Healthy lottery. A design theory for a mobile system to increase compliance of individuals with diabetes

This article shows the preliminary results of an ongoing study to develop a system that financially rewards individuals with diabetes. Previous studies have already shown that monetary incentives appear to be the strongest motivator for older individuals with type II diabetes. Nonetheless, design criteria for a mobile service are not well established and there is no study available to assess the viability of a system that financially rewards individuals for self-management. Therefore, in this paper we explore a design theory that describes a new mobile service that integrates data from existing mobile application, and includes a self-supported lottery in a business model, which allows patients with effective self-management to be rewarded without any deficit. Our prototype is based on a social business model, which aims at improving patients’ health and that can be described as ”healthy” for them

Technical and Behavioral Interventions for Medication Adherence through Mobile Health

In this research, we present a novel intervention, Carrot and Stick, to improve the outcome of one of the self-management tasks, medication adherence (MA), among patients with chronic disease(s). Our design incorporates the growing importance of mobile health (m-health) in Health Information Technology (HIT) with the users’ dependency on mobile phones to facilitate valuable behavioral changes. Drawing on Social Cognitive Theory, Social Exchange Theory, Goal-setting Theory, and people’s dependence on smartphones, we develop the functionalities in our intervention, including positive and negative reinforcement, goal-setting, and social connections. The iterative process of our development follows the Design Science Approach. In the evaluation and validation of our intervention, we not only examine the intervention’s impacts on patients through analytical models and simulation but also demonstrate the possible active support of the intervention from healthcare providers based on the current pay-for-performance (P4P) scheme. Our results suggest that (1) with the help of electronic medication container, appropriate reminder design can reduce the patients’ chances of forgetting doses, overdosing, and intaking doses at the wrong time, (2) positive reinforcement can help increase the probability of the patient achieving expected MA, while negative reinforcement has a further impact that is added to the increment, (3) our intervention can assist the patient in saving more than $600 per year, and (4) under the current P4P scheme, physicians with the exceptional performance or with bad performance are likely to invest in the intervention to change their patients’ behaviors, while physicians with good performance are less likely to participate. Our research is the first to utilize negative reinforcement in intervention design to enhance MA; it is also the first to provide corresponding interventional solutions that are customized according to elements derived from theories. Besides, the focus and understanding of healthcare providers’ involvement in the incentive program can facilitate the adoption, prescription, and implementation of the proposed intervention

Tailoring persuasive health games to gamer type

Persuasive games are an effective approach for motivating health behavior, and recent years have seen an increase in games designed for changing human behaviors or attitudes. However, these games are limited in two major ways: first, they are not based on theories of what motivates healthy behavior change. This makes it difficult to evaluate why a persuasive approach works. Second, most persuasive games treat players as a monolithic group. As an attempt to resolve these weaknesses, we conducted a large-scale survey of 642 gamers' eating habits and their associated determinants of healthy behavior to understand how health behavior relates to gamer type. We developed seven different models of healthy eating behavior for the gamer types identified by BrainHex. We then explored the differences between the models and created two approaches for effective persuasive game design based on our results. The first is a one-size-fits-all approach that will motivate the majority of the population, while not demotivating any players. The second is a personalized approach that will best motivate a particular type of gamer. Finally, to make our approaches actionable in persuasive game design, we map common game mechanics to the determinants of healthy behavior

Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial.

IntroductionObesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone.Methods and analysisWe are recruiting 795 adults, aged 18-70 years with a body mass index ≥30 kg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5% to ≥5% reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months.Ethics and disseminationHuman research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders.Trial registration numberNCT03157713

Eat & tell: A randomized trial of random-loss incentive to increase dietary self-tracking compliance

National Research Foundation (NRF) Singapore under International Research Centres in Singapore Funding Initiativ

Critical Perspectives Sustainability of the on South African Civil Society Sector

This report presents the findings of a research and advocacy process that included consultative workshops with CSOs in all nine of South Africa's provinces, interviews with CSOs, politicians, government departments, the NLB, NDA and local funders. The report highlights the successes and ongoing problems associated with the NLB and the NDA. It locates them within a broader context of government unevenness, inefficiency and corruption