title: Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial.
abstract: Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions.
  
  
  
  This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.
  
  
  
  The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a 'points' based loyalty platform, whereby local businesses 'sponsor' the incentive (retail vouchers) in return for increased footfall to their business.
  
  
  
  ISRCTN17975376 (Registered 19/09/2014).
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Institute of Clinical Sciences B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland. ruth.hunter@qub.ac.uk.
authors.forename: Ruth F
authors.initials: RF
authors.lastname: Hunter
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Brennan
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Tang
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Smith
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Murray
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Tully
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Chris
authors.initials: C
authors.lastname: Patterson
authors.affiliation: School of Biological Sciences/UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Alberto
authors.initials: A
authors.lastname: Longo
authors.affiliation: School of Biological Sciences/UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: George
authors.initials: G
authors.lastname: Hutchinson
authors.affiliation: School of Sociology, Social Policy and Social Work/UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Prior
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, England.
authors.forename: David P
authors.initials: DP
authors.lastname: French
authors.affiliation: Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, England.
authors.forename: Jean
authors.initials: J
authors.lastname: Adams
authors.affiliation: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland.
authors.forename: Emma
authors.initials: E
authors.lastname: McIntosh
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
mesh_terms: D000328:Adult; D002947:Cities; D003362:Cost-Benefit Analysis; D015444:Exercise; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D009660:Northern Ireland; D009765:Obesity / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life; D012107:Research Design; D011795:Surveys and Questionnaires; D017132:Workplace
keywords: Behaviour change maintenance; Behavioural economics; Cluster RCT; Economic evaluation; Financial incentives; Intervention; Mediation analyses; Physical activity; Workplace