Health Promotion through Monetary Incentives: Evaluating the Impact of Different Reinforcement Schedules on Engagement Levels with a mHealth App

Background: Financial rewards can be employed in mHealth apps to effectively promote health behaviors. However, the optimal reinforcement schedule—with a high impact, but relatively low costs—remains unclear. Methods: We evaluated the impact of different reinforcement schedules on engagement levels with a mHealth app in a six-week, three-arm randomized intervention trial, while taking into account personality differences. Participants (i.e., university staff and students, N = 61) were awarded virtual points for performing health-related activities. Their performance was displayed via a dashboard, leaderboard, and newsfeed. Additionally, participants could win financial rewards. These rewards were distributed using a fixed schedule in the first study arm, and a variable schedule in the other arms. Furthermore, payouts were immediate in the first two arms, whereas payouts in the third arm were delayed. Results: All three reinforcement schedules had a similar impact on user engagement, although the variable schedule with immediate payouts was reported to have the lowest cost per participant. Additionally, the impact of financial rewards was affected by personal characteristics. Especially, individuals that were triggered by the rewards had a greater ability to defer gratification. Conclusion: When employing financial rewards in mHealth apps, variable reinforcement schedules with immediate payouts are preferred from the perspective of cost and impact.