Boosting Physical Activity among Individuals with Low Engagement through Double-Point Incentives in a Community-Based mHealth Intervention: A Retrospective Observational Study (Preprint)

BACKGROUND Community-based mHealth interventions for physical activity are being implemented in many countries; however, maintaining user engagement remains challenging. Therefore, the impact of additional short-term monetary incentives on low-engaged (LE) participants needs to be elucidated as a potential alternative. OBJECTIVE This study aimed to evaluate the effectiveness of an additional financial incentive, specifically a double-point event, within a community-based mHealth intervention designed to increase physical activity among individuals with low engagement. METHODS Using retrospective data from a Seoul Metropolitan Government mHealth intervention, we evaluated the effects of a one-week double-point incentive on participants’ physical activity. During three registration phases from November to December 2021, 50,145 individuals enrolled. Our analysis focused on the LE group (n=27,833, 55.5%), who averaged fewer than three days per week of meeting the daily step challenge (at least 7,000 steps) before the intervention. We performed a segmented regression analysis to assess changes in physical activity before and after the event. Multivariable logistic regression and Cox proportional hazards models were employed to identify factors associated with improving and maintaining physical activity after starting the intervention. RESULTS Out of 27,833 LE participants, only 137% (n=3,835) improved their physical activity. Daily challenge engagements per week increased by 253 times, and average daily steps increased by 192497 (SMD=0.55, 95% CI: 0.51-0.58). In multivariable logistic regression, older age was significantly associated with improved physical activity immediately after starting the intervention. However, 50% of the improved group was likely to return to low engagement three weeks after the intervention ended. Older age and use of certain wearable devices were associated with the maintenance of physical activity after the intervention. CONCLUSIONS Double-point incentives in the short term may serve as a cue-to-action to motivate low-engagement targets; however, they do not seem to guarantee long-term maintenance in the context of community-based mHealth interventions. Further research is needed to identify additional strategies beyond monetary incentives to sustain long-term healthy behavior