Abstract
Offering individuals financial incentives for changing their health-related behaviour is one possible strategy for improving health and reducing morbidity and premature mortality. However, several important aspects of the behavioural and cognitive consequences of this type of intervention remain unclear. First, there is uncertainty regarding the effectiveness of financial incentives in achieving sustained changes in repeated health behaviours, as well as of the factors that might modify any effects. Second, the variables that might confound the impact of incentives on health-related behaviours remain unexplored. Third, the speculated unintended consequences of financial incentives on cognitive processes, including information processing and decision-making, have yet to be examined systematically. This thesis addresses these uncertainties.Study 1 is a systematic review and meta-analysis aiming to estimate the effectiveness of financial incentives in achieving sustained change across repeated health-behaviours (smoking cessation, healthier eating, including reduced alcohol consumption and increased physical activity) and to examine the factors that modify any impacts. Findings indicate that although financial incentives changed repeated health-behaviours, their role in reducing non-communicable disease burden is potentially limited, given effects were not sustained beyond three months after incentive removal. Results also highlight the role of recipients’ deprivation level in modifying incentive impacts on behaviour overall, as well as that of incentive value in modifying impacts on smoking cessation.
Study 2 is a qualitative study exploring the variables that might confound the impact of financial incentives on health-related behaviours. The study describes and compares the stop-smoking experiences of pregnant smokers’ who were incentivised for smoking cessation with those of women who were not. Results highlight the need to be cautious about attributing the effects of financial-incentive schemes to incentives per se. Given that incentive schemes are complex behavioural interventions, their impacts could derive from indirect influences, mediated by changes to some aspects of the process involved in their delivery, including the provision of increased support.
Study 3 is a randomised controlled trial aiming to estimate further the effectiveness of financial incentives in changing health-related behaviours, by assessing their impact on uptake of the HPV vaccinations. The study also aims to examine the modifying role of recipients’ deprivation level and to addresses the uncertainty regarding the speculated unintended consequences of incentives on decision-making processes. Results indicate that although incentives increased vaccination completion rates, impacts were not modified by recipients’ deprivation level and uptake remained lower than the national target, necessitating consideration of other ways of achieving it. The quality of decisions to get vaccinated was unaffected by the offer of incentives. Knowledge of the vaccination’s side-effects, however, was not assessed in this study. Findings therefore, are not conclusive about the impact of incentives on the processing of risk-relevant information.
Study 4 is a web-based experiment addressing the uncertainty regarding the speculated unintended consequences of financial incentives on information processing. It aims to determine the impact of incentives on the processing of risk-relevant information associated with an incentivised behaviour with potential adverse effects, as assessed by participants’ perceived risk related to engaging in the behaviour and their knowledge of its side-effects. The findings provide no evidence for the unintended consequences of incentives on the processing of risk-information.
The thesis concludes with a discussion of the main findings and related implications for practice, policy and future research.
| Date of Award | 1 Nov 2013 |
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| Original language | English |
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| Supervisor | Theresa Marteau (Supervisor) & Florian Vogt (Supervisor) |