Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research |
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| Institution: | 1. PolicyLab and Center for Pediatric Clinical Effectiveness, Children''s Hospital of Philadelphia (CC Kenyon, C Flaherty, GC Floyd, and BP Jenssen), Philadelphia Pa;2. Division of General Pediatrics, Children''s Hospital of Philadelphia (CC Kenyon and BP Jenssen), Philadelphia Pa;3. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (CC Kenyon, BP Jenssen, and VA Miller), Philadelphia Pa;4. Division of Adolescent Medicine, Children''s Hospital of Philadelphia (VA Miller), Philadelphia Pa;1. Department of Pediatrics, University of Washington School of Medicine and Seattle Children''s Hospital (EK Chung), Seattle, Wash;2. Department of Pediatrics, Johns Hopkins University School of Medicine (BS Solomon and EM Perrin), Baltimore, Md;3. Johns Hopkins University School of Nursing (EM Perrin), Baltimore, Md;4. Department of Pediatrics, Boston Children''s Hospital and Harvard Medical School (A Starmer), Boston, Mass;5. Department of Pediatrics, Baylor College of Medicine and Texas Children''s Hospital (TL Turner), Houston, Tex;6. Departments of Pediatrics and Medical Education, University of Miami Miller School of Medicine (L Chandran), Miami, Fla;1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children''s Healthcare of Atlanta (PP Kamat), Atlanta, Ga;2. Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children''s Healthcare of Atlanta (HK Simon and C Sulton), Atlanta, Ga;3. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children''s Center (SR Kudchadkar), Baltimore, Md;4. Department of Pediatrics, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children''s Center (SR Kudchadkar), Baltimore, Md;5. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children''s Center (SR Kudchadkar), Baltimore, Md;6. Yerkes National Primate Research Center, Emory University, Atlanta, GA USA, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga;1. Department of Pediatrics, Warren Alpert Medical School at Brown University & Hasbro Children''s Hospital, Division of Pediatric Hospital Medicine (P Poitevien);2. Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine & Lucile Packard Children''s Hospital (R Blankenburg);3. Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota School of Medicine & Masonic Children''s Hospital (MB Pitt), Minneapolis, Minn;1. Department of Health Law, Policy, and Management, Boston University School of Public Health (RC Sheldrick), Boston, Mass;2. Department of Counseling, Clinical, and School Psychology, University of California (ML Barnett), Santa Barbara, Calif;1. School of Population and Public Health, University of British Columbia (H Burt and Q Doan), Vancouver, British Columbia, Canada;2. Department of Pediatrics, University of British Columbia (Q Doan), Vancouver, British Columbia, Canada;3. Faculty of Medicine, University of British Columbia (T Landry), Vancouver, British Columbia, Canada;4. Department of Pediatrics, University of Alberta (B Wright), Edmonton, Alberta, Canada;5. Emergency Medicine Section of Data Analytics, Children''s National (KW McKinley), Washington, DC;6. Faculty of Medicine, University of Alberta (T Landry), Edmonton, Alberta, Canada;1. Department of Pediatrics (KJ Martin), Johns Hopkins University School of Medicine, Baltimore, Md;2. Cincinnati Children''s Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio;3. Department of Pediatrics (KA Copeland, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio |
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| Abstract: | In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation. |
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