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This is a great example of how brands can use a combination of transactional AND experiential benefits to cater to the preferences of high-priority customer groups. Another method of catering your loyalty program to a diverse set of customer groups is by developing a tiered program. This allows the brand to customise the benefits offered based on customer behaviours, spending habits and preferences. Home News Growth. Newsletter Signup. Get the latest insights and analysis delivered to your inbox.
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NBN Co adds over new suburbs to fibre upgrade list. Right to repair: Large scale IT buyers can influence product design Shivering in summer? Sweating in winter? Your building is living a lie. Building a modern workplace for a remote workforce. The cost utility results for the intervention are presented in Table 5. By contrast, the study found significant intervention effects for improvement in mental wellbeing.
However, this was not supported with findings from the quality of life and mental health measures, and so we are cautious in over-interpreting this positive finding. It is conceivable that mental wellbeing improved in the intervention group as a result of being involved in an employee health and wellbeing trial at a time when there were significant re-structuring in the organisations. Whilst the decline in absenteeism hours was not statistically significant it is arguably economically significant and worth exploring in future studies powered to detect such economic impacts [ 21 ].
Hence, from the employers perspective and valuing absenteeism using a human capital approach, the intervention could be deemed to be worthwhile. Given the rationale for intervention, its theoretical underpinning and our pilot data, these results defy easy explanation.
Our qualitative findings point to some issues with the level and type of incentives [ 19 ]. These aspects were informed a priori via a CV survey with all participants, and with the types of vouchers were discussed in pre-intervention focus groups with the target population. They were also shown to be popular in our pilot work [ 12 ]. Our intervention was 6 months in duration which is in line with other PA interventions attempting to elicit and support PA maintenance a period consonant with the mean in a recent review [ 10 ].
However, from our qualitative findings it is clear that some participants reported feeling frustrated with early technological glitches that impacted on accurate monitoring of PA behaviour [ 19 , 20 ]. The importance of study context should not be underestimated in the interpretation of our study findings. During our recruitment phase, a number of participating organisations undertook significant re-structuring due to the then current economic austerity, resulting in uncertainty regarding job security and job location; a time when employee health and wellbeing was at its most vulnerable.
The impact of this was evident in our qualitative data which highlighted how motivation can be more usefully seen as a property of systems incorporating technologies, organisation and action rather than just of individuals [ 19 ]. Further details regarding the findings from the process evaluation are provided in Gough et al. Our findings suggest interesting conjectures regarding causal mechanisms. These findings have important implications in respect of some of the contentious issues highlighted in the literature on the use of financial incentives for achieving behaviour change.
They suggest that using financial incentives within a complex behaviour change intervention with multiple components collectively does not necessarily diminish, and may facilitate intrinsic motivation. Our results also suggest that the provision of financial incentives does not necessarily increase financial extrinsic motivation.
These findings are in line with a systematic review of psychological and economic studies which concluded that there was no evidence that extrinsic incentives would crowd out incentivised health behaviours [ 23 ]. However, given the complex nature of this intervention, it is important to note that the positive findings for internal motivation could also be related to our use of self-regulation Behaviour Change Techniques including self-monitoring and feedback on PA behaviour.
More generally, whilst the intervention group showed increases in some hypothesised mediators of initiation, these increases were not related to PA behaviour at 6 months. However, hypothesised mediators of maintenance were related to PA behaviour at 6 months. Especially notable are the findings that internal motivation mitigated reduction in PA behaviour at 6 months. Self-regulation appears to have mitigated and attenuated the reduction in steps in the intervention group.
As reported above, our results run counter to predictions of Self Determination Theory suggesting that there is a role for financial incentives and self-regulation interventions. However, the amount of variance explained by our measured mediators of behaviour change was low. Therefore, future studies would need to examine other potential mediators of behaviour change to shed further light on these associations.
Our previous systematic review [ 11 ] suggested that studies of mechanisms of intervention effect have generally been of poor methodological quality and would benefit from a framework based on consensus about how mediation should be measured and tested in trials of complex interventions.
Such a framework should include the use of formal mediation tests, the embedding of evidence-based techniques for changing hypothesised mediators and the need to investigate constructs with particular relevance for initiation and maintenance of behaviour change.
Future research should also examine mediators of adverse effects such as found in the present study so we can better understand unintended consequences and negative findings [ 24 ].
These results pose several scientific and real world implementation challenges that are too infrequently exposed in public heath intervention trials [ 25 ], including how to balance positive and negative results when primary and secondary outcomes are discordant [ 26 ]. On the other hand, some journals claim now to select articles for publication based on their contribution to the literature and welcome null results that challenge conventional wisdom or prior expectations [ 27 ].
The results from our trial certainly challenged prior expectations. However, it is notoriously hard to disprove any hypothesis, and so negative studies must have the precision and strength of design to be reasonably persuasive. We would probably have claimed as much had the direction of the intervention effect been positive. Some may also argue that with a primary outcome of total PA, the lack of a significant intervention effect is not surprising given that the intervention specifically incentivised workplace PA.
However, we hypothesised that participants would also be encouraged to further participate in additional PA outside the workplace. Workplace PA was specifically measured using the remote sensing monitoring system sensors and keyfobs and the GPAQ which incorporates a workplace PA domain. However, we also used a well-validated pedometer, followed a standardised measurement protocol including sealing the pedometer to prevent reactivity , and we supplemented the data with the GPAQ and daily PA monitoring using the remote sensing system.
There was consistency in the direction and magnitude of our findings for total PA and workplace PA. If the significant negative effect at 6 months is indicative of a true negative effect of this intervention in this setting , one might still ask whether the result is generalisable. Is this recruited sample of public sector office workers in Northern Ireland representative of office workers elsewhere in the UK?
We have no reason to conclude that it is not [ 3 , 5 , 7 , 13 ], but are mindful of the modelling undertaken by Basu and Kiernan [ 30 ] which demonstrated that two key factors impacting the success of workplace-based financial incentives for behaviour change are i who participates this will be explored in a detailed process evaluation as the overall null effect might be masking differential effects in different population sub-groups and ii the levels of incentives.
Thus it is important to further investigate the potential causal mechanisms using mediation and moderation analyses to gain a better understanding of our findings.
Our study was not powered to detect changes in mediating variables, and because of low power and multiple testing, the results need to be interpreted with caution.
In summary, the PAL Scheme intervention was not more effective than waiting-list control. Reduced health care costs, reduced absenteeism and improved mental wellbeing in the intervention group are somewhat noteworthy, and results suggest that the intervention could be cost beneficial for employers. Finally, we believe our results pose several scientific and real world implementation challenges that are too infrequently exposed in public heath intervention trials.
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When do financial incentives reduce intrinsic motivation? Comparing behaviors studied in psychological and economic literatures. Health Psychol. J Epidemiol Community Health. Article PubMed Google Scholar. Tannahill A, Kelly MP. Layers of complexity in interpreting evidence on effectiveness. Evaluating policy and service interventions: framework to guide selection and interpretation of study end points.
Wilcox AJ. A positive approach to negative results. Interventions to increase physical activity among healthy adults: meta-analysis of outcomes. Am J Public Health. Zhang H, ed. PLoS One. Basu S, Kiernan M. A simulation modeling framework to optimize programs using financial incentives to motivate health behavior change. Med Decis Mak. Download references. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Ruth F.
Hunter, Jennifer M. You can also search for this author in PubMed Google Scholar. RH was joint Principal Investigator, led the design and execution of the study, was involved in the interpretation of the data, and led the writing of the manuscript. JM assisted with recruitment and data collection, led the analyses for the primary and secondary outcomes, and the mediation analyses, was involved in the interpretation of the data, and was involved in drafting the manuscript.
JT led the conduct, analysis and interpretation of the CV survey that informed the level of financial incentive used in the intervention, and assisted with recruitment and data collection. CP supervised the design, conduct and interpretation of the quantitative data for the primary and secondary analysis. DF oversaw the theoretical aspect of the intervention, advised on the measurement of mediators of behaviour change, and was significantly involved in the interpretation of the mediation analyses.
EMcI supervised the design, conduct and interpretation of the health economic data, including the cost-benefit analyses. XY led the health economic analyses, and was significantly involved in the interpretation of the data, and wrote the health economic material and supplementary material. FK was the joint Principal Investigator, led the design and execution of the study, oversaw all subsequent analyses and interpretation of the data, and was involved in drafting the manuscript.
Brennan project manager year 1—2 of the study , Alberto Longo and George Hutchinson developed the CV survey and oversaw the conduct and interpretation of the results , Lindsay Prior advised on the qualitative research , Mark A.
All authors contributed to study design and intervention development. All authors reviewed and interpreted the result and edited the manuscript. All authors read and approved the final manuscript. Correspondence to Ruth F. All participants provided written informed consent prior to the start of the study. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Components of the physical activity monitoring system wifi beacons, keyfobs and website.
DOCX kb. Methodology: Contingent Valuation Survey to elicit plausible financial incentives required for increasing physical activity. DOCX 20 kb. Table S2. Mean SD outcomes at months six and 12 according to group and ANCOVA results before and after adjusting for season, with imputation of missing values on the six or 12 month outcomes.
Table S3. Table S5. DOCX 24 kb. Table S7. NHS and social care resource use per participant over six months complete case.
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