Financial Health Incentives to Promote Physical Activity Among Hospital Employees: A Randomized Control Trial

Study Overview
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Brief Summary
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The objective of this randomized control trial is to examine whether incentives-for-steps (i.e. $1 per day step count goals are reached) increase daily step counts among physically inactive hospital employees.

Detailed Description
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A 24-week, parallel arm, randomized control trial will be employed to examine the impact of incentives on physical activity among physically inactive Hamilton Health Science Corporation employees. Participants will be randomly allocated (1:1) into control (i.e. wellness program and accelerometer) or intervention groups (i.e. wellness program, accelerometer, incentives), where only intervention participants will receive reward points for completing daily step count goals. After randomization, a baseline 'run-in' assessment phase will occur one week prior to the study intervention (T0). During this 'run-in' period, participants will wear a Bluetooth enabled StepsCount Piezo accelerometer, which will track participants' daily steps and moderate to vigorous physical activity (MVPA), and synchronize their accelerometer (i.e. upload information) to the Change4Life program for seven days. Participants will also be asked to complete the Behavioural Regulation to Exercise Questionnaire (BREQ-3) and the Self-Efficacy for Exercise Scale. Throughout the 24-week study, all participants will be asked to wear the accelerometer and synchronize it to the Change4Life program daily. Date, steps per day, and bout minutes of MVPA per day (bouts include 10 or more continuous minutes of MVPA) will be collected when the accelerometer is synchronized. Daily synchronization from the accelerometer to the Change4Life program must be completed by 10 am the next morning. Participants will be instructed to increase their daily step counts by 1,000 and 2,000 steps above baseline (T0) over the course of the first six weeks of the study. On week 7, participants will be asked to increase daily steps per day to 3,000 over baseline, and maintain that level of activity for the duration of the study. Outcome measures will be assessed at baseline (T0), intervention end point (T2), and follow up (T3).

Official Title
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Examining Financial Health Incentives to Promote Physical Activity Among Inactive Hospital Employees: A Web-based Randomized Control Trial

Conditions
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Physically Inactive Hospital Employees

Intervention / Treatment
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* Behavioral: Wellness program
* Device: Accelerometer
* Behavioral: Incentive


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over the age of 18 years English speaking Exclusion Criteria: Existing medical condition, which could be exacerbated by physical activity as measured by the Physical Activity Readiness Questionnaire. Note. Participants cannot enrol in the study without Internet access

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Wellness program, accelerometer, incentives<br>During the intervention period (weeks 1 to 12), intervention participants will be eligible to earn daily reward points contingent on step count goal achievement. Intervention participants will earn 100 reward points (i.e. $1) for each day that specific step count goals are reached. During weeks 13 to 24, participants will no longer receive daily reward points for completing specific step count goals. | Behavioral: Wellness program<br>* All participants have access to Change4Life, a web-based health education and behaviour change program. Individuals are rewarded with very modest incentives (uncertain chance; less than 1 in 100 chance of earning) when they complete learning modules or health tasks.<br>Device: Accelerometer<br>* All participants will be asked to wear the StepsCount Piezo accelerometer, which tracks steps and bout minutes of MVPA per day, synchronize the device to the Change4Life program, and reach daily step count goals for 24 weeks.<br>Behavioral: Incentive<br>* During the first 12 weeks, participants will be eligible to earn $1 in vouchers (e.g., grocery, cinema) when daily goals are reached. The total amount available over the 3-month intervention period will be $90 (9,000 points). During weeks 13 to 24, participants will not receive daily reward points for completing step count goals.<br>|
| Active Comparator: Wellness program and accelerometer<br>During the 24 week trial, control participants will receive no additional incentives when step count goals are reached. | Behavioral: Wellness program<br>* All participants have access to Change4Life, a web-based health education and behaviour change program. Individuals are rewarded with very modest incentives (uncertain chance; less than 1 in 100 chance of earning) when they complete learning modules or health tasks.<br>Device: Accelerometer<br>* All participants will be asked to wear the StepsCount Piezo accelerometer, which tracks steps and bout minutes of MVPA per day, synchronize the device to the Change4Life program, and reach daily step count goals for 24 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Steps | Steps per day will be objectively assessed using the Bluetooth enabled, medical grade, StepsCount Piezo accelerometer | Daily for 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 10 Minute Bouts of Moderate to Vigorous Physical Activity | 10 minutes bouts of moderate to vigorous physical activity per day will be objectively assessed using the Bluetooth enabled, medical grade, StepsCount Piezo accelerometer. | Daily for 24 weeks | 
| Motivation to Exercise - Behavioural Regulation to Exercise Questionnaire; BREQ-3 | Participants will be asked to complete the Behavioural Regulation to Exercise Questionnaire (BREQ-3; Markland & Tobin, 2004; Wilson et al., 2006), a 24-item questionnaire designed to measure self-determined motivation to exercise. This questionnaire will be administered online at baseline (T0; week 0), intervention end point (T2; week 12), and follow up assessments (T3; week 24). | Baseline (T0; week 0), intervention end point (T2; week 12), and follow up assessments (T3; week 24). | 
| Walking Self-Efficacy - Self-Efficacy for Exercise Scale; SEE Scale | Participants will be asked to complete a modified version of the Self-efficacy for Exercise (SEE) Scale (Resnick & Jenkins, 2000), a 9-item questionnaire designed to measure self-reported confidence to exercise (i.e. walk). This questionnaire will be administered online at baseline (T0; week 0), intervention end point (T2; week 12), and follow up assessments (T3; week 24). | Baseline (T0; week 0), intervention end point (T2; week 12), and follow up assessments (T3; week 24). | 
| 10 Minute Bouts of Moderate to Vigorous Physical Activity | Participants will also be asked to complete a modified version of the International Physical Activity Questionnaire - Short Form (IPAQ-SF), a six-item questionnaire designed to measure moderate and vigorous physical activity, as well as time spent walking (Booth, 2000; Craig et al., 2003). This questionnaire will be administered online at intervention end point (T2; week 12), and follow up assessments (T3; week 24). | Intervention end point (T2; week 12), and follow up assessments (T3; week 24). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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financial health incentives, physical activity, behavioral economics, randomized control trial, workplace health