Abstract
BackgroundDespite many advantages of web-based health behavior interventions such as wide accessibility or low costs, these interventions are often accompanied by high attrition rates, particularly in usage under real-life conditions. It would therefore be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence.ObjectiveThis naturalistic study examined real-life usage data of a 12-week web-based physical activity (PA) intervention (Fitness Coach) among insurants who participated in an additional incentive program (incentive group) and those who did not (nonincentive group). Users in the incentive group had the perspective of receiving €30 (about US $33) cash back at the end of the intervention.MethodsRegistration and real-life usage data as part of routine data management and evaluation of the Fitness Coach were analyzed between September 2016 and June 2018. Depending on the duration of use and the weekly recording of tasks, 4 adherence groups (low, occasional, strong, and complete adherence) were defined. Demographic characteristics were collected by a self-reported questionnaire at registration. We analyzed baseline predictors and moderators of complete adherence such as participation in the program, age, gender, and BMI using binary logistic regressions.ResultsA total of 18,613 eligible persons registered for the intervention. Of these, 15,482 users chose to participate in the incentive program (incentive group): mean age 42.4 (SD 14.4) years, mean BMI 24.5 (SD 4.0) kg/m2, median (IQR) BMI 23.8 (21.7-26.4) kg/m2; 65.12% (10,082/15,482) female; and 3131 users decided not to use the incentive program (nonincentive group): mean age 40.7 (SD 13.4) years, mean BMI 26.2 (SD 5.0) kg/m2, median BMI 25.3 (IQR 22.6-28.7) kg/m2; 72.18% (2260/3131) female. At the end of the intervention, participants in the incentive program group showed 4.8 times higher complete adherence rates than those in the nonincentive program group (39.2% vs 8.1%), also yielding significantly higher odds to complete the intervention (odds ratio [OR] 12.638) for the incentive program group. Gender significantly moderated the effect with men in the incentive group showing higher odds to be completely adherent than women overall and men in the nonincentive group (OR 1.761). Furthermore, older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion.ConclusionsThis is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence. Male users, in particular, seem to be strongly motivated by incentives to complete the intervention. Based on these findings, health care providers can use differentiated incentive systems to increase regular participation in web-based PA interventions.
Highlights
Promoting a healthy lifestyle, especially reducing sedentary behavior and increasing physical activity (PA), is crucial in the prevention of chronic diseases such as cardiovascular disease, type 2 diabetes, breast and colon cancer as well as hypertension [1]
Older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion. This is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence
755 (2.45%) registered as guests who were not insured by the health insurance company and were unable to participate in the incentive program
Summary
Especially reducing sedentary behavior and increasing physical activity (PA), is crucial in the prevention of chronic diseases such as cardiovascular disease, type 2 diabetes, breast and colon cancer as well as hypertension [1]. Besides numerous face-to-face PA interventions [4,5], electronic health (eHealth) and mobile health (mHealth) interventions have become increasingly popular to promote health behavior change such as increasing PA levels [6]. Testing the effectiveness of internet interventions for behavior change, in particular for promoting PA, has yielded positive results despite small effect sizes with standardized mean differences ranging from 0.14 to 0.20 for self-reported PA [7,8,9,10] Based on this evidence, many stakeholders in health care including health insurers have developed web-based interventions promoting PA as a public health approach [11,12]. It would be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence
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