Background
Methods
Design
Participants and recruitment
Study a: Quantitative phase
Study B: Qualitative phase
Data collection
Cash incentive | An agreed amount of cash, provided after a period of time or at a number of time points if weight loss is maintained |
Non-cash incentive | An incentive with a monetary value but that is not cash, provided after a period of time or at a number of time points if weight loss is maintained (e.g. retail or gift voucher, gym membership, etc.) |
Deposit contract | Make a monetary deposit which is refunded at certain time intervals or at the end of a period of time if you maintain your weight (i.e. a commitment to maintain your weight) |
Matched deposit contract | Same as deposit contract, plus the deposit amount is matched if weight loss is maintained (i.e. “double your money”) |
Lottery* | Go into a draw to win either a cash or non-cash ‘prize’ or incentive |
Analysis
Results
Participants
Participant characteristics
Study A (N = 130) | Study B (N = 28) | ||||
---|---|---|---|---|---|
n | % | n | % | ||
Gender | Female | 88 | 67.7 | 13 | 46.4 |
Male | 42 | 32.3 | 15 | 53.6 | |
Age Group | 40–44 | 2 | 1.5 | 0 | 0 |
45–54 | 10 | 7.7 | 4 | 14.3 | |
55–64 | 53 | 40.8 | 6 | 21.4 | |
65–74 | 54 | 41.5 | 15 | 53.6 | |
75+ | 11 | 8.5 | 3 | 10.7 | |
SEIFAa | 1st Quintile (most disadvantaged) | 18 | 13.8 | 2 | 7.1 |
2nd Quintile | 24 | 18.5 | 0 | 0 | |
3rd Quintile | 23 | 17.7 | 3 | 10.7 | |
4th Quintile | 35 | 26.9 | 6 | 21.4 | |
5th Quintile (most advantaged) | 30 | 23.1 | 17 | 60.7 | |
ARIAb | Major city | 85 | 65.4 | 27 | 96.4 |
Inner regional | 20 | 15.4 | 1 | 3.6 | |
Outer regional/ Remote/Very Remote | 25 | 19.2 | 0 | 0 | |
Weight statusc | Lost more weight | – | – | 7 | 25.0 |
Stayed the same weight | – | – | 10 | 35.7 | |
Put on weight | – | – | 11 | 39.3 |
Quantitative results (study a)
Financial incentives would be helpful |
N
| % |
---|---|---|
Yes – very helpful | 48 | 36.9 |
Yes – somewhat helpful | 26 | 20.0 |
No – not helpful | 30 | 23.1 |
No opinion | 26 | 20.0 |
N
| % | |
---|---|---|
Motivation: non-cash reward | ||
Strongly agree | 48 | 64.9 |
Agree | 15 | 20.3 |
Neither agree or disagree | 9 | 12.2 |
Disagree | 2 | 2.7 |
Strongly disagree | 0 | 0.0 |
Motivation: cash reward | ||
Strongly agree | 37 | 50.0 |
Agree | 20 | 27.0 |
Neither agree or disagree | 13 | 17.6 |
Disagree | 3 | 4.1 |
Strongly disagree | 1 | 1.4 |
Motivation: deposit contract | ||
Strongly agree | 20 | 27.0 |
Agree | 10 | 13.5 |
Neither agree or disagree | 19 | 25.7 |
Disagree | 14 | 18.9 |
Strongly disagree | 11 | 14.9 |
Motivation: matched deposit contract | ||
Strongly agree | 31 | 41.9 |
Agree | 5 | 6.8 |
Neither agree or disagree | 18 | 24.3 |
Disagree | 12 | 16.2 |
Strongly disagree | 8 | 10.8 |
Motivation: amount of money | ||
$50 | 25 | 33.8 |
$100 | 14 | 18.9 |
$150 | 7 | 9.5 |
$200 | 12 | 16.2 |
More than $200 | 7 | 9.5 |
Other | 9 | 12.2 |
Deposit if goal not met | ||
Donated to a charity of participant’s choice | 57 | 77.0 |
Donated to any charity | 10 | 13.5 |
Other | 7 | 9.5 |
Motivation: non-cash rewards | ||
Reward points | 17 | 23.0 |
Gym membership | 4 | 5.4 |
General gift vouchers | 18 | 24.3 |
Vouchers for leisure-related products | 6 | 8.1 |
Vouchers for food products | 24 | 32.4 |
Other | 5 | 7.0 |
Qualitative results (study B)
Maintenance program impressions
Yeah, something to maintain what you’ve achieved through the program … I do think you plateau. You have a really good experience and then it flattens off for a while, and sometimes you probably need that motivation, I don’t know what it would be, to just get off the plateau and go down to the next level, you know. (Female, 69 years, female-only group).
I think if you prove that you’ve maintained your seventy kilo weight and it hasn’t changed, you’re self-sustainable. I don’t need the group. I’ve changed my behaviour so much that you know what, this is rock solid. (Male, 65 years, male-only group).
Financial incentives impressions
I think it should be to make you feel better, to reward you that you look better or feel better or exercise better, like whatever the reward is, should be relative to a healthy, better - making yourself feel better, because I think money just doesn’t do it. (Female, 58 years, female-only group).
Type of Financial Incentive | Supporting quote | Opposing quote |
---|---|---|
Cash reward |
... it is a win, win situation, you still keep on losing weight and you earn some cash, so yeah, I guess it could be some encouragement. Because … free money is always a good motivator ... You avoid your own money but you think, oh I’m working very hard for it, this makes you work hard to keep your weight off. Yeah maybe.
(Female, 55 years, female-only group) |
Well, it doesn’t mean that we don’t want to maintain our weight, it just means that that wouldn’t be an incentive, really… What we’re saying is basically, with the services that we would like, it’s like value adding to what we’ve already done. Whereas to me, getting cash is not value adding, right? Value adding is being offered additional things....
(Female, 69 years, female-only group) |
Non-cash reward |
There’s merit to it, provided it’s something you wish to ... that is of value to you.
(Male, 67 years, male-only group) |
I find half the time I get vouchers from retail outlets, they’re vouchers I don’t want to use, so I tend to give them away or don’t use them. I have about 5 sitting in my purse at the moment that I left downstairs and found.
(Female, 57 years, mixed gender group) |
Deposit contract | There were no quotes to use in support of deposit contracts |
It is, you always think, okay, what happens if I can’t keep my commitment and I don’t lose my weight, so what happens to the money, so it is gone, so I haven’t lost my weight and I lost the money so that would make me even more … Yeah you would go out and buy cake and put on more weight.
(Female, 55 years, female-only group) |
Matched deposit contract |
You’re getting some return on your investment, besides losing your weight.
(Male, 71 years, male-only group) |
That’s what it is. It’s a financial contract...You’re going to break it at some stage.
(Male, 72 years, male-only group) |
Lottery |
I would be more interested in a bit of fun, but you know …
(Female, 73 years, mixed gender group) |
A lottery just means that you’re not really getting rewarded, only that the winner will.
(Male, 53 years, mixed-gender group) |
Themes regarding incentives for maintaining weight
-
Health as an incentive
I think the reward should be to better my own health. I just don’t see getting a reward like that. I mean the reward is a better health, feeling better in yourself that is my reward. (Female, 73 years, female-only group).
… what motivated me ... there’s a saying that says "pain is the master we obey". It was a great incentive and I feel better. I like my gardening and I like doing things and you know, I have arthritis and this program helped me ... The weight loss helped and the exercise helped me, so overall, I feel a lot better. (Male, 65 years, male-only group)
-
Individual responsibility for health behaviour
People should take responsibility for themselves. (Male, 69 years, male-only group).
It’s not necessary, because I am self-motivated, but a lot of people aren’t self-motivated, so maybe they do need that. (Female, 73 years, mixed-gender group)
-
Program support
I definitely need a boost of some kind. Somebody from the main office getting in touch with you. Just to prompt you. To remind you or something. (Male, 78 years, mixed-gender group).
Yeah, I slowly unravelled, you know. Once the program was here, we had that contact …. They gave that support at the time … One step was removed, everything just fell apart. (Male, 71 years, male-only group).
I needed to do something … but I found that the follow up, it was finished, it was gone and that was the end of the story. I was a bit disappointed (Female, 72 years, mixed-gender group).
A little bit of follow up would be really good and a discount for the shakes and things would be fantastic (Female, 72 years, mixed-gender group, put on weight)
-
Peer support
Somewhere we could all get to. Then we would motivate each other. I think that would help me. A few people getting together and like you were saying, because I think then you feed off the others motivation, you help each other. (Female, 73 years, mixed gender group).
Well, support groups can work. Nothing works for everybody all the time. (Male, 54 years, male-only group).