title: A mixed-methods randomized controlled trial of financial incentives and peer networks to promote walking among older adults.
abstract: BACKGROUND
  Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more.
  
  
  METHODS
  We conducted a 24-week randomized trial in which 92 older adults with a computer and Internet access received a pedometer, daily walking goals, and weekly feedback on goal achievement. Participants were randomized to weekly feedback only (Comparison), entry into a lottery with potential to earn up to $200 each week walking goals were met (Financial Incentive), linkage to four other participants through an online message board (Peer Network), or both interventions (Combined). Main outcomes were the proportion of days walking goals were met during the 16-week intervention and 8-week follow-up. We conducted a content analysis of messages posted by Peer Network and Combined arm participants.
  
  
  RESULTS
  During the 16-week intervention, there were no differences in the proportion of days walking goals were met in the Financial Incentive (39.7%; p = .78), Peer Network (24.9%; p = .08), and Combined (36.0%; p = .77) arms compared with the Comparison arm (36.0%). During 8 weeks of follow-up, the proportion of days walking goals were met was lower in the Peer Network arm (18.7%; p = .025) but not in the Financial Incentive (29.3%; p = .50) or Combined (24.8%; p = .37) arms, relative to the Comparison arm (34.5%). Messages posted by participants focused on barriers to walking and provision of social support.
  
  
  CONCLUSIONS
  Financial incentives and peer networks delivered through eHealth technologies did not result in older adults walking more.
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, MI, USA University of Michigan, Ann Arbor, MI, USA jkullgre@med.umich.edu.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Kullgren
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Harkins
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA Penn CMU Roybal P30 Center on Behavioral Economics and Health, Philadelphia, PA, USA.
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.affiliation: Indiana University, Bloomington, IN, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Gonzales
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA Penn CMU Roybal P30 Center on Behavioral Economics and Health, Philadelphia, PA, USA.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Tao
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA Penn CMU Roybal P30 Center on Behavioral Economics and Health, Philadelphia, PA, USA.
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA Penn CMU Roybal P30 Center on Behavioral Economics and Health, Philadelphia, PA, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA Penn CMU Roybal P30 Center on Behavioral Economics and Health, Philadelphia, PA, USA Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, MI, USA University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA Penn CMU Roybal P30 Center on Behavioral Economics and Health, Philadelphia, PA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Karlawish
mesh_terms: D000368:Aged; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D009042:Motivation; D010379:Peer Group; D012201:Reward; D016138:Walking
keywords: behavioral economics; eHealth; financial incentives; older adults; walking