Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours

Abstract

Financial incentive interventions are increasingly used as a method of encouraging healthy behaviours, from attending for vaccinations to taking part in regular physical activity. There is a growing body of research on the effectiveness of financial incentive interventions for health behaviours. Wide variations in the nature of these interventions make it difficult to draw firm conclusions about what makes an effective incentive, for whom and under what circumstances. Whilst there has been some recognition of the theoretical complexity of financial incentive interventions for health behaviours, there is no framework that categorises these interventions. This limits the research community's ability to clearly establish which components of financial incentives interventions are more and less effective, and how these components might interact to enable behavioural change. We propose a framework for describing health-promoting financial incentive interventions. Drawing on our experience of a recently completed systematic review, we identify nine domains that are required to describe any financial incentive intervention designed to help individuals change their health behaviours. These are: direction, form, magnitude, certainty, target, frequency, immediacy, schedule and recipient. Our framework should help researchers and policy-makers identify the most effective incentive configurations for helping individuals adopt healthy behaviours.

Keywords:

• incentives
• health behaviour
• behavioural economics
• motivation

Acknowledgements

This work is produced under the terms of a Career Development Fellowship research training fellowship issued by the National Institute of Health Research to J.A. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service (NHS), The National Institute for Health Research or the Department of Health. J.A. and E.L.G. are funded in part, and F.F.S. is funded in full, as staff members of Fuse, the Centre for Translational Research in Public Health, a United Kingdom Clinical Resarch Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding for Fuse from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research is gratefully acknowledged. None of the funders played any role in the preparation of the manuscript or the decision to submit.

Notes

1. This is only one aspect of the ethics and acceptability of financial incentive interventions that has been questioned. Fuller discussion of the ethics and acceptability of financial incentive interventions are available elsewhere (Halpern, Madison, & Volpp, 2009; Marteau, Ashcroft, & Oliver, 2009).