Behavioural incentive interventions for health behaviour change in 5-18 year olds: systematic review and meta-analysis

Abstract

Background: Recent research has demonstrated the effectiveness of incentive schemes for health behaviour change in adults. However, little is known about the effectiveness of such schemes in children and adolescents. Methods: Eight bibliographic databases were searched independently by two reviewers. Eligibility criteria included controlled trials using behavioural incentives (rewards provided contingent on successful performance of the target behaviour) as an intervention component for health behaviour change. Intervention effects (SMDs) were calculated and pooled by specific health behaviour, and overall, using a random effects model. Findings: Twenty-three studies were included (n=7506 identified). There were promising findings that behavioural incentives may 1) encourage smoking abstinence, or reduce the number of cigarettes smoked (6/9 studies); 2) change eating behaviour (5/5 studies); 3) increase physical activity (7/9 studies). Overall, a small positive effect was calculated for health behaviour change immediate post-intervention (ES=0.22, 95% Cl 0.08, 0.35), and at ≥6 months follow-up (ES=0.18, 95% Cl -0.01, 0.38). Certain incentives (including financial and non-financial) had a greater effect (ES=0.55, 95% Cl 0.12, 0.98) than studies with uncertain incentives such as lotteries and competitions (ES=0.17, 95% Cl 0.05, 0.30), Non-financial incentives had a greater effect (ES=0.47, 95% Cl 0.01, 0.93) than interventions with a financial incentive, lottery, or competition component (ES=0.19. 95% Cl 0.01, 0.93). Discussion: Findings suggest that incentive schemes used alone or as part of a multi-component intervention may encourage uptake and initiation of health behaviour change. However, further research is required to determine how interventions can then be adapted to facilitate maintained behaviour change.