Background Poor engagement in health promoting behaviours is a key determinant of morbidity and mortality worldwide and results in substantial social, healthcare and economic costs. Financial incentives have been shown to be effective in encouraging a range of healthy behaviours, such as physical activity and attending for vaccination and screening. However, concerns about the acceptability of such interventions remain, with limited evidence exploring acceptability in a range of stakeholders to date. This systematic review explored empirical studies and scholarly writing on the acceptability of financial incentive interventions for encouraging healthy behaviours amongst adults, aged 18 years and older, living in high-income countries.
Methods Electronic searches of relevant databases up to November 2012, together with reference and citation searches, were conducted to identify empirical studies and scholarly writing exploring the acceptability of health promoting financial incentive interventions. Papers were included if they: had an English language title, were published in a peer-reviewed journal, and explored the acceptability of health promoting financial incentives from the perspective of members of the public, potential recipients, potential practitioners who may be involved in delivery, and policy makers. Data was analysed using thematic analysis.
Results Fifty five papers met the criteria for inclusion in the review: 39 were scholarly writing and 16 were empirical studies. Issues concerning acceptability fell into five themes: 1) the nature of fair exchange, 2) design and delivery, 3) effectiveness and cost-effectiveness, 4) recipients, and 5) impact on individuals and wider society. Throughout, there were contradictions in included papers with opposing views on almost all issues identified. However, there was consensus that if health promoting financial incentives are effective and cost effective, then they are likely to be considered acceptable. No evidence was returned that explored the acceptability of financial incentives to policy makers, and there was limited qualitative evidence, exploring acceptability of financial incentives in detail.
Conclusion The available evidence suggests that health promoting financial incentives are acceptable when they are considered effective; when they provide benefits to individual recipients and wider society; when they are fair; and when they are delivered to individuals who are deemed appropriate. Disagreement exists in the literature on what specific aspects of all of these issues makes health promoting financial incentives acceptable. Further qualitative research is needed to establish wider acceptability of financial incentives and the key constructs that make financial incentives acceptable or not in a range of stakeholders, particularly with policy makers.
- financial incentives
- health behaviours
- systematic review