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The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis

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  • Emma L Giles
  • Shannon Robalino
  • Elaine McColl
  • Falko F Sniehotta
  • Jean Adams

Abstract

Background: Financial incentive interventions have been suggested as one method of promoting healthy behaviour change. Objectives: To conduct a systematic review of the effectiveness of financial incentive interventions for encouraging healthy behaviour change; to explore whether effects vary according to the type of behaviour incentivised, post-intervention follow-up time, or incentive value. Data Sources: Searches were of relevant electronic databases, research registers, www.google.com, and the reference lists of previous reviews; and requests for information sent to relevant mailing lists. Eligibility Criteria: Controlled evaluations of the effectiveness of financial incentive interventions, compared to no intervention or usual care, to encourage healthy behaviour change, in non-clinical adult populations, living in high-income countries, were included. Study Appraisal and Synthesis: The Cochrane Risk of Bias tool was used to assess all included studies. Meta-analysis was used to explore the effect of financial incentive interventions within groups of similar behaviours and overall. Meta-regression was used to determine if effect varied according to post-intervention follow up time, or incentive value. Results: Seventeen papers reporting on 16 studies on smoking cessation (n = 10), attendance for vaccination or screening (n = 5), and physical activity (n = 1) were included. In meta-analyses, the average effect of incentive interventions was greater than control for short-term (≤six months) smoking cessation (relative risk (95% confidence intervals): 2.48 (1.77 to 3.46); long-term (>six months) smoking cessation (1.50 (1.05 to 2.14)); attendance for vaccination or screening (1.92 (1.46 to 2.53)); and for all behaviours combined (1.62 (1.38 to 1.91)). There was not convincing evidence that effects were different between different groups of behaviours. Meta-regression found some, limited, evidence that effect sizes decreased as post-intervention follow-up period and incentive value increased. However, the latter effect may be confounded by the former. Conclusions: The available evidence suggests that financial incentive interventions are more effective than usual care or no intervention for encouraging healthy behaviour change. Trial Registration: PROSPERO CRD42012002393

Suggested Citation

  • Emma L Giles & Shannon Robalino & Elaine McColl & Falko F Sniehotta & Jean Adams, 2014. "The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-16, March.
    • Handle: RePEc:plo:pone00:0090347
    DOI: 10.1371/journal.pone.0090347
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    2. Gill Thomson & Heather Morgan & Nicola Crossland & Linda Bauld & Fiona Dykes & Pat Hoddinott & on behalf of the BIBS team, 2014. "Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-21, October.
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    4. Fontecha, John E. & Walteros, Jose L. & Nikolaev, Alexander, 2021. "Reach maximization for social lotteries," Omega, Elsevier, vol. 105(C).
    5. Marco Fabbri & Paolo Nicola Barbieri & Maria Bigoni, 2019. "Ride Your Luck! A Field Experiment on Lottery-Based Incentives for Compliance," Management Science, INFORMS, vol. 65(9), pages 4336-4348, September.
    6. Leonard E Egede & Rebekah J Walker & Clara E Dismuke-Greer & Sarah Pyzyk & Aprill Z Dawson & Joni S Williams & Jennifer A Campbell, 2021. "Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-11, March.
    7. Crossland, Nicola & Thomson, Gill & Morgan, Heather & Dombrowski, Stephan U. & Hoddinott, Pat, 2015. "Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings," Social Science & Medicine, Elsevier, vol. 128(C), pages 10-17.
    8. Gneezy, Uri & Kajackaite, Agne & Meier, Stephan, 2020. "Incentive-Based Interventions," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, pages 523-536.
    9. Raymond M Duch & Adrian Barnett & Maciej Filipek & Javier Espinosa-Brito & Laurence S J Roope & Mara Violato & Philip M Clarke, 2023. "Cash versus lottery video messages: online COVID-19 vaccine incentives experiment," Oxford Open Economics, Oxford University Press, vol. 2, pages 9-8.
    10. Finkelstein, Eric A. & Bilger, Marcel & Baid, Drishti, 2019. "Effectiveness and cost-effectiveness of incentives as a tool for prevention of non-communicable diseases: A systematic review," Social Science & Medicine, Elsevier, vol. 232(C), pages 340-350.
    11. Frauke Becker & Nana Anokye & Esther W de Bekker-Grob & Ailish Higgins & Clare Relton & Mark Strong & Julia Fox-Rushby, 2018. "Women’s preferences for alternative financial incentive schemes for breastfeeding: A discrete choice experiment," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-19, April.
    12. Edberg, Dana & Mukhopadhyay, Sankar & Wendel, Jeanne, 2019. "Incentive design to boost health for juveniles with Medicaid coverage: Evidence from a field experiment," Economics & Human Biology, Elsevier, vol. 33(C), pages 101-115.
    13. Yusi Gong & Taylor P Trentadue & Swastina Shrestha & Elena Losina & Jamie E Collins, 2018. "Financial incentives for objectively-measured physical activity or weight loss in adults with chronic health conditions: A meta-analysis," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-16, September.
    14. Emmanuel Aboagye & Jan Hagberg & Iben Axén & Lydia Kwak & Malin Lohela-Karlsson & Eva Skillgate & Gunilla Dahlgren & Irene Jensen, 2017. "Individual preferences for physical exercise as secondary prevention for non-specific low back pain: A discrete choice experiment," PLOS ONE, Public Library of Science, vol. 12(12), pages 1-15, December.
    15. Catherine Henderson & Martin Knapp & Ksenija Yeeles & Stephen Bremner & Sandra Eldridge & Anthony S David & Nicola O’Connell & Tom Burns & Stefan Priebe, 2015. "Cost-Effectiveness of Financial Incentives to Promote Adherence to Depot Antipsychotic Medication: Economic Evaluation of a Cluster-Randomised Controlled Trial," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-18, October.
    16. Triyana, Margaret & White, Justin S., 2022. "Non-monetary incentives for tobacco prevention among youth in Indonesia," Journal of Health Economics, Elsevier, vol. 83(C).
    17. Inghels, Maxime & Kim, Hae-Young & Mathenjwa, Thulile & Shahmanesh, Maryam & Seeley, Janet & Wyke, Sally & McGrath, Nuala & Sartorius, Benn & Yapa, H. Manisha & Dobra, Adrian & Bärnighausen, Till & Ta, 2022. "Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa," Social Science & Medicine, Elsevier, vol. 311(C).
    18. Gregg, Rebecca & Patel, Ajay & Patel, Sumaiya & O’Connor, Laura, 2017. "Public reaction to the UK government strategy on childhood obesity in England: A qualitative and quantitative summary of online reaction to media reports," Health Policy, Elsevier, vol. 121(4), pages 450-457.
    19. Zain UI Abideen & Zeeshan Ahmed & Huan Qiu & Yiwei Zhao, 2023. "Do Behavioral Biases Affect Investors’ Investment Decision Making? Evidence from the Pakistani Equity Market," Risks, MDPI, vol. 11(6), pages 1-32, June.
    20. Talia Goren & Itai Beeri & Dana R. Vashdi, 2023. "Framing policies to mobilize citizens' behavior during a crisis: Examining the effects of positive and negative vaccination incentivizing policies," Regulation & Governance, John Wiley & Sons, vol. 17(2), pages 570-591, April.
    21. Eiji Yamamura & Yoshiro Tsutsui & Fumio Ohtake, 2023. "Would Monetary Incentives to COVID-19 vaccination reduce motivation?," Papers 2311.11828, arXiv.org.
    22. Liu, Jenny X. & Vallin, Janelli & Chiu, Calvin & Cabrera, F. Abigail & Hunter, Lauren A. & Rao, Aarthi & Njau, Prosper & McCoy, Sandra I., 2023. "Designing for two: How enhancing human-centered design with behavioral nudges unlocked breakthroughs to promote young women's psychological safety and access to reproductive care in Tanzania," Social Science & Medicine, Elsevier, vol. 320(C).
    23. Elizabeth Greene & Allison Pack & Jill Stanton & Victoria Shelus & Elizabeth E Tolley & Jamilah Taylor & Wafaa M El Sadr & Bernard M Branson & Jason Leider & Natella Rakhmanina & Theresa Gamble, 2017. "“It Makes You Feel Like Someone Cares” acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-18, February.

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