A Randomized Trial of Economic Incentives to Promote Walking Among Full Time Employees

Duke University

Status: Completed

Conditions: Physical Activity

Treatments: Behavioral: Cash Incentives; Device: Fitbit; Other: Usual Care; Behavioral: Charitable Incentives

Study type: Interventional

Funder types: Other

Identifiers

NCT01855776

HSRG10NOV002

Details and patient eligibility

About

This study aims to assess the uptake, effectiveness, and cost-effectiveness of a scalable walking programme for full-time employees both with and without incentives.

Full description

The first part of this study comprises an in-home face-to-face survey with 950 full-time employees in Singapore. The survey aims to identify what an optimal programme might look like and to quantify the potential uptake of the programme, if offered. Stated preference conjoint analysis, which assesses individual preferences for attributes of specific programmes, will be used.

The second part of this study is a Randomised Controlled Trial (RCT) of a 12-month walking programme. Up to 800 full-time employees will be recruited and allocated to one of four research arms: Control Group, Programme Only Group, Cash Incentive Group and Charitable Incentive Group. Participants in the intervention arms will be asked to track their physical activities using Fitbit Zip, a wireless pedometer, which automatically uploads the data to a custom website. Those in the incentive arms will earn money or raise money for charities if they meet weekly exercise targets. Those in the control and Programme Only groups with receive a weekly payment for participation. Incentives and participation payment will be provided from months 1 - 6, after which they will be withdrawn.

The key outcome variable of the RCT is defined as bouts (in minutes) of moderate to vigorous physical activity ("MVPA bouts") as measured via accelerometry. Data will be collected at baseline and month 6 and 12 assessments.

Findings from the RCT will also be used to determine the cost to employers of implementing each programme and the incremental cost-effectiveness of the incentive programmes compared to the basic programme without incentives. The primary hypotheses are that the basic programme will have lower costs per person than the cash or charity programmes, but that the incentive programmes will be more cost-effective relative to the less expensive and less effective basic programme.

Enrollment: 800 patients

Sex: All

Ages: 21 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Full-time employees living in Singapore
• Aged between 21-65

Exclusion criteria

• report difficulty doing 10 minutes of aerobic activities without stopping
• report difficulty walking up 10 stairs without stopping
• report difficulty performing basic activities of daily living
• have any medical conditions that limit their ability to walk as a means of physical activity
• self-identify medical conditions that limit ability to walk AND do not have medical consent
• answer 'YES' to any PAR-Q questions

Trial design

800 participants in 4 patient groups

Control Group

Other group

Description:

The control group will receive a "usual care" educational programme at baseline created by the Singapore Health Promotion Board. This guide describes the importance of physical activity and illustrates one possible physical activity programme. It also discusses strategies for adopting a healthy lifestyle. They will not receive the Fitbit Zip wireless pedometer from the study team. However, they will receive $4 per week, regardless of physical activity levels.

Treatment:

Other: Usual Care

Programme Only Group

Experimental group

Description:

This group receives the Fitbit Zip, and access to the Fitbit website. Fitbit Zip counts the number of steps walked, calories burned, and distance travelled. Participants can set goals for their physical activity levels, and will have access to personalised feedback from Fitbit. This group will also receive $4 per week, regardless of physical activity levels.

Treatment:

Other: Usual Care

Device: Fitbit

Cash Incentive Group

Experimental group

Description:

This group receives the Fitbit Zip and the opportunity to earn money each week based on the number of steps logged on the pedometer during that week. We will offer the following incentive schedule: * $0 SGD for less than 50,000 steps during the week * $15 SGD for 50,000 - 69,999 steps during the week (max of 20,000 steps per day) * $30 SGD for 70,000 or more steps during the week (max of 20,000 steps per day) Participants will receive monthly payments in cash after their physical activity is confirmed. The incentive will be calculated separately for each week of the 6-month incentive programme.

Treatment:

Other: Usual Care

Device: Fitbit

Behavioral: Cash Incentives

Charitable Incentive Group

Experimental group

Description:

This group is identical to the cash incentive group except that incentive payments will be donated directly to a tax-exempt nonprofit charity of the participant's choice. The charity will be selected at the start of the programme but will be limited to the most common tax-exempt nonprofit charities operating in Singapore. As a motivational feedback component of the programme, participants will receive a thank-you email or letter from the charity.

Treatment:

Behavioral: Charitable Incentives

Other: Usual Care

Device: Fitbit