Liu Sam, Hodgson Corinne, Zbib Ahmad M, Payne Ada Y M, Nolan Robert P
Cardiac eHealth Research Unit, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada.
J Med Internet Res. 2014 Jul 2;16(7):e163. doi: 10.2196/jmir.3458.
Internet-based health programs have been shown to be effective in reducing risk for cardiovascular disease. However, their rates of enrollment and engagement remain low. It is currently unclear whether rewards from established loyalty programs can serve as a conditioned stimulus to improve the use of a freely available Internet-based program.
The objectives of the study were to (1) examine enrollment rates and levels of engagement with the My Health eSupport program between a Conditioned Reward group and a Control group, and (2) investigate the influence of loyalty rewards and participant characteristics on levels of enrollment and program engagement.
The study sample (n=142,726) consisted of individuals who were offered enrollment in an Internet-based health intervention (My Health eSupport) after completing the Heart&Stroke Risk Assessment on the Heart and Stroke Foundation website. My Health eSupport programs provided encouragement and tips for lifestyle change. This is a free, self-guided, fully automated program that proactively delivers tailored email messages at 2-week intervals based on the participant's stage of motivational "readiness" and priority for lifestyle change. Participants in the Conditioned Reward group were offered a single exposure of 20 loyalty reward points from the Air Miles loyalty program for completing the Heart&Stroke Risk Assessment (10 reward points) and enrolling in the Internet-based program (10 reward points). Meanwhile, no rewards were given to the Control group participants. All data were collected between February 1, 2011 and February 10, 2012.
In total, 51.38% (73,327/142,726) of individuals in the Conditioned Reward group and 48.62% (69,399/142,726) of individuals in the Control group completed the Heart&Stroke Risk Assessment. Subsequently, significantly more individuals from the Conditioned Reward group (52.96%, 38,835/73,327) enrolled in the My Health eSupport program than Controls (4.07%, 2826/69,399). Regression analyses indicated that individuals were 27.9 times (95% CI 26.4-29.4; P<.001) more likely to join the My Health eSupport program when presented with loyalty rewards controlling for gender, age, education, ethnicity, employment, and number of modifiable risk factors. However, ongoing engagement level was low in both groups and it was not influenced by loyalty rewards. Instead, individuals were more likely to engage with the My Health eSupport program if they were greater than 60 years of age (OR 12.56, 95% CI 5.66-27.8; P<.001), were female (OR 1.27, 95% CI 1.09-1.46; P=.002), or had one or more modifiable risk factors (OR 1.38, 95% CI 1.31-1.45; P<.001).
Our findings suggest that a single exposure of loyalty rewards may be used to encourage individuals to enroll in an Internet-based preventative health program, but additional strategies are required to maintain engagement level. Future studies need to examine the schedules of loyalty reward reinforcement on the long-term engagement level of Internet-based health programs.
基于互联网的健康项目已被证明在降低心血管疾病风险方面有效。然而，其注册率和参与度仍然较低。目前尚不清楚既定忠诚度计划的奖励是否可作为一种条件刺激，以提高对免费的基于互联网的项目的使用。
本研究的目的是：（1）检查条件奖励组和对照组之间My Health eSupport项目的注册率和参与程度，以及（2）调查忠诚度奖励和参与者特征对注册水平和项目参与度的影响。
研究样本（n = 142,726）由在心脏与中风基金会网站完成心脏与中风风险评估后被提供参与基于互联网的健康干预（My Health eSupport）的个体组成。My Health eSupport项目为生活方式改变提供鼓励和提示。这是一个免费的、自我指导的、全自动的项目，根据参与者的动机“准备度”阶段和生活方式改变的优先级，每两周主动发送一次量身定制的电子邮件。条件奖励组的参与者在完成心脏与中风风险评估（10个奖励积分）并注册基于互联网的项目（10个奖励积分）后，可获得来自加拿大航空里程忠诚度计划的单次20个忠诚度奖励积分。同时，对照组参与者未获得奖励。所有数据于2011年2月1日至2012年2月10日期间收集。
条件奖励组中共有51.38%（73,327/142,726）的个体和对照组中48.62%（69,399/142,726）的个体完成了心脏与中风风险评估。随后，条件奖励组中注册My Health eSupport项目的个体（52.96%，38,835/73,327）显著多于对照组（4.07%，2826/69,399）。回归分析表明，在控制性别、年龄、教育程度、种族、就业情况和可改变风险因素数量的情况下，获得忠诚度奖励的个体加入My Health eSupport项目的可能性高27.9倍（95%CI 26.4 - 29.4；P <.001）。然而，两组的持续参与度都较低，且不受忠诚度奖励的影响。相反，如果个体年龄大于60岁（OR 12.56，95%CI 5.66 - 27.8；P <.001）、为女性（OR 1.27，95%CI 1.09 - 1.46；P =.002）或有一个或多个可改变风险因素（OR 1.38，95%CI 1.31 - 1.45；P <.001），则更有可能参与My Health eSupport项目。
我们的研究结果表明，单次给予忠诚度奖励可用于鼓励个体注册基于互联网的预防性健康项目，但需要额外的策略来维持参与度。未来的研究需要考察忠诚度奖励强化时间表对基于互联网的健康项目长期参与度的影响。
