Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods

Abstract

ObjectiveFinancial incentives are effective in encouraging healthy behaviours, yet concerns about acceptability remain. We conducted a systematic review exploring acceptability of financial incentives for encouraging healthy behaviours. MethodDatabase, reference, and citation searches were conducted from the earliest available date to October 2014, to identify empirical studies and scholarly writing that: had an English language title, were published in a peer-reviewed journal, and explored acceptability of financial incentives for health behaviours in members of the public, potential recipients, potential practitioners or policy makers. Data was analysed using thematic analysis. ResultsEighty one papers were included: 59 pieces of scholarly writing and 22 empirical studies, primarily exploring acceptability to the public. Five themes were identified: fair exchange, design and delivery, effectiveness and cost-effectiveness, recipients, and impact on individuals and wider society. Although there was consensus that if financial incentives are effective and cost effective they are likely to be considered acceptable, a number of other factors also influenced acceptability. ConclusionFinancial incentives tend to be acceptable to the public when they are effective and costeffective. Programmes that benefit recipients and wider society; are considered fair; and are delivered to individuals deemed appropriate are likely to be considered more acceptable.

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

“…Findings from both stakeholder groups provide strong support for previous research, where a variety of stakeholders across a range of clinical and public health settings have described health-promoting financial incentives as coercive, divisive and akin to bribery. 49,50,91,[93][94][95][96] However, unlike previous work in other settings, in which stakeholders have challenged the potential effectiveness of health promoting financial incentives in general (sometimes as a way of avoiding discussion of acceptability altogether), [93][94][95][96] there was, overall, an acceptance that financial incentives could be effective in encouraging the uptake of preschool vaccinations for some parents. A more detailed understanding of what aspects of acceptability of health-promoting financial incentives are common across all settings and which are context-specific -as well as what determines context-specific differenceswould be helpful.…”

“…Similar results have been reported in relation to financial incentives for other healthy behaviours. 93 However, governance and ethical issues were raised relating to the potential for vouchers to be used to facilitate unhealthy behaviours, such as buying alcohol or cigarettes, which would sit in contrast to the work being undertaken to promote healthy behaviours generally. Findings from both stakeholder groups provide strong support for previous research, where a variety of stakeholders across a range of clinical and public health settings have described health-promoting financial incentives as coercive, divisive and akin to bribery.…”

Parental Preferences for the Organization of Preschool Vaccination Programs Including Financial Incentives: A Discrete Choice Experiment

“…34 These findings (along with those of the current DCE) are in contrast to qualitative work and surveys, which tends to find that incentives are generally not considered acceptable. 7–9,14 …”

Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial: a three-armed randomised controlled trial of financial incentives

“…A recent review of studies on acceptability of financial incentives for health behaviours found that incentives tend to be considered acceptable if they are clinically effective and cost-effective, and if they benefit recipients and the wider society. 51 The review was not able to determine if opinions on acceptability were different for different target behaviours. In addition, incentives for screening were not considered.…”

“…Few trials of financial incentives have included CEA as part of their evaluation of the incentive. Giles et al 51 conducted a systematic review of studies of financial incentives for encouraging uptake of health behaviours and concluded that 'little evidence for cost-effectiveness has been published'. In the current financial environment, it is important to ensure that any interventions are cost-effective.…”