Physical activity after commitment lotteries: examining long-term results in a cluster randomized trial

The Influence of Behavioral Sciences on Adherence to Physical Activity and Weight Loss in Overweight and Obese Patients: A Systematic Review of Randomized Controlled Trials

In recent years, weight gain and reduced physical activity in the general population have contributed to the development of obesity and other health problems; on the other hand, studies in behavioral sciences have been used to modify behaviors for a healthier life, so the objective of this study was to identify the evidence of interventions in behavioral sciences on adherence to physical activity and weight loss in obese patients. This systematic review study is based on a search of the electronic databases PubMed, Web of Science, Scopus, and Cochrane. Studies assessed the evidence from intervention studies that assessed the influence of intervention studies of behavioral sciences on public health. The articles were published between 2013 and 2023. The systematic search of the databases identified 2951 articles. The review analyzed 10 studies. Behavioral science interventions presented evidence through strategies such as multicomponent interventions, lottery and financial incentives, message framing, message framing with financial incentive and physical activity, and psychological satisfaction, demonstrating results in weight loss and maintenance and increased physical activity. This study presents scientific evidence through healthy behavior change methodologies, and future studies can explore these strategies in conjunction with public health technologies in the search for public-private partnerships to promote physical activity in adults.

Effectiveness of behavioural economics-informed interventions to promote physical activity: A systematic review and meta-analysis

OBJECTIVE

For beneficial health outcomes sufficient and sustained physical activity levels are recommended but difficult to achieve. This systematic review evaluates the effectiveness of behavioural economics (BE)-informed interventions to increase individuals' physical activity level in the long-term.

METHODS

We conducted a systematic literature search using Medline (via PubMed), PsycInfo, and EconLit (both via EBSCOhost) including randomized controlled trials of at least 24 weeks duration that evaluated BE-informed interventions to promote physical activity in adults. Potential BE approaches were commitment devices, social incentives, motivational feedback, goal setting, gamification, and financial incentives. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for (cluster-) randomized trials. A random-effects meta-analysis was conducted to summarize the outcome measure daily step count.

RESULTS

Based on 13 studies with 4347 participants, the BE-informed interventions most often applied were commitment lotteries (n = 8) and social incentives (n = 7). Risk of bias assessment classified five studies as low, six as moderate, and two as high risk of bias. Significant results on study level towards BE-informed interventions were observed for commitment lotteries (n = 3) and gamification (n = 4). Including healthy and diseased individuals in the meta-analysis (n = 10), the increase in daily step count in experimental groups compared to control was statistically significant for the intervention period (standardized mean difference (SMD) = 0.13, 95%-CI: 0.00-0.25, I2 = 59%, p = 0.04) but not for the follow-up (SMD = 0.08, 95%-CI: -0.00-0.17, I2 = 17%, p = 0.06). Excluding high risk of bias studies (n = 2) resulted in statistically significant effects with reduced heterogeneity for both periods.

CONCLUSION

Our review reveals a potential effect of BE-informed interventions to promote physical activity. The small effect underlines the importance to evaluate the behavioural channels which may explain the heterogeneity in individuals' responses to BE strategies.

Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial

BACKGROUND

Smoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support.

METHODS AND DESIGN

We examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date.

DISCUSSION

There is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace.

TRIAL REGISTRATION

Netherlands Trial Register Identifier: NL8463 . Date of registration: 17-03-2020.

Pilot Evaluation of the Impact of Lottery-Based Incentives on Engagement Levels of Male Low SES Vocational Students With an mHealth App

In general, individuals with lower socioeconomic status (SES) are less physically active and adhere to poorer diets than higher SES individuals. To promote healthier lifestyles in lower SES populations, we hosted a digital health promotion program among male vocational students at a school in The Netherlands. In a pilot study, we evaluated whether this target audience could be engaged with an mHealth app using lottery-based incentives that trigger feelings of anticipated regret. Especially, we studied the social and interpersonal aspects of regret lotteries in a within-subject experimental design. In this design, subjects either participated in a social variant (i.e., with students competing against their peers for a chance at a regret lottery), or an individual variant (i.e., with subjects solely individually engaged in a lottery). Additionally, we studied the impact of different payout schedules in a between-subject experimental design. In this design, participants were assigned to either a short-term, low-value payout schedule, or a long-term, high-value payout schedule. From a population of 72 male students, only half voluntarily participated in our 10-week program. From interviews, we learned that the main reason for neglecting the program was not related to the lottery-based incentives, nor to the prizes that were awarded. Instead, non-enrolled subjects did not join the program, because their peers were not joining. Paradoxically, it was suggested that students withheld their active participation until a larger portion of the sample was actively participating. From the subjects that enrolled in the program (N = 36, males, between 15 and 25 years of age), we found that a large proportion stopped interacting with the program over time (e.g., after roughly 4 weeks). Our results also indicated that students performed significantly more health-related activities when assigned to the social regret lottery, as opposed to the individual variant. This result was supported by interview responses from active participants: They mainly participated to compete against their peers, and not so much for the prizes. Hence, from this study, we obtained initial evidence on the impact of social and competitive aspects in lottery-based incentives to stimulate engagement levels in lower SES students with an mHealth app.

Barriers to, and Facilitators of, Exercising in Fitness Centres among Adults with and without Physical Disabilities: A Scoping Review

Fitness centres are an obvious arena for performing physical activity for the general population but representation of adults with physical disabilities (AwPD) is lacking. To increase possibilities for AwPD to exercise in fitness centres together with adults without physical disabilities (AwoPD), the aim of this study was to identify, synthesise, and compare barriers to, and facilitators of, exercising in fitness centres for each group. A scoping review was conducted and data extraction of the barriers and facilitators was performed independently by two researchers on six categories of contextual factors based on the framework of Di Blasi: (1) The fitness centre setting; (2) The fitness centre user characteristics; (3) The fitness instructor/staff characteristics; (4) The fitness centre user-instructor/management relationship; and (5) The fitness/exercise characteristics. An extra category, (6) Other relationships, was added. The PRISMA Extension for Scoping Reviews was used for reporting. Of the 102 included papers, only 26 (25%) of the papers were on AwPD, which focused mainly on physical barriers (category 1: inaccessible settings). In contrast, the remaining 76 papers involving AwoPD focused primarily on facilitators (category 2: motivational factors and exercising effects). In categories 3-6, the two groups had similar results, as both groups preferred skilled instructors, a welcoming and comfortable fitness centre environment, an ability to exercise at their preferred type and level, and good social connections. Since most data were based on AwoPD, more studies on actual experiences from AwPD are needed, to reveal the facilitators/motivational factors for fitness centre use.

[Remote control or unlikely control? Behavioral economics and the promotion of healthy behaviors¿Control remoto o remota probabilidad de control? La economía comportamental y la promoción de determinados patrones de comportamiento]

Behavioral economics is a field of knowledge and practices that studies the effect of psychological, cognitive, emotional, and social factors relating to decision-making by individuals and institutions. It assumes that human choices are not the result of careful consideration of costs and benefits, and that some aspects (e.g., defaults, framings, and anchoring effects) may influence an individual's decision-making. Thus, the aim of this essay is to present some general aspects of behavioral economics and discuss its possible application in the promotion of healthy behaviors. One of the roles of health care professionals is to facilitate the adoption of healthy behaviors by the population. There is evidence of a positive influence of some behavioral economics concepts regarding the adoption of various health behaviors, such as food choices, physical activity, adherence to vaccination campaigns, and organ donation. Thus, it is believed that the appropriation of some of these concepts and insights may both promote healthier behaviors and support more effective actions to encourage these healthy behaviors.