Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study

Abstract

BackgroundHealth insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss.MethodsWe used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups.ResultsBoth independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance.ConclusionsIf financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5136-z) contains supplementary material, which is available to authorized users.

A descriptive study of potential participant preferences for the design of an incentivised weight loss programme for people with type 2 diabetes mellitus attending a public hospital in Lima, Peru

“…The proportion of participants who would participate in an incentivised weight loss programme was high (85%) but the proportion who would participate in an unincentivised programme was even higher (94%). A similar pattern was observed in a mixed-methods study of acceptability of incentives for a weight loss maintenance programme, in which 93.9% supported the programme generally but only 77% supported cash incentives 24 . The finding may indicate that in our sample weight loss as a goal was a more powerful motivator than the financial incentive.…”

“I’m Still on Track”: A Qualitative Exploration of Participant Experiences of a Weight Loss Maintenance Program

“…Although the personal responsibility discourse was ubiquitous, participant narratives also accommodated a need for the program and recognition of the utility of the program; these opposing notions seemed to co-exist with the agency participants felt within the structure of the program [32]. The tension between individual responsibility and the need for external support mechanisms for weight loss maintenance in a similar population has been described previously [20]. This finding also reflects other research findings where reliance on personal responsibility and self-reflection for weight management was found unsuccessful, and participants 'changed their strategy' to include more reliance on external surveillance from an intervention/program [27].…”

“…A semi-structured discussion guide (see Supplementary Materials) was developed by the research team and reviewed by the HWFL program service provider to explore participants' experiences of using the LTMP. The discussion guide was based on previous literature of individuals' experience of weight management programs [19] and drew on knowledge gained from a previous focus group study with HWFL program participants describing their experiences with the program [20]. Participants were asked about their experience with the initial weight loss program as an introduction to the interview, and then about their experiences with the LTMP.…”

Beyond weight loss: Impact of a weight management programme for mid‐older Australians in private health insurance

“…The HWFL service provider in partnership with one health insurer, identified a need to support HWFL graduates with weight‐loss maintenance. Following formative research and consistent with accepted best practice, the HWFL programme was extended with the addition of the long‐term maintenance program (LTMP). The LTMP, also delivered remotely, offers individually tailored behavioural support and relapse management for maintaining healthy weight‐related behaviours, providing participants unlimited contact (through phone calls, an online portal, emails or SMS) with the HWFL support team, as well as regular case review for up to 24 months as described elsewhere .…”