Incentives motivate behavior change, yet there is a widening gap between those of us who use incentives to encourage healthy behavior and those of us who prefer not to provide rewards to encourage healthy behavior. Well, both camps are right, and we're here to bridge the gap.
Natural Incentives vs. Artificial Incentives
Incentives are little more than providing someone a good reason to do something. For example, when Ryan helps his brother-in-law move a new sofa into his house, he is rewarded by the feeling of doing something nice for a family member. This is an example of a reward that occurs naturally for performing a behavior. He does the deed because it feels good, and it's what his brother-in-law and him do for each other.
Compare this to when Drew's wife promises that if he cleans the kitchen he can choose the movie for their date night. Is Drew happy the kitchen is clean? Sure. But the real reward for him is knowing that this weekend he'll be able to watch the new Woody Allen movie rather than The Help. This clever system Drew's wife uses to keep the house in order is an example of an artificial reward.
In other words, Drew is performing a task that should be performed anyway (cleaning the kitchen) but the reward he's receiving is not derived directly from that task. These simplistic examples illustrate how natural and artificial rewards motivate our behavior, but you may know them better by the types of motivation they create: intrinsic and extrinsic motivation.
How We Are Motivated
Intrinsic motivation comes from within. In corporate wellness, we often see this among "high performing" individuals who have the drive to exercise regularly, eat the right foods, and take care of their mental and physical health. We often see intrinsic motivation as the type of motivation everyone "should" have.
Predictably, extrinsic motivation is the result of an artificial incentive and is motivation that is precipitated by an outside factor such as cash, prizes, points, or rewards that are personally meaningful (like getting to choose the movie on date night). Some wellness professionals have propagated the idea that using incentives in wellness programs is bad and that intrinsic motivation is somehow better than extrinsic motivation.
These arguments are based on evidence that conclusively shows that while artificial incentives (e.g., cash and prizes) are highly effective at motivating behavior change, modified behaviors often revert back to their original state once the incentive is removed. Thus, the argument is that artificial incentives cannot motivate behavior change for the long term and are therefore valueless.
The conclusion that incentives don't work is wrong, and it exposes an industry-wide misuse of the term "incentive" to simply imply artificial rewards. As we've demonstrated, both intrinsic and extrinsic motivators are the result of incentives. The external motivator of receiving a cash reward for losing weight is an incentive, as is the intrinsic desire to be healthier for your child.
Overcoming Immediacy is the Key to Behavior Change
Eating a piece of chocolate cake has a strong natural incentive - the immediate gratification of enjoying chocolate cake. For almost everyone, the immediate reward of enjoying chocolate cake is stronger than the idea of being healthy. Thus, people choose to eat the chocolate cake, us included.
Our experience in wellness comes from helping individuals lose weight, so this chocolate cake example is important to us. The fundamental problem we must solve is this: For an overweight person, how can we make the idea of "being healthy" overpower the immediate gratification of enjoying that piece of chocolate cake? In other words, we have to figure out a way to flip the strength of these competing incentives.
Debating the value of intrinsic versus extrinsic motivation misses the much larger point, which is the strength of incentives. In many cases, artificial incentives provide strong motivation for healthy behavior change. Just think: when one of your employees has a choice between eating a carrot or eating chocolate cake, you know very well which one they will choose.
But if that same employee had the choice between receiving $50 or eating chocolate cake, which do you think they'll pick? Of course, almost all of them will choose the $50 over the chocolate cake. The objection that the removal of an extrinsic incentive will result in a changed behavior slipping back to the old behavior is valid.
If you offer an employee $50 to not eat cake, they'll make the healthy choice. But if you don't offer $50 next time, then the employee probably picks the cake. And this should not be surprising. Consider this: If your employer stopped paying you would you still go to work? Probably not. Does that mean you don't care about your job or the work you do?
No it doesn't. Similarly, when an external incentive is removed and a healthy behavior is lost, that doesn't mean the healthy behavior was valueless, or that an employee doesn't care about being healthy. It only means that a powerful incentive that had previously shaped a positive course of action was removed.
There is a larger issue underlying the intrinsic/extrinsic debate. We've heard dogmatic ideas about what behaviors people "should" practice and what "should" motivate them. Ideas like being healthy, living longer, even looking better "should" be motivating enough on their own. Well, obviously people aren't adequately motivated by those ideas, because our country has a growing obesity epidemic.
What is maddening for us wellness professionals is that all employees want to be healthy. Ask 100 of your employees if they want to be healthy, and all 100 of them will say yes. But as we know, just because they want to be healthy, doesn't mean that they will do what's necessary to get healthy.
By using artificial incentives (in this example, $50), we can change the decision-making process involved in choosing between carrots and chocolate cake. The financial incentive makes the carrots much more appealing by making the reward for the healthy behavior more immediate. Research has proven time and time again that strong incentives, such as financial rewards, create extrinsic motivation that leads to healthy behavior change in the short term.
Transitioning Incentives for Long-term Effectiveness
Artificial incentives are the key to motivating behavior change by helping people make healthy choices in the moment. But natural incentives (e.g., looking and feeling better, lowering blood pressure, fitting into smaller clothes) are critical to maintaining those healthy behaviors over time. Intrinsic motivators are terrible at getting people started, but they're good at facilitating long term change.
For example, a smart weight management strategy will use extrinsic incentives to jumpstart the weight loss process, then transition to intrinsic incentives to leverage those positive results. The debate over using intrinsic or extrinsic motivators is wrong. It is irrelevant whether a motivation is extrinsic or intrinsic, what matters is what works. Both natural and artificial incentives have their place, and both are necessary to motivate long term behavior change.
About the Author
Ryan Beckland and Drew Schiller are co-founders of Scale Down Challenge, an online platform that helps wellness programs administer healthy weight loss challenges for employees. The low cost, collaborative challenges help prevent weight-related medical diseases by using the power of incentives to motivate behavior change. Learn more at www.scaledownchallenge.com
