Does it Pay to Incentivize Cancer Prevention?
Capitalizing on the insight that behavior is influenced by its consequences.
Posted Mar 15, 2017
Psychologists have long looked to conscious, reflective processes in considering the most powerful ways to encourage individuals to alter their behavior in ways that promote health, prevent illness, or detect diseases early. Techniques that have been directed at health behavior change include: strategically framing persuasive health messages in terms of losses versus gains; reducing defensive resistance to potentially threatening health messages by affirming values that people hold dear; and tailoring messages to the stage of the behavior change process where a person is. More recently, alternatives to these methods have been explored, such as capitalizing on unconscious and more impulsive and associative processes. Techniques based in this realm include changing implicit automatic attitudes through conditioning the undesired behavior (e.g., eating unhealthy snacks) by pairing them repeatedly with aversive images (e.g., of obesity and heart disease).1
Other techniques involve very little psychological expertise to devise beyond the powerful insight that much of human behavior is influenced by its consequences.2 One of these tools is financial incentives. For instance, a popular app-based program, PACT, allows people to be paid for engaging in healthy behaviors such as exercising and eating fruits and vegetables.3 The program involves making a commitment to engage in healthy behaviors and indicating what you will pay other members if you don’t meet your goals. If you meet your goals, you are paid by funds generated by other members who did not meet their goals. This is an intriguing example of allowing people to increase their motivation by setting up contingencies of financial rewards and punishments.
Financial incentives are also being leveraged by behavioral scientists as a way to prevent cancer. Human papillomavirus (HPV) vaccination, particularly in young women and men, is a way to prevent the contraction of high-risk strains of the virus that are associated with later cancer development. HPV vaccinations could prevent 28,000 cases of cancer of the cervix, vulva, vagina, penis, anus, and back of the throat in the United States each year. Despite this, there are low levels of uptake of this vaccine and difficulty with individuals not receiving all of the three doses required for full coverage.4 Nationally, only 63 percent of adolescent girls and 50 perccent of adolescent boys have received at least one of the doses of the vaccine.5
A study in the UK investigated whether shopping vouchers worth £45 ($65 USD) along with an invitation to attend an appointment and an informational leaflet could increase vaccination rates in 16-18 year old girls who had not yet received an invitation to attend an appointment or who had not responded to a previous invitation.6 The incentive was successful in increasing the percent of young women, relative to a control condition who received just the invitation and the informational leaflet, who obtained the first and third doses of the vaccine.
Using financial incentives may be more motivating for those who are of lower socioeconomic status,7 making them a potentially powerful tool in addressing health disparities. However, there are concerns that this may promote lower quality decisions that are not based upon knowledge of the relevant information, or worse, not aligned with the decision maker’s values. In the HPV vaccination study, level of social deprivation (a measure based on area of residence) did not influence the effectiveness of incentives, and, importantly, incentives did not reduce decision quality. The authors noted, however, that it was not clear whether the incentives provided the opportunity for young women who were already predisposed to getting the vaccination to act in accordance with their values (e.g., by providing the means to afford travel to an appointment) or the whether the incentives actually changed their attitudes toward receiving the vaccination.
The results of this study are promising, especially considering that the effectiveness of incentives for health behaviors such as quitting smoking, eating more healthily, reducing alcohol consumption, and increasing physical activity has been shown to wane beyond three months following removal of the incentive. Vaccination, even a three part one, is not an ongoing health behavior. However, disseminating and implementing even interventions shown to be effective can be challenging. The use of incentives may be complicated for the public, health professionals, and policy makers because of their perceived potential to be coercive and the necessity for cost effectiveness analysis. In addition, HPV vaccination is controversial because of its connection to early sexual activity such that implementing financial incentives on a broad level might not be viewed as acceptable.
1 Sheeran, P., Gollwitzer, P. M., & Bargh, J. A. (2013). Nonconscious processes and health. Health Psychology, 32(5), 460-473. doi:10.1037/a0029203
2 Silverman, K., Jarvis, B. P., Jessel, J., & Lopez, A. A. (2016). Incentives and motivation. Translational Issues in Psychological Science, 2(2), 97-100. doi:10.1037/tps0000073
6 Mantzari, E., Vogt, F., & Marteau, T. M. (2015). Financial incentives for increasing uptake of HPV vaccinations: A randomized controlled trial. Health Psychology, 34(2), 160-171. doi:10.1037/hea0000088
7 Mantzari, E., Vogt, F., Shemilt, I., Wei, Y., Higgins, J. T., & Marteau, T. M. (2015). Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis. Preventive Medicine: An International Journal Devoted to Practice and Theory, 7575-85.