一项随机试验的二次数据分析，该试验考察小额经济激励对减肥内在动机和外在动机的影响。
Secondary data analysis from a randomized trial examining the effects of small financial incentives on intrinsic and extrinsic motivation for weight loss.
作者信息
Leahey Tricia M, LaRose Jessica Gokee, Lanoye Autumn, Fava Joseph L, Wing Rena R
机构信息
University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269-1101, USA;
Virginia Commonwealth University School of Medicine, 830 E. Main Street, PO Box 980430, Richmond, VA, 23298, USA;
出版信息
Health Psychol Behav Med. 2017;5(1):129-144. doi: 10.1080/21642850.2016.1276460. Epub 2017 Jan 13.
OBJECTIVES
To examine whether (a) an obesity treatment involving financial incentives yields higher levels of extrinsic motivation for weight management compared to an identical intervention without incentives, (b) extrinsic motivation for weight management mediates, or accounts for, the difference in weight loss outcomes between the two interventions, and (c) there is any evidence that financial incentives and associated extrinsic motivation "crowd out" intrinsic motivation for weight control.
METHODS
Participants (N=153, 80.4% Female; BMI = 33.2 ± 5.9) were randomly assigned to a 3-month Web-based behavioral weight loss program (WBWL) or the same program plus small financial incentives delivered consistent with behavioral economics and behavior change theories (WBWL+$). Weight was objectively assessed at baseline, post-treatment (month 3), and after a 9-month no-treatment follow-up phase (month 12). Intrinsic and extrinsic motivation for weight management were assessed at months 3 and 12 using a modified version of the Treatment Self-Regulation Questionnaire, with questions added to specifically target extrinsic motivation related to incentives.
RESULTS
Compared to WBWL alone, WBWL+$ had better weight loss and higher levels of both extrinsic intrinsic motivation for weight management (p's≤.02). Moreover, during the no-treatment follow-up phase, the trajectories of weight regain did not significantly differ between WBWL and WBWL+$ (p=.58). Extrinsic motivation was not a significant mediator of treatment outcomes.
CONCLUSIONS
Modest financial incentives delivered consistent with behavioral economics and behavior change theories do not undermine intrinsic motivation for weight management during obesity treatment; in fact, they yield higher levels of both extrinsic and intrinsic motivation. Additional research is needed to better understand the mechanisms by which incentives improve outcomes in health behavior change interventions.
目的
探讨（a）与无激励措施的相同干预相比，包含经济激励的肥胖治疗是否能产生更高水平的体重管理外在动机；（b）体重管理的外在动机是否介导或解释了两种干预在体重减轻结果上的差异；以及（c）是否有证据表明经济激励及相关外在动机“挤出”了体重控制的内在动机。
方法
参与者（N = 153，80.4%为女性；BMI = 33.2±5.9）被随机分配到一个为期3个月的基于网络的行为减肥计划（WBWL）或相同计划加上符合行为经济学和行为改变理论的小额经济激励措施（WBWL + $）。在基线、治疗后（第3个月）以及9个月的无治疗随访期（第12个月）客观评估体重。使用治疗自我调节问卷的修改版在第3个月和第12个月评估体重管理的内在和外在动机，增加了专门针对与激励相关的外在动机的问题。
结果
与单独的WBWL相比，WBWL + $有更好的体重减轻效果以及更高水平的体重管理外在和内在动机（p值≤0.02）。此外，在无治疗随访期，WBWL和WBWL + $之间体重反弹的轨迹没有显著差异（p = 0.58）。外在动机不是治疗结果的显著中介因素。
结论
符合行为经济学和行为改变理论的适度经济激励措施在肥胖治疗期间不会破坏体重管理的内在动机；事实上，它们会产生更高水平的外在和内在动机。需要进一步研究以更好地理解激励措施改善健康行为改变干预结果的机制。
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