Evaluating the Carrot Rewards App, a Population-Level Incentive-Based Intervention Promoting Step Counts Across Two Canadian Provinces: A Quasi-Experimental Study.
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BACKGROUND The Carrot Rewards application app was developed as part of an innovative public private partnership to reward Canadians with loyalty points exchangeable for retail goods travel rewards and groceries for engaging in healthy behaviors such as walking OBJECTIVE The purpose of this study was to examine whether a multi component intervention including goal setting graded tasks biofeedback and very small incentives tied to daily step goal achievement assessed by built in smartphone accelerometers could increase physical activity in two Canadian provinces British Columbia BC and Newfoundland and Labrador NL METHODS A 12 week quasi experimental single group pre post study was conducted Among eligible participants n 78 882 44 39 n 35 014 enrolled in the Carrot Rewards Steps walking program during the recruitment period June 13th July 10th 2016 During the two week baseline or run in period mean steps day were calculated for participants Thereafter participants earned incentives in the form of loyalty points worth 0 04 CAD every day they reached their personalized daily step goal i e baseline mean 1 000 steps level of first daily step goal Participants earned additional points worth 0 40 CAD for meeting their step goal 10 non consecutive times in a 14 day period called a Step Up Challenge Participants could earn up to 5 00 CAD during the 12 week evaluation period Upon meeting the 10 day contingency participants could increase their daily goal by 500 steps with the objective of gradually increasing the number of steps participants take each day by 3 000 Only participants with five or more valid days days with step counts between 1 000 and 40 000 during the baseline period were included in the analysis n 32 229 The primary study outcome was mean steps day by week and was analyzed using linear mixed effects models RESULTS Of the 32 229 participants with valid baseline data the mean age was 33 7 11 6 years and 66 11 21 306 32 229 were female The mean daily step count at baseline was 6 511 22 Just over half of users 50 69 16 336 32 229 were categorized as physically inactive accumulating less than 5 000 daily steps at baseline Results from the mixed effects models revealed statistically significant increases in mean daily step counts when comparing baseline with each Study Week PUnder 0001 Compared to baseline participants walked 115 70 more steps 95 CI 74 59 156 81 PUnder 0001 at Study Week 12 Users classified as high engagers app engagement above the sample median 48 13 15 511 32 229 in BC and NL walked 738 70 95 CI 673 81 803 54 PUnder 0001 and 346 00 95 CI 239 26 452 74 PUnder 0001 more steps respectively Among physically inactive high engagers 21 08 7 022 32 229 an average increase of 1 224 66 steps per day 95 CI 1160 69 1288 63 PUnder 0001 was observed Effect sizes were modest CONCLUSIONS Providing very small but immediate rewards for personalized daily step goal achievement as part of a multi component intervention increased daily step counts on a population scale especially for physically inactive individuals and individuals who engaged more with the walking program Positive effects in both BC and NL provide evidence of replicability