"Pay them if it works": discrete choice experiments on the acceptability of financial incentives to change health related behaviour.

The use of financial incentives to change health-related behaviour is often opposed by members of the public. We investigated whether the acceptability of incentives is influenced by their effectiveness, the form the incentive takes, and the particular behaviour targeted. We conducted discrete choice experiments, in 2010 with two samples (n = 81 and n = 101) from a self-selected online panel, and in 2011 with an offline general population sample (n = 450) of UK participants to assess the acceptability of incentive-based treatments for smoking cessation and weight loss. We focused on the extent to which this varied with the type of incentive (cash, vouchers for luxury items, or vouchers for healthy groceries) and its effectiveness (ranging from 5% to 40% compared to a standard treatment with effectiveness fixed at 10%). The acceptability of financial incentives increased with effectiveness. Even a small increase in effectiveness from 10% to 11% increased the proportion favouring incentives from 46% to 55%. Grocery vouchers were more acceptable than cash or vouchers for luxury items (about a 20% difference), and incentives were more acceptable for weight loss than for smoking cessation (60% vs. 40%). The acceptability of financial incentives to change behaviour is not necessarily negative but rather is contingent on their effectiveness, the type of incentive and the target behaviour

Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers:Development and validation of two short scales

Healthcare workers (HCWs) are an important priority group for vaccination against influenza, yet, flu vaccine uptake remains low among them. Psychosocial studies of HCWs’ decisions to get vaccinated have commonly drawn on subjective expected utility models to assess predictors of vaccination, assuming HCWs’ choices result from a rational information-weighing process. By contrast, we recast those decisions as a commitment to vaccination and we aimed to understand why HCWs may want to (rather than believe they need to) get vaccinated against the flu. This article outlines the development and validation of a 9-item measure of cognitive empowerment towards flu vaccination (MoVac-flu scale) and an 11-item measure of cognitive empowerment towards vaccination advocacy. Both scales were administered to 784 frontline NHS HCWs with direct patient contact between June 2014 and July 2015. The scales exhibited excellent reliability and a clear unidimensional factor structure. An examination of the nomological network of the cognitive empowerment construct in relation to HCWs’ vaccination against the flu revealed that this construct was distinct from traditional measures of risk perception and the strongest predictor of HCWs’ decisions to vaccinate. Similarly, cognitive empowerment in relation to vaccination advocacy was a strong predictor of HCWs’ engagement with vaccination advocacy. These findings suggest that the cognitive empowerment construct has important implications for advancing our understanding of HCWs’ decisions to vaccinate as well as their advocacy behavior

Evaluating the Peer Education Project in secondary schools

Purpose The purpose of this paper is to determine the efficacy of the Peer Education Project (PEP), a school-based, peer-led intervention designed to support secondary school students to develop the skills and knowledge they need to safeguard their mental health and that of their peers. Design/methodology/approach Six schools from across England and the Channel Islands took part in an evaluation of the PEP across the 2016/2017 academic year. In total, 45 trained peer educators from the sixth form and 455 Year 7 students completed pre- and post-questionnaires assessing their emotional and behavioural difficulties, perceived school climate, and knowledge, skills and confidence related to mental health. Findings Results indicate that participation in the PEP is associated with significant improvement in key skills among both peer educators and student trainees, and in understanding of key terms and readiness to support others among trainees. Most students would recommend participation in the programme to other students. Originality/value While peer education has been found to be effective in some areas of health promotion, research on the effectiveness of peer-led mental health education programmes in schools is limited. This study contributes evidence around the efficacy of a new peer education programme that can be implemented in secondary schools. </jats:sec

Predicting mental health improvement and deterioration in a large community sample of 11- to 13-year-olds.

Of children with mental health problems who access specialist help, 50% show reliable improvement on self-report measures at case closure and 10% reliable deterioration. To contextualise these figures it is necessary to consider rates of improvement for those in the general population. This study examined rates of reliable improvement/deterioration for children in a school sample over time. N = 9074 children (mean age 12; 52% female; 79% white) from 118 secondary schools across England provided self-report mental health (SDQ), quality of life and demographic data (age, ethnicity and free school meals (FSM) at baseline and 1 year and self-report data on access to mental health support at 1 year). Multinomial logistic regressions and classification trees were used to analyse the data. Of 2270 (25%) scoring above threshold for mental health problems at outset, 27% reliably improved and 9% reliably deteriorated at 1-year follow up. Of 6804 (75%) scoring below threshold, 4% reliably improved and 12% reliably deteriorated. Greater emotional difficulties at outset were associated with greater rates of reliable improvement for both groups (above threshold group: OR = 1.89, p < 0.001, 95% CI [1.64, 2.17], below threshold group: OR = 2.23, p < 0.001, 95% CI [1.93, 2.57]). For those above threshold, higher baseline quality of life was associated with greater likelihood of reliable improvement (OR = 1.28, p < 0.001, 95% CI [1.13, 1.46]), whilst being in receipt of FSM was associated with reduced likelihood of reliable improvement (OR = 0.68, p < 0.01, 95% CI [0.53, 0.88]). For the group below threshold, being female was associated with increased likelihood of reliable deterioration (OR = 1.20, p < 0.025, 95% CI [1.00, 1.42]), whereas being from a non-white ethnic background was associated with decreased likelihood of reliable deterioration (OR = 0.66, p < 0.001, 95% CI [0.54, 0.80]). For those above threshold, almost one in three children showed reliable improvement at 1 year. The extent of emotional difficulties at outset showed the highest associations with rates of reliable improvement

Predicting changing preferences: How people think about public policy proposals

Preference utilitarianism provides a useful normative framework for deciding about public policy. However, preferences are not stable over time, and they may in particular be influenced by the implementation of the public policy itself: people\u27s values might change adaptively, making the policy better than it seemed before implementation; or they might change counteradaptively, making the policy worse than it seemed before. In six experiments, I examined how subjects think about the potential of public policy to change preferences: How do they predict preferences to change, and how does predicted preference change alter what they think of the policy? I also investigated subjects\u27 second-order preferences, that is, what preferences they want others to hold. When we ask subjects to predict in which direction preferences might change, they predict change in their favored direction: subjects who initially think the policy is good predict preferences to change adaptively; those who initially think it bad predict preferences to change counteradaptively. Wishful thinking is a plausible mechanism for this tendency, since subjects also have second-order preferences in the direction of their initial rating: Subjects who think the policy is a good idea want others to like it; those who think the policy a bad idea want others not to like it. With the notable exception of one study, we find that their pattern of predicting preference change leads subjects to polarize their opinions about the policies. When we tell subjects to imagine adaptive preference change in either direction, their second-order preferences influence how they adjust their rating, with the result that subjects who initially rate the policy unfavorably think it worse than before if values were to adapt. I discuss several mechanisms that could be implicated in this phenomenon

Predicting changing preferences: How people think about public policy proposals

Preference utilitarianism provides a useful normative framework for deciding about public policy. However, preferences are not stable over time, and they may in particular be influenced by the implementation of the public policy itself: people\u27s values might change adaptively, making the policy better than it seemed before implementation; or they might change counteradaptively, making the policy worse than it seemed before. In six experiments, I examined how subjects think about the potential of public policy to change preferences: How do they predict preferences to change, and how does predicted preference change alter what they think of the policy? I also investigated subjects\u27 second-order preferences, that is, what preferences they want others to hold. When we ask subjects to predict in which direction preferences might change, they predict change in their favored direction: subjects who initially think the policy is good predict preferences to change adaptively; those who initially think it bad predict preferences to change counteradaptively. Wishful thinking is a plausible mechanism for this tendency, since subjects also have second-order preferences in the direction of their initial rating: Subjects who think the policy is a good idea want others to like it; those who think the policy a bad idea want others not to like it. With the notable exception of one study, we find that their pattern of predicting preference change leads subjects to polarize their opinions about the policies. When we tell subjects to imagine adaptive preference change in either direction, their second-order preferences influence how they adjust their rating, with the result that subjects who initially rate the policy unfavorably think it worse than before if values were to adapt. I discuss several mechanisms that could be implicated in this phenomenon

Second-order preferences

Data for Promberger and Baron paper on second-order preferences

When do financial incentives reduce intrinsic motivation?:comparing behaviors studied in psychological and economic literatures

Objective: To review existing evidence on the potential of incentives to undermine or “crowd out” intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. Method: We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. Results: In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. Conclusion: The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research