A Randomized Trial of Social Comparison Feedback and Financial Incentives to Increase Physical Activity

Abstract

Purpose To compare the effectiveness of different combinations of social comparison feedback and financial incentives to increase physical activity. Design Randomized trial (Clinicaltrials.gov number, NCT02030080). Setting Philadelphia, Pennsylvania. Participants Two hundred eighty-six adults. Interventions Twenty-six weeks of weekly feedback on team performance compared to the 50th percentile (n = 100) or the 75th percentile (n = 64) and 13 weeks of weekly lottery-based financial incentive plus feedback on team performance compared to the 50th percentile (n = 80) or the 75th percentile (n = 44) followed by 13 weeks of only performance feedback. Measures Mean proportion of participant-days achieving the 7000-step goal during the 13-week intervention. Analysis Generalized linear mixed models adjusting for repeated measures and clustering by team. Results Compared to the 75th percentile without incentives during the intervention period, the mean proportion achieving the 7000-step goal was significantly greater for the 50th percentile with incentives group (0.45 vs 0.27, difference: 0.18, 95% confidence interval [CI]: 0.04 to 0.32; P = .012) but not for the 75th percentile with incentives group (0.38 vs 0.27, difference: 0.11, 95% CI: −0.05 to 0.27; P = .19) or the 50th percentile without incentives group (0.30 vs 0.27, difference: 0.03, 95% CI: −0.10 to 0.16; P = .67). Conclusion Social comparison to the 50th percentile with financial incentives was most effective for increasing physical activity.

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

“…First, a key element of our study design was the use of loss aversion, a principle from behavioral economics 13, 17, 18, 19, 28, 29, 30, 31, 32, 33, 34. Most previous financial incentive‐based physical activity interventions have used gain‐framed incentives16, 39, 40, 41—individuals earn a reward after the behavior is achieved.…”

“…The study was conducted using Way to Health, a research technology platform at the University of Pennsylvania used previously for physical activity interventions 17, 18, 19, 22. Patients used the study website to create an account, provide informed consent online, and completed baseline eligibility surveys and the MacNew heart disease quality of life questionnaire 23, 24.…”

“…Power calculations (a priori) were based on previous work17, 18, 19 and assumed a baseline mean step count of 6000 steps in the control group with an SD of 2000 steps, a 15% dropout rate, and a 2‐sided α of 0.05. It was estimated that a sample of 148 patients (74 per arm) would ensure at least 80% power to detect a 1000‐step difference between the incentive and control arms in the change in mean daily steps from baseline to the maintenance incentive phase.…”

“…For the prespecified main analysis, we used multiple imputation for data that were missing and step values less than 1000. We have used this method in previous work17, 18, 19, 25 and in this study because evidence indicates that step values less than 1000 may not represent accurate data capture 26, 27. Five imputations were conducted using the mice package in R (R Foundation for Statistical Computing, Vienna, Austria), which allows for patient random effects with this data structure 37.…”

“…However, thus far there is limited evidence of interventions that use these devices to effectively sustain behavior change among high‐risk patients 13, 15, 16. Our previous work found that financial incentive‐based approaches that use mobile technologies can be effective in increasing physical activity,17, 18, 19 but only if they are designed to appropriately leverage insights from behavioral economics—a field that incorporates insights from psychology to design interventions that address predictable barriers to behavior change 20, 21. For example, we found that the framing of financial incentives significantly impacted their effectiveness 18.…”