On supplementing foot in the door incentives for ehealth program engagement

Financial health incentives,such as paying people to lose weight,are being widely implemented by western nations and large corporations. a growing number of studies have tested the impact of incentives on health behaviors,though few have evaluated the approach on a population-scale. in this issue of the journal of medical internet research,liu et al add to the evidence-base by examining whether a single incentive can motivate enrollment and engagement in a preventive ehealth program in a sample of 142,726 canadian adults. while the incentives increased enrollment significantly (by a factor of about 28),a very high level of program attrition was noted (90%). the foot in the door incentive technique employed was insufficient; enrollees received incentives for signing-up for,but not for engaging with,the ehealth program. to supplement this technique and drive sustained behavior change,several theoretically-and empirically-based strategies are proposed. specifically,incentives indexed to behavioral achievements over time are highlighted as one approach to boost engagement in this population in the future.