Empirical testing of a widely available insurance-based monetary incentive program for exercise: A randomized trial

对广泛使用的基于保险的锻炼货币激励计划的实证检验：一项随机试验

• 批准号: 10278186
• 负责人: Omar Galarraga
• 金额: $ 68.37万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10278186
• 关键词: Accelerometer; Adherence; Adult; Age; Behavior; Body Weight decreased; Cardiovascular Diseases; Colon; Data; Diabetes Mellitus; Dropout; Enrollment; Exercise; Fees; Frequencies; Funding; Future; Guidelines; Habits; Health; Health Benefit; Health Insurance; Healthcare; Household; Incentives; Income; Insurance; Intervention; Low income; Malignant Neoplasms; Mediating; Mediator of activation protein; Modeling; Negative Reinforcements; Outcome; Participant; Patient Self-Report; Pharmacotherapy; Physical activity; Physical assessment; Pilot Projects; Productivity; Provider; Psychological reinforcement; Quality-Adjusted Life Years; Randomized Controlled Trials; Regrets; Reinforcement Schedule; Research; Research Support; Risk; Schedule; Swimming; Taxes; Testing; Time; Training; Visit; alcohol abuse therapy; base; behavior change; community setting; cost; cost utility analysis; economic impact; economic incentive; efficacy evaluation; energy balance; exercise program; financial incentive; fitness; improved; incentive program; innovation; labor force participation; medication compliance; moderate-to-vigorous physical activity; mortality; primary outcome; programs; randomized trial; secondary outcome; sexual risk behavior; smoking cessation; systematic review; theories

Participation in regular physical activity (PA) has numerous health benefits including reduced risk of all-cause mortality,1-7 cardiovascular disease,8-12 diabetes,13-16 and cancers of the breast17-19 and colon,20-23 as well as energy balance.24 However, only 54% of U.S. adults meet national guidelines of expending > 1000 kcals/week through PA,25 and as few as 10% meet guidelines when objective assessments of PA are used.26 Thus, there is a need to improve adherence to PA programs using innovative approaches. Economic incentives have been shown to be powerful motivators for behavior change and for improving health outcomes.28-37 While there is evidence suggesting the general efficacy of incentive programs for increasing PA,38 research has not yet demonstrated the optimal format for incentive programs. Nonetheless, spurred by organizational incentives (i.e., tax breaks) provided by the Affordable Health Care Act, major insurance companies are now offering economic incentives for regular attendance at fitness facilities in the absence of empirical support. Thus, we propose to conduct an RCT to examine the efficacy of the exercise incentive program currently offered by three major US insurance companies39-41 consisting of a $200 rebate on fitness facility membership fees for at least 50 confirmed visits to the fitness facility (maximum 1/day, verified by objective swipe-card data) over 6 months. In the context of the RCT, we will also compare the insurance-based standard incentive program to a second, loss-frame incentive condition in which the same incentive schedule is used, but with participants told (and reminded during the course of the program) that $200 of their membership fee is being held and will be returned or forfeited depending on whether they use the gym at least 50 times in the next 6 months. The proposed RCT will be conducted in a community setting at the Greater Providence YMCAs. Aim 1. Conduct an RCT (N=330) comparing (a) the widely used insurance-based Standard incentives program (n=110), (b) a Loss-framed incentive program (n=110), and (c) no-incentive Control (n=110). Each participant will be enrolled for two consecutive 6-month periods for a total of 12 months per participant. The primary outcome will be number of visits to the fitness facility. Secondary outcomes will include total moderate-to-vigorous PA (MVPA) over 7-day periods at 3-month intervals through accelerometers and self-reported MVPA. We hypothesize that the two incentive conditions will result in higher attendance at the YMCA and more PA, with the Loss-framed incentive program outperforming the Standard insurance-based program. Aim 2. Examine habit formation and anticipated regret as putative mediators and household income and age as moderators of the incentive-based programs. Aim 3. Conduct a within trial cost-utility analysis from a societal perspective to quantify (a) the incremental costs per quality-adjusted life year (QALY) gained, (b) cost per change in YMCA attendance, and (c) cost per incremental change in PA. We will additionally apply a productivity model to estimate the economic impact of the intervention on future household and labor force participation.

参加常规体育锻炼（PA）具有许多健康益处，包括降低全因风险 死亡率，1-7个心血管疾病，8-12糖尿病，13-16，乳腺癌17-19和结肠癌，20-23以及 24但是，美国只有54％的美国成年人符合国家指南，以> 1000 kcals/nek 通过PA，当使用PA的客观评估时，25％的人符合准则。26因此， 是需要使用创新方法来提高对PA计划的依从性。经济激励措施已经 证明是行为改变和改善健康成果的有力动力。28-37虽然有 有证据表明激励计划增加PA的一般疗效，38研究尚未 展示了激励计划的最佳格式。尽管如此，组织激励措施刺激了 （即税收减免）由《平价医疗保健法》提供，主要保险公司现在正在提供 在没有经验支持的情况下，在健身设施定期出席的经济激励措施。因此，我们 建议进行RCT检查目前提供的锻炼激励计划的功效 三家美国主要保险公司39-41包括在健身设施会员费用AT上的200美元回扣 至少有50次确认对健身设施的访问（最多1/天，通过客观滑动卡数据验证）超过6 月份。在RCT的背景下，我们还将将基于保险的标准激励计划与 其次，使用相同激励时间表的损失框架激励条件，但在参与者告诉参与者 （并在计划的过程中提醒）他们的会员费中的200美元被持有，将是 根据他们在接下来的6个月中至少使用50次体育馆，返回还是没收。这 拟议的RCT将在大普罗维登斯YMCA的社区环境中进行。目标1。进行 RCT（n = 330）比较（a）广泛使用的基于保险的标准激励计划（n = 110），（b）a 损失框架激励计划（n = 110）和（c）无侵点控制（n = 110）。每个参与者将被注册 连续两个6个月，每个参与者总共12个月。主要结果将是 访问健身设施的数量。次要结果将包括总中度至vigoul PA（MVPA） 通过加速度计和自我报告的MVPA以3个月的间隔时间在7天的时间内。我们假设这一点 这两个激励条件将导致YMCA的出勤率更高，而PA则更多，而损失框架 激励计划优于基于标准的保险计划。目标2。检查习惯形成和 预期的遗憾是推定的调解人，家庭收入和年龄作为基于激励的主持人 程序。目标3。从社会角度进行试验的成本效用分析，以量化（a） 每年获得质量调整的生活年（QALY）的增量成本，（b）YMCA出席的每次变更成本，以及 （c）PA的每次增量变化成本。我们还将采用生产力模型来估计经济 干预对未来家庭和劳动力参与的影响。