Abstract
In the last decade, there has been a robust increase in research using financial incentives
to promote healthy behaviors as behavioral economics and new monitoring technologies
have been applied to health behaviors. Most studies of financial incentives on health
behaviors have focused on adults, yet many unhealthy adult behaviors have roots in
childhood and adolescence. The use of financial incentives is an attractive but controversial
strategy in childhood. In this review, we first propose 5 general considerations in
designing and applying incentive interventions to children. These include: 1) the
potential impact of incentives on intrinsic motivation, 2) ethical concerns about
incentives promoting undue influence, 3) the importance of child neurodevelopmental
stage, 4) how incentive interventions may influence health disparities, and 5) how
to finance effective programs. We then highlight empirical findings from randomized
trials investigating key design features of financial incentive interventions, including
framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size)
effects on a range of childhood behaviors from healthy eating to adherence to glycemic
control in type 1 diabetes. Though the current research base on these subjects in
children is limited, we found no evidence suggesting that loss-framed incentives perform
better than gain-framed incentives in children and isolated studies from healthy food
choice experiments support the use of immediate, small incentives versus delayed,
larger incentives. Future research on childhood incentives should compare the effectiveness
of gain versus loss-framing and focus on which intervention characteristics lead to
sustained behavior change and habit formation.
Keywords
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Article Info
Publication History
Published online: August 14, 2021
Accepted:
August 10,
2021
Received:
March 16,
2021
Footnotes
The authors have no conflict of interest to disclose.
Identification
Copyright
Copyright © 2021 by Academic Pediatric Association
