Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis

Eleni Mantzari, Florian Vogt, Ian Shemilt, Yinghui Wei, Julian P T Higgins, Theresa M Marteau, Eleni Mantzari, Florian Vogt, Ian Shemilt, Yinghui Wei, Julian P T Higgins, Theresa M Marteau

Abstract

Objectives: Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behavior, (b) incentive value and attainment certainty, (c) recipients' deprivation level.

Methods: Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviors at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints.

Results: Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behavior-change, with effects sustained until 18months from baseline (OR: 1.53, 95% CI 1.05-2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21-3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22-3.85), but only at >6-12months from baseline. Other assessed variables did not independently modify effects at any time-point.

Conclusions: Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal.

Keywords: Financial incentives; Health promotion; Health-related behavior; Meta-analysis; Systematic review.

Copyright © 2015. Published by Elsevier Inc.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Study estimates of financial incentives effects on health behaviors at time-points from intervention start.
Fig. 3
Fig. 3
Study estimates of financial incentives effects on health behaviors at time-points after incentive removal.
Fig. 4
Fig. 4
The effect of financial incentives on health-behavior according to recipients' deprivation level at multiple measurement times.

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