Economic evaluation of an incentive-based program to increase physical activity and reduce sedentary behaviour in middle-aged adults

Background: Incentive-based programs represent a promising approach for health insurers to encourage health-promoting behaviours. However, little is known about the value for money of such programs. This study aimed to determine the cost-effectiveness of the ACHIEVE (Active CHoices IncEntiVE) program designed to incentivise increased physical activity and reduced sedentary behaviour in middle-aged adults. Methods: A within-trial cost-efficacy analysis was conducted. Benefits were assessed by evaluating paired t-tests from participants’ pre- and post- trial Body Mass Index (BMI) (kg/m2), sitting time (minutes/day) and metabolic equivalents (METS) minutes. A health sector perspective was adopted for the assessment of costs. Pathway analysis was used to determine the resource use associated with the intervention, with costs expressed in Australian dollars (A$) for the 2015 reference year. A long-term cost-effectiveness analysis was undertaken which extended the analysis time horizon and the trial population to the relevant eligible Australian population. Within this analysis, the 16-week intervention was modelled for roll-out across Australia over a 1-year time horizon targeting people with private health insurance who are insufficiently active and highly sedentary. Improved health related quality of life quantified in Health-Adjusted Life Years (HALYs) (based on the health impacts of increased metabolic equivalent (MET) minutes and reduced body mass index (BMI) and cost-offsets (resulting from reductions in obesity and physical inactivity-related diseases) were tracked until the cohort reached age 100 years or death. A 3$77,432. The cost per participant recruited was A$944. The incremental cost-effectiveness ratio (ICER) for MET increase per person per week was A$0.61; minute of sedentary time reduced per participant per day was A$5.15 and BMI unit loss per participant was A$763. The long-term cost effectiveness analysis indicated that if the intervention was scaled-up to all eligible Australians, approximately 265,095 participants would be recruited to the program at an intervention cost of A$107.4 million. Health care cost savings were A$33.4 million. Total HALYs gained were 2,709. The mean ICER was estimated at A$27,297 per HALY gained which is considered cost-effective in the Australian setting. Conclusion: The study findings suggest that financial incentives to promote physical activity and reduce sedentary behaviour are likely to be cost-effective. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12616000158460 (10/02/2016)

Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia

BackgroundScaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder.MethodsA qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report &ldquo;20 Questions for Developing a Scaling up Case Study&rdquo;, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically.ResultsNineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the &ldquo;Environment&rdquo;, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to &ldquo;Scale up strategy&rdquo; (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions.ConclusionAttributes of the &ldquo;Environment&rdquo; and &ldquo;Scale up strategy&rdquo; consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.</jats:sec

Can an incentive-based intervention increase physical activity and reduce sitting among adults? the ACHIEVE (Active Choices IncEntiVE) feasibility study

BackgroundDespite recent interest in the potential of incentivisation as a strategy for motivating healthier behaviors, little remains known about the effectiveness of incentives in promoting physical activity and reducing sedentary behavior, and improving associated health outcomes.This pre-post-test design study investigated the feasibility, appeal and effects of providing non-financial incentives for promoting increased physical activity, reduced sedentary time, and reduced body mass index (BMI) and blood pressure among inactive middle-aged adults.MethodsInactive men (n&thinsp;=&thinsp;36) and women (n&thinsp;=&thinsp;46) aged 40&ndash;65 years were recruited via a not-for-profit insurance fund and participated in a 4 month pre-post design intervention. Baseline and post-intervention data were collected on self-reported physical activity and sitting time (IPAQ-Long), BMI and blood pressure. Participants were encouraged to increase physical activity to 150 mins/week and reduce sedentary behavior by 150 mins/week in progressive increments. Incentives included clothing, recipe books, store gift vouchers, and a chance to win one of four Apple iPad Mini devices. The incentive component of the intervention was supported by an initial motivational interview and text messaging to encourage participants and provide strategies to increase physical activity and reduce sedentary behaviors.ResultsOnly two participants withdrew during the program, demonstrating the feasibility of recruiting and retaining inactive middle-aged participants. While two-thirds of the sample qualified for the easiest physical activity incentive (by demonstrating 100 mins physical activity/week or 100 mins reduced sitting time/week), only one third qualified for the most challenging incentive. Goals to reduce sitting appeared more challenging, with 43% of participants qualifying for the first incentive, but only 20% for the last incentive. More men than women qualified for most incentives. Mean leisure-time physical activity increased by 252 mins/week (leisure-time), with 65% of the sample achieving at least 150 mins/week; and sitting time decreased by 3.1 h/day (both p&thinsp;&lt;&thinsp;0.001) between baseline and follow-up. BMI, systolic and diastolic (men only) blood pressure all significantly decreased. Most participants (50&ndash;85%) reported finding the incentives and other program components helpful/motivating.ConclusionsAcknowledging the uncontrolled design, the large pre-post changes in behavioral and health-related outcomes suggest that the ACHIEVE incentives-based behavior change program represents a promising approach for promoting physical activity and reducing sitting, and should be tested in a randomized controlled trial.<br /

SDG5 “Gender Equality” and the COVID-19 pandemic: A rapid assessment of health system responses in selected upper-middle and high-income countries

Introduction: The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. Methods: We apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March–July 2022. Australia, Brazil, Germany, the United Kingdom, and the USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG5 were analyzed: maternity care/reproductive health, gender-based violence, and gender equality/women's leadership. Results: We found similar trends across countries. Pandemic policies strongly cut into women's health, constrained prevention and support services, and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and women's leadership was weak. All healthcare systems failed to protect women's health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US. Conclusions: Our study highlights a need for revising pandemic policies through a feminist lens

Reply: Hearing the voices of Australian frontline healthcare workers during the COVID-19 pandemic

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Associations between pre-COVID-19 physical activity profiles and mental wellbeing and quality of life during COVID-19 lockdown among adults

Abstract: The COVID-19 pandemic has been detrimental to the physical and mental health and wellbeing of people across the globe. Regular physical activity has consistently demonstrated an array of health benefits, but the impact of regular physical activity habits pre-pandemic on health and wellbeing during the pandemic is largely unknown. The purpose of this study was to identify distinct pre-COVID-19 lockdown physical activity profiles [i.e., walking, leisure-time moderate-vigorous physical activity (MVPA), domestic MVPA and muscle strengthening exercise] and assess whether these profiles were associated with mental wellbeing and quality of life during COVID-19 lockdown. A total of 442 adults (Mage = 43.97 ± 13.85; 75.6% female) from Melbourne, Australia completed an online questionnaire measuring pre-COVID-19 physical activity, including walking habits, leisure-time MVPA, domestic MVPA, and muscle strengthening exercise – and completed measures of mental wellbeing and health related quality of life. Latent profile analysis identified five distinct profiles that differed in terms of levels of walking, leisure-time MVPA, domestic MVPA and muscle strengthening exercise. Based on the observed pre-COVID-19 lockdown profiles, it appears that high levels of MVPA and muscle strengthening exercise may serve as a protective factor against the potential negative impact of a global pandemic lockdown on mental wellbeing and quality of life

What hinders and helps academics to conduct dissemination and implementation (D&I) research in the field of nutrition and physical activity? An international perspective

BACKGROUND: Ineffective research-practice translation is a major challenge to population health improvement. This paper presents an international perspective on the barriers and facilitators associated with the uptake of and engagement in Dissemination and Implementation (D&amp;I) research in the fields of physical activity and nutrition. METHODS: A mixed methods study involving participants from the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) network. Participants completed an online survey (May-July 2018) and/or participated in a focus group during the annual ISBNPA conference (June 2018). Descriptive statistics were generated for quantitative online and pre-focus group survey data. Fisher\u27s exact tests investigated associations of (i) length of time in academia, (ii) career stage and (iii) country of work, and agreement with \u27perceptions of D&amp;I\u27. Qualitative data were analysed thematically. RESULTS: In total, 141 participants responded to the survey (76% female, 21% aged 35-39&thinsp;years, 14 countries represented) and 25 participated in focus groups (n&thinsp;=&thinsp;3). Participants self-identified as having knowledge (48%), skills (53%) and experience supporting others (40%) to conduct D&amp;I research. The majority (96%) perceived D&amp;I was important, with 66% having organizational support for D&amp;I, yet only 52% reported prioritizing D&amp;I research. Perceptions of D&amp;I differed by length of time in academia, career stage and country of work. Barriers included: (i) lack of D&amp;I expertise; (ii) lack of organisational support/value for D&amp;I; (iii) embedded scientific beliefs/culture; (iv) methodological challenges with D&amp;I research; (v) funding/publishing priorities and; (vi) academic performance structures. Facilitators included: (i) increased presence/value of D&amp;I; (ii) collective advocacy; (iii) organisational support for D&amp;I; (iv) recruitment of D&amp;I scientists and; (v) restructure of academic performance models, funding/publishing criteria. CONCLUSIONS: Individual, organisational and system-wide factors hindered academics\u27 engagement with and support for D&amp;I research, which was perceived to reduce opportunities for research-practice translation. Factors were mostly consistent across countries and individual career stages/time spent in academia. Embedding D&amp;I early within academic training, and system-wide reorientation of academic performance and funding structures to promote and facilitate D&amp;I research, are some of the necessary actions to reduce the research-practice gap. Consistent with public health more broadly, these changes are long overdue in the fields of physical activity and nutrition