title: Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviors that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behavior, (b) incentive value and attainment certainty, (c) recipients' deprivation level.
  
  
  METHODS
  Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviors at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints.
  
  
  RESULTS
  Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behavior-change, with effects sustained until 18months from baseline (OR: 1.53, 95% CI 1.05-2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21-3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22-3.85), but only at >6-12months from baseline. Other assessed variables did not independently modify effects at any time-point.
  
  
  CONCLUSIONS
  Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal.
authors.affiliation: Health Psychology Section, King's College London, London, UK. Electronic address: em578@medschl.cam.ac.uk.
authors.forename: Eleni
authors.initials: E
authors.lastname: Mantzari
authors.affiliation: Institute of Pharmaceutical Science, King's College London, London, UK. Electronic address: me@fvogt.net.
authors.forename: Florian
authors.initials: F
authors.lastname: Vogt
authors.affiliation: Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK. Electronic address: ids29@medschl.cam.ac.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Shemilt
authors.affiliation: MRC Clinical Trials Unit Hub for Trials Methodology Research, MRC Clinical Trials Unit, London, UK. Electronic address: yinghui.wei@plymouth.ac.uk.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Wei
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol UK; Centre for Reviews and Dissemination, University of York, York, UK. Electronic address: Julian.higgins@bristol.ac.uk.
authors.forename: Julian P T
authors.initials: JP
authors.lastname: Higgins
authors.affiliation: Health Psychology Section, King's College London, London, UK; Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK. Electronic address: tm388@medschl.cam.ac.uk.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Marteau
mesh_terms: D000328:Adult; D005382:Financing, Personal; D006184:Habits; D015438:Health Behavior; D006801:Humans; D009042:Motivation; D016032:Randomized Controlled Trials as Topic
keywords: Financial incentives; Health promotion; Health-related behavior; Meta-analysis; Systematic review
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