Insights into Action: A Mega Study to Promote Sustainable Behaviour Change

Intervention is delivered via the Vitality Mobile Application (Vitality App). Each day, individuals will be shown one of 5 cards, which serve as the intervention:

1. Control – simple reminder
2. Personalised forward looking goal reminder
3. Loss aversion
4. Authority nudge/ancillary benefit gain
5. Resolution/fresh start effect

Intervention is delivered via the Vitality Mobile Application (Vitality App). Each day, individuals will be shown one of 5 cards, which serve as the intervention:

1. Control – simple reminder:
"Remember to earn your points
Keep tracking activity to earn points and rewards
<CTA> How to earn points <links to How to earn points> MOVE MORE: https://members.vitality.co.uk/my-points/how-to-earn-points#move-more>"
Justification: Simple reminders have been shown to effectively prompt action by making goals more salient. Reminders can significantly improve adherence to desired behaviours (Milkman et al., 2011). This nudge provides a straightforward reminder to keep users engaged in tracking activities, thus fostering consistent participation.

2. Personalised forward looking goal reminder:
"You’re close to earning a coffee
Almost enough points for a Caffè Nero reward
<CTA> How to earn points <links to How to earn points> MOVE MORE: https://members.vitality.co.uk/my-points/how-to-earn-points#move-more>"
Justification: Highlighting progress towards a goal can boost motivation. According to the Goal Gradient Hypothesis (Hull, 1932), individuals are more motivated as they perceive themselves to be closer to achieving their goals. This nudge leverages this principle by emphasizing the proximity to earning a reward, thereby encouraging continued effort. Koo and Fishbach (2012) found that framing progress in a way that emphasizes closeness to the goal (e.g., "You're close to earning a coffee") can enhance motivation more than framing it in terms of what has already been accomplished. This is because the perceived distance to the goal influences the intensity of goal-directed behaviour.

3. Loss aversion:
"Exercise more to protect your rewards
Time is running out to earn a Caffè Nero reward
<CTA> How to earn points <links to How to earn points> MOVE MORE: https://members.vitality.co.uk/my-points/how-to-earn-points#move-more>"
Justification: Loss aversion is a well-established concept in behavioural economics, indicating that people prefer to avoid losses rather than acquire equivalent gains. This concept, introduced by Kahneman and Tversky (1979), explains why individuals are more motivated to prevent losing something than to gain something of equal value. In the context of health interventions, loss aversion has been shown to be particularly effective. Patel et al. (2016) conducted a study where financial incentives were framed as potential losses rather than gains to encourage physical activity. The study found that participants who faced the prospect of losing money if they did not meet activity goals were more motivated and showed higher levels of physical activity compared to those who were offered financial rewards for achieving the same goals. By emphasizing the potential loss of a near-earned reward, such as the Caffè Nero reward in the given message, the nudge effectively leverages the principle of loss aversion. This encourages users to engage in the desired behaviour (exercising) to avoid the feeling of losing out on the reward, thereby increasing overall engagement and adherence.

4. Authority nudge/ancillary benefit gain:
"Improve your quality of sleep
Latest evidence suggests exercise can improve sleep
<CTA> Find out more <links to https://www.vitality.co.uk/magazine/how-to-get-the-zs-you-deserve-6-common-sleeping-myths-put-to-bed/>"
Justification: The Authority Nudge involves leveraging the influence of perceived authority figures to encourage behaviour change. This concept is supported by research indicating that individuals are more likely to comply with suggestions or directives from those they view as credible experts (Osman, 2018).cWhen health recommendations are presented as evidence-based and endorsed by experts, they are perceived as more trustworthy and compelling.By framing the message around authoritative evidence that exercise improves sleep, this nudge leverages the authority principle and aims to encourage individuals to engage in regular physical activity.


5. Resolution/fresh start effect:
"Make 2024 the year you move more
Hit your weekly points goal to start the year well
<CTA> How to earn points <links to How to earn points> MOVE MORE: https://members.vitality.co.uk/my-points/how-to-earn-points#move-more>"
Justification: The fresh start effect, identified by Dai, Milkman, and Riis (2014), refers to the increased motivation to pursue goals following temporal landmarks, such as the New Year. This nudge capitalizes on this effect by framing the new year as an opportunity to establish and commit to new health goals, thereby enhancing motivation.

2024-03-18

2024-04-22

Physical Activity (PA) behaviour, measured in PA days and PA points

Physical Activity (PA) behaviour, measured in PA days and PA points:

1. PA days refer to how many days a person has recorded PA. this can be from gym vists, or from biometricallly recorded PA from digital devices (smartphones and watches)

2. Vitality assigns points to members for doing PA. Points calculated using 'MET point mapping' and adjusted with internal measures. (METS offer a practical method for measuring PA as a multiple of the resting metabolic rate. METS are routinely used in the literature to describe the aerobic power of an individual. One MET is defined as the amount of oxygen consumed while sitting at rest. Each activity is then benchmarked against the resting MET value. For example, a brisk walk has a value of 4 METS, indicating an individual is exerting four times the energy than they would if they were sitting still (Je-é et al., 1990).)

Long term PA behaviour/habits measured in PA days and PA points

Experimental Design

Study Title: Mega Study on Physical Activity Nudges among Vitality UK Members

Introduction: Non-communicable diseases (NCDs) account for 74% of all deaths globally, with physical inactivity being a significant factor. In the UK, over 25% of adults fall below recommended activity levels. This study investigates the effectiveness of different nudges in promoting physical activity (PA) among individuals, using a mega study framework to compare five interventions.


Objectives:
1. Evaluate the effectiveness of five different nudges on increasing PA levels.
2. Determine the sustainability of PA behavior changes.
3. Provide insights for public health strategies to combat physical inactivity.

Methodology:

Study Design:
This is a randomized controlled trial (RCT) with 90,000 Vitality UK members, randomly assigned to one of five groups: one control group with a simple reminder and four treatment groups receiving different nudge interventions.

Population and Sample Size:
- Population: Vitality health insurance members who have opted into the rewards program and engaged with a baseline incentive program.
- Sample Size: 90,000 participants

Inclusion Criteria:
- Age 18 and above
- Current Vitality health insurance members
- Opted into the Vitality rewards program (VAR)
- Prior engagement with the Vitality program

Exclusion Criteria:
- Medical conditions prohibiting physical activity
- Not opted into Vitality and VAR or not syncing devices for PA tracking

Interventions:
Participants will be assigned to one of the following groups:
1. Control – simple reminder
2. Personalized forward-looking goal reminder
3. Loss aversion
4. Authority nudge/ancillary benefit gain
5. Resolution/fresh start effect

Data Collection:
- Baseline Data: Demographic information, baseline PA levels, and health metrics.
- Intervention Data: Engagement with nudges, changes in PA levels, and adherence to PA recommendations.
- Outcome Data: Objective and biometrically verified PA data, collected through wearable devices and Vitality's digital health platform.

Outcome Measures:
- Primary Outcome: Change in PA levels from baseline, measured in PA days and PA points.
- Secondary Outcomes: Sustained PA levels at follow-up intervals (3 months, 6 months), subgroup analyses based on demographics and baseline PA levels.

Data Analysis:
- Primary Analysis: Comparison of PA levels between control and treatment groups using statistical tests and regression analysis.
- Secondary Analysis: Subgroup analyses to explore variations in intervention effectiveness by demographics and baseline PA levels.
- Sensitivity Analysis: Assess robustness of findings by varying analytical assumptions and methods.

Results:
Ongoing analysis will focus on the comparative effectiveness of each nudge intervention. Initial findings will be reported after the six-week intervention period, with follow-up analyses at 3 and 6 months post-intervention.

Discussion:
The study will provide insights into behavior change mechanisms, sustainability of PA increases, and public health policy implications. Findings will help develop strategies to reduce the global burden of diseases associated with physical inactivity.

Experimental Design

Study Title: Mega Study on Physical Activity Nudges among Vitality UK Members

Introduction: Non-communicable diseases (NCDs) account for 74% of all deaths globally, with physical inactivity being a significant contributing factor. In the UK, over 25% of adults fall below recommended activity levels. This study aims to investigate the effectiveness of different nudges in promoting physical activity (PA) among individuals, leveraging a mega study framework to compare five interventions simultaneously.

Objectives:
The primary objective of this study is to identify effective strategies for fostering regular physical activity habits among Vitality UK members. We aim to:
1. Evaluate the relative effectiveness of five different nudges on increasing PA levels.
2. Determine the sustainability of PA behavior changes induced by these nudges.
3. Provide actionable insights for evidence-based public health strategies to combat physical inactivity.

Methodology:

Study Design:
This is a randomized controlled trial (RCT) involving 90,000 participants from Vitality UK's member population. Participants will be randomly assigned to one of five groups: one control group/simple reminder and four treatment groups, each receiving a different nudge intervention.

Population and Sample Size:
- Population: Vitality health insurance members who have opted into the rewards program and have prior engagement with a baseline incentive program.
- Sample Size: 90,000 participants

Inclusion Criteria:
- Age 18 and above
- Current Vitality health insurance members
- Opted into the Vitality rewards program (VAR)
- Prior engagement with Vitality program

Exclusion Criteria:
- Individuals with medical conditions prohibiting physical activity
- Individuals that have not opted into Vitality and VAR or have not synced their devices for PA tracking

Interventions:
Participants will be assigned to one of the following groups:
1. Control – simple reminder
2. Personalised forward looking goal reminder
3. Loss aversion
4. Authority nudge/ancillary benefit gain
5. Resolution/fresh start effect

Data Collection:
- Baseline Data: Collected on demographic information, baseline PA levels, and health metrics.
- Intervention Data: Engagement with nudges, changes in PA levels, and adherence to PA recommendations.
- Outcome Data: Objective and biometrically verified PA data, collected through wearable devices and Vitality's digital health platform.

Outcome Measures:
- Primary Outcome: Change in PA levels from baseline, measured in PA days and PA points.
- Secondary Outcomes: Sustained PA levels at follow-up intervals (3 months, 6 months), subgroup analyses based on demographics and baseline PA levels.

Data Analysis:
- Primary Analysis: Comparison of PA levels between control and treatment groups using statistical tests and regression analysis.
- Secondary Analysis: Subgroup analyses to explore variations in intervention effectiveness by demographics and baseline PA levels.
- Sensitivity Analysis: Assess the robustness of findings by varying analytical assumptions and methods.

Results:
Ongoing analysis will focus on the comparative effectiveness of each nudge intervention. Initial findings will be reported after the completion of the six-week intervention period, with follow-up analyses conducted at 3 and 6 months post-intervention.

Discussion:
The study will provide insights into the mechanisms of behavior change, the sustainability of PA increases, and implications for public health policies. The findings will contribute to developing strategies to reduce the global burden of diseases associated with physical inactivity.

Randomisation done in office by a computer

Individual

No

N/A

55,170 unique individuals

55,170 unique individuals