Reisgies Helena, Shukri Arim, Scheckel Benjamin, Karasch Olaf, Wiesen Daniel, Stock Stephanie, Müller Dirk
Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany; Department of Business Administration and Health Care Management, University of Cologne, Universitätsstraße 91, 50931 Cologne, Germany.
Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany.
Soc Sci Med. 2023 Oct 22;338:116341. doi: 10.1016/j.socscimed.2023.116341.
For beneficial health outcomes sufficient and sustained physical activity levels are recommended but difficult to achieve. This systematic review evaluates the effectiveness of behavioural economics (BE)-informed interventions to increase individuals' physical activity level in the long-term.
We conducted a systematic literature search using Medline (via PubMed), PsycInfo, and EconLit (both via EBSCOhost) including randomized controlled trials of at least 24 weeks duration that evaluated BE-informed interventions to promote physical activity in adults. Potential BE approaches were commitment devices, social incentives, motivational feedback, goal setting, gamification, and financial incentives. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for (cluster-) randomized trials. A random-effects meta-analysis was conducted to summarize the outcome measure daily step count.
Based on 13 studies with 4347 participants, the BE-informed interventions most often applied were commitment lotteries (n = 8) and social incentives (n = 7). Risk of bias assessment classified five studies as low, six as moderate, and two as high risk of bias. Significant results on study level towards BE-informed interventions were observed for commitment lotteries (n = 3) and gamification (n = 4). Including healthy and diseased individuals in the meta-analysis (n = 10), the increase in daily step count in experimental groups compared to control was statistically significant for the intervention period (standardized mean difference (SMD) = 0.13, 95%-CI: 0.00-0.25, I = 59%, p = 0.04) but not for the follow-up (SMD = 0.08, 95%-CI: -0.00-0.17, I = 17%, p = 0.06). Excluding high risk of bias studies (n = 2) resulted in statistically significant effects with reduced heterogeneity for both periods.
Our review reveals a potential effect of BE-informed interventions to promote physical activity. The small effect underlines the importance to evaluate the behavioural channels which may explain the heterogeneity in individuals' responses to BE strategies.
为实现有益健康的结果，建议保持充足且持续的身体活动水平，但这很难做到。本系统评价评估了基于行为经济学（BE）的干预措施对长期提高个体身体活动水平的有效性。
我们使用Medline（通过PubMed）、PsycInfo和EconLit（均通过EBSCOhost）进行了系统的文献检索，纳入了至少为期24周的随机对照试验，这些试验评估了基于BE的干预措施对促进成年人身体活动的效果。潜在的BE方法包括承诺机制、社会激励、动机反馈、目标设定、游戏化和经济激励。使用修订后的Cochrane偏倚风险工具对（整群）随机试验进行偏倚风险评估。进行随机效应荟萃分析以汇总每日步数这一结局指标。
基于13项研究共4347名参与者，最常应用的基于BE的干预措施是承诺抽奖（n = 8）和社会激励（n = 7）。偏倚风险评估将5项研究归类为低风险，6项为中度风险，2项为高风险。在研究层面，观察到承诺抽奖（n = 3）和游戏化（n = 4）对基于BE的干预措施有显著效果。在荟萃分析中纳入健康和患病个体（n = 10），与对照组相比，实验组在干预期的每日步数增加具有统计学意义（标准化均数差（SMD）= 0.13，95%置信区间：0.00 - 0.25，I² = 59%，p = 0.04），但在随访期无统计学意义（SMD = 0.08，95%置信区间：-0.00 - 0.17，I² = 17%，p = 0.06）。排除高偏倚风险研究（n = 2）后，两个时期均产生了具有统计学意义的效果且异质性降低。
我们的评价揭示了基于BE的干预措施对促进身体活动的潜在效果。这种微小的效果凸显了评估行为渠道的重要性，这些渠道可能解释个体对BE策略反应的异质性。
