Problem Statement: Incentives have received wide use as a means of engaging and motivating participants in worksite health programs. However, the impact of incentives on changing behavior and improving overall health is not well-defined and is dependent on the type of incentive, the mode in which it is delivered and cultural significance.

Objectives and Scope of Study: This paper evaluates 2008 to 2013 incentive approaches and implementation efforts, and their potential for developing more effective employer wellness programs.

Method: Employer incentive program has been developed and implemented over multiple program years in conjunction with a comprehensive lifestyle program to decrease cardiovascular disease risk. The program involved the completion of a risk assessment and participation in online or telephonic health coaching programs. Incentives varied by amount, vehicle, timing and required activities.

Results and Observations: Results varied depending on the incentive approach. Participation rates were highest in 2008 (38%), however more participants completed coaching goals in 2009 (69%) and 2012 (84%). Coaching goal completion decreased in 2010 (43%) when coaching was not incented. Participants decreased blood pressure, cholesterol, BMI, blood glucose and smoking rates, and coaching participants had improved biometric measures compared to non-coached participants. When participants were asked what motivated their participation, getting the incentive ranked #2 behind improved health. Preliminary data in 2013 suggest that participants are more engaged when incentives are more immediate.

Conclusions: Incentives are influential for program participation and incenting coaching does appear to be a motivating factor for completion. Immediacy of incentive receipt appears to increase engagement and motivation for completing incented activities. While the impact of incentives per se on behavior change is equivocal, incentives do generate program engagement, likely by attracting people who are thinking about making changes (contemplators) and accelerating their decision to make a change. Incentives possibly attract those not thinking about change (precontemplators) because they are attracted by the reward.

Applications: These findings will enhance development of more effective employer health promotion programs and improve employee health.

Innovations or Technical Contributions: Incentives need to migrate from extrinsic (financial) to intrinsic (I want to do this for my health) motivators. The search for intrinsic motivators in combination with this study have led to the exploration of how social networks, challenges, game mechanics, and mobile technology may support development of non-financial incentives.

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