Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups

BMC Public Health

Jean Adams²  Elaine McColl¹  Falko F Sniehotta³  Emma L Giles³ 

[1] Newcastle Clinical Trials Unit, 4th Floor William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK;Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK;Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, Tyne and Wear, UK

关键词: Healthy behaviours;    Financial incentives;    Acceptability;    Qualitative focus groups;   

Others  :  1122803
DOI  :  10.1186/s12889-015-1409-y

 received in 2014-07-08, accepted in 2015-01-13,  发布年份 2015

【 摘 要 】

Background

There is evidence that financial incentive interventions, which include both financial rewards and also penalties, are effective in encouraging healthy behaviours. However, concerns about the acceptability of such interventions remain. We report on focus groups with a cross-section of adults from North East England exploring their acceptance of financial incentive interventions for encouraging healthy behaviours amongst adults. Such information should help guide the design and development of acceptable, and effective, financial incentive interventions.

Methods

Eight focus groups with a total of 74 adults were conducted between November 2013 and January 2014 in Newcastle upon Tyne, UK. Focus groups lasted approximately 60 minutes and explored factors that made financial incentives acceptable and unacceptable to participants, together with discussions on preferred formats for financial incentives. Verbatim transcripts were thematically coded and analysed in Nvivo 10.

Results

Participants largely distrusted health promoting financial incentives, with a concern that individuals may abuse such schemes. There was, however, evidence that health promoting financial incentives may be more acceptable if they are fair to all recipients and members of the public; if they are closely monitored and evaluated; if they are shown to be effective and cost-effective; and if clear health education is provided alongside health promoting financial incentives. There was also a preference for positive rewards rather than negative penalties, and for shopping vouchers rather than cash incentives.

Conclusions

This qualitative empirical research has highlighted clear suggestions on how to design health promoting financial incentives to maximise acceptability to the general public. It will also be important to determine the acceptability of health promoting financial incentives in a range of stakeholders, and in particular, those who fund such schemes, and policy-makers who are likely to be involved with the design, implementation and evaluation of health promoting financial incentive schemes.

【 授权许可】

   
2015 Giles et al.; licensee BioMed Central.

【 参考文献 】

• [1]Swann C, Carmona C, Ryan M, Raynor M, Baris E, Dunsdon S, et al. Health systems and health-related behaviour change: a review of primary and secondary evidence. National Institute for Health and Clinical Excellence 2010.
• [2]Department of Health: Our healthier nation: a contract for health. Her Majesty’s Stationery Office, London; 1998.
• [3]Department of Health: Choosing health: making healthier choices easier. Her Majesty’s Stationery Office, London; 2004.
• [4]Giles EL, Robalino S, McColl E, Sniehotta FF, Adams J: The effectiveness of financial incentives for health behaviour change: Systematic review and meta-analysis. PLOS ONE 2014, 9:1-16.
• [5]Adams J, Giles EL, McColl E, Sniehotta FF: Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours. Health Psychol Rev 2014, 8(3):286-95.
• [6]Bains N, Pickett W, Hoey J: The use and impact of incentives in population based smoking cessation programs, a review. Am J Health Promot 1998, 12:307-20.
• [7]Christianson J, Leatherman S, Sutherland K. Financial incentives, healthcare providers and quality improvements: a review of the evidence. Health Foundation. 2007.
• [8]Hardeman W, Griffin S, Johnston M, Kinmonth AL, Wareham NJ: Interventions to prevent weight gain: a systematic review of psychological models and behaviour change methods. Int J Obesity 2000, 24:131-43.
• [9]Jepson R, Clegg A, Forbes C, Lewis R, Sowden A, Kleijnen J: The determinants of screening uptake and interventions for increasing uptake: a systematic review. Health Technol Assess. 2000, 4(14):1-133. i-vii
• [10]Kane RL, Johnson P, Town RJ, Butler M: A structured review of the effect of economic incentives on consumers’ preventive behavior. Am J Prev Med 2004, 27(4):327-52.
• [11]Sutherland K, Leatherman S, Christianson J. Paying the patient, does it work? The Health Foundation. 2008.
• [12]Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D: The effect of financial incentives on the quality of health care provided by primary care physicians (Review). Cochrane Database Syst Rev. 2011, 9:CD008451. doi:10.1002/14651858.CD008451.pub2
• [13]Jochelson K. Paying the patient: improving health using financial incentives. Kings Fund. 2007.
• [14]Kavanagh JTA, Oakley A, Harden A: A scoping review of the evidence for incentive schemes to encourage positive health and other social behaviors in young people. Institute of Education, University of London, London; 2005.
• [15]Kavanagh JSC, Thomas J: Incentives to improve smoking, physical activity, dietary and weight management behaviours: a scoping review of the research evidence. Institute of Education, University of London, London; 2009.
• [16]Müller-Riemenschneider F, Reinhold T, Nocon M, Willich SN: Long-term effectiveness of interventions promoting physical activity: A systematic review. Prev Med 2008, 47:354-68.
• [17]Giles EL, Robalino S, Adams J, Sniehotta FF, McColl E: Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods, Year: 2015, doi:10.10.16/j.ypmed.2014.12.029
• [18]Arterburn D, Westbrook EO, Wiese CJ, Ludman EJ, Grossman DC, Fishman PA, et al.: Insurance coverage and incentives for weight loss among adults with metabolic syndrome. Obesity 2008, 16:70-6.
• [19]Bonevski B, Bryant J, Lynagh M, Paul C: Money as motivation to quit: A survey of a non-random Australian sample of socially disadvantaged smokers’ views of the acceptability of cash incentives. Prev Med 2012, 55:122-6.
• [20]Bonevski B, Bryant J, Paul C: Encouraging smoking cessation among disadvantaged groups: A qualitative study of the financial aspects of cessation. Drug Alcohol Rev 2011, 30:411-8.
• [21]Cameron J, Ritter A: Contingency management: perspectives of Australian service providers. Drug Alcohol Rev 2007, 26:183-9.
• [22]Ducharme LJ, Knudsen HK, Abraham AJ, Roman PM: Counselor attitudes toward the use of motivational incentives in addiction treatment. Am J Addict 2010, 19:496-503.
• [23]Kim A, Kamyab K, Zhu J, Volpp K: Why are financial incentives not effective at influencing some smokers to quit? Results of a process evaluation of a worksite trial assessing the efficacy of financial incentives for smoking cessation. J Occup Environ Med 2011, 53:62-7.
• [24]London AJ, Borasky DA Jr, Bhan A: Ethics Working Group of the H.I.V Prevention Trials Network: Improving ethical review of research involving incentives for health promotion. PLoS Med 2012, 9:e1001193.
• [25]Luyten J, Vandevelde A, Van Damme P, Beutels P: Vaccination policy and ethical challenges posed by herd immunity, suboptimal uptake and subgroup targeting. Public Health Ethics 2011, 4:280-91.
• [26]Mantzari E, Vogt F, Marteau TM: The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid? BMC Pregnancy Childbirth 2012, 12:24. BioMed Central Full Text
• [27]Mhurchu CN, Eyles H, Dixon R, Matoe L, Teevale T, Meagher-Lundberg P: Economic incentives to promote healthier food purchases: exploring acceptability and key factors for success. Health Promot Int 2012, 27:331-41.
• [28]Schmidt H: Bonuses as incentives and rewards for health responsibility: a good thing? J Med Philos 2008, 33:198-220.
• [29]Marteau T, Ashcroft R, Oliver A: Using financial incentives to achieve healthy behaviour. BMJ 2009, 338:983-5.
• [30]Eunson J, Murray L. The acceptability of carrotts. Ipsos Mori; 2012.
• [31]Lynagh M, Sanson-Fisher R, Bonevski B: What’s good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change. Int J Behav Med 2013, 20:114-20.
• [32]Madison KM, Volpp K, Halpern SD: The law, policy, and ethics of employers’ use of financial incentives to improve health. J Law Med Ethics 2011, 39:450-68.
• [33]Parke H, Ashcroft R, Brown R, Marteau TM, Seale C: Financial incentives to encourage healthy behaviour: an analysis of UK media coverage. Health Expect 2011, 16:292-304.
• [34]Mitchell MS, Goodman JM, Alter DA, John LK, Oh PI, Pakosh MT, et al.: Financial incentives for exercise adherence in adults: systematic review and meta-analysis. Am J Prev Med 2013, 45:658-67.
• [35]Ashcroft RE, Marteau T, Oliver A: Payment to look after health: incentive mechanisms require deeper understanding. BMJ 2008, 337:a1135.
• [36]Malone SW, Jason L: Using incentives, lotteries, and competitions in work-site smoking cessation interventions. Drug Alcohol Abuse Rev 1990, 1:313-37.
• [37]Oliver A, Bauld L: A consideration of user financial incentives to address health inequalities. J Health Politics Policy Law 2012, 37:201-26.
• [38]Ashcroft RE: Personal financial incentives in health promotion: where do they fit in an ethic of autonomy. Health Expect 2011, 14:191-200.
• [39]Donatelle RJ, Hudson D, Dobie S, Goodall A, Hunsberger M, Oswald K: Incentives in smoking cessation: status of the field and implications for research and practice with pregnant smokers. Nicotine Tob Res 2004, 6:S163-79.
• [40]Grant RW: The ethics of incentives: historical origins and contemporary understandings. Econ Philos 2002, 18:111-39.
• [41]Popay J: Should disadvantaged people be paid to take care of their health? No. BMJ 2008, 337:141.
• [42]Petry NM: Contingency management treatments: controversies and challenges. Addict 2010, 105:1507-9.
• [43]Cookson R: Should disadvantaged people be paid to take care of their health? Yes. BMJ 2008, 337:141.
• [44]Moller AC, McFadden H, Hedeker D, Spring B: Financial motivation undermines maintenance in an intensive diet and activity intervention. J Obesity 2012, 37(5):819-27.
• [45]Lynagh M, Bonevski B, Symonds I, Sanson-Fisher RW: Paying women to quit smoking during pregnancy? Acceptability among pregnant women. Nicotine Tob Res 2011, 13:102-1036.
• [46]Promberger M, Brown RC, Ashcroft RE, Marteau TM: Acceptability of financial incentives to improve health outcomes in UK and US samples. J Med Ethics 2011, 37:682-7.
• [47]Promberger M, Dolan P, Marteau TM: “Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour. Soc Sci Med 2012, 75(12):2509-14.
• [48]Priebe S, Sinclair J, Burton A, Marougka S, Larsen J, Firn M, Ashcroft R: Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study. J Med Ethics 2010, 36(8):463-8.
• [49]Flick U: An introduction to qualitative research. SAGE Publications Ltd, London; 2004.
• [50]Gale NK, Heath G, Cameron E, Rashid S, Redwood S: Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013, 13:1-8. BioMed Central Full Text
• [51]Ipsos Media CT. Social grade a classification tool bite sized thought piece. Ipsos Mori; 2009.
• [52]Lee J, Park DH, Han I: The effect of negative online consumer reviews on product attitude: An information processing view. Electron Commer Res Appl 2008, 7:341-52.
• [53]Gomez B, Jones JPIII: Research methods in geography: A critical introduction. John Wiley & Sons, West Sussex; 2010.
• [54]Krueger RA, Casey MA: Focus groups a practical guide for applied research. 4th edition. SAGE Publications Ltd, London; 2009.
• [55]Rea LM, Parker RA: Designing and conducting survey research: A comprehensive guide. 3rd edition. John Wiley & Sons, San Francisco; 2012.
• [56]Carlsen B, Glenton C: What about N? A methodological study of sample-size reporting in focus group studies. BMC Med Res Methodol 2011, 11:1-10. BioMed Central Full Text
• [57]Bryman A: Social research methods. 2nd edition. Oxford University Press, Oxford; 2004.
• [58]Strauss AL: Qualitative analysis for social scientists. Cambridge University Press, Cambridge; 2003.
• [59]Barnett-Page E, Thomas J: Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol 2009, 9:1-11. BioMed Central Full Text
• [60]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [61]Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19:349-57.
• [62]Volpp KG, Pauly MV, Loewenstein G, Bangsberg D: P4P4P: an agenda for research on pay-for-performance for patients. Health Aff 2009, 28:206-14.
• [63]Hoddinott P, Morgan H, MacLennan G, Sewel K, Thomson G, Bauld L, et al.: Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public. BMJ Open 2014, 4:9.
• [64]Meads DM, McCabe C, Camidge DC, Hill KM, House AO, Hulme CT: A contingent valuation survey of user financial incentives for health behaviour change. Value Health 2013, 16(3):A11.
• [65]Parke H, Ashcroft R, Brown R, Marteau TM, Seale C: Financial incentives to encourage healthy behaviour: An analysis of UK media coverage. Health Expectations 2013, 16:292-304.
• [66]Raiff BR, Jarvis BP, Turturici M, Dallery J: Acceptability of an internet-based contingency management intervention for smoking cessation: Views of smokers, nonsmokers, and healthcare professionals. Exp Clin Psychopharm 2013, 21:204-13.
• [67]Aveyard P, Bauld L: Incentives for promoting smoking cessation: what we still do not know. Cochrane Database Syst Rev. 2011, 8:ED000027. doi:10.1002/14651858.ED000027
• [68]Mitchell MS, Faulkner GE: On supplementing “foot in the door” incentives for eHealth program engagement. J Med Internet Res 2014, 16:e179.
• [69]Schmidt H, Voigt K, Wikler D: Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives. New England J Med 2010, 362:e3.
• [70]Pearson SD, Lieber SR: Financial penalties for the unhealthy? Ethical guidelines for holding employees responsible for their health. Health Aff 2009, 28:845-52.
• [71]Smithson J: Focus Groups. In The SAGE handbook of social research methods. Edited by Alasuutari PBL, Brannen J. SAGE Publications Ltd, London; 2008.
• [72]Ni Mhurchu C, Aston L, Jebb S: Effects of worksite health promotion interventions on employee diets: a systematic review. BMC Public Health 2010, 10:62. BioMed Central Full Text