Due to budgetary pressures, the NHS is increasingly prioritising promoting healthy living as a form of preventative care. The U.K Obesity Statistics Report estimates that around 64% of the U.K’s adult population are either overweight or obese, with higher incidence found around high-deprivation areas. With UK-wide costs of obesity estimated to reach £8.3 billion in 2025, it is becoming increasingly urgent to address nation-wide habits around physical activity and healthy eating, with many schemes approaching incentivisation to encourage this. In this article we identify some of the most interesting technological solutions in the field and we evaluate some of these solutions against current behavioural research, to see what the future of behaviour change incentivisation holds.
There have been a variety of public health programmes aimed at promoting national and regional change in behaviour. Their approaches vary from social incentivisation, such as the Oklahoma City ‘This City is Going on a Diet’ campaign, which motivated citizens to lose a million pounds over five years, to competition-based weight loss, such as ‘Shape-Up Rhode Island’, which was found to reduce the proportion of the population that was obese from 39% at baseline to 31% at study end. Singapore’s National Steps Challenge has also been successful over multiple years, finding that 70% of previously inactive participants at the end of the first launch averaged more than 7000 steps per day over the challenge. The British currently average around 3000-4000 steps per day; achieving anywhere from 7000-10’000 steps a day is equivalent to the Chief Medical Officer’s physical activity guidelines. A public health campaign oriented around increasing physical activity could be a solution to a huge national health problem.
However, such campaigns are often either small-scale or struggle to maintain effects long after they occur. Research has increasingly investigated the potential to incentivise people to lose weight, but has struggled to find approaches that work. Many studies find that weight is regained in months following the trial period. Previous trials have approached positive and negative, lottery-based, individual and group-financed options for promoting weight loss. Both Volpp et. al. in 2008, and John et. al. in 2011 found that financially incentivising people produced significant weight loss over the study period, but it was not sustained beyond this time. Studies in 2013 and 2021 again found changes over the study period but found all lost weight was regained when following up.
However, there is much greater evidence surrounding incentivising people to develop healthy behaviours. Mantzari et. al. in 2015 conducted a review on behaviour change incentivisation, finding that financial incentives did motivate behaviour change, with improvements being maintained even months after the study finished. They also found that participants from lower-income backgrounds exhibited greater behaviour change patterns. Other findings agree with the potential benefits of incentivisation, but clarify that the effects of incentivisation differ substantially based on the nature of the behaviour, the size of the incentive, the characteristics of the population involved, the social context and the design of interventions.
Past research has determined frameworks for most effectively financially incentivising behaviour change. The most successful approaches consist of assured and immediate incentives which are conditional on behaviour, and are indexed and increasing over time. Loss-based interventions are also effective, but difficult to use on a large-scale basis. Finally, group-based incentives and team-based social-competition incentivisation sees greater effects than individual incentivisation. However, many studies stress the importance of a holistic approach to incentivisation, and highlight the necessity of this to participants achieving long-term behavioural change.
Marteau et. al. found that using a holistic approach for behaviour change was most effective; this can include social support, advice from a dietician or therapist, and help to goal-set and self-monitor throughout study periods. Many current health apps don’t engage with behavioural science to offer this holistic approach. Gamification, which is the application of game mechanics in non-game contexts, offers many opportunities to make sure interventions are comprehensive and person-centred. Gamified approaches have been found to increase motivation and engagement in a variety of fields, so are ideal for targeting population health behaviour change.
Gamification offers many holistic features in accessible digital solutions. Many of its core mechanics are oriented around keeping users motivated and engaged, such as points systems, goal-setting, streaks, challenges and bonuses, and leadership boards. These aspects can all be utilised in collaboration with artificial intelligence for data collection and personalisation in order to deliver experiences that motivate every individual differently. This is supported in research, which has found that different individuals achieve behaviour change under different approaches:
- Older players prefer collaboration over competition
- Younger players prefer greater immersion
- Women prefer badges over direct competition
- Social Competition works for strangers
- Social Collaboration works for people who already know one another and for families
Gamified solutions offer a unique opportunity to approach behaviour change in an engaging and motivational way, with flexibility to incorporate many of the findings from previous research. A digital solution also allows applications to leverage social connections in a multitude of ways. Furthermore, the personalisation that is possible with gamification solutions, due to the use of behavioural data training applications, means that approaches can be tailored to people from many different backgrounds to find the best experience for all.
The world of behaviour change and incentivisation holds huge opportunities for public health improvement. The key to achieving public sector success is working from a research-based approach, and leveraging social connections in the best way to achieve supportive environments for those seeking to achieve behavioural change. There are many solutions in the market attempting to deliver this, however gamification offers an innovative approach which incorporates many of the findings from research alongside an engaging and motivating format. When gamified solutions engage with current research findings to fully immerse users in their behaviour change journey, they can potentially offer a solution to one of the biggest public health challenges today.
PUBLIC is always keen to hear from startups and innovators with solutions to tackle public health problems, please don’t hesitate to get in touch.