Policy support – Incentive models to improve adherence

Role this area should play in the mHealth space

A high proportion of mobile solutions target behavioural interventions, or involve regular monitoring or action for which user adherence is a critical success factor. An aspect that may not need specific incentives is where the mHealth solution is helping to keep somebody’s health condition stable, avoid complications or deterioration, when the reinforcing feedback for adherence is the maintenance of a good health state. It becomes more challenging when the sustained use of an mHealth intervention is required for preventive or lifestyle changes, or to take a preventative medication, where non-compliance does not result in any short-term adverse health status implications for the user. An adherence incentive strategy can therefore be an important component of the design of an mHealth programme in order to assure success.

Current challenges and limitations
  • Adherence incentives are not often considered when designing an mHealth programme.
  • Evidence of what incentives work is still emerging.
  • It may not seem acceptable to public agencies funding mHealth programmes to offer financial incentives, and therefore it is necessary to share positive experiences when these have succeeded, to help reinforce the acceptability of this approach.


What benefit could this bring to adopters of this innovation?
Improved adherence would be expected to improve the impact and health outcomes of any mHealth intervention. Admittedly the cost of any financial or reward-based incentives would need to be considered as part of the total cost of running the programme.
How does it contribute to major EU policy priorities? (e.g. EHDS, COVID-19, DTHC etc.)


Gamification to improve adherence

Approach or solution A short paper illustrating how the inclusion of gamification can incentivise people, especially in this case paediatric patients, to comply with a clinical management protocol.   Organisation or initiative Research publication: MHealth Games as Rewards: Incentive or Distraction? Gary, K., Stoll, R., Rallabhandi, P., Patwardhan, M., Hamel, D., Amresh, A., ... &… ...

Reward points incentive model to improve adherence

Approach or solution An examination of the design of a points-based reward system, looking specifically at which features of the scheme proved to have the greatest adherence impact   Organisation or initiative Research publication: Brower, J., LaBarge, M. C., White, L., & Mitchell, M. S. (2020). Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal… ...

Financial incentive models to improve adherence (II)

Approach or solution A comparison of two financial incentive models to improve adherence to a physical activity programme, comparing a gain and a loss model.   Organisation or initiative Research publication: Hafner, M., Pollard, J., & Van Stolk, C. (2020). Incentives and physical activity: An assessment of the association between Vitality's Active Rewards with Apple… ...

Financial incentive models to improve adherence (I)

Approach or solution Reimbursing the cost of an mHealth tool through adherence rewards   Organisation or initiative Research publication: Lee, J., Bae, S., Park, D., Kim, Y., & Park, J. (2020). The effectiveness of a monetary reimbursement model for weight reduction via a smartphone application: a preliminary retrospective study. Scientific Reports, 10(1), 1-7.   URL… ...

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What is on the horizon?

There are increasing cyber-secure means to connect mobile health tools to financial or points legers that can administer incentives. This will make it easier to adopt reward-based adherence schemes in the future, in situations where they are acceptable.
Gamification experience is growing, and their graphical and algorithmic sophistication is increasing, making these more likely to be successful, and cheap to adopt, in the future.