Ryu Eric, Farraday David, Fanaroff Alexander C, Coratti Samantha, Chokshi Neel P, Zhu Jingsan, Szymczak Julia E, Russell Louise B, Norton Laurie, Small Dylan, Volpp Kevin G, Klaiman Tamar
Department of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
BMC Public Health. 2025 May 16;25(1):1804. doi: 10.1186/s12889-025-22717-0.
Physical activity reduces the risk of major cardiovascular events, but many people who are most at-risk do not get enough exercise. In the BE ACTIVE randomized controlled trial, - a study in which text messages were used to communicate with participants- game playing (gamification), financial incentives, and the combination of gamification plus financial incentives increased physical activity from baseline more than control over a 12-month intervention period. Participants randomized to gamification plus financial incentives maintained a significantly greater increase than control over the 6-month post-intervention follow-up. To understand the impact of the interventions on motivation and performance we conducted semi-structured interviews with a subset of participants.
Using extreme case sampling, interviewees were selected from participants who were randomized to an intervention arm and were identified as either high or low performers based on their change from baseline to the end of the trial in mean daily step count. During semi-structured telephone interviews, participants were asked their thoughts and feelings about the trial, motivations for participation, and about specific aspects of the intervention. Interviews were conducted within 6 months after the participant completed participation in the trial. Thematic analysis was conducted inductively and deductively, and identified themes were mapped onto the COM-B Framework to understand the interaction between different themes.
We achieved saturation after conducting interviews with 55 participants (30 high performers and 25 low performers); 19 in the gamification arm, 19 in the financial incentives arm, and 17 in the gamification plus financial incentives arm. Based on qualitative interviews, the importance of individual accountability via goal setting and feedback appears to be a primary factor in behavior change in this trial; however, the combination of accountability with the opportunity of access to the intervention had additional impact on the results.
Gamification and financial incentives both increased physical activity in the BE ACTIVE study, but results may be improved by tailoring interventions based on participants' personal traits and level of social support to optimize motivation. (328 words) TRIAL REGISTRATION: NCT03911141 Registration date: 04/09/2019.
体育活动可降低重大心血管事件的风险，但许多高危人群缺乏足够的锻炼。在“积极行动”随机对照试验中（该研究通过短信与参与者沟通），游戏化、经济激励以及游戏化加经济激励的组合，在为期12个月的干预期内，相较于对照组，能使身体活动水平从基线水平有更大提升。随机分配到游戏化加经济激励组的参与者在干预后6个月的随访期内，相较于对照组，身体活动水平的提升仍显著更大。为了解这些干预措施对动机和表现的影响，我们对部分参与者进行了半结构化访谈。
采用极端案例抽样法，从随机分配到干预组的参与者中选取受访者，并根据他们从基线到试验结束时每日平均步数的变化，将其确定为高表现者或低表现者。在半结构化电话访谈中，询问参与者对试验的想法和感受、参与动机以及干预措施的具体方面。访谈在参与者完成试验后的6个月内进行。采用归纳法和演绎法进行主题分析，并将确定的主题映射到COM - B框架上，以了解不同主题之间的相互作用。
在对55名参与者（30名高表现者和25名低表现者）进行访谈后，我们达到了饱和状态；游戏化组19人，经济激励组19人，游戏化加经济激励组17人。基于定性访谈，通过目标设定和反馈实现个人问责的重要性似乎是该试验中行为改变的主要因素；然而，问责与获得干预措施机会的结合对结果有额外影响。
在“积极行动”研究中，游戏化和经济激励都增加了身体活动，但通过根据参与者的个人特质和社会支持水平调整干预措施以优化动机，可能会改善结果。（328字）试验注册号：NCT03911141 注册日期：2019年9月4日。
