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

Emma Giles, Shannon Robalino, Elaine McColl, Falko Sniehotta, Jean M. Adams

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    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,, 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. Metaregression 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 postintervention 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.
    Original languageEnglish
    Pages (from-to)0
    JournalPLoS ONE
    Issue number3
    Publication statusPublished - 11 Mar 2014

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