Cardiovascular disease patients’ views on using financial incentives for health behavior change

Are deposit contracts acceptable?

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Background: There is an urgent need to find new approaches that improve long-term adherence to a healthy lifestyle for people with cardiovascular disease (CVD). Deposit contracts (a financial incentive in which the participant deposits own money) are inexpensive and effective, but acceptability among CVD patients is unclear. This study investigated the acceptability of a deposit contract intervention for physical activity among CVD patients. Methods: We approached CVD patients through the Harteraad patient panel of the Dutch CVD patient organization and asked them to fill in an online survey. In total (N = 659) CVD patients with a mean age of 66.2 years completed the survey. The survey assessed acceptability of deposit contracts, responses to a concrete example of a deposit contract for physical activity behavior change, and suitable moments for implementation. Results: Overall, half of the participants (45.6%) confirmed needing extra commitment to maintain lifestyle change. Yet, a small part of the sample was convinced by the idea that losing money could be motivating (18.8%) and indicated that they would be willing to deposit money themselves (13.2%). Responding to a concrete example of a deposit contract for physical activity, a quarter of the sample (26.2%) reported there was a chance they would participate. Furthermore, 27.1% of the participants found the deposit contract effective and 27.4% found it acceptable. Exploratory analyses showed that a subgroup of younger and lower educated participants responded more favorably. Opinions on when to start with a deposit contract were mixed. Conclusions: Because acceptability was generally found to be low, future research should also investigate strategies to leverage commitment principles for CVD patients without a cash deposit requirement. When deposit contracts are offered to CVD patients in practice, we recommend offering them as an optional, additional element to existing interventions that patients can opt-in to.