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: 10668257
• 负责人: Omar Galarraga
• 金额: $ 5.83万
• 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 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668257
• 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; Mediating; Mediator; Modeling; Negative Reinforcements; Outcome; Participant; Patient Self-Report; Pharmacotherapy; Physical activity; Physical assessment; Pilot Projects; Productivity; Provider; Psychological reinforcement; Randomized, Controlled Trials; Regrets; Reinforcement Schedule; Research; Research Support; Risk; Schedule; Swimming; Taxes; Testing; Training; Visit; alcohol abuse therapy; behavior change; community setting; cost; cost per quality-adjusted life year; cost utility analysis; economic impact; economic incentive; efficacy evaluation; energy balance; exercise program; financial incentive; fitness; improved; incentive program; incremental cost; innovation; labor force participation; malignant breast neoplasm; 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.

参加定期的体育活动（PA）有许多健康益处，包括降低各种原因的风险。 死亡率，心血管疾病1-7，糖尿病8-12，13-16，乳腺癌1 - 7 -19，结肠癌20-23，以及 然而，只有54%的美国成年人达到了每周消耗> 1000千卡的国家指导方针。 通过PA，当使用PA的客观评估时，25和少至10%符合指南。 需要使用创新的方法来提高对PA计划的坚持。经济激励措施一直是 28 -37虽然存在着一种新的方法，但它仍然是改变行为和改善健康结果的强大动力。 有证据表明，激励计划对提高PA的一般功效，38研究尚未 证明了激励计划的最佳形式。尽管如此，在组织激励的推动下， (i.e.,税收减免）提供的平价医疗保健法案，主要保险公司现在提供 在缺乏实证支持的情况下，定期参加健身设施的经济激励措施。因此我们 建议进行随机对照试验，以检查目前提供的运动激励计划的有效性， 美国三大保险公司39 -41，包括健身设施会员费的200美元回扣， 至少50次确认的健身设施访问（每天最多1次，通过客观的刷卡数据验证） 个月在随机对照试验的背景下，我们还将比较基于保险的标准激励计划与 第二，损失帧激励条件，其中使用相同的激励计划，但参与者被告知 (and在节目过程中提醒），他们的会员费200美元正在举行，并将 退还或没收取决于他们是否使用健身房至少50次在未来6个月。的 拟议的RCT将在大普罗维登斯基督教青年会的社区环境中进行。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）无激励控制（n=110）。每位参与者将被招募 每名参与人连续两个6个月，共计12个月。主要结果将是 健身设施的使用次数。次要结局将包括总中度至重度PA（MVPA） 通过加速度计和自我报告的MVPA，以3个月为间隔，在7天内进行。我们假设 这两个激励条件将导致更高的出席率在基督教青年会和更多的PA，与损失框架 激励计划优于标准保险计划。目标二。检查习惯的形成， 预期后悔作为假定的中介和家庭收入和年龄作为调节剂的激励为基础的 程序.目标3。从社会角度进行试验内成本效用分析，以量化（a） 获得的每质量调整生命年（QALY）增量成本，（B）YMCA出勤率变化的成本，以及 (c)PA中每一增量变化的成本。我们还将应用生产率模型来估计经济增长率。 干预对未来家庭和劳动力参与的影响。

项目成果

Guidelines for assessment of affect-related constructs.

• DOI: 10.3389/fpsyg.2023.1253477
• 发表时间: 2023
• 期刊: FRONTIERS IN PSYCHOLOGY
• 影响因子: 3.8
• 作者: Williams, David M;Rhodes, Ryan E
• 通讯作者: Rhodes, Ryan E

Testing an insurance-based monetary incentive program for exercise: RCT design and rationale.

测试基于保险的锻炼货币激励计划：RCT 设计和原理。

• DOI: 10.1016/j.cct.2023.107382
• 发表时间: 2023
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Williams,DavidM;Bohlen,LaurenConnell;Dunsiger,Shira;Ayala-Heredia,Viveka;Griffin,Elizabeth;Dionne,Laura;Wilson-Barthes,Marta;Unick,Jessica;LaRowe,LisaR;Galárraga,Omar
• 通讯作者: Galárraga,Omar