Effectiveness and cost-effectiveness of a loyalty scheme for physical activity behaviour change maintenance: results from a cluster randomised controlled trial

Abstract

BackgroundWe evaluated the effectiveness and cost-effectiveness of a loyalty scheme based intervention involving rewards for increasing physical activity in public sector employees.MethodsA cluster randomised wait-list controlled trial in public sector organisations in Northern Ireland. We randomly assigned clusters (1:1) using a computer generated random sequence. Researchers were masked to allocation, but participants were not. Employees aged 18–65 years with no self-reported medical contraindications to physical activity were included. The Physical Activity Loyalty Scheme (PAL) intervention was based on high-street loyalty cards where participants earned points for minutes of activity that could be redeemed for rewards, complemented by evidence-based behaviour change techniques. The primary outcome was objectively measured mean steps/day at 6 months using a validated pedometer (Yamax Digi-Walker CW-701) over 7 days, assessed with intention to treat analysis. Secondary outcomes included health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Cost-effectiveness, cost-benefit and mediation analyses were conducted. Trial registered with Current Controlled Trials, number ISRCTN17975376.ResultsBetween September 2014 and October 2015, we recruited and randomly assigned 37 clusters (from nine organisations; mean clusters per organisation = four) and 853 participants to the intervention (n = 19 with 457 participants) or control group (n = 18 with 396 participants). Primary outcome data were available for 249 (54·4%) intervention and 236 (59·6%) control participants. Mean steps/day were significantly lower in the intervention vs control group (adjusted mean difference = − 336, 95% CI: -612 to − 60, p = 0·02) at 6 months. Participants redeemed only 39% (SD 43%) of their earned points. Using the Quality Adjusted Life Year outcome, the intervention was not cost effective from an NHS/PSS perspective. A net cost analysis from an employer perspective demonstrated the intervention group was associated with a mean of 2·97 h less absenteeism over a 4 week period (p = 0·62), which could result in net savings ranging from £66 to £735 depending on the wage rate employed. At 4-weeks post-baseline there were significant increases in identified regulation, integrated regulation, intrinsic motivation, social norms and intentions in intervention compared to control participants.ConclusionsOur mixed results pose challenges that are too infrequently exposed in public heath intervention trials. Although the intervention successfully altered several hypothesised mediating constructs it did not translate into long-term behaviour change. Our incentive level may have been too low to incentivise change, despite being designed a priori by a Contingent Valuation Survey. There were also major re-structuring of several organisations which presented significant implementation challenges, and technical limitations.Trial registrationISRCTN17975376 (Registered 19/09/2014).Electronic supplementary ma...

The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers: a 3-arm cluster randomised controlled trial

“…A study amongst employees with mixed professions who participated in a similar counselling intervention on physical activity, with one group only receiving counselling and another group receiving counselling and fitness testing, also showed no effects on physical activity compared to a control group (27). A recent study on a 6-month workplace intervention with a different approach, studying a loyalty scheme with financial incentives, also did not show a significant improvement in physical activity (28).…”

“…Different from previous studies (27)(28)(29)(30), our aim was to increase physical activity or reduce sedentary behaviour in order to improve mental health and cognition (16). Therefore, how the intervention was presented to participants may have altered their attitudes or behaviours.…”

A loyalty scheme to encourage physical activity in office workers: a cluster RCT

“…c ANCOVA comparison between 6-month means in the intervention group vs. 6-month means in the control group adjusted for baseline values of the outcome, randomisation stratum and season, and corrected for clustering. Reproduced with permission from Hunter et al 48 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.…”

“…48 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.RESULTS FROM THE HEALTH ECONOMICS ANALYSISNIHR Journals Library www.journalslibrary.nihr.ac.uk pairs of cost difference and QALY difference Point estimate of ICER (cost difference = £25.85, QALY difference = -0.00009, ICER = -£290,178/QALY gained) Threshold at £20,000/QALY gained Threshold at £30,000/QALY gained Cost-effectiveness plane representing 1000 bootstrapped cost difference and QALY difference pairs.…”

Mechanisms of physical activity behavior change in an incentive-based intervention: Mediation analysis.

“…People who work in predominantly office-based occupations tend to spend a large part of their day inactive, and public organizations have been shown to have higher sickness absenteeism rates than private sector organizations (Black, Frost, & Frost, 2011;Hamilton, Hamilton, & Zderic, 2007). For example, whilst our objective measure of physical activity behavior (pedometer steps/day) indicated that participants assigned to both the intervention and control groups had a fairly high level of baseline physical activity, over 50% of participants were categorized as having 'low' physical activity levels according to self-reported General Physical Activity Questionnaire (GPAQ) (Hunter et al, 2019(Hunter et al, , 2018. However, evidence regarding the effectiveness of workplace physical activity interventions is mixed especially for long-term behavior change (Hutchinson & Wilson, 2012;Malik, Blake, & Suggs, 2014).…”