Financial incentives don't encourage us to get on the treadmill

Incentivization: Attaching a reward to a desired behavior or threatening a punishment for failing to conduct that behavior. This is done in hopes that it will motivate individuals to behave in particular ways. 

Reward power: The idea that when a behavior leads to a reward, we come to associate the behavior with the reward and are thus motivated to continue engaging in the behavior in the future. In essence, rewards become the motivation for the desired behavior. 

Extrinsic motivation: When we are motivated to partake in a behavior to obtain an external reward, rather than because we think the behavior itself is rewarding.¹

Intrinsic motivation: Motivation to take part in an activity for the sake of the activity itself, not due to external rewards.1

Quasi-Experimental Studies: Study designs where there are practical and ethical barriers to conducting randomized controlled trials, which leads to non randomized participant selection.²

Two-Arm Design: A form of cluster randomized trials that randomly separates participants in two groups, to evaluable a single intervention - in this case, the use of loyalty cards as financial incentivization.²

Exercise and physical activity are critical practices for overall health and wellbeing, yet they are seldom given the attention they deserve. Physical activity is a preventative tool for various health issues, with 6-10% of deaths from noncommunicable diseases (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) worldwide owed to physical inactivity. Exercise is a low-cost alternative to disease treatment and prevention, but few adults engage in the recommended minimum amount of physical activity per week.³ To combat what has been called a ‘pandemic’, public health experts have sought effective ways to incentivize adults to partake in regular physical activity. Unfortunately, the mere knowledge of the benefits of exercise are not enough to motivate us to exercise.

One possible solution for this ‘pandemic’ of inactivity are incentives. Incentives have been shown to effectively deter behaviors that negatively affect health (smoking, substance abuse), and promote the establishment of structured exercise routines. However, few studies have examined whether incentivization can work when people are encouraged to engage in physical activity by their own free will.

Setting the scene

The link between incentives and motivation is heavily studied, as we often behave in non-rational ways that work counter to our best interests. Incentives can provide a potential escape from this cycle of irrational, unproductive spirals, as they can change how we value our behavioural choices. However, their efficacy varies greatly depending on the targeted behavior and the type of incentive that is offered. Often, the way that the incentive is framed - either as something you can gain, or as something you can stand to lose - also impacts its effectiveness. 

Although rationally, we should all engage in behaviors that are good for our health, that is not always the case, which financial incentives could help combat. Public health authorities will often trial financial incentives to nudge people to take better care of their health. One study found that monetary incentives made individuals more likely to go pick up their test results and engage in preventative behavior if they found they had contracted a disease. 

To understand how incentives could motivate adults to increase their physical activity, Professor of Public Health Ruth F. Hunter and her colleagues designed an intervention that used loyalty cards as a way to incentivize adults to exercise. While she identified a gap in the research, the idea of using loyalty cards is not new. Governments in both the United Kingdom and the United States encouraged public health officers to collaborate with business sectors through loyalty card schemes, as they have effectively encouraged other types of behavior, such as shopping.

Ruth et al. recruited participants from two buildings at Northern Ireland’s main government offices, as individuals in sedentary workplaces like these are representative of the majority of workers who are likely not getting the recommended amount of physical activity. Participants needed to be between the ages of 16-65, be at work at least four days a week (as the gym was on-site), and needed to be fit enough to complete 15 minutes of moderate-paced walking.

Incentives: Passes & Loyalty Programs 

Participants were randomly assigned to the incentive group or the non-incentive group. The incentive group received a passholder that enrolled them in a loyalty program, where they could exchange physical activity minutes for various rewards from local businesses. Participants in the non-incentive group still received a passholder, but did not collect points based on their physical activity. As the study was interested in workplace physical activity, only minutes of exercise recorded during work hours were recorded (using the pass as a logging system). Participants were able to see how many physical activity minutes they had accumulated.

Both groups were given a pass and could monitor their levels of physical activity to ensure a consistent level of intrinsic motivation for both groups, as self-monitoring one’s progress can make us more aware of our behaviors and increase our desire to engage in healthier habits. Only the incentive group was nudged towards extrinsic motivation, as they collected one point for every physical activity minute they completed. The researchers particularly focused on the minutes of physical activity at Week 12 of the program and at the 6-month mark, so they could examine both the short-term effectiveness of financial incentives and their long-term impact. 

COM-B Framework

To ensure that all of the factors that could influence behavioral change were addressed, the researchers applied a behavioral science framework, which, in this case, was the COM-B model. The COM-B model suggests that there are three key factors required for behavioral (B) changes to occur: Capability (a psychological and physical ability to participate in an activity), Opportunity (external factors that enable the activity to take place), and Motivation (the conscious and unconscious cognitive processes that encourage behavior).

Capability was ensured as participants self-reported that they were physically able to engage in a 15-minute moderate-paced walk. And any individuals who had been advised to not exercise by a medical professional were not eligible to participate in the study.

All participants had the opportunity to exercise, as only individuals who spent a significant amount of time at the workplace, where opportunities for physical activity were available and tracked, were able to participate in the study.

Motivation was promoted for both groups intrinsically, through the ability to track one’s progress, and extrinsically for the incentive group, through the loyalty program. 

In both the short-term and long-term, there was no significant difference between the amount of physical activity recorded by individuals in the incentive group and individuals in the non-incentive group. At 12 weeks, participants in the incentive group recorded, on average, 0.9 minutes less than participants in the non-incentive group. At 6 months, participants in the incentive group recorded, on average, 2.2 minutes more than participants in the incentive group. 

However, in a survey that asked participants to rate their level of satisfaction with various aspects of the program on a 5-point Likert-type scale,  89% of participants felt that having the pass card was “very helpful” in encouraging them to do more physical activity. Although the financial incentives did not lead to a significant change in behavior, having an overall program available did, as 63% of those who participated ended up engaging in physical activity at the workplace. 

The results suggest that intrinsic motivation may be more important than extrinsic motivation when motivating individuals to participate in healthier behaviors, which is supported by the crowding out effect. The crowding out effect suggests that when rewards are offered for behaviors, individuals lose inherent motivation to partake in the behavior, which diminishes their likelihood of engaging in it. Thus, public health professionals should focus on interventions which increase intrinsic motivation to engage in healthy behaviors instead. 

Can Money Buy Good Health? RCT of Financial Incentives for Weight Loss: Although this intervention found that financial incentives did not have a significant effect on motivation to engage in physical activity, this article examines a successful intervention where participants were financially incentivized to lose weight. Participants had daily weigh-ins, and those that were offered a financial incentive lost more weight than those who were not paid. 

Should We Pay Students to Go to School?: Financial incentives might be useful for promoting other kinds of socially-beneficial behavior. This article examines how financially incentivizing students to attend school could prevent kids from dropping out. Like in this intervention, however, these payments weren’t perfect, as they did not improve academic achievement. 

The Science of Reward: Rewards are powerful, but they can be finicky. Sometimes they work, but other times they diminish intrinsic motivation. So that we can properly leverage the power of rewards, this article explores the science behind incentivization.