Top

Published in:

01-12-2013 | Original Research

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

Authors: Donna M Zulman, MD, MS, Laura J. Damschroder, MS, MPH, Ryan G Smith, BA, Paul J. Resnick, PhD, Ananda Sen, PhD, Erin L Krupka, PhD, Caroline R Richardson, MD

Published in: Translational Behavioral Medicine | Issue 4/2013

ABSTRACT

In 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.

Available only for authorised users

Finkelstein EA, Fiebelkorn IC, Wang G. State-level estimates of annual medical expenditures attributable to obesity. Obes Res. 2004;12:18-24.PubMedCrossRef

Sullivan PW, Ghushchyan V, Ben-Joseph RH. The effect of obesity and cardiometabolic risk factors on expenditures and productivity in the United States. Obesity. 2008;16:2155-2162.PubMedCrossRef

Wolf AM, Finer N, Allshouse AA, et al. PROCEED: prospective obesity cohort of economic evaluation and determinants: baseline health and healthcare utilization of the U.S. sample. Diabetes Obes Metab. 2008;10:1248-1260.PubMed

Field AE, Coakley EH, Spadano JL, et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001;161:1581-1586.PubMedCrossRef

Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4:579-591.PubMedCrossRef

New York Times. Obama's health reform speech. Available at http://www.nytimes.com/2009/06/15/health/policy/15obama.text.html. Accessed 8 December 2010.

Center for Disease Control and Prevention. Comprehensive Workplace Health Programs to Address Physical Activity, Nutrition, and Tobacco Use in the Workplace. Available at http://www.cdc.gov/workplacehealthpromotion/nhwp/index.html. Accessed 6 November 2012.

Baicker K, Cutler D, Song Z. Workplace wellness programs can generate savings. Health Aff (Millwood). 2010;29:304-311.CrossRef

Kaiser Family Foundation and Health Research & Educational Trust. Employer Health Benefits 2010 Annual Survey: Wellness Programs, Health Risk Assessments, and Disease Management Programs. Available at http://ehbs.kff.org/2010.html. Accessed 7 November 2012.

10.

Okie S. The employer as health coach. N Engl J Med. 2007;357:1465-1469.PubMedCrossRef

11.

Pelletier KR. 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. J Occup Environ Med. 2009;51:822-837.PubMedCrossRef

12.

Kroeze W, Werkman A, Brug J. A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med. 2006;31:205-223.PubMedCrossRef

13.

Strecher V. Internet methods for delivering behavioral and health-related interventions (eHealth). Annu Rev Clin Psychol. 2007;3:53-76.PubMedCrossRef

14.

Richardson CR, Buis LR, Janney AW, et al. An online community improves adherence in an Internet-mediated walking program. Part 1: results of a randomized controlled trial. J Med Internet Res. 2010;12:e71.PubMedCrossRef

15.

Slootmaker SM, Chinapaw MJ, Schuit AJ, Seidell JC, Van Mechelen W. Feasibility and effectiveness of online physical activity advice based on a personal activity monitor: randomized controlled trial. J Med Internet Res. 2009;11:e27.PubMedCrossRef

16.

Ware LJ, Hurling R, Bataveljic O, 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. J Med Internet Res. 2008;10:e56.PubMedCrossRef

17.

Capps K, Harkey JB. Employee health and productivity management programs: The use of incentives, a survey of major U.S. employers. Available at http://www.healthcarevisions.net/f/2008_Use_of_Incentives_Survey-Results-2008.pdf. Accessed 10 August 2012.

18.

Alegria M. AcademyHealth 25th Annual Research Meeting chair address: from a science of recommendation to a science of implementation. Health Serv Res. 2009;44:5-14.PubMedCrossRef

19.

Rubenstein LV, Pugh J. Strategies for promoting organizational and practice change by advancing implementation research. J Gen Intern Med. 2006;21:S58-S64.PubMedCrossRef

20.

Stetler CB, Legro MW, Wallace CM, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21:S1-S8.PubMedCrossRef

21.

Damschroder LJ, Hagedorn HJ. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. 2011;25:194-205.PubMedCrossRef

22.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.PubMedCrossRef

23.

Forman J, Damschroder LJ. Qualitative content analysis. In: Jacoby L, Siminoff L, eds. Empirical research for bioethics: a primer. Oxford, UK: Elsevier; 2008.

24.

Miles MB, Huberman AM. Qualitative data analysis: a sourcebook. Thousand Oaks: Sage Publications; 1994.

25.

Sandelowski M, Barroso J. Writing the proposal for a qualitative research methodology project. Qual Health Res. 2003;13:781-820.PubMedCrossRef

26.

Michigan Senate Bill. No 849, Sec 414b (2006).

27.

U.S. Department of Labor. FAQs about the HIPAA nondiscrimination requirements. Available at http://www.dol.gov/ebsa/faqs/faq_hipaa_ND.html. Accessed 10 December 2010.

28.

Mello MM, Rosenthal MB. Wellness programs and lifestyle discrimination—the legal limits. N Engl J Med. 2008;359:192-199.PubMedCrossRef

29.

Americans with Disabilities Act of 1990, as Amended. Available at http://www.ada.gov/pubs/adastatute08.htm. Accessed 6 November 2012.

30.

Department of Justice. Americans with Disabilities Act: Title III technical assistance manual covering public accommodations and commercial facilities. Available at http://www.ada.gov/taman3.html. Accessed 14 December 2010.

31.

U.S. Equal Employment Opportunity Commission. Section 902 Definition of the Term Disability: Notice concerning The Americans With Disabilities Act Amendments Act Of 2008. Available at http://www.eeoc.gov/policy/docs/902cm.html. Accessed 10 December 2010.

32.

U.S. Department of Health and Human Services. Minimum necessary requirement. Available at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/minimumnecessary.html. Accessed 10 December 2010.

33.

Wang YC, Coxson P, Shen YM, Goldman L, Bibbins-Domingo K. A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes. Heal Aff. 2012;31:199-207.CrossRef

34.

Tudor-Locke C, Hatano Y, Pangrazi RP, Kang M. Revisiting "how many steps are enough?". Med Sci Sports Exerc. 2008;40:S537-S543.PubMedCrossRef

35.

Charness G, Gneezy U. Incentives to exercise. Econometrica. 2009;77:909-931.CrossRef

36.

Volpp KG, Gurmankin Levy A, Asch DA, et al. A randomized controlled trial of financial incentives for smoking cessation. Cancer Epidemiol Biomarkers Prev. 2006;15:12-18.PubMedCrossRef

37.

Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360:699-709.PubMedCrossRef

38.

Gneezy U, Rustichini A. Pay enough or don't pay at all. Q J Econ. 2000;115:791-810.CrossRef

39.

Redmond P, Solomon J, Lin M. Can incentives for healthy behavior improve health and hold down Medicaid costs? Available at http://www.cbpp.org/6-1-07health.pdf. Accessed 14 December 2010.

40.

Steinbrook R. Imposing personal responsibility for health. N Engl J Med. 2006;355:753-756.PubMedCrossRef

41.

Schmidt H, Gerber A, Stock S. What can we learn from German health incentive schemes? BMJ. 2009;339:b3504.PubMedCrossRef

42.

Schmidt H, Voigt K, Wikler D. Carrots, sticks, and health care reform–problems with wellness incentives. N Engl J Med. 2010;362:e3.PubMedCrossRef

43.

Patient Protection and Accountable Care Act. P.L. 111–148. Available at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_laws&docid=f:publ148.111.pdf. Accessed 14 December 2010.

Title: Implementation and evaluation of an incentivized Internet-mediated walking program for obese adults
Authors: Donna M Zulman, MD, MS
Laura J. Damschroder, MS, MPH
Ryan G Smith, BA
Paul J. Resnick, PhD
Ananda Sen, PhD
Erin L Krupka, PhD
Caroline R Richardson, MD
Publication date: 01-12-2013
Publisher: Springer US
Published in: Translational Behavioral Medicine / Issue 4/2013
Print ISSN: 1869-6716
Electronic ISSN: 1613-9860
DOI: https://doi.org/10.1007/s13142-013-0211-6

At a glance: The STEP trials

Springer Medicine

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

ABSTRACT

At a glance: The STEP trials

Springer Medicine

ABSTRACT

Please log in to get access to this content

Other articles of this Issue 4/2013

Peer-delivered physical activity interventions: an overlooked opportunity for physical activity promotion

Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program

HCI and mobile health interventions

Implementing point of care “e-referrals” in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies

News from the CDC: chronic fatigue syndrome (CFS) and standardized patient videos — a novel approach to educating medical students about CFS

mHealth approaches to child obesity prevention: successes, unique challenges, and next directions