One Size Doesn’t Fit All: Making Incentives Stick

Feb 14, 2014, 9:00 AM, Posted by

Emmy Ganos

By Emmy Ganos

I work for the country's largest foundation dedicated to health, but I have a secret. I have a huge problem staying away from my go-to comforts: macaroni and cheese, doughnuts, and most of all, the couch. I'm able to keep away from donuts most of the time, by exercising huge degrees of willpower on my way home from work each night (RIGHT PAST the Krispy Kreme). But by the time I get home, that's enough exercising for me, and I'm ready for my macaroni and my couch.

And, another secret, I barely exercise. About once a week, I walk for transportation around Philadelphia, and I walk fast. But that's the full extent of it for me. It is not uncommon for me to spend whole days on the couch -- with a great book and my cat on my lap, working on my laptop, or binge-watching HBO with my husband. I rarely exercise at work--despite free exercise classes and a free gym. 

But I know that these things are important. My dad was just diagnosed with heart failure a few months ago, and I know the single best thing I can do to keep my own heart healthy is to eat a healthy diet and to exercise. But I just can't seem to do it. On the rare days I do decide to make a change and pick up some new exercise regimen, I can never seem to stick with it for longer than a week.

Research on health behavior suggests that being offered an attractive incentive to exercise could appeal to my extrinsic motivation for long enough that intrinsic motivation will have a chance to kick in. If the right incentive helped me to make exercising a part of my routine, it would first become a habit and then just a part of my lifestyle. The trick is finding an incentive that works.

Which brings me to a new article by RWJF grantee Elizabeth Merrick and her colleagues Dominic Hodgkin and Constance Horgan, “Person-Centered Incentives for Health Behaviors.” The article describes the possibilities of customizing incentives to each individual's values and preferences as a way to make them more effective.

In my case, a very common wellness program incentive--a free gym membership--just isn't going to work. I have access to a small gym in my apartment building, a large gym at work, and free exercise classes 5 days a week. Clearly, access isn't my issue. But perhaps there is something else that would do the trick? Maybe a “jeans day” for every week that I attend the office gym at least 3 times would be the thing that works for me. (Hint to HR: I think this would actually work for me! I love wearing jeans!)

Merrick and colleagues advocate giving people the option to select from an array of incentives. And there are so many types to choose from—prizes, gift cards, discounts, gym memberships, competitions, charitable donations, and more. The people who set incentives can't possibly know what's going to work best for everyone, and tailoring incentives by providing options is a great way to convey respect for the preferences of the incentivized person, and to offer them both the dignity and control that can help to make the incentive stick.

Merrick and colleagues outline a useful framework to understand person-centered incentives, and recommend further research.  And there is much left to learn: Do person-centered incentives actually work better? How do we structure these choices? How many options is too many? What is the distribution of preferences within different populations? What types of incentives work best for what types of behaviors? I'm eager to learn what they, and our other grantees who are applying behavioral economics to health and health care problems, find in future research.

Health behaviors are complex, and so is motivation. The idea that incentives shouldn't be one-size-fits-all makes a lot of sense. I’m hopeful that more employers, health plans, businesses and others will continue to make progress in offering respectful, person-centered strategies for incentivizing healthy lifestyles.

This commentary originally appeared on the RWJF Pioneering Ideas blog.