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

<div><p>Background</p><p>Financial incentive interventions have been suggested as one method of promoting healthy behaviour change.</p><p>Objectives</p><p>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.</p><p>Data Sources</p><p>Searches were of relevant electronic databases, research registers, <a href="http://www.google.com" target="_blank">www.google.com</a>, and the reference lists of previous reviews; and requests for information sent to relevant mailing lists.</p><p>Eligibility Criteria</p><p>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.</p><p>Study Appraisal and Synthesis</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusions</p><p>The available evidence suggests that financial incentive interventions are more effective than usual care or no intervention for encouraging healthy behaviour change.</p><p>Trial Registration</p><p>PROSPERO <a href="http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012002393#.Uv7D-7RFA7A" target="_blank">CRD42012002393</a></p>