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Saturday 1 October 2016
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Paying people to change their behaviour "can work"

Paying people to change their behaviour can work, at least in the short term, according to a leading health psychologist, but unanswered questions about this approach.

Personal financial incentives are increasingly being used to motivate patients and general populations to change their behaviour, most often as part of schemes aimed at reducing rates of obesity, smoking, and other addictive behaviours.

For example, a smoking cessation scheme in Essex offers pregnant women £20 food vouchers for a one-week cessation; £40 after four weeks; and another £40 at one year.

Theresa Marteau, Professor of Health Psychology at Kings College London, and colleagues reviewed evidence on the effectiveness of financial incentives in achieving health-related behaviour change and examined the basis for concerns about their use.

Schemes targeting habitual behaviours, such as smoking or physical inactivity in high income countries, may be more effective if they provide incentives for initial as well as sustained behaviour change, explain the researchers in a paper published on bmj.com.

In contrast, for schemes aimed at initiating relatively simple behaviours in low-income populations, such as clinic attendance and participation in vaccination programmes, small incentives delivered immediately seem most effective.

But financial incentives can also have unintended effects on motivation, informed choices, and the doctor-patient relationship, warn the authors.

Opinion on the use of incentives varies, but the authors suggest that offering a reward can help people to align their actions more closely with their true preferences.

For example, most people would prefer to eat more healthily and to be more physically active than they actually are. In this way, incentives operate to enhance rather than to restrict autonomy, they say.

The researchers believe that offering personal financial incentives is one of several means by which behaviour may be changed and should be seen as part of a broad approach. Even when effective, the use of financial incentives will depend on its acceptability to general populations, healthcare professionals, and policymakers alike.

Ultimately, if personal financial incentives prove to be effective and acceptable in only a few contexts, they may still offer an important means by which to improve population health, they conclude.

BMJ

Should patients be offered financial incentives to quit smoking or lose weight? Your comments (terms and conditions apply):

"Rewarding bad behaviour is not a good idea. You should reward those already exhibiting good behavour, ie, those who are already non-smokers, eat healthily, etc and then their good example will show others the way. Otherwise where is the incentive to maintain the good behaviour? You would be better off reverting to old ways and getting paid to change again!" – Katrina, Cornwall