A systematic review of the use of financial incentives and penalties to encourage uptake of healthy behaviors: protocol Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors The effect of introducing a financial incentive to promote application of fluoride varnish in dental practice in Scotland: a natural experiment An Empirical Evaluation of the Effectiveness of Tangible Incentives in Increasing Participation and Behavior Change in a Worksite Health Promotion Program Can Financial Incentives Help People Trying to Establish New Habits? Experimental Evidence with New Gym Members Effectiveness of Financial Incentives in a Worksite Diabetes Prevention Program Coupling Financial Incentives With Direct Mail in Population-Based Practice Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study. The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. 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. Effectiveness of monetary incentives for recruiting adolescents to an intervention trial to reduce smoking. Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public Why are Financial Incentives not Effective at Influencing Some Smokers to Quit? Results of a Process Evaluation of a Worksite Trial Assessing the Efficacy of Financial Incentives for Smoking Cessation Effects of Financial Incentives on Saving Outcomes and Material Well-Being: Evidence From a Randomized Controlled Trial in Uganda. Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial. Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial
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 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 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 The first is that they have value in enhancing the program ’s salience . For participants they serve as a reminder of their commitment and goals . For non participants they may function as a means of making them more aware of the program and thus enhancing the likelihood that they will participate in future program offerings . A second reason for using tangible incentives is for their direct motivational value . To the extent that they are delivered contingent on level of participation or accomplishment , employees may participate at a higher level and change their behavior more in order to earn these rewards . A number of worksite health promotion programs have employed tangible incentives . 4 - 1 ° In the well-known Live for Life program developed by Johnson and Johnson , for example , employees are offered annual risk factor screening as well as a variety of educational classes on diet , exercise , smoking cessation , and stress management . Participants in these classes receive a variety of tangible items , including T-shirts , pens , and caps . This program is reported to have had positive effects on smoking , l~ exercise ] 2 and absenteeism ? " We conducted a r and omized controlled trial testing the effect of modest incentives to attend the gym among new members of a fitness facility , a population that is already engaged in trying to change a health behavior . Our experiment r and omized 836 new members of a private gym into a control group , receiving a $ 30 payment unconditionally , or one of 3 incentive groups , receiving a payment if they attended the gym at least 9 times over their first 6 weeks as members . The incentives were a $ 30 payment , a $ 60 payment , and an item costing $ 30 that leveraged the endowment effect . These incentives had only moderate impacts on attendance during members ’ first 6 weeks and no effect on their subsequent visit trajectories . We document substantial overconfidence among new members about their likely visit rates and discuss how overconfidence may undermine the effectiveness of a modest incentive program Purpose To evaluate the effect of financial incentive in a diabetes prevention weight loss program at worksites . Design Group-level r and omized intervention study . Setting Four long-term care facilities , r and omly assigned to “ incentive-IG ” or “ non incentive-NIG ” groups . Participants Ninety-nine employees , all overweight or obese ( BMI = mean 34.8±7.4 kg/m2 ) and at risk for type 2 diabetes . Intervention A 16 week weight loss program ( diabetes prevention program ) with a 3 month follow up . IG could either choose a " st and ard incentive " to receive cash award when achieving the projected weight loss or to participate in a " st and ard plus deposit incentive " to get additional money matched with their deposit for projected weight loss . All of the participants received a one-hour consultation for a healthy weight loss at the beginning . Measures Weight-loss , diabetes risk score ( DRS ) , and cardiovascular risk outcomes . Analyses Linear and logistic regressions for completed cases with adjustments for clustering effect at group level . Results IG lost on average more pounds ( p=0.027 ) , reduced BMI ( p=0.04 ) , and reduced in DRS ( p=0.011 ) compared to NIG at week 16 . At the 12-week follow-up period , those in IG plus deposit subgroup had twice the odds ( OR=2.2 , p=0.042 ) and those in the st and ard IG had three times the odds of achieving weight loss goals than NIG ; those in the IG plus deposit group reduced DRS by 0.4 ( p=0.045 ) . Conclusion Monetary incentives appear to be effective in reducing weight and diabetes risk 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 Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior , but the effectiveness of those adjustments is controversial . We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight . They were r and omly assigned to a control arm , with no financial incentive for achieving the goal , or to one of three intervention arms offering an incentive valued at $ 550 . Two intervention arms used health insurance premium adjustments , beginning the following year ( delayed ) or in the first pay period after achieving the goal ( immediate ) . A third arm used a daily lottery incentive separate from premiums . At twelve months there were no statistically significant differences in mean weight change either between the control group ( whose members had a mean gain of 0.1 pound ) and any of the incentive groups ( delayed premium adjustment , -1.2 pound ; immediate premium adjustment , -1.4 pound ; daily lottery incentive , -1.0 pound ) or among the intervention groups . The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive design s , larger incentives , or both 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 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 study objective is to evaluate the effect of monetary incentives on response rates of  adolescents  to a smoking-related survey  as the first step toward participation in an intervention trial . METHODS A sample of 4,200 adolescent members of a managed care organization were r and omized to one of four incentive groups : a $ 2 cash group , a $ 15 cash group , a $ 200 prize drawing group , or a no-incentive group . We compared group-specific response rates and willingness to be contacted about future study activities , as well as costs . RESULTS Incentives increased survey response rates ( 55 % response without incentive vs. a 69 % response with incentive ) , with response of 74 % in the $ 15 cash group , 69 % in the token group , and 63 % with a prize incentive . Incentives did not adversely affect willingness of adolescents to be contacted about a smoking intervention , ( 65 % willing with incentives vs. 60 % without , P = 0.03 ) . In terms of cost per additional survey completed , token and prize groups were marginally more expensive than the no-incentive group ( $ 0.40 and $ 1.42 , respectively ) while the large cash incentive was substantially more costly ( $ 11.37 ) . CONCLUSIONS Monetary incentives improve response rates to a mailed survey , without adverse impact on willingness to further participate in intervention activities . However , a variety of issues must be considered when using incentives for recruitment to intervention studies Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 Objective : Process evaluation of a worksite intervention in which employees were offered $ 750 to complete a cessation program and to quit smoking . Methods : Awareness and attitudes about financial incentives were assessed following a r and omized controlled trial of 878 smokers at a US-based company . Results : Cessation program attendance was higher in incentive group versus control ( 20.2 % vs 7.1 % , P < 0.01 ) . Most quitters ( 69.8 % ) in the incentive group who were already motivated to quit and reported that they would have quit for less money , said incentives were “ not at all ” or only “ somewhat ” important . Most nonquitters in the incentive group reported that even $ 1500 would not have motivated them to quit . Conclusions : Financial incentives are ineffective at motivating some smokers to quit . Internal motivation and readiness to quit need to be sufficiently high for relatively modest incentives to be effective The use of savings products to promote financial inclusion has increasingly become a policy priority across sub-Saharan Africa , yet little is known about how families respond to varying levels of savings incentives and whether the promotion of incentivized savings in low-re source setting s may encourage households to restrict expenditures on basic needs . Using data from a r and omized controlled trial in Ug and a , we examine : 1 ) whether low-income households enrolled in an economic-empowerment intervention consisting of matched savings , workshops , and mentorship  reduced spending on basic needs and 2 ) how varied levels of matching contributions affected household savings and consumption behavior . We compared primary school-attending AIDS-affected children ( N = 1,383 ) r and omized to a control condition with two intervention arms with differing savings-match incentives : 1:1 ( Bridges ) and 1:2 ( Bridges PLUS ) . We found that : 1 ) 24 months post-intervention initiation , children in Bridges and Bridges PLUS were more likely to have accumulated savings than children in the control condition ; 2 ) higher match incentives ( Bridges PLUS ) led to higher deposit frequency but not higher savings in the bank ; 3 ) intervention participation did not result in material hardship ; and 4 ) in both intervention arms , participating families were more likely to start a family business and diversify their assets ABSTRACT BACKGROUND More than half of adults in the United States do not attain the minimum recommended level of physical activity to achieve health benefits . The optimal design of financial incentives to promote physical activity is unknown . OBJECTIVE To compare the effectiveness of individual versus team-based financial incentives to increase physical activity . DESIGN R and omized , controlled trial comparing three interventions to control . PARTICIPANTS Three hundred and four adult employees from an organization in Philadelphia formed 76 four-member teams . INTERVENTIONS All participants received daily feedback on performance towards achieving a daily 7000 step goal during the intervention ( weeks 1– 13 ) and follow-up ( weeks 14– 26 ) periods . The control arm received no other intervention . In the three financial incentive arms , drawings were held in which one team was selected as the winner every other day during the 13-week intervention . A participant on a winning team was eligible as follows : $ 50 if he or she met the goal ( individual incentive ) , $ 50 only if all four team members met the goal ( team incentive ) , or $ 20 if he or she met the goal individually and $ 10 more for each of three teammates that also met the goal ( combined incentive).MAIN MEASURES Mean proportion of participant-days achieving the 7000 step goal during the intervention . KEY RESULTS Compared to the control group during the intervention period , the mean proportion achieving the 7000 step goal was significantly greater for the combined incentive ( 0.35 vs. 0.18 , difference : 0.17 , 95 % confidence interval [ CI ] : 0.07–0.28 , p < 0.001 ) but not for the individual incentive ( 0.25 vs 0.18 , difference : 0.08 , 95 % CI : -0.02–0.18 , p = 0.13 ) or the team incentive ( 0.17 vs 0.18 , difference : -0.003 , 95 % CI : -0.11–0.10 , p = 0.96 ) . The combined incentive arm participants also achieved the goal at significantly greater rates than the team incentive ( 0.35 vs. 0.17 , difference : 0.18 , 95 % CI : 0.08–0.28 , p < 0.001 ) , but not the individual incentive ( 0.35 vs. 0.25 , difference : 0.10 , 95 % CI : -0.001–0.19 , p = 0.05 ) . Only the combined incentive had greater mean daily steps than control ( difference : 1446 , 95 % CI : 448–2444 , p ≤ 0.005 ) . There were no significant differences between arms during the follow-up period ( weeks 14– 26 ) . CONCLUSIONS Financial incentives rewarded for a combination of individual and team performance were most effective for increasing physical activity . Trial Registration Clinical trials.gov identifier : NCT02001194 There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss .  Between March 2010 and January 2012 , in a r and omized controlled trial , we assigned 700 obese persons to three experimental arms . We test whether particular subgroups react differently to financial incentives for weight loss . Two treatment groups obtained a cash reward ( € 150 and € 300 with 237 and 229 participants , respectively ) for achieving an individually-assigned target weight within four months ; the control group ( 234 participants ) was not incentivized . Participants and administrators were not blinded to the intervention . We find that monetary rewards effectively induced  obese individuals to reduce weight across all subgroups . However , there is no evidence for treatment-effect heterogeneity for those groups that were incentivized . Among those who were in the € 300 group , statistically significant and large weight losses were observed for women , singles , and those who are not working ( all above 4 kg in four months ) . In addition , the magnitude of the reward matters only for women and migrants . The effectiveness of financial incentives to reduce weight nevertheless raises sensitive ethical issues that should be taken into consideration by policymakers ABSTRACT BACKGROUND Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases , but daily engagement rates among these patients may be low . OBJECTIVE To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes . DESIGN R and omized , controlled trial . ( Clinical trials.gov Identifier : NCT01282957 ) . PARTICIPANTS Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System . INTERVENTIONS Twelve weeks of daily home-monitoring of blood glucose , blood pressure , and weight ( control group ; n = 28 ) ; a lottery incentive with expected daily value of $ 2.80 ( n = 26 ) for daily monitoring ; and a lottery incentive with expected daily value of $ 1.40 ( n = 21 ) for daily monitoring . MAIN MEASURES Daily use of three home-monitoring devices during the three-month intervention ( primary outcome ) and during the three-month follow-up period and change in A1c over the intervention period ( secondary outcomes ) .KEY RESULTS Incentive arm participants used devices on a higher proportion of days relative to control ( 81 % low incentive vs. 58 % , P = 0.007 ; 77 % high incentive vs. 58 % , P = 0.02 ) during the three-month intervention period . There was no difference in adherence between the two incentive arms ( P = 0.58 ) . When incentives were removed , adherence in the high incentive arm declined while remaining relatively high in the low incentive arm . In month 6 , the low incentive arm had an adherence rate of 62 % compared to 35 % in the high incentive arm ( P = 0.015 ) and 27 % in the control group ( P = 0.002 ) . CONCLUSIONS A daily lottery incentive worth $ 1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive
Our framework should help research ers and policy-makers identify the most effective incentive configurations for helping individuals adopt healthy behaviours
Financial incentive interventions are increasingly used as a method of encouraging healthy behaviours , from attending for vaccinations to taking part in regular physical activity .
There is a growing body of research on the effectiveness of financial incentive interventions for health behaviours .
Wide variations in the nature of these interventions make it difficult to draw firm conclusions about what makes an effective incentive , for whom and under what circumstances .
Whilst there has been some recognition of the theoretical complexity of financial incentive interventions for health behaviours , there is no framework that categorises these interventions .
This limits the research community 's ability to clearly establish which components of financial incentives interventions are more and less effective , and how these components might interact to enable behavioural change .
We propose a framework for describing health-promoting financial incentive interventions .