title: Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups.
abstract: BACKGROUND
  There is evidence that financial incentive interventions, which include both financial rewards and also penalties, are effective in encouraging healthy behaviours. However, concerns about the acceptability of such interventions remain. We report on focus groups with a cross-section of adults from North East England exploring their acceptance of financial incentive interventions for encouraging healthy behaviours amongst adults. Such information should help guide the design and development of acceptable, and effective, financial incentive interventions.
  
  
  METHODS
  Eight focus groups with a total of 74 adults were conducted between November 2013 and January 2014 in Newcastle upon Tyne, UK. Focus groups lasted approximately 60 minutes and explored factors that made financial incentives acceptable and unacceptable to participants, together with discussions on preferred formats for financial incentives. Verbatim transcripts were thematically coded and analysed in Nvivo 10.
  
  
  RESULTS
  Participants largely distrusted health promoting financial incentives, with a concern that individuals may abuse such schemes. There was, however, evidence that health promoting financial incentives may be more acceptable if they are fair to all recipients and members of the public; if they are closely monitored and evaluated; if they are shown to be effective and cost-effective; and if clear health education is provided alongside health promoting financial incentives. There was also a preference for positive rewards rather than negative penalties, and for shopping vouchers rather than cash incentives.
  
  
  CONCLUSIONS
  This qualitative empirical research has highlighted clear suggestions on how to design health promoting financial incentives to maximise acceptability to the general public. It will also be important to determine the acceptability of health promoting financial incentives in a range of stakeholders, and in particular, those who fund such schemes, and policy-makers who are likely to be involved with the design, implementation and evaluation of health promoting financial incentive schemes.
authors: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK. e.l.giles@ncl.ac.uk.
authors: Emma L
authors: EL
authors: Giles
authors: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK. falko.sniehotta@ncl.ac.uk.
authors: Falko F
authors: FF
authors: Sniehotta
authors: Newcastle Clinical Trials Unit, 4th Floor William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. elaine.mccoll@ncl.ac.uk.
authors: Elaine
authors: E
authors: McColl
authors: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK. jma79@medschl.cam.ac.uk.|Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. jma79@medschl.cam.ac.uk.
authors: Jean
authors: J
authors: Adams
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics* / Q000379:methods*; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D012201:Reward; D055815:Young Adult
references: Obesity (Silver Spring). 2008 Jan;16(1):70-6
references: 18223615
references: Cochrane Database Syst Rev. 2011;(9):CD008451
references: 21901722
references: Drug Alcohol Rev. 2007 Mar;26(2):183-9
references: 17364854
references: BMC Med Res Methodol. 2009;9:59
references: 19671152
references: J Health Polit Policy Law. 2012 Apr;37(2):201-26
references: 22147947
references: Int J Qual Health Care. 2007 Dec;19(6):349-57
references: 17872937
references: Health Technol Assess. 2000;4(14):i-vii, 1-133
references: 10984843
references: Am J Addict. 2010 Nov-Dec;19(6):496-503
references: 20958844
references: J Occup Environ Med. 2011 Jan;53(1):62-7
references: 21187795
references: Exp Clin Psychopharmacol. 2013 Jun;21(3):204-13
references: 23750691
references: BMJ. 2008;337:a1135
references: 18684762
references: J Med Philos. 2008 Jun;33(3):198-220
references: 18567903
references: BMJ. 2009;338:b1415
references: 19359291
references: N Engl J Med. 2010 Jan 14;362(2):e3
references: 20042747
references: Prev Med. 2008 Oct;47(4):354-68
references: 18675845
references: Health Expect. 2011 Jun;14(2):191-200
references: 21348904
references: Drug Alcohol Rev. 2011 Jul;30(4):411-8
references: 21355917
references: PLoS One. 2014;9(3):e90347
references: 24618584
references: Am J Health Promot. 1998 May-Jun;12(5):307-20
references: 10181140
references: J Med Ethics. 2010 Aug;36(8):463-8
references: 20581423
references: J Med Ethics. 2011 Nov;37(11):682-7
references: 21670321
references: Int J Obes Relat Metab Disord. 2000 Feb;24(2):131-43
references: 10702762
references: BMC Med Res Methodol. 2011;11:26
references: 21396104
references: Am J Prev Med. 2013 Nov;45(5):658-67
references: 24139781
references: Prev Med. 2012 Aug;55(2):122-6
references: 22691939
references: J Med Internet Res. 2014;16(7):e179
references: 25092221
references: BMJ. 2008;337:a594
references: 18614509
references: BMC Pregnancy Childbirth. 2012;12:24
references: 22471787
references: Prev Med. 2015 Apr;73:145-58
references: 25600881
references: Nicotine Tob Res. 2004 Apr;6 Suppl 2:S163-79
references: 15203819
references: Health Psychol Rev. 2014;8(3):286-95
references: 25053215
references: Int J Behav Med. 2013 Mar;20(1):114-20
references: 22094998
references: BMJ. 2008;337:a589
references: 18614508
references: BMC Public Health. 2010;10:62
references: 20146795
references: Health Expect. 2013 Sep;16(3):292-304
references: 21771227
references: Health Aff (Millwood). 2009 May-Jun;28(3):845-52
references: 19414897
references: Am J Prev Med. 2004 Nov;27(4):327-52
references: 15488364
references: J Law Med Ethics. 2011 Fall;39(3):450-68
references: 21871042
references: Health Aff (Millwood). 2009 Jan-Feb;28(1):206-14
references: 19124872
references: Soc Sci Med. 2012 Dec;75(12):2509-14
references: 23102753
references: BMC Med Res Methodol. 2013;13:117
references: 24047204
references: BMJ Open. 2014;4(7):e005524
references: 25037645
references: PLoS Med. 2012;9(3):e1001193
references: 22479154
references: Cochrane Database Syst Rev. 2011;(8):ED000027
references: 21833985
references: Addiction. 2010 Sep;105(9):1507-9
references: 20707772
references: Health Promot Int. 2012 Sep;27(3):331-41
references: 21742702
references: Nicotine Tob Res. 2011 Nov;13(11):1029-36
references: 21690320
references: J Obes. 2012;2012:740519
references: 22548152