The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice

Abstract

Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior.

Keywords:

• incentives
• contingency management
• conditional cash transfer
• pay-for-performance
• wellness

Acknowledgments

Publication of this article was funded by the Open Access Promotion Fund of the Johns Hopkins University Libraries. Financial support for manuscript preparation was provided by the National Institutes of Health grants T32DA007209, R21DA029162, and R01DA023469. The funding sources had no other role in manuscript preparation or in the decision to publish. The authors thank George Bigelow, Kelly Dunn, Maxine Stitzer, and Eric Strain for their helpful feedback on an earlier version of this manuscript.

Disclosure

The authors report no conflicts of interest in this work.