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

Jan-Niklas Kramer; Peter Tinschert; Urte Scholz; Elgar Fleisch; Tobias Kowatsch

doi:10.1016/j.amepre.2018.09.018

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

Am J Prev Med. 2019 Feb;56(2):e45-e54. doi: 10.1016/j.amepre.2018.09.018. Epub 2018 Dec 13.

Authors

Jan-Niklas Kramer¹, Peter Tinschert¹, Urte Scholz², Elgar Fleisch³, Tobias Kowatsch⁴

Affiliations

¹ Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.
² Department of Psychology, Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland.
³ Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland; Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.
⁴ Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland. Electronic address: tobias.kowatsch@unisg.ch.

PMID: 30553693
DOI: 10.1016/j.amepre.2018.09.018

Abstract

Introduction: There has been limited research investigating whether small financial incentives can promote participation, behavior change, and engagement in physical activity promotion programs. This study evaluates the effects of two types of small financial incentives within a physical activity promotion program of a Swiss health insurance company.

Study design: Three-arm cluster-randomized trial comparing small personal financial incentives and charity financial incentives (10 Swiss Francs, equal to US$10.40) for each month with an average step count of >10,000 steps per day to control. Insureds' federal state of residence was the unit of randomization. Data were collected in 2015 and analyses were completed in 2018.

Setting/participants: German-speaking insureds of a large health insurer in Switzerland were invited. Invited insureds were aged ≥18 years, enrolled in complementary insurance plans and registered on the insurer's online platform.

Main outcome measures: Primary outcome was the participation rate. Secondary outcomes were steps per day, the proportion of participant days in which >10,000 steps were achieved and non-usage attrition over the first 3 months of the program.

Results: Participation rate was 5.94% in the personal financial incentive group (OR=1.96, 95% CI=1.55, 2.49) and 4.98% in the charity financial incentive group (OR=1.59, 95% CI=1.25, 2.01) compared with 3.23% in the control group. At the start of the program, the charity financial group had a 12% higher chance of walking 10,000 steps per day than the control group (OR=1.68, 95% CI=1.23, 2.30), but this effect dissipated after 3 months. Steps per day and non-usage attrition did not differ significantly between the groups.

Conclusions: Small personal and charity financial incentives can increase participation in physical activity promotion programs. Incentives may need to be modified in order to prevent attrition and promote behavior change over a longer period of time.

Trial registration: This study is registered at www.isrctn.com ISRCTN24436134.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Charities / economics
Exercise*
Female
Health Promotion / economics*
Healthy Lifestyle
Humans
Insurance, Health, Reimbursement*
Male
Middle Aged
Motivation*