Low-Income Participants’ Preference Between Financial Incentives for Behavioral Goals vs Weight Loss Targets and Associations With Behavioral Goal Adherence

Abstract

Purpose

Examine associations between whether participants’ were matched to their preferred financial incentive design and behavioral goal adherence in a weight management intervention.

Design

Secondary quantitative analysis incorporating qualitative survey data.

Setting

Primary care clinics in socioeconomically disadvantaged communities in New York City and Los Angeles.

Subjects

668 participants (mean age 47.7 years, 81.0% female, 72.6% Hispanic) with obesity were enrolled in the Financial Incentives foR Weight Reduction (FIReWoRk) intervention.

Measures

We explored qualitatively participant’s reasons for hypothetically choosing a behavioral goal-directed vs a weight loss outcome-based financial incentive program. Additionally, behavioral adherence to different goals was collected at the 6-month timepoint, categorized by match to preferred financial incentive design.

Analysis

Logistic regression was used to examine if participants with certain demographic and higher psychosocial factors were more likely to choose goal-directed over outcome-based incentives. Additionally, logistic regression was used to test for associations between preference and behavioral adherence, using incentive type as an interaction term.

Results

60.2% of participants preferred the goal-directed incentive, with the majority stating that it was more structured. Married participants were more likely to prefer goal-directed incentives (OR = 1.57, CI = 1.06-2.33, P = .025). Moderation analysis revealed that participants who preferred goal-directed and were matched to goal-directed had greater rates of behavioral adherence for program attendance and self-weighing, but not dietary tracking and physical activity tracking, compared to those who preferred outcome-based and were matched to outcome-based.

Conclusion

Receiving one’s preferred incentive design may not play a strong role in behavioral goal adherence during financially incentivized weight loss interventions.