Facilitators and Barriers to Implementation of Financial Incentive Interventions for Health Behaviour Change: A Systematic Review Protocol

Abstract

Background Health behaviours, whether protective or harmful in nature, significantly impact health outcomes. Nevertheless, it is recognised that adherence to a healthy lifestyle and enabling behaviour change remains a significant challenge. In efforts to optimise healthcare delivery to ensure positive health outcomes, behavioural economics has provided critical insights on various tools aimed at behaviour change, one of which is financial incentives. However, financial incentive programmes are complex, heterogeneous in design and context-dependant which renders them challenging to implement in real-life settings. Hence, careful consideration to facilitators of and barriers to their implementation to maximise their use is warranted. Aim This study aims to investigate the factors that influence the implementation of financial incentive programmes targeted at any behaviour change in real-life settings, as reported by key stakeholders, to guide future implementation initiatives. We will also conduct a sensitivity analysis comparing smoking to other behaviours, given its significant detrimental impact on health outcomes and its role in widening health disparities. Methods A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Rapid Review 2020 guidelines, as well as expert recommendations, will be undertaken, to identify stakeholder-reported challenges and enablers of implementation of financial incentive programmes globally. Seven electronic databases, including MEDLINE, EMBASE and CENTRAL, will be searched for papers published from inception to June 2024. A narrative synthesis of the findings will be presented and subsequently mapped to the Theoretical Domains Framework and the Behaviour Change Wheel. Sensitivity analysis comparing findings from smoking studies will be compared to other behaviours. Ethics and dissemination Ethical approval is not required for the review. The protocol and rapid review will be submitted to an open-access peer-reviewed journal for publication. The review findings will allow for the design of effective financial incentive interventions informed by theory, which are adaptable and applicable across various settings.