Reduction of Financial Health Incentives and Changes in Physical Activity

• Published in: JAMA Network Open
• Main Authors: Spilsbury, Sean, Wilk, Piotr, Taylor, Carolyn, Prapavessis, Harry, Mitchell, Marc
• Format: Article in Journal/Newspaper
• Language: English
• Published: American Medical Association (AMA) 2023
• Subjects: General Medicine; Newfoundland
• Online Access: http://dx.doi.org/10.1001/jamanetworkopen.2023.42663; https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2811524/spilsbury_2023_oi_231233_1698675613.44697.pdf

Importance Governments and others continue to use financial incentives to influence citizen health behaviors like physical activity. However, when delivered on a population scale they can be prohibitively costly, suggesting more sustainable models are needed. Objectives To evaluate the association of incomplete financial incentive withdrawal (“schedule thinning”) with physical activity after more than a year of incentive intervention and to explore whether participant characteristics (eg, app engagement and physical activity) are associated with withdrawal outcomes. Design, Setting, and Participants This case-control study with a pre-post quasi-experimental design included users of a government-funded health app focused on financial incentives. Eligible participants were residents in 3 Canadian provinces over 25 weeks in 2018 and 2019. Data were analyzed from July 2021 to December 2022. Exposure Due to fiscal constraints, financial incentives for daily physical activity goals were withdrawn in Ontario in December 2018 (case)—representing a 90% reduction in incentive earnings—but not in British Columbia or Newfoundland and Labrador (controls). Main Outcome and Measures The primary outcome was objectively assessed weekly mean daily step count. Linear regression models were used to compare pre-post changes in daily step counts between provinces (a difference-in-differences approach). Separate models were developed to examine factors associated with changes in daily step count (eg, app engagement and physical activity). Clinically meaningful initial effect sizes were previously reported (approximately 900 steps/d overall and 1800 steps/d among the physically inactive). Results In total there were 584 760 study participants (mean [SD] age, 34.3 [15.5] years; 220 388 women [63.5%]), including 438 731 from Ontario, 124 101 from British Columbia, and 21 928 from Newfoundland and Labrador. Significant physical activity declines were observed when comparing pre-post changes in Ontario to British Columbia (−198 steps/d; ...