"The idea of price as an incentive mechanism for social marketers can be traced back at least to Lefebvre and Flora (1988; link to pdf). The two cases they used to illustrate their approach to incorporating social marketing into public health interventions included charging people nominal fees for participating in community blood cholesterol screening programs and awarding prizes for participating in a quit smoking contest. Charging fees for this screening service is much like the product pricing models used in social marketing programs in developing countries. The latter approach of offering prizes has been successfully diffused around the world to attract community and workforce participants into behavior change programs and to reward some successful achievers of the behavioral goal with prizes, which are usually determined through a random drawing (Nelson et al.,1987; O’Connor et al., 2006)...
In reviewing the results of eleven Quit & Win smoking cessation contests conducted throughout New York State that enrolled over 5,504 adult smokers, with each program offering a cash prize of $1,000, O’Connor et al. (2006) found that nine out of ten smokers who enrolled in a contest reported making a quit attempt, and between 53 percent and 72 percent reported quitting for the full month of the contest. Maintenance of nonsmoking status at four to six months ranged from 22 percent to 49 percent, with an average of 31 percent. Based on a statewide population survey, eight of the eleven programs showed quit rates that were significantly higher than the estimated quit rate of 21 percent reported by smokers who made a quit attempt in the past year. These authors concluded that for a relatively modest investment (ranging from $4,345 to $91,441), promotional contests with a monetary incentive can recruit thousands of smokers to make a serious quit attempt, with many remaining smoke-free months later...
A systematic review of forty-seven studies that evaluated the effects of economic incentives on consumers’ preventive health behaviors was conducted by Kane, Johnson, Town, and Butler (2004). They categorized the preventive behaviors as complex when a sustained behavior change was required and as simple when the behavior was more of a one-off proposition, such as an immunization. They found that economic incentives worked 73 percent of the time (74 percent for simple behaviors, and 72 percent for complex ones) and were most effective for short-term changes or simple preventive care with well-defined behavioral goals. They were unable to ascertain whether such effects would last over the long term...
Wall, Mhurchu, Blakely, Rodgers, and Wilton (2008) found support for using economic incentives to modify dietary behaviors including food purchases, food consumption, and weight loss. Their evidence came from four randomized trials they identified in the literature that compared interventions using incentives to comparable interventions without incentives or control conditions. They noted that small sample sizes and the short duration of the studies limited the generalizability of their findings. Thus these promising results point to the necessity of supporting larger-scale studies, especially ones aimed at high-risk population groups…
In a review of research using financial incentives across a diversity of groups for various health behaviors, Marteau, Ashcroft, and Oliver (2009) reported that the evidence for incentive effectiveness may be strongest in drug abuse treatment programs but that incentives seemed to have little effect on smoking cessation or weight loss efforts (also see Paul-Ebhohimhen & Avenell, 2007). As others have noted, economic incentives do appear to increase discrete, infrequent behaviors such as attending clinic appointments or receiving vaccinations - especially among people from lower-income groups. What is encouraging is that adherence to treatment protocols, particularly for tuberculosis and antipsychotic medications, seems to be responsive to economic incentives as well.
However, Marteau and colleagues (2009) found that among the unintended consequences of economic incentives for behavior change, when studied in classrooms and workplaces, is that intrinsic motivation is weakened. Whether this effect holds true for health behaviors is unknown. These authors also note that the exchange relationship is altered when switching from social rewards to financial ones. The ways in which service relationships (such as those between health care providers and patients) may be altered by incentives or Conditional Cash Transfer programs is also unexamined.
The issue of whether financial incentives are appropriate, even when they do work, is a concern among many groups of people, especially when the behaviors involved relate to health or other prosocial choices. Among the concerns about using financial incentives that Marteau et al. (2009) identify are that offering incentives is bribery or paying people do things against their own wishes, it is implicit or explicit coercion, it is a waste of public monies, it creates a sense of unfairness in that people should be expected to act in the preferred manner without monetary rewards, and it encourages a sense of dependence or entitlement among various socioeconomic groups. Marteau et al.’s conclusion is that even though financial incentives have been shown in some cases to be effective in changing behavior, under what conditions, for whom, and with what unintended outcomes remain to be determined. Yet Marteau et al. also offer these insights about using incentives:
♣ Using payments can be more powerful than providing information and less restrictive than legislation in changing behaviors.
♣ Targeting habitual behaviors such as smoking cessation and physical activity with schemes that provide valued incentives on an intermittent basis and are embedded in effective behavior change programs can lead to initial as well as sustained behavior change.
♣ Relatively simple behaviors such as clinic attendance and participation in vaccination programs can be increased through offering small incentives that are immediately available.
♣ An incentive program must be acceptable to the general population, health care professionals, and policymakers."
Adapted from: From: Lefebvre, R.C (in press). Social marketing and social change: Strategies and tools for improving health, well-being and the environment (San Francisco: Jossey-Bass, expected 2013).
Kane, R. L., Johnson, P. E., Town, R. J., & Butler, M. (2004). A structured review of the effect of economic incentives on consumers’ preventive behavior. American Journal of Preventive Medicine; 27:327–352.
Lefebvre, R. C., & Flora, J. A. (1988). Social marketing and public health intervention. Health Education Quarterly, 15:299–315.
Marteau, T. M., Ashcroft, R. E., & Oliver, A. (2009). Using financial incentives to achieve healthy behaviour. British Medical Journal; 338:b1415.
Nelson, D. J., Sennett, L., Lefebvre, R. C., Loiselle, L., McClements, L., & Carleton, R. A. (1987). A campaign strategy for weight loss at worksites. Health Education and Research: Theory and Practice; 2:27–31.
O’Connor, R., Fix, B., Celestino, P., Carlin-Menter, S., Hyland, A., & Cummings, K. M. (2006). Financial incentives to promote smoking cessation: Evidence from 11 Quit and Win contests. Public Health Management and Practice; 12:44–51.
Paul-Ebhohimhen, V., & Avenell, A. (2007). Systematic review of the use of financial incentives in treatments for obesity and overweight. Obesity Reviews; 9:355–367.
Wall, J., Mhurchu, C. N., Blakely, T., Rodgers, A., & Wilton, J. (2008). Effectiveness of monetary incentives in modifying dietary behavior: A review of randomized, controlled trials. Nutrition Reviews; 64:518–531