Health reward schemes poor at tackling 'entrenched' behaviour, study finds

Costly schemes paying people to quit smoking or lose weight provide only limited health benefits and their behaviour often reverts once incentives are withdrawn, a review has concluded.

Incentive programmes less likely to alter 'complex and entrenched' behaviours such as smoking

The NHS has launched several new incentive schemes in recent years despite limited evidence they can promote healthier behaviour, such as quitting smoking and losing weight.

In the latest review of the evidence, researchers from the University of Newcastle in Australia found schemes tackling these 'entrenched' behaviours had only limited effect on the population's health.

There was little evidence that the effects persisted once the incentive was stopped. Researchers said this challenged the viability of these incentive schemes.

Instead, targeting schemes at simple, one-off actions such as attending vaccination were far more likely to work, they found.

In September last year, a NICE 'citizens council' made up of members of the public voted in favour of incentive schemes.

Recent NHS efforts included smoking cessation campaign 'Give It Up For Baby' in NHS Tayside, costing £1,700 per quitter, and the Pounds For Pounds weight loss scheme in NHS Eastern and Costal Kent.

In the study, researchers Marita Lynagh and Rob Sanson-Fisher looked at studies into incentive schemes in the US and the UK published in the past five years.

They found that personal financial incentives can be effective at driving healthy behaviour change, but only in certain circumstances.

Incentives were most likely to succeed when simple, discrete and time-limited. For instance, receiving immunisations or attendance at heatlh and education services.

In comparison, incentive programmes were less likely to alter 'complex and entrenched' behaviours such as smoking, diet and exercise, they found.

Schemes worked best when targetted at socially disadvantaged groups. Such groups were amenable to the schemes when they help to overcome the causes of health inequalities, such as costs of transport, medication and child care.

But studies showed there was 'little evidence for the long-term sustainability of effects once the incentive is withdrawn', wrote researchers. 'This represents a key challenge to the viability of incentive-based programmes.'

Authors concluded: 'We need effective public health interventions that clinicians can adopt easily to encourage people to change their health behaviors, to produce improved health outcomes for populations and a reduced burden on health care systems.

'Financial incentives are not the panacea to all health risk behaviors, but do hold promise for encouraging certain population groups to modify particular health behaviors.'

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