Title: Effectiveness and Cost-effectiveness of a Physical Activity Loyalty Card to Maintain Behaviour Change: A Cluster Randomised Controlled Trial
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: In light of evidence of modest, short term effects of physical activity (PA) interventions, particularly in the workplace, there is a need for more innovative approaches. NICE guidance has highlighted the lack of evidence about what helps people maintain behaviour change and about how to make walking an habitual activity. Despite the workplace being an ideal setting to encourage habitual activity, there is limited evidence on effective, maintained PA behaviour change interventions. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions. Using the MRC framework for complex interventions we have developed a multi-component intervention aimed at achieving maintained PA behaviour change. The intervention is based on concepts similar to those that underpin high street loyalty cards, whereby repeated behaviour is rewarded with financial incentives. Using sensors placed around the workplace environment to monitor and promote activity, the intervention provides rewards (retail vouchers sponsored by businesses) for activity, feedback and other evidence-based behaviour change techniques (BCTs). The intervention is based on principles of Learning Theory and Social Cognitive Theory; accepted theoretical frameworks for behaviour change. The study will target office-based employees from public sector organisations in Lisburn city centre. Participants will be encouraged to undertake activity within a 2km radius of their workplace utilising opportunities in the workplace neighbourhood. The intervention will be delivered in partnership with the local City Council and Health and Social Care Trust who are responsible for the health and wellbeing of the South East population. Intervention funding is provided by both these organisations and the Public Health Agency. The cluster RCT will recruit 1380 employees from 5 public sector organisations. Participants will be randomly allocated by cluster (the smallest organisational unit) to either the Intervention Group or Control Group. The Intervention Group will participate in the PAL Scheme for 6 months. A pre-intervention phase will involve focus groups with employees and a bespoke Discrete Choice Experiment (DCE) to explore the levels of incentive that could optimise behaviour change. The waiting list Control Group will be given the opportunity to participate in the intervention at the end of the study. Both groups will complete all outcome measures. The primary outcome is steps/day recorded using a pedometer for 7 consecutive days at baseline, 6, 12 and 18 months. Questionnaires will measure health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources at baseline, 6 and 18 months. Focus groups will further explore who the intervention worked for and why. Interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme. Process evaluations will be undertaken to assess the intervention “dose” delivered using PAL scheme and website usage data, and intervention fidelity. An economic evaluation will be conducted from the NHS and employer perspective advocated by NICE. 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.

Lay abstract: Increasing participation in physical activity has great potential for improving public health. The Government recommends that all adults should undertake a minimum of 150 minutes of at least moderate intensity physical activity every week. Past attempts to increase physical activity have only been modestly effective for short periods of time. Most adults spend a large part of their time in work, so this is a good setting to promote programmes of physical activity that could encourage a longer term, habitual increase in activity. However, there are few studies that show how we can best encourage physical activity in the workplace. The Government is encouraging the use of incentives for promoting healthy lifestyles, but little is known about how effective they are. We have developed a novel “physical activity loyalty scheme” which works in the same way as well-known high street loyalty schemes, where participants earn points and receive rewards for repeatedly shopping in a particular store. Our scheme uses sensors placed along footpaths, the nearby local park, leisure centre, shopping mall, bus stops and train stations, and a small loyalty card. When users go for a walk, they swipe their card across the sensors and information is collected on the time that the card was scanned, sent to our study website and processed. Participants can then log onto their own account to get feedback on their activity. They “earn” 10 points for each minute of activity that they complete and can exchange the collected points for vouchers (e.g. free cinema pass, free sandwich voucher) that have been sponsored by local retailers. We have already tested this scheme with a group of civil servants to confirm that: 1) the technology worked; 2) people were very interested to take part; 3) the intervention has the potential to increase physical activity; 4) local businesses will sponsor the rewards which creates a sustainable business model. The next stage is to do a larger study to find out if the difference the scheme can make to people’s health would be worthwhile. We will recruit about 1400 employees within large public sector organisations, and half of them will be randomly allocated to take part in this intervention immediately and the other half would be given the opportunity to participate in the scheme at the end of the study. The study will show whether the intervention leads to increased physical activity levels after 6 months and if this effect is maintained 1 year after the programme ends. Participants will be asked to wear a small pedometer (worn on their waist) to measure the number of steps they take over 7 days. We will also examine the effects of the intervention on health, mental wellbeing, quality of life, absence from work and use of healthcare facilities using questionnaires. At the end of the intervention we will invite participants, senior managers from participating organisations and retailers to attend discussion groups, to give us their views about the intervention. This project is being delivered in partnership with the local City Council and Heath and Social Care Trust and if successful, it should be suitable for rolling out to other organisations.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE