Effectiveness and cost-effectiveness of a loyalty scheme for physical activity behaviour change maintenance: results from a cluster randomised controlled trial

Hunter, R. F., Murray, J. M., Gough, A., Tang, J., Patterson, C. C., French, D. P., McIntosh, E. , Xin, Y. and Kee, F. (2018) Effectiveness and cost-effectiveness of a loyalty scheme for physical activity behaviour change maintenance: results from a cluster randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 127. (doi:10.1186/s12966-018-0758-1) (PMID:30541563) (PMCID:PMC6291971)

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Abstract

BACKGROUND:We evaluated the effectiveness and cost-effectiveness of a loyalty scheme based intervention involving rewards for increasing physical activity in public sector employees. METHODS:A cluster randomised wait-list controlled trial in public sector organisations in Northern Ireland. We randomly assigned clusters (1:1) using a computer generated random sequence. Researchers were masked to allocation, but participants were not. Employees aged 18-65 years with no self-reported medical contraindications to physical activity were included. The Physical Activity Loyalty Scheme (PAL) intervention was based on high-street loyalty cards where participants earned points for minutes of activity that could be redeemed for rewards, complemented by evidence-based behaviour change techniques. The primary outcome was objectively measured mean steps/day at 6 months using a validated pedometer (Yamax Digi-Walker CW-701) over 7 days, assessed with intention to treat analysis. Secondary outcomes included health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Cost-effectiveness, cost-benefit and mediation analyses were conducted. Trial registered with Current Controlled Trials, number ISRCTN17975376. RESULTS:Between September 2014 and October 2015, we recruited and randomly assigned 37 clusters (from nine organisations; mean clusters per organisation = four) and 853 participants to the intervention (n = 19 with 457 participants) or control group (n = 18 with 396 participants). Primary outcome data were available for 249 (54·4%) intervention and 236 (59·6%) control participants. Mean steps/day were significantly lower in the intervention vs control group (adjusted mean difference = - 336, 95% CI: -612 to - 60, p = 0·02) at 6 months. Participants redeemed only 39% (SD 43%) of their earned points. Using the Quality Adjusted Life Year outcome, the intervention was not cost effective from an NHS/PSS perspective. A net cost analysis from an employer perspective demonstrated the intervention group was associated with a mean of 2·97 h less absenteeism over a 4 week period (p = 0·62), which could result in net savings ranging from £66 to £735 depending on the wage rate employed. At 4-weeks post-baseline there were significant increases in identified regulation, integrated regulation, intrinsic motivation, social norms and intentions in intervention compared to control participants. CONCLUSIONS:Our mixed results pose challenges that are too infrequently exposed in public heath intervention trials. Although the intervention successfully altered several hypothesised mediating constructs it did not translate into long-term behaviour change. Our incentive level may have been too low to incentivise change, despite being designed a priori by a Contingent Valuation Survey. There were also major re-structuring of several organisations which presented significant implementation challenges, and technical limitations. TRIAL REGISTRATION:ISRCTN17975376 (Registered 19/09/2014).

Item Type:Articles
Additional Information:The study was funded by the National Institute for Health research (NIHR) Public Health Research (Ref: 12/211/82)
Keywords:Adults, effectiveness, intervention, incentives, physical activity, cost-effectiveness, behaviour change
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Xin, Miss Yiqiao and McIntosh, Professor Emma
Authors: Hunter, R. F., Murray, J. M., Gough, A., Tang, J., Patterson, C. C., French, D. P., McIntosh, E., Xin, Y., and Kee, F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:International Journal of Behavioral Nutrition and Physical Activity
Publisher:BioMed Central
ISSN:1479-5868
ISSN (Online):1479-5868
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in International Journal of Behavioral Nutrition and Physical Activity 15(1):127
Publisher Policy:Reproduced under a Creative Commons License

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