Reducing risk behaviors linked to noncommunicable diseases in Mongolia: a randomized controlled trial. Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol Coupling Financial Incentives With Direct Mail in Population-Based Practice Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors Effectiveness of a School Based Intervention for Prevention of Non-communicable Diseases in Middle School Children of Rural North India: A Randomized Controlled Trial Behavioral economic incentives to improve adherence to antiretroviral medication A Randomized Trial of Incentives for Smoking Treatment in Medicaid Members. The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment Incentives increased return rates but did not influence partial nonresponse or treatment outcome in a randomized trial. Internet-based incentives increase blood glucose testing with a non-adherent, diverse sample of teens with type 1 diabetes mellitus: a randomized controlled Trial Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Providing reviews of evidence to COPD patients: controlled prospective 12-month trial The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care Supporting health behaviour change in chronic obstructive pulmonary disease with telephone health-mentoring: insights from a qualitative study
OBJECTIVES We tested the efficacy of a 6-session , evidence -based health promotion intervention aim ed at reducing noncommunicable disease ( NCD ) risk behaviors . METHODS Two hundred male and female factory workers in Ulaanbaatar , Mongolia were r and omly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention . RESULTS The health promotion intervention increased daily fruit and vegetable intake and physical activity , increased readiness for NCD risk behavior reduction and health promotion knowledge , and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention . CONCLUSIONS The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs . Dissemination of the intervention may improve productivity , reduce costs of health services , and better the quality of life for Mongolians Non-communicable diseases ( NCDs ) are emerging as the predominant global health challenge of this century . Physical inactivity is one of the primary risk factors for NCDs . Therefore , increasing physical activity levels is a public health imperative . The arrival of affordable wearable technologies , such as wireless pedometers , provides one strategy for encouraging walking . However , the effectiveness of these technologies in promoting sustained behavior change has not been established . Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions , including physical activity interventions that rely on wearable technologies . The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives ( cash or donations to charity ) for reaching weekly physical activity goals . We present here the design and baseline characteristics of participants of this four arm r and omized controlled trial . 800 full-time employees ( desk-bound office workers ) belonging to 15 different worksites ( on average , 53 ( sd : 37 ) employees at each worksite ) were successfully r and omized to one of four study arms . If shown to be effective , wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents Background The use of financial incentives and penalties to encourage uptake of healthy behaviors is increasingly seen as a viable intervention in developed countries . Previous review s of the effectiveness of financial incentives and penalties for encouraging the uptake of healthy behaviors have focused on individual behaviors making it difficult to draw overall conclusions about the effectiveness of such interventions . This systematic review will explore the effectiveness of financial incentives and penalties for encouraging a wide range of behaviors , including : smoking cessation , increased physical activity , healthier dietary intake , sensible patterns of alcohol consumption , safe sun , safe sex , and primary preventive clinical behaviors . Methods Systematic methods will be used to search existing literature and screen studies for inclusion . All studies that meet the following inclusion criteria will be included in the review : participants were 18 years old or older and living in high-income countries ; interventions included cash or cash-like incentives to promote the uptake of healthy behaviors , or cash or cash-like penalties to discourage unhealthy behaviors ; the comparator was usual care or no intervention ; study design was r and omized controlled trial , cluster r and omized controlled trial , controlled before and after study , or interrupted time series analysis . Two review ers will independently screen the publications to ensure they meet the inclusion criteria . Quality will be assessed by two research ers , working independently , using the Cochrane risk of bias tool . Meta- analysis will be conducted , if appropriate . Any studies identified as at ‘ high risk of bias ’ will be excluded from meta- analysis . Discussion This systematic review will provide policy-relevant recommendations for the use of financial incentives and penalties as a method of encouraging uptake of healthy behaviors Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy . However , little is known about how to translate incentive-based strategies to public health practice geared toward improving population -level health , and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail . This study reports results of a population -based r and omized controlled trial testing a direct mail , incentive-based intervention for promoting mammography uptake . The study population was composed of a r and om sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening . Participants ( N = 18,939 ) were r and omized into three groups : ( 1 ) Direct Mail only , ( 2 ) Direct Mail plus Incentive , and ( 3 ) Control . Both direct mail groups received two mailers with a message about the importance of mammography ; however , Mail plus Incentive mailers also offered a $ 25 incentive for getting a mammogram . Logistic regression analyses measured intervention effects . Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups . The use of incentives also proved to be cost-effective . Additionally , the Direct Mail only group was more likely to receive mammography than the Control group . Findings offer experimental evidence on how the population -based strategy of direct mail coupled with a financial incentive can encourage healthy behavior , as well as how incentive-based programs can be translated into health promotion practice aim ed at achieving population -level impact Consider the following paradox : few people would balk if research ers offered smokers $ 1,000 to participate in a year-long r and omized trial of a smoking cessation intervention , yet many would find it distasteful for a large employer to pay its smoking employees an extra $ 1,000 if they remained smoke-free for one year . Such discrepant judgments are underst and able from the perspective of classical economics . Research participants merit compensation for the risks and opportunity costs they endure in the service of public health , whereas individuals should need no reward for promoting their own well being . However , contrary to traditional theories of rationality , people frequently fail to make health-promoting choices , particularly when such choices require short-term sacrifices to foster long-term goals .1,2 Thus , corporate and government health plan leaders are increasingly applying extrinsic motivations such as financial incentives and other programs to augment health – particularly cardiovascular health – while hopefully increasing productivity and restraining costs.3 , 4 Early evidence suggests that financial incentives can effectively promote the cardioprotective behaviors of smoking cessation,5 , 6 weight loss,7 , 8 and cholesterol reduction.9  Incentives are also currently being studied as a means of promoting warfarin adherence.10 Although the results of these early studies are promising , further research is needed to determine which incentive structures and amounts are optimal , assess the ability of incentives to produce sustained behavior changes , and evaluate the cost-effectiveness of implementing incentive programs  . Ethical dimensions of the incentives themselves are also in need of further analysis . For example , some have charged that financial incentive programs are coercive , inequitable , and inconsistent with shared social values.11 Others have even suggested that implementing incentive programs serves to punish patients for their illnesses.12 In this essay , we outline the rationale for incentive programs to promote cardiovascular health , identify the ethical arguments that have been used to challenge such programs , and assess the merits of these arguments Objective To assess the effectiveness of a multi-component school based intervention in improving knowledge and behavioral practice s regarding diet , physical activity and tobacco use in middle schoolchildren of rural-Ballabgarh , North-India . Methods A total of 40 middle schools were grouped into two , based on geographic proximity and r and omly assigned to the intervention or control group in a cluster r and omized controlled trial . The target population consisted of 2,348 children study ing in 6th and 7th grade s in these schools . The intervention consisted of a school component ( policies ) , a classroom component ( activities ) and a family component [ Information Education & Communication ( IEC ) material ] . The main outcome measures were knowledge and behavioral changes in physical activity , diet and tobacco which were self- reported . Results Post-intervention , a significant number of intervention schools adopted the tobacco policy ( 16/19 ) , physical activity policy ( 6/19 ) and healthy food policy ( 14/19 ) as compared to the control schools ( n = 21 ) . Knowledge about physical activity , diet and tobacco improved significantly in the intervention group as compared to the control group . Proportion of students attending Physical Training ( PT ) classes for five or more days in a week in the intervention group compared to the control group increased significantly ( 17.8 % ; p < 0.01 ) . Proportion of students consuming fruits increased in the intervention group compared to the control group ( 10 % ; p < 0.01 ) . Pre-post decrease in the prevalence of current smoking was significantly more in the intervention group as compared to the control group ( 7.7 % ; p < 0.01 ) . Conclusions Healthy setting s approach for schools is feasible and effective in improving knowledge and behavioral practice s of non-communicable diseases ( NCD ) risk factors in adolescents in rural India Objective : Fixed incentives have been largely unsuccessful in improving adherence to antiretroviral medication . Therefore , we evaluate whether small incentives based on behavioral economic theory can increase adherence to antiretroviral medication among treatment-mature adults in Kampala , Ug and a. Design : A r and omized control trial design tests whether providing small incentives based on either attending timely clinic visits ( intervention group 1 ) or achieving high medication adherence ( intervention group 2 ) can increase antiretroviral adherence . Antiretroviral adherence is measured by medical event monitoring system ( MEMS ) caps . Methods : Overall , 155 HIV-infected men and women age 19–78 were r and omized into one of two intervention groups and received small prizes of US $ 1.50 awarded through a drawing conditional on either attending scheduled clinic appointments or achieving at least 90 % antiretroviral adherence . The control group received the usual st and ard of care . Results : Preliminary results based on pooling the intervention groups showed individuals receiving incentives were 23.7 percentage points more likely to achieve 90 % antiretroviral adherence compared with the control group [ 95 % confidence interval ( CI ) , 6.7–40.7 % ] . Specifically , 63.3 % ( 95 % CI , 52.9–72.8 % ) of participants in the pooled intervention groups maintained at least 90 % mean adherence during the first 9 months of the intervention , compared with 39.6 % ( 95 % CI , 25.8–54.7 % ) in the control group . Conclusion : Small prize incentives result ed in a statistically significant increase in antiretroviral adherence . Although more traditional fixed incentives have not produced the desired results , these findings suggest that small incentives based on behavioral economic theory may be more effective in motivating long-term adherence among treatment-mature adults INTRODUCTION Low-income population s are especially likely to smoke and have difficulty quitting . This study evaluated a monetary incentive intended to increase smoking treatment engagement and abstinence among Medicaid recipients who smoke . STUDY DESIGN Two-group r and omized clinical trial of Incentive ( n=948 ) and Control interventions ( n=952 ) for smoking . SETTING / PARTICIPANTS Medicaid recipients recruited from primary care patients ( n=920 ) and callers to the Wisconsin Tobacco Quit Line ( n=980 ) . INTERVENTION Participants were offered five quitline cessation calls and were encouraged to obtain cessation medication ( covered by Medicaid ) . All participants received payment for completing a baseline assessment and a 6-month smoking test . Only Incentive condition participants received compensation for taking counseling calls ( $ 30 per call ) and for biochemically verified abstinence at the 6-month visit ( $ 40 ) . MAIN OUTCOME MEASURES Seven-day point-prevalence smoking abstinence 6-months post study entry and cost/quit . RESULTS Incentive condition participants had significantly higher biochemically determined 7-day point-prevalence smoking abstinence rates 6 months after study induction than did Controls ( 21.6 % vs 13.8 % , respectively , p<0.0001 ) . A positive treatment effect of incentives was present across other abstinence indices , but the size of effects and levels of abstinence varied considerably across indices . Incentive condition participants were also significantly more likely than non-incentivized Control participants to accept Wisconsin Tobacco Quit Line treatment calls and their acceptance of calls mediated their attainment of higher abstinence rates at 6-month follow-up . The cost/quit/participant averaged $ 4,268.26 for the Control participants and $ 3,601.37 for the Incentive participants . CONCLUSIONS This study shows that fairly moderate levels of incentive payments for treatment engagement and abstinence ( a total possible payment of $ 190 ) increased very low-income smokers ' engagement and success in smoking cessation treatment . CLINICAL REGISTRATION This study is registered at www . clinical trials.gov : NCT02713594 Background Financial incentives are often used to influence professional practice , yet the factors which influence their effectiveness and their behavioural mechanisms are not fully understood . In keeping with clinical guidelines , Childsmile ( Scotl and ’s oral health improvement programme ) advocates twice yearly fluoride varnish application ( FVA ) for children in dental practice . To support implementation Childsmile offered dental practitioners a fee-per-item payment for varnishing 2–5-year-olds ’ teeth through a pilot . In October 2011 payment was extended to all dental practitioners . This paper compares FVA pre- and post-roll-out and explores the financial incentive ’s behavioural mechanisms . Methods A natural experimental approach using a longitudinal cohort of dental practitioners ( n = 1090 ) compared FVA pre- ( time 1 ) and post- ( time 2 ) financial incentive . Responses from practitioners who did not work in a Childsmile pilot practice when considering their 2–5-year-old patients ( novel incentive group )  were compared with all other responses ( continuous incentive group ) . The Theoretical Domains Framework ( TDF ) was used to measure change in behavioural mechanisms associated with the incentive . Analysis of covariance was used to investigate FVA rates and associated behavioural mechanisms in the two groups . Results At time 2 , 709 74 % , of eligible responders , were followed up . In general , FVA rates increased over time for both groups ; however , the novel incentive group experienced a greater increase ( β [ 95 % CI ] = 0.82 [ 0.72 to 0.92 ] ) than the continuous incentive group . Despite this , only 33 % of practitioners reported ‘ always ’ varnishing increased risk 2–5-year-olds ’ teeth following introduction of the financial incentive , 19 % for st and ard risk children . Domain scores at time 2 ( adjusting for time 1 ) increased more for the novel incentive group ( compared to the continuous incentive group ) for five domains : knowledge , social/professional role and identity , beliefs about consequences , social influences and emotion . Conclusions In this large , prospect i ve , population -wide study , a financial incentive moderately increased FVA in dental practice . Novel longitudinal use of a vali date d theoretical framework to underst and behavioural mechanisms suggested that financial incentives operate through complex inter-linked belief systems . While financial incentives are useful in narrowing the gap between clinical guidelines and FVA , multiple intervention approaches are required OBJECTIVE Our aim was to analyze monetary incentives and shortening the question naire as means of increasing response rates in a mailed follow-up survey 1 year after inpatient psychotherapeutic treatment . Additionally , effects on partial nonresponse and the assessment of treatment outcome were examined . STUDY DESIGN AND SETTING In a 2x2 factorial design , a sample of 3,825 patients was r and omized to the two following interventions : ( 1 ) receiving a prepaid monetary incentive or none ; and ( 2 ) getting a short or a long question naire . Treatment outcome was measured prospect ively by a self- assessment instrument for psychopathology . RESULTS When using incentives , the response rate significantly increased by 7.3 % ( 95 % confidence interval [ CI ] 2.6 - 11.9 % ) . Receiving a short question naire led to an augmentation of the response rate of 3.7 % ( 95 % CI 0.9 - 8.3 % ) , which was not significant . The corresponding odds ratios were significantly increased for monetary incentives ( 1.36 ; 95 % CI 1.30 - 1.88 ) , and when abridging the question naire ( 1.15 ; 95 % CI 1.01 - 1.31 ) . However , partial nonresponse and treatment outcome were independent of the two factors . CONCLUSION Incentives and a shorter question naire led to higher return rates but did not affect partial nonresponse and self-report of treatment outcome in a r and omized postal survey Non-adherence with self-monitoring blood glucose ( SMBG ) among teenagers with type 1 diabetes can be a problem . The purpose of this study was to investigate the feasibility , acceptability , and preliminary efficacy of using Internet-based incentives to improve adherence with SMBG in non-adherent teenagers . Participants were r and omly assigned to  contingent ( CS ; N = 23 ) , where they had to meet web camera-verified SMBG goals to earn incentives , or  non-contingent ( NS ) groups ( N = 18 ) , where they earned incentives independent of adherence . Brief motivational interviewing ( MI ) was given prior to the intervention . Attrition was 15 % in the CS group . Participants and parents endorsed the intervention on all intervention dimensions . Daily SMBG increased after one MI session , and further increased when incentives were added , but significantly more for so for older participants . SMBG declined slowly over time , but only returned to baseline levels for younger NS participants . Internet-based incentive interventions are feasible , acceptable , and show promise for improving adherence with SMBG PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim Goods-based contingency management interventions ( e.g. , those using vouchers or prizes as incentives ) have demonstrated efficacy in reducing cocaine use  , but cost has limited dissemination to community clinics . Recent research suggests that development of a cash-based contingency management approach may improve treatment outcomes while reducing operational costs of the intervention . However , the clinical safety of providing cash-based incentives to substance abusers has been a concern . The present 16-week study compared the effects of goods-based versus cash-based incentives worth $ 0 , $ 25 , $ 50 , and $ 100 on short-term cocaine abstinence in a small sample of cocaine-dependent methadone patients ( N = 12 ) . A within-subject design was used ; a 9-day washout period separated each of 8 incentive conditions . Higher magnitude ( $ 50 and $ 100 ) cash-based incentives ( checks ) produced greater cocaine abstinence compared with the control ( $ 0 ) condition , but a magnitude effect was not seen for goods-based incentives ( vouchers ) . A trend was observed for greater rates of abstinence in the cash-based versus goods-based incentives at the $ 50 and $ 100 magnitudes . Receipt of $ 100 checks did not increase subsequent rates of cocaine use above those seen in control conditions . The efficacy and safety data provided in this and other recent studies suggest that use of cash-based incentives deserves consideration for clinical applications of contingency management , but additional confirmation in research using larger sample s and more prolonged periods of incentive delivery is needed BACKGROUND This study tested the effects of two organizational support processes , the provision of financial incentives for superior clinical performance and the availability of a  patient ( smoker ) registry and proactive telephone support system for smoking cessation , on provider adherence to accepted practice guidelines and associated patient outcomes . METHODS Forty clinics of a large multispecialty medical group practice providing primary care services were r and omly allocated to study conditions . Fifteen clinics each were assigned to the experimental conditions " control " ( distribution of printed versions of smoking cessation guidelines ) and " incentive " ( financial incentive pay-out for reaching preset clinical performance targets ) .  Ten clinics were r and omized to receive financial incentives combined with access to a central ized patient registry and intervention system ( " registry " ) . Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients ' smoking cessation behaviors . RESULTS  Patients ' tobacco use status  was statistically significant ( P < 0.01 ) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition . Patients visiting registry clinics accessed counseling programs statistically significantly more often ( P < 0.001 ) than patients receiving care in the control condition . Other endpoints did not statistically significantly differ between the experimental conditions . CONCLUSIONS The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practice s and patient behaviors was mixed . Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment The aim of this study was to evaluate a novel patient-held manual design ed to reduce the evidence – practice gap in chronic obstructive pulmonary disease ( COPD ) . The intervention manual contained summaries of research evidence . It was developed using current best practice for patient information material s and design ed to cause discussion of evidence between patient and doctor . A controlled before- and -after study was employed in two similar but geographically separate regions of metropolitan Adelaide , South Australia . Participants had moderate to severe COPD , with 249 included at baseline and 201 completing the study .  Evidence -based COPD management was measured using an indicator with three components : rates of influenza vaccination , bone density testing , and pulmonary rehabilitation . A survey of behavioral steps leading to practice change was conducted with the trial . Analysis , by median split of socioeconomic disadvantage , showed significant difference between study arms for only one component of the indicator of evidence -based practice , enrolment in pulmonary rehabilitation and only for the most socioeconomically disadvantaged stratum . For both socioeconomic strata , more intervention participants than control participants reported remembering being given the information material , reading part or all , and finding it very or quite helpful . Other significant differences were restricted to the stratum of greatest socioeconomic disadvantage : reading all of the material , learning from it , referring back , and talking to a doctor about a topic from the material . Above 90 % of all participants who received the manual reported reading from it , 42 % reported discussing topics with a doctor , but only 10 % reported treatment change attributable to the manual . We have found that people with COPD will read an evidence manual developed using current best practice . However , the study demonstrated improvement for only one of the three components of an indicator of evidence -based disease management for only the most socioeconomically disadvantaged stratum of participants . Future interventions should be design ed to better translate reading uptake into evidence -based disease management Objective . Immunizations and other cost-effective preventive services remain underused by many children , especially those living in poverty . Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns , we design ed and tested an intervention combining these strategies . We studied whether a system of semiannual assessment and feedback , coupled with financial incentives , could improve pediatric preventive care in a Medicaid health maintenance organization ( HMO ) . Methodology . We r and omly assigned primary care sites serving children in a Medicaid HMO to one of three groups : a feedback group ( where physicians received written feedback about compliance scores ) , a feedback and incentive group ( where physicians received feedback and a financial bonus when compliance criteria were met ) , and a control group . We evaluated compliance with pediatric preventive care guidelines  through semiannual chart audits during the years 1993 to 1995 . Results . Compliance with pediatric preventive care improved dramatically in the study period . Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores ( from 56%–73 % ) , as well as scores for immunizations ( from 62%–79 % ) and other preventive care ( from 54%–71 % ) . However , no significant differences were observed between either intervention group and the control group , nor were there any interaction ( group-by-time ) effects . Conclusions . Feedback to physicians , with or without financial incentives , did not improve pediatric preventive care in this Medicaid HMO during a time of rapid , secular improvements in care . Possible explanations include the context and timing of the intervention , the magnitude of the financial incentives , and lack of physician awareness of the intervention Background Adoption and maintenance of healthy behaviours is pivotal to chronic disease self-management as this influences disease progression and impact . This qualitative study investigated health behaviour changes adopted by participants with moderate or severe chronic obstructive pulmonary disease ( COPD ) recruited to a r and omised controlled study of telephone-delivered health-mentoring . Methods Community nurses trained as health-mentors used a patient-centred approach with COPD patients recruited in general practice to facilitate behaviour change , using a framework of health behaviours ; ‘ SNAPPS ’ Smoking , Nutrition , Alcohol , Physical activity , Psychosocial well-being , and Symptom management , through regular phone calls over 12 months . Semi-structured interviews in a purposive sample sought feedback on mentoring and behaviour changes adopted . Interviews were analysed using iterative thematic and interpretative content approaches by two investigators . Results Of 90 participants allocated to health-mentoring , 65 ( 72 % ) were invited for interview at 12-month follow up . The 44 interviewees , 75 % with moderate COPD , had a median of 13 mentor contacts over 12 months , range 5–20 . Interviewed participants ( n = 44 , 55 % male , 43 % current smokers , 75 % moderate COPD ) were representative of the total group with a mean age 65 years while 82 % had at least one additional co-morbid chronic condition . Telephone delivery was highly acceptable and enabled good rapport . Participants rated ‘ being listened to by a caring health professional ’ as very valuable . Three participant groups were identified by attitude to health behaviour change : 14 ( 32 % ) actively making changes ; 18 ( 41 % ) open to and making some changes and 12 ( 27 % ) more resistant to change . COPD severity or current smoking status was not related to group category . Mentoring increased awareness of COPD effects , helping develop and personalise behaviour change strategies , even by those not actively making changes . Physical activity was targeted by 43 ( 98 % ) participants and smoking by 14 ( 74 % ) current smokers with 21 % reporting quitting . Motivation to maintain changes was increased by mentor support . Conclusions Telephone delivery of health-mentoring is feasible and acceptable to people with COPD in primary care . Health behaviours targeted by this population , mostly with moderate disease , were mainly physical activity and smoking reduction or cessation . Health-mentoring increased motivation and assisted people to develop strategies for making and sustaining beneficial change . Trial registration
Our primary conclusion is that there is a lack of compelling evidence that incentives of any form represent a compelling NCD reduction strategy .
The rising epidemic of non-communicable diseases ( NCDs ) poses substantial health and economic challenges to both individuals and society .
Application of incentive-based strategies based on traditional and behavioural economic theory has emerged as a potential strategy to address rising rates of NCDs .
Yet , whether or not incentives truly represent a promising strategy for addressing NCDs has not been systematic ally addressed nor is it clear whether certain behavioural economic strategies outperform others or simply offering a cash-based incentive for meeting a goal .
In this systematic review we aim to determine whether there is an evidence base for any of these strategies .