title: On supplementing "Foot in the door" incentives for eHealth program engagement.
abstract: Financial health incentives, such as paying people to lose weight, are being widely implemented by Western nations and large corporations. A growing number of studies have tested the impact of incentives on health behaviors, though few have evaluated the approach on a population-scale. In this issue of the Journal of Medical Internet Research, Liu et al add to the evidence-base by examining whether a single incentive can motivate enrollment and engagement in a preventive eHealth program in a sample of 142,726 Canadian adults. While the incentives increased enrollment significantly (by a factor of about 28), a very high level of program attrition was noted (90%). The "foot in the door" incentive technique employed was insufficient; enrollees received incentives for signing-up for, but not for engaging with, the eHealth program. To supplement this technique and drive sustained behavior change, several theoretically- and empirically-based strategies are proposed. Specifically, incentives indexed to behavioral achievements over time are highlighted as one approach to boost engagement in this population in the future.
authors.affiliation: Faculty of Kinesiology and Physical Education, Graduate Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada. marc.mitchell@uhn.ca.
authors.forename: Marc Steven
authors.identifier: http://orcid.org/0000-0002-2772-9614
authors.initials: MS
authors.lastname: Mitchell
authors.forename: Guy E
authors.identifier: http://orcid.org/0000-0001-8898-2536
authors.initials: GE
authors.lastname: Faulkner
mesh_terms: D034742:Electronic Mail; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D012201:Reward
keywords: cardiovascular risk; prevention; rewards
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