Implementation and evaluation of an incentivized Internet-mediated walking program for obese adults

ABSTRACTIn response to rising health care costs associated with obesity rates, some health care insurers are adopting incentivized technology-enhanced wellness programs. The purpose of this study is to evaluate the large-scale implementation of an incentivized Internet-mediated walking program for obese adults and to examine program acceptance, adherence, and impact. A mixed-methods evaluation was conducted to investigate program implementation, acceptance, and adherence rates, and physical activity rates among program participants. Program implementation was shaped by national and state policies, data security concerns, and challenges related to incentivizing participation. Among 15,397 eligible individuals, 6,548 (43 %) elected to participate in the walking program, achieving an average of 6,523 steps/day (SD 2,610 steps). Participants who uploaded step counts for 75 % of days for a full year (n = 2,885) achieved an average of 7,500 steps (SD 3,093). Acceptance and participation rates in this incentivized Internet-mediated walking program suggest that such interventions hold promise for engaging obese adults in physical activity.

[1]  Candice Bowman,et al.  The Role of Formative Evaluation in Implementation Research and the QUERI Experience , 2006 .

[2]  Laura J. Damschroder,et al.  Qualitative Content Analysis , 2007 .

[3]  G A Colditz,et al.  Impact of overweight on the risk of developing common chronic diseases during a 10-year period. , 2001, Archives of internal medicine.

[4]  G. Charness,et al.  Incentives to Exercise , 2008 .

[5]  M. Sandelowski,et al.  Writing the Proposal for a Qualitative Research Methodology Project , 2003, Qualitative health research.

[6]  Acsw John T. Pardeck Americans with Disabilities Act of 1990 , 1997 .

[7]  V. Strecher Internet methods for delivering behavioral and health-related interventions (eHealth). , 2007, Annual review of clinical psychology.

[8]  E. Finkelstein,et al.  State-level estimates of annual medical expenditures attributable to obesity. , 2004, Obesity research.

[9]  J. Lowery,et al.  Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science , 2009, Implementation science : IS.

[10]  P. Sullivan,et al.  The Effect of Obesity and Cardiometabolic Risk Factors on Expenditures and Productivity in the United States , 2008, Obesity.

[11]  David Cutler,et al.  Workplace wellness programs can generate savings. , 2010, Health affairs.

[12]  Robert Hurling,et al.  Rates and Determinants of Uptake and Use of an Internet Physical Activity and Weight Management Program in Office and Manufacturing Work Sites in England: Cohort Study , 2008, Journal of medical Internet research.

[13]  R. Steinbrook Imposing personal responsibility for health. , 2006, The New England journal of medicine.

[14]  Stephanie Stock,et al.  What can we learn from German health incentive schemes? , 2009, BMJ : British Medical Journal.

[15]  Kevin G Volpp,et al.  A randomized, controlled trial of financial incentives for smoking cessation. , 2009, The New England journal of medicine.

[16]  Willem Van Mechelen,et al.  Feasibility and Effectiveness of Online Physical Activity Advice Based on a Personal Activity Monitor: Randomized Controlled Trial , 2009, Journal of medical Internet research.

[17]  S. Okie The employer as health coach. , 2007, The New England journal of medicine.

[18]  K. R. Pelletier A Review and Analysis of the Clinical and Cost-Effectiveness Studies of Comprehensive Health Promotion and Disease Management Programs at the Worksite: Update VII 2004–2008 , 2009, Journal of occupational and environmental medicine.

[19]  Kirsten Bibbins-Domingo,et al.  A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes. , 2012, Health affairs.

[20]  David E. Goodrich,et al.  An Online Community Improves Adherence in an Internet-Mediated Walking Program. Part 1: Results of a Randomized Controlled Trial , 2010, Journal of medical Internet research.

[21]  David M Williams,et al.  The Impact of Incentives on Exercise Behavior: A Systematic Review of Randomized Controlled Trials , 2014, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[22]  K. Voigt,et al.  Carrots, sticks, and health care reform--problems with wellness incentives. , 2010, The New England journal of medicine.

[23]  M. Rosenthal,et al.  Wellness programs and lifestyle discrimination--the legal limits. , 2008, The New England journal of medicine.

[24]  L. Damschroder,et al.  A guiding framework and approach for implementation research in substance use disorders treatment. , 2011, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[25]  M. Alegría AcademyHealth 25th Annual Research Meeting chair address: From a science of recommendation to a science of implementation. , 2009, Health services research.

[26]  Linda S. Lotto Qualitative Data Analysis: A Sourcebook of New Methods , 1986 .

[27]  E. Calle,et al.  Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms , 2004, Nature Reviews Cancer.

[28]  Jacqueline A. Pugh,et al.  Strategies for promoting organizational and practice change by advancing implementation research , 2006 .

[29]  Brenda White,et al.  DEPARTMENT OF LABOR , 2006 .

[30]  A. Rustichini,et al.  Pay Enough or Don't Pay at All , 2000 .

[31]  C. Tudor-Locke,et al.  Revisiting "how many steps are enough?". , 2008, Medicine and science in sports and exercise.

[32]  L. Aronne,et al.  PROCEED: Prospective Obesity Cohort of Economic Evaluation and Determinants: baseline health and healthcare utilization of the US sample * , 2008, Diabetes, obesity & metabolism.

[33]  W. Kroeze,et al.  A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors , 2006, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.