Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review

J. Jaime Miranda*, Robert W. Aldridge, M. Amalia Pesantes, María Lazo-Porras, Jill Portocarrero, Francisco Diez-Canseco, Rodrigo M. Carrillo-Larco, Antonio Bernabe-Ortiz, Antonio J. Trujillo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery. We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential to foster its use as potential effective interventions.

Original languageEnglish
Article number163
JournalWellcome Open Research
Publication statusPublished - 2021
Externally publishedYes

Bibliographical note

Funding Information:
We are thankful to Sebasti?n Ar?mbulo Castillo, Janina Bazalar Palacios, Pablo Cazzulino, Dercy Centeno, Jhacksson C?rdova Agurto, Darwin Del Castillo-Fern?ndez, Oscar Flores, Luis Helguero Sant?n, Hongsheng Lu, Marianne Luyo Avalo, Luis Mari Huarache, Raisa Nadine Mart?nez Rivera, Daniel Mendoza-Quispe, Juan Diego Mendoza Salda?a, Percy Fernando Nateros Baldeon, Andrea Oriette Ruiz Alejos, Niels Pacheco Barrios, Julia Pauschardt, Diana Fiorela Sanchez Velazco, Fiorela Solano Zapata, Janeth Tenorio, Bing Xuan Ho, Elizabeth Zavaleta Lopez, and Ludwing Zeta Sol?s for their support during the search and review process.

Publisher Copyright:
© 2021 Miranda JJ et al.


  • Behavioral economics
  • Evidence synthesis
  • Incentives
  • Interventions
  • Non-communicable diseases
  • Quality
  • Systematic review
  • Trials


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