ImageDubai recently launched an initiative to pay chunky citizens real gold to lose weight, as part of the United Arab Emirates’ efforts to curb the obesity epidemic.  I would guess they will have some success in the short term, but I would be curious to see if contestants keep the weight off.

Various monetary incentives are becoming a larger and larger part of the wellness culture.  Wellness professionals would love employees to be motivated by a desire to not become sick.  However, for most people the possibility of maybe getting sick somewhere in the future causes their motivation to also move to “sometime in the future”. The prospect of an immediate reward is much more motivating.

I am not against incentives.  They can be used successfully. However, before going down that road it is important to understand the plusses and minuses of using incentives.

Plus side

  • Incentives have been shown to be powerful tools for short term, easy to accomplish behavior (flu shot, complete a health assessment).
  • Incentives often increase participation.  Participation can be a first step toward lasting behavior change.

But their usefulness may be limited in regard to more complex, deep-seated behaviors.

Downsides

  • Paying incentives may become economically unsustainable over long periods of time.
  • Incentives are not shown to work for long-term maintenance of behavior change.
  • Incentives can encourage the potential for unintended negative consequences (cheating, short cuts and unethical behavior).
  • Incentives may be construed as an entitlement and potentially reduce motivation and appreciation for the wellness program.

Incentives should be one element, among many, in driving engagement, participation and sustained behavior change.  It should not be the primary mechanism to drive outcomes. 

If not incentives, then what?

  • Create a supportive culture.  Provide opportunities to give and receive social support (promote team challenges, buddy systems).
  • Provide an environment where the healthy choice is the easy choice (such as, healthy vending and cafeteria food, walking paths or exercise classes at the workplace).
  • Provide comprehensive communications: tell them, tell them, and tell them again.
  • Implement relevant programs.  Use a needs and interest survey to find out what is of interest to your employees.
  • Use recognition as a reward.
  • Make the wellness program part of the culture.  It should be part of recruitment, onboarding, safety, community affairs, productivity, etc.

The true cost of making something as deeply personal as health choices about money, is a culture where it’s more difficult for people to want to do something good for themselves (just tell me what I need to do to get the money).  According to positive psychology research, one of the key elements for true happiness or well being, is pursuing items for their own sake, not merely to get anything else.

Valorie Bender, CWPM

Sources:

NY Daily News (last updated July 22, 2013). Dubai paying citizens gold to lose weight in fight against obesity.  Retrieved July 22, 2013, from http://www.nydailynews.com/life-style/health/dubai-gold-weight-loss-article-1.1402404#ixzz2ZnnHSGNv

Terry, P.E. PhD, Serxner, S.A., PhD, MPH, Moller, A. PhD, Spring, B.A. PhD. The Motivation Issue.  The Art of Health Promotion, March/April, 2013.

Witherspoon, Reese, How to Create an Environment Where Intrinsic Motivation Can Flourish. Last updated July 17, 2013. Health Enhancement Systems. Retrieved July 22, 2012 from http://www.hesonline.com/blog.

Seligman, Martin E. (2011).  Flourish A Visionary New Understanding of Happiness and Well Being. New York, N.Y.: Free Press.

 

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When it comes to tobacco use, our nation has come a long way. Between 1965 (when the first US general’s report came out) and 2000, rates dropped rapidly from almost 45% of American adults who smoked to approximately 25% in 2000 (Centers for Disease Control and Prevention).  However, since 2000 rates have steadied out – at about 19.3% as of 2010. Smoking is still costing the US more than it can afford. Smoking costs US businesses $97 billion dollars each year in productivity losses alone (Centers for Disease Control and Prevention, 2008).

People smoke for a number of reasons, including relief from stress or other discomforts, distraction, enjoyment, a concentration aid, social reasons, or for added help in weight management. Whatever the motivation may be that leads to smoking, the result is always the same- addiction. Quitting smoking is never as simple as starting.

Motivation plays a key role in quitting, and often is the predictor of success. Motivation behind behavior change can either be intrinsic or extrinsic. An extrinsic motivator is something external to the individual that is spawning the change. These tend to be incentives or punishments offered by a separate party. Extrinsic motivators, particularly with tobacco cessation, have not been associated with success. Intrinsic motivators are more effective in generating behavior change, as an intrinsic motivator would be internal and have value to the individual. For example, a mother may have a personal reason to lose weight such as being able to follow their toddler up and down the stairs.

With the knowledge that incentives and punishments may not be the most effective route to get employees to quit smoking, employers need to find another way to reach their employees. Programs often rely on incentives to increase awareness and participation. Incentives can still be used in this way for smoking cessation programming, however, it is important to remember their limitations and that there is no evidence that incentives actually increase quitting rates. Reasons for this may be linked to Prochaska’s[1] stages of change theory in which individuals are divided into five separate stages (pre-contemplation, contemplation, preparation, action and maintenance) describing their readiness to change a behavior. Current smoking cessation programs are successful in moving individuals already in the action stage through the behavior. However, these programs have not yet found a way to be successful in generating long-term quitting in those in the pre-contemplation, contemplation and preparation stages.

Some employers are turning to policies to get their employees to quit smoking. Again, just like with incentives, policies represent an extrinsic motivator for employees and may not generate long-term change, or drastically changing the health status and costs of the organization.

In order to generate not only immediate, but indefinite behavior change in smokers programs need to focus on the individual and provide support (Cochrane Collaborative Review). Along with policies, employers need to review what benefits are available for employees. The more access employees who are contemplating or attempting quitting have to various sources of support (nicotine replacement therapy, group programming, individual counseling etc.), the more likely they are to succeed. Employees should be educated on the policy and why it exists, and encouraged to take advantage of the resources provided to help them. Focusing on other components of health, such as physical activity, nutrition and social support also strengthens a program as well as helps to prevent relapse. Smoking is not an isolated behavior, and letting employees know their overall health status is cared about will contribute to their success, as well as to an organization’s positive and supportive environment.


[1] Glanz, K., F. Marcus-Lewis, and B.K. Rimer, editors (2008).  Health Behavior and Health Education, (4th  edition).  California: Jossey-Bass Publishers.

 Kay Monks

Kay is a senior at American University in Washington, D.C, where she is enrolled in the Health Promotion Education program. Kay has been an intern with AdvancingWellness since early 2011.