Financial motivation undermines maintenance in an intensive diet and activity intervention

Arlen C Moller, H Gene McFadden, Donald Hedeker, Bonnie Spring, Arlen C Moller, H Gene McFadden, Donald Hedeker, Bonnie Spring

Abstract

Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect). We assessed participants' context-specific financial motivation to participate in the Make Better Choices trial-a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (α = .97). Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, t(165) = 2.15, P = .04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, t(160) = 2.42, P = .016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed.

Figures

Figure 1
Figure 1
Financial motivation predicting weight change (% of original body weight). high: top quartile; low: bottom quartile.
Figure 2
Figure 2
Financial motivation x gender predicting composite diet-activity improvement score. $: financial motivation. high: top quartile; low: bottom quartile.

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