Less carrot more stick: promoting health behavior change with deposit contracts

Buisonjé, D.R. de (2024)

Doctoral Thesis

Two types of financial incentives can help improve healthy lifestyles: carrots (a reward where one can gain something) and sticks (a deposit contract where one can lose something). In a deposit contract, participants deposit own money and can lose or earn it back depending on lifestyle changes. We studied the potential of deposit contracts to stimulate a healthy lifestyle.
A smartphone app was developed together with the Swiss university ETH Zurich to conduct experimental research into the effects of deposit contracts. In addition, we collaborated with the American company WayBetter to observe the effects of commercially available deposit contracts. Finally, the opinion of people with cardiovascular disease and healthcare professionals regarding financial incentives and deposit contracts for lifestyle change was investigated.
The results show that deposit contracts can have strong effects on exercise behavior (daily step counts) in the short term. The results also show that voluntary participation in deposit contracts is limited, but can be increased by doubling the amount deposited and by allowing participants to determine the amount themselves. Finally, healthcare providers think it is a good idea to use financial incentives, but people with cardiovascular disease themselves are skeptical about the use of deposit contracts.

• Lifestyle change
• Cardiovascular disease
• Financial incentives
• Deposit contracts
• Loss aversion
• Gamification
• Health behavior change
• Physical activity

• All authors: Buisonjé, D.R. de
• Supervisor: Evers, A.W.M.
• Co-supervisor: Kemps, H.M.C.; Reijnders, T.
• Committee: Rombouts, S.A.R.B.; Dijk, W.W. van; Adriaanse, M.A.; Atsma, D.E.; Veling, H.
• Qualification: Doctor (dr.)
• Awarding Institution: Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University
• Date: 2024-02-29
• ISBN (print): 9789464837698
• Sponsorship: Studies published in this dissertation were supported by The Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON2016-12 BENEFIT, ZonMw (The Netherlands Organization for Health Research and Development), Leiden University and the members of the BENEFIT consortium. This work was performed in the framework of the Medical Delta program eHealth & selfmanagement for a healthy society. Medical Delta is gratefully acknowledged for financial support for the printing costs of this thesis.