Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups

Abstract

Background Financial incentive interventions to encourage healthy behaviours are increasingly common. Previous literature lacks an empirical grounding on whether or not incentives are acceptable and why. We sought to gain an insight into the factors related to acceptability of financial incentive interventions for health behaviours and to understand preferred formats for financial incentives. Methods Eight focus groups were conducted with 74 members of the UK public. Audio recordings were transcribed verbatim with thematic analysis to identify key themes. Findings Five themes were identified: the nature of fair exchange; effectiveness and cost-effectiveness; impact on individuals and wider society; acceptable recipients; and ‘other issues’. Discussion Participants were distrusting of financial incentive interventions. However, they were more likely to be deemed acceptable if they were fair to recipients, if they were closely monitored and evaluated, if they were shown to be effective and cost-effective, and if health education is also provided. Participants preferred positive rewards, and those in the format of shopping vouchers rather than cash incentives. These results highlight clear suggestions for how to design acceptable health promoting financial incentives.