“Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour

The use of financial incentives to change health-related behaviour is often opposed by members of the public. We investigated whether the acceptability of incentives is influenced by their effectiveness, the form the incentive takes, and the particular behaviour targeted. We conducted discrete choice experiments, in 2010 with two samples (n = 81 and n = 101) from a self-selected online panel, and in 2011 with an offline general population sample (n = 450) of UK participants to assess the acceptability of incentive-based treatments for smoking cessation and weight loss. We focused on the extent to which this varied with the type of incentive (cash, vouchers for luxury items, or vouchers for healthy groceries) and its effectiveness (ranging from 5% to 40% compared to a standard treatment with effectiveness fixed at 10%). The acceptability of financial incentives increased with effectiveness. Even a small increase in effectiveness from 10% to 11% increased the proportion favouring incentives from 46% to 55%. Grocery vouchers were more acceptable than cash or vouchers for luxury items (about a 20% difference), and incentives were more acceptable for weight loss than for smoking cessation (60% vs. 40%). The acceptability of financial incentives to change behaviour is not necessarily negative but rather is contingent on their effectiveness, the type of incentive and the target behaviour.


Treatment A
The patient receives standard medication worth £50 per month for stopping smoking.
This medication is proven to help 10 out of 100 treated.

Treatment B
The patient is paid cash £50 per month for not smoking.
This intervention is proven to help 5 out of 100 treated.
Which treatment should be funded? This medication is proven to help 10 out of 100 treated.

Treatment B
The patient is paid cash £50 per month for not smoking.
This intervention is proven to help 10 out of 100 treated.
Which treatment should be funded?
You will now see pairs of treatments for a different problem: treatments for weight loss for overweight people.
The task is otherwise the same as what you've been doing so far.
For each pair, please pick the treatment you think should be funded.

Treatment A
The patient receives standard treatment worth £50 per month for weight loss.
This treatment is proven to help 10 out of 100 treated. This treatment is proven to help 10 out of 100 treated.

Treatment B
The patient receives vouchers for healthy groceries worth £50 per month for meeting weight loss targets.
This intervention is proven to help 5 out of 100 treated.
Which treatment should be funded?

Treatment A Treatment B
What do you think about the NHS paying overweight people cash if they lose weight?

Which of the following four statements best describes your view?
This is acceptable if it leads to benefits that outweigh any negative effects.
This would be acceptable if it leads to benefits that outweigh any negative effects, but I don't think this is the case in the real world.
I can imagine no benefits that could ever outweigh the negative effects this has, even in an ideal world, so it is not acceptable. This is not acceptable even if the benefits were to outweigh any negative effects.
What do you think about the NHS paying smokers cash to stop smoking?

Which of the following four statements best describes your view?
This is acceptable if it leads to benefits that outweigh any negative effects.
This would be acceptable if it leads to benefits that outweigh any negative effects, but I don't think this is the case in the real world.
I can imagine no benefits that could ever outweigh the negative effects this has, even in an ideal world, so it is not acceptable. This is not acceptable even if the benefits were to outweigh any negative effects.

How responsible do you think smokers are for smoking?
Not at all responsible ------Entirely responsible We have gone too far in pushing equal rights in this country.
Our society would be better off if the distribution of wealth was more equal. We need to dramatically reduce inequalities between the rich and the poor, whites and people of color, and men and women. Discrimination against minorities is still a very serious problem in our society.
It seems like blacks, women, homosexuals and other groups don't want equal rights, they want special rights just for them. Society as a whole has become too soft and feminine.
Imagine the NHS would offer you a choice of interventions to help you improve your health through behaviour change. Which type of intervention would you personally choose?
Please rank the interventions from 1 to 5, where 1 is your most preferred and 5 is your least preferred option.
Please use each number (1-5) once, to assign a rank to each option: We would welcome your comments about why you chose between the different treatments the way you did.
(Please indicate whether what you write applies to smoking cessation, or weight loss, or both).