The National Diabetes Prevention Program (National DPP) helps individuals with prediabetes make lifestyle changes to prevent type 2 diabetes. Some lifestyle change programs use incentives to promote health goals, but the impact of incentives in these settings has not been systematically assessed. We conducted a systematic literature review to assess the effectiveness of incentives in programs similar to the National DPP lifestyle change program. Manuscripts were included if they focused on the use of incentives in chronic disease lifestyle change programs in adults; occurred in high-to-middle income countries; were published in 2008-2019; and were written in English. Manuscripts were excluded if they focused on diet- or walking-only programs; medical interventions; screenings, pharmaceutical treatments, or one-time services; or had no comparison group. We examined the effectiveness of incentives for improving the following measures: weight, BMI, blood pressure, cholesterol, and HbA1c. We identified 21 studies that met our inclusion/exclusion criteria. Nearly all studies were randomized controlled trials, with general wellness programs in the workplace being the most common. The most common incentive characteristics by category were: type—cash (10/21); amount--$1-$25 (10/21); frequency—multiple times (17/21); amount variability—fixed (8/21); and certainty—criteria-based guaranteed (12/21). The direction of effect for incentives was favorable for 94/111 (85%) comparisons for the five health-related measures, of which 47/94 (50%) were statistically significant (p<0.05). Only 2/111 (2%) comparisons were unfavorable and statistically significant. We did not identify particular incentive characteristics that were predictive of effectiveness, and we did not assess cost-effectiveness of incentives. Incentives may be useful for reaching health goals in lifestyle change programs and should be evaluated for cost-effectiveness if they are used.


C. Atkins: None. L. Hulbert: None. R. Skeete: None. S.L. Michael: None. B. Smith: None. M. Cannon: None.

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