discovery Vitality, Sandton, South Africa
| | - Jon Patricios
- Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Maboreke
- Research Division, Discovery Vitality, Sandton, South Africa
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Shah SN, Digenis-Bury E, Russo ET, O'Malley S, Blanding N, McHugh A, Wada R. No-cost gym visits are associated with lower weight and blood pressure among non-Latino black and Latino participants with a diagnosis of hypertension in a multi-site demonstration project. Prev Med Rep 2018; 10:66-71. [PMID: 29520336 PMCID: PMC5842286 DOI: 10.1016/j.pmedr.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/22/2018] [Accepted: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Well documented, persistent racial/ethnic health disparities in obesity and hypertension in the US demonstrate the continued need for interventions that focus on people of color who may be at higher risk. We evaluated a demonstration project funded by the CDC's Racial/Ethnic Approaches to Community Health (REACH) program at four federally qualified health centers (FQHC) and YMCA fitness and wellness centers in Boston. No-cost YMCA memberships were offered from June 2014 to June 2015 to non-Latino black and Latino adults with a diagnosis of hypertension. YMCA visit data were merged with health data for 224 participants (n = 1265 health center visits). We assessed associations between gym visit frequency and weight, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) using longitudinal time-varying linear fixed-effects models. The total number of gym visits over the entire program duration was 5.5, while the conditional total number of visits (after the first gym visit has been made) was 17.3. Having visited the gym at least 10 times before an FQHC exam was, on average, associated with lower weight (1.19 kg, p = 0.01), lower BMI (0.43 kg/m2, p = 0.01) and reductions in SBP (-3.20 mm Hg, p = 0.01) and DBP (-2.06 mm Hg p = 0.01). Having visited the gym an average of 1.4 times per month (study average) was associated with reductions in weight, BMI, and DBP. No-cost gym visits were associated with improved weight and blood pressure in hypertensive non-Latino black and Latino adults in this program. Additional evaluation is necessary to assess the sustainability of these effects.
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Affiliation(s)
- Snehal N. Shah
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
- Department of Pediatrics, Boston University School of Medicine, 850 Harrison Ave, Boston, MA 02116, United States
| | - Eleni Digenis-Bury
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
| | - Elizabeth T. Russo
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
| | - Shannon O'Malley
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
| | - Nineequa Blanding
- Chronic Disease Prevention and Control Division, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
| | - Anne McHugh
- Chronic Disease Prevention and Control Division, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
| | - Roy Wada
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Ave, 6th Floor, Boston, MA 02118, United States
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Abstract
The Botswana workplace wellness program (WWP) for health care workers (HCWs) was initiated in 2007. WWP implementation was assessed using a sequential, explanatory, mixed methods design including a national implementation assessment (27 health districts) and in-depth interviews (n = 38). Level of implementation varied across districts with health screening, therapeutic recreation, and health promotion implemented more frequently than occupational health activities and psychosocial services. Facilitators to WWP implementation included establishment of a dedicated, diverse WWP committee; provision of administrative support, and integration of activities into organizational culture. Barriers included competing priorities related to delivery of health services to clients, limited technical ability to deliver occupation health activities and psychosocial support, receipt of health services from colleagues, and limited appreciation for personal wellness by some HCWs. Ensuring the well-being of HCWs is critical in reaching international health goals.
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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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15
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Blaga OM, Vasilescu L, Chereches RM. Use and effectiveness of behavioural economics in interventions for lifestyle risk factors of non-communicable diseases: a systematic review with policy implications. Perspect Public Health 2018; 138:100-110. [PMID: 28715989 PMCID: PMC5748366 DOI: 10.1177/1757913917720233] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM There is limited evidence on what behavioural economics strategies are effective and can be used to inform non-communicable diseases (NCDs) public health policies designed to reduce overeating, excessive drinking, smoking, and physical inactivity. The aim of the review is to examine the evidence on the use and effectiveness of behavioural economics insights on reducing NCDs lifestyle risk factors. METHODS Medline, Embase, PsycINFO, and EconLit were searched for studies published between January 2002 and July 2016 and reporting empirical, non-pharmacological, interventional research focusing on reducing at least one NCDs lifestyle risk factor by employing a behavioural economics perspective. RESULTS We included 117 studies in the review; 67 studies had a low risk of bias and were classified as strong or very strong, 37 were moderate, and 13 were weak. We grouped studies by NCDs risk factors and conducted a narrative synthesis. The most frequent behavioural economics precepts used were incentives, framing, and choice architecture. We found inconclusive evidence regarding the success of behavioural economics strategies to reduce alcohol consumption, but we identified several strategies with policy-level implications which could be used to reduce smoking, improve nutrition, and increase physical activity. CONCLUSION Most studies targeting tobacco consumption, physical activity levels, and eating behaviours from a behavioural economics perspective had promising results with potential impact on NCDs health policies. We recommend future studies to be implemented in real-life settings and on large samples from diverse populations.
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Affiliation(s)
- Oana M. Blaga
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania, 7 Pandurilor St, 400376, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania, 7 Pandurilor St, 400376, Cluj-Napoca, Romania
| | - Livia Vasilescu
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania, 7 Pandurilor St, 400376, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania, 7 Pandurilor St, 400376, Cluj-Napoca, Romania
| | - Razvan M. Chereches
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania, 7 Pandurilor St, 400376, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University Cluj-Napoca, Romania, 7 Pandurilor St, 400376, Cluj-Napoca, Romania
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McGill B, O'Hara BJ, Grunseit AC, Bauman A, Osborne D, Lawler L, Phongsavan P. Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study. BMC Public Health 2018; 18:244. [PMID: 29439689 PMCID: PMC5811982 DOI: 10.1186/s12889-018-5136-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. METHODS We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups. RESULTS Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance. CONCLUSIONS If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.
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Affiliation(s)
- Bronwyn McGill
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia. .,Charles Perkins Centre, John Hopkins Drive, University of Sydney, Sydney, NSW, 2006, Australia. .,The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia.
| | - Blythe J O'Hara
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.,Charles Perkins Centre, John Hopkins Drive, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anne C Grunseit
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.,Charles Perkins Centre, John Hopkins Drive, University of Sydney, Sydney, NSW, 2006, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.,Charles Perkins Centre, John Hopkins Drive, University of Sydney, Sydney, NSW, 2006, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia
| | - Dale Osborne
- Osborne Research Services, Rozelle, NSW, 2039, Australia
| | - Luke Lawler
- Prima Health Solutions, PO Box 7468, Warringah Mall, NSW, 2100, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.,Charles Perkins Centre, John Hopkins Drive, University of Sydney, Sydney, NSW, 2006, Australia
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Hooker SA, Wooldridge JS, Ross KM, Masters KS. Do Monetary Incentives Increase Fitness Center Utilization? It Depends. Am J Health Promot 2017; 32:606-612. [PMID: 29214817 DOI: 10.1177/0890117116689321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine the effects of an employer-based monetary incentive program on membership termination and usage at a fitness center. DESIGN Retrospective nested case-control study examining the relationship between participation in an incentive program, visits to the fitness center, and membership termination at 1 year. SETTING University-based fitness center. PARTICIPANTS Members (N = 1122) of a university-based fitness center. INTERVENTION Members were offered either a US$25 incentive for each month they visited the fitness center at least 10 times or no incentive. MEASURES Data were extracted from the membership database and included membership termination at 1 year (yes, no), length of membership (days), participation in the incentive program (yes, no), and visits to the fitness center per month. ANALYSIS Cox proportional hazards model. RESULTS Members in the incentive program visited the fitness center on average more times per month (5.3 vs 4.3; P < .0001) but were significantly more likely to terminate memberships at 1 year compared to members who did not receive the incentive (38% vs 31%; P = .013). After controlling for relevant covariates, members who received the incentive had a 24% greater hazard of terminating their memberships compared to members who did not receive the incentive (hazard ratio [HR] = 1.24; P = .041). After controlling for the number of visits per month, the incentive program was no longer significantly related to membership termination (HR = 1.21; P = .07). CONCLUSION Being in a monetary incentive program to attend a fitness center may be initially associated with a greater fitness center utilization but may not be associated with a reduced risk of membership termination.
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Affiliation(s)
- Stephanie A Hooker
- 1 Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | | | - Kaile M Ross
- 1 Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Kevin S Masters
- 1 Department of Psychology, University of Colorado Denver, Denver, CO, USA
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18
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Mason MR, Ickes MJ, Campbell MS, Bollinger LM. An Incentivized, Workplace Physical Activity Intervention Preferentially Increases Daily Steps in Inactive Employees. Am J Health Promot 2017; 32:638-645. [PMID: 28851235 DOI: 10.1177/0890117117723803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although physical activity (PA) is associated with decreased risk of chronic diseases, fewer than half of American adults meet the recommendations for daily PA, in part, due to large amounts of sedentary time in the workplace. PURPOSE To determine the efficacy of an incentivized workplace PA intervention. DESIGN Retrospective cohort design. SETTING Large southeastern university. PARTICIPANTS Of the 16 588 eligible employees working ≥8 h/wk, 6246 (37.6%) participated and 2206 (13.3%) were included in data analysis. INTERVENTION Six-week PA intervention with tiered incentives (value: $10.50-$29.00). MEASURES Steps/day measured via consumer-grade PA monitors for 1-week pre-, 6-weeks during, and 1-week postintervention. ANALYSIS Participants were grouped by preintervention PA into 4 groups: <6000 (I); 6000 to 7999 (II); 8000 to 9999 (III); and ≥10 000 (IV) steps/d ( n = 481, 540, 485, and 700, respectively) in accordance with the tiered incentive schedule. Statistical comparisons were made by repeated-measures analysis of variance. RESULTS During the intervention, participants achieving ≥10 000 steps/d increased by 60%. Groups I, II, and III significantly increased steps/day during the intervention (46%, 24%, and 11%, respectively), which was partially maintained in groups I and II 1-week postintervention. Group IV did not increase steps/day during the intervention and significantly decreased steps/day 1-week postintervention. The estimated cost per participant of this intervention increased with from group I ($55.41) to IV ($71.90). CONCLUSION An incentivized, workplace PA intervention preferentially increases PA and is most cost-effective among university employees with low initial PA who may benefit substantially from increased levels of PA.
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Affiliation(s)
- M Ryan Mason
- 1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Melinda J Ickes
- 1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Marilyn S Campbell
- 1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Lance M Bollinger
- 1 Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
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Abstract
OBJECTIVE To evaluate whether participation in a worksite wellness program differs by age and sex and is associated with frequency and average cost of medical claims. METHODS Healthcare cost data were available for school district employees during the academic years ending in 2009 through 2014. The wellness program was available in the later 3 years. The frequency and the average cost of medical claims were compared between the 3 years prior to and the 3 years during the wellness program. RESULTS Wellness program participation increased from 65.6% 2011-2012 to 79.7% 2012-2013. The increase occurred within age-groups and for males and females. The average age of program participants was significantly lower in 2011-2012 (48.2 vs. 49.4, p = 0.0099), but similar in the next 2 academic years. Participation in at least one behavior change campaign in each year was 52.1%, 53.7%, and 73.7% of all wellness program participants, respectively. Female employees were significantly more likely to complete one or more behavior change campaigns in each year of the wellness program (p < 0.0001). The percentage of employees filing at least one claim per time period was higher for those in the wellness program (p < 0.0001), but average medical claims payments were lower for those in the wellness program. After subtracting program costs, the cost savings from the wellness program was $3,612,402. The benefit-to-cost ratio was 3.6. CONCLUSION Participation in the wellness program resulted in lower average medical claim costs than non-participation but number of claims were higher in program participants.
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Affiliation(s)
- Ray M. Merrill
- Department of Health Science, College of Life Sciences, Brigham Young University, Provo, UT, USA
| | - James D. LeCheminant
- Department of Exercise Sciences, College of Life Sciences, Brigham Young University, Provo, UT, USA
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20
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Gray N, Picone G, Sloan F, Yashkin A. Relation between BMI and diabetes mellitus and its complications among US older adults. South Med J 2015; 108:29-36. [PMID: 25580754 DOI: 10.14423/smj.0000000000000214] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study examined relations between elevated body mass index (BMI) and time to diagnosis with type 2 diabetes mellitus and its complications among older adults in the United States. METHODS Data came from the Medicare Current Beneficiary Survey, 1991-2010. A Cox proportional hazard model was used to assess relations between excess BMI at the first Medicare Current Beneficiary Survey interview and time to diabetes mellitus diagnosis, complications, and insulin dependence among Medicare beneficiaries, older than 65 years of age with no prior diabetes mellitus diagnosis, and who were not enrolled in Medicare Advantage (N = 14,657). RESULTS Among individuals diagnosed as having diabetes mellitus, elevated BMIs were associated with a progressively higher risk of complications from diabetes mellitus. For women with a BMI ≥40, the risk of insulin dependence (hazard ratio [HR] 3.57; 95% confidence interval [CI] 2.36-5.39) was twice that for women with 25 ≤ BMI < 27.5 (HR 1.77; 95% CI 1.33-2.33). A similar pattern was observed in risk of cardiovascular (25 ≤ BMI < 27.5: HR 1.34; 95% CI 1.15-1.54; BMI ≥40: HR 2.45; 95% CI 1.92-3.11), cerebrovascular (25 ≤ BMI < 27.5: HR 1.30; 95% CI 1.06-1.57; BMI ≥40: HR 2.00; 95% CI 1.42-2.81), renal (25 ≤ BMI < 27.5: HR 1.31; 95% CI 1.04-1.63; BMI ≥40: HR 2.23; 95% CI 1.54-3.22), and lower extremity complications (25 ≤ BMI < 27.5: HR 1.41; 95% CI 1.22-1.61; BMI ≥40: HR 2.95; 95% CI 2.35-3.69). CONCLUSIONS Any increase in BMI above normal weight levels is associated with an increased risk of being diagnosed as having complications of diabetes mellitus. For men, the increased risk of these complications occurred at higher BMI levels than in women. Ocular complications occurred at higher BMI levels than other complication types in both men and women.
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Affiliation(s)
- Natallia Gray
- From the Department of Economics and Finance, Southeast Missouri State University, Cape Girardeau, the Department of Economics, University of South Florida, Tampa, and the Department of Economics, Duke University, Durham, North Carolina
| | - Gabriel Picone
- From the Department of Economics and Finance, Southeast Missouri State University, Cape Girardeau, the Department of Economics, University of South Florida, Tampa, and the Department of Economics, Duke University, Durham, North Carolina
| | - Frank Sloan
- From the Department of Economics and Finance, Southeast Missouri State University, Cape Girardeau, the Department of Economics, University of South Florida, Tampa, and the Department of Economics, Duke University, Durham, North Carolina
| | - Arseniy Yashkin
- From the Department of Economics and Finance, Southeast Missouri State University, Cape Girardeau, the Department of Economics, University of South Florida, Tampa, and the Department of Economics, Duke University, Durham, North Carolina
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21
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Tzeng A, Tzeng TH, Vasdev S, Grindy A, Saleh JK, Saleh KJ. The Role of Patient Activation in Achieving Better Outcomes and Cost-Effectiveness in Patient Care. JBJS Rev 2015; 3:01874474-201501000-00004. [PMID: 27501025 DOI: 10.2106/jbjs.rvw.n.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alice Tzeng
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Sonia Vasdev
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Anna Grindy
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Jamal K Saleh
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, San Francisco, CA 94143-0728
| | - Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
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22
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Abstract
The rising burden of chronic disease poses a challenge for all public health systems and requires innovative approaches to effectively improve population health. Persisting inequalities in health are of particular concern. Disadvantage because of education, income, or social position is associated with a larger burden of disease and, in particular, multimorbidity. Although much has been achieved to enhance population health, challenges remain, and approaches need to be revisited. In this paper, we join the debate about how a new wave of public health improvement might look. We start from the premise that population health improvement is conditional on a health-promoting societal context. It is characterised by a culture in which healthy behaviours are the norm, and in which the institutional, social, and physical environment support this mindset. Achievement of this ambition will require a positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders. We emphasise three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour. We give examples of how these mechanisms might be achieved.
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Affiliation(s)
- Sally C Davies
- Office of the Chief Medical Officer, Department of Health, London, UK
| | | | | | - Tom Fowler
- Office of the Chief Medical Officer, Department of Health, London, UK; Field Epidemiology Services - West Midlands, Public Health England, Birmingham, UK; Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
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Lambert EV, Kolbe-Alexander TL. Innovative strategies targeting obesity and non-communicable diseases in South Africa: what can we learn from the private healthcare sector? Obes Rev 2013; 14 Suppl 2:141-9. [PMID: 24102989 DOI: 10.1111/obr.12094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 12/01/2022]
Abstract
Over 50% of South African adult women and 30% of adult men are either overweight or obese, and nearly half of all adults are insufficiently active, with major increases in obesity-associated healthcare expenditures since 1980, a high proportion of which are paid by private health insurance. In this paper, we describe the Vitality programme, an incentivized health promotion programme from South Africa's largest private health insurer, Discovery Health, with over 2.5 million beneficiaries. Wellness activities of the programme include health risk assessments, subsidized gym memberships and smoking cessation or weight loss programmes with many incentives, including cash back on purchases of healthy foods. This incentive-based programme has shown a significant relationship between levels of engagement in wellness activities, in particular increasing participation in fitness-related activities, with lower healthcare expenditure and an increase in the overall ratio of healthy foods to total food purchases. This programme demonstrates that incentives may reduce the barriers for entry into care, increase preventive screening and increase engagement in healthy behaviours for prevention and management of obesity. This 'carrots versus sticks' approach may have implications for public health policy even in lower- and middle-income settings and underserved communities.
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Affiliation(s)
- E V Lambert
- UCT/MRC Exercise Science and Sports Science Research Unit, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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24
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Patel DN, Nossel C, Alexander E, Yach D. Innovative business approaches for incenting health promotion in sub-Saharan Africa: progress and persisting challenges. Prog Cardiovasc Dis 2013; 56:356-62. [PMID: 24267443 DOI: 10.1016/j.pcad.2013.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Non-communicable chronic diseases related to behaviors such as tobacco use, overeating, excess alcohol intake and physical inactivity account for increasing morbidity and mortality in South Africa. Over the last 15 years, Discovery Health, the largest private health plan in South Africa, has developed a voluntary health promotion program called Vitality with over 1.5 million members. Vitality was designed with many applications drawn from the growing field of behavioral economics, including the use of incentives and rewards. Incentives offered on the program are aimed at lowering the financial barriers to activities such as visiting the gym, buying healthy food or receiving preventive screening. Members accrue points for engagement which translate into discounts on a range of goods and services. Although the full impact of the program cannot yet be quantified, engagement with the program is continually increasing and there is compelling evidence that this translates into better health and cost outcomes.
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Affiliation(s)
- Deepak N Patel
- Discovery Vitality, Johannesburg, Sandton 2156, South Africa
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Anderson P, Harrison O, Cooper C, Jané-Llopis E. Incentives for health. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 2:107-133. [PMID: 21916718 DOI: 10.1080/10810730.2011.601531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article discusses incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments. Whereas paying individuals directly to be healthier seems to have a limited effect, offering financial incentives through health insurance improves health. Changing the environment to make healthier choices more accessible acts as an incentive to improve health. Employers can provide incentives to improve the health of their employees. Producers and service providers can take voluntary action to make their products less harmful, and they can be nudged into marketing healthier products within a regulatory environment. International agreements and monitoring systems can incentivize governments to do more for health. Lessons from climate change adaptation suggest that multilevel governance and policy integration are greater obstacles to policy change and implementation than knowing what has to be done. Policy change and implementation are triggered by many drivers, many of which are side effects of other policy pressures rather than of the direct policy goal itself. Effective action to reduce noncommunicable diseases will require leveraging social networks into a new ways of thinking about health; making better health prestigious and aspirational, and giving health and wellness a brand that encourages positive behavior change.
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Affiliation(s)
- Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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