Objectives: To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty (PAL) Scheme, a multi-component intervention based on concepts similar to those that underpin a high-street loyalty card, aimed at encouraging habitual physical activity behaviour and maintained increases in mean steps/day.
Design: A cluster-randomised controlled trial and embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting: Office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland.
Participants: 853 participants (mean age 43.6 years (SD 9.6); 71% female) were randomly allocated by cluster to either the Intervention Group or (Waiting-List) Control Group.
Intervention: The six month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main Outcome Measures: The primary outcome was mean steps/day recorded using a sealed pedometer (Yamax Digiwalker CW-701, Japan) worn on the waist for seven consecutive days at six and 12 months post-intervention. Secondary outcomes included health, mental wellbeing, quality of life, work absenteeism and presenteeism and use of healthcare resources.
Results: The mean steps/day were significantly lower for the Intervention Group compared to the control group (6,990 [SD 3,078] vs 7,576 [SD 3,345] respectively, adjusted mean difference= -336, 95% CI: -612 to -60, P=0.02) at six months post-baseline, but not significantly lower at 12 months post-baseline. There was a small but significant enhancement of mental wellbeing, in the Intervention Group (difference between groups for the Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS] of 1.34 points, 95% CI: 0.48 to 2.20), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared to no intervention. The intervention was £25.85 (95% CI: -29.89, 81.60) more costly per participant but had no effect on QALYs (incremental QALY= -0.0000891, 95% CI: -0.008, 0.008).
Limitations: Significant re-structuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions: Overall, assignment to the Intervention Group resulted in a small but significant decline in mean pedometer-measured steps/day at six months relative to baseline, compared to the waiting-list control group. The PAL Scheme was deemed to be not cost-effective compared to no intervention, primarily due to no additional QALY gained through the intervention.
Future Work: Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
|Number of pages||114|
|Journal||Public Health Research|
|Publication status||Published - Aug 2019|