Trial Evaluating Hedonic vs Cash Incentives

The evidence is overwhelming that sustained physical activity reduces risks for non-communicable diseases, increases longevity, and reduces medical costs. Yet, the rates of physical activity have been steadily decreasing such that physical inactivity is now the fourth leading cause of death worldwide. In Singapore, 33% of adults are insufficiently active despite Singapore being a highly walkable city with numerous subsidized community-based physical activity programs. A review of the literature shows that, to date, no study has directly compared cash versus hedonic rewards for health behavior change despite theory suggesting hedonic rewards may work better. Furthermore, hedonic rewards can often be purchased at lower cost than their cash equivalent. This makes hedonic rewards potentially more cost-effective if they are proven to be at least as effective at increasing positive behavior change compared to giving the same value in cash.

Thus, we aim to determine, using a randomized trial with two parallel arms, whether hedonic rewards (Arm 1) can be more effective than their cash equivalent (Arm 2) in promoting increases in physical activity, assessed via step counts measured by a Fitbit physical activity tracker, during a 4-calendar month intervention. We hypothesize that the average proportion of months meeting the incentivized step target across participants will be greater for those in the hedonic incentive arm as compared to those in the cash incentive arm (primary outcome).