Effect of Incentives and Mailing Features on Online Health Program Enrollment
Open accessAbstract
Background With the growing use of Internet-based interventions, strategies are needed to encourage broader participation. This study examined the effects of combinations of monetary incentives and mailing characteristics on enrollment, retention, and cost effectiveness for an online health program.Methods In 2004, a recruitment letter was mailed to randomly selected Midwestern integrated health system members aged 21-65 and stratified by gender and race/ethnicity; recipients were randomly pre-assigned to one of 24 combinations of incentives and various mailing characteristics. Enrollment and 3-month retention rates were measured by completion of online surveys. Analysis, completed in 2005, compared enrollment and retention factors using t tests and chi-square tests. Multivariate logistic regression modeling assessed the probability of enrollment and retention.Results Of 12,289 subjects, 531 (4.3%) enrolled online, ranging from 1% to 11% by incentive combination. Highest enrollment occurred with unconditional incentives, and responses varied by gender. Retention rates ranged from 0% to 100%, with highest retention linked to higher-value incentives. The combination of a $2 bill prepaid incentive and the promise of $20 for retention (10% enrollment and 71% retention) was optimal, considering per-subject recruitment costs ($32 enrollment, $70 retention) and equivalent enrollment by gender and race/ethnicity.Conclusions Cash incentives improved enrollment in an online health program. Men and women responded differently to mailing characteristics and incentives. Including a small prepaid monetary incentive ($2 or $5) and revealing the higher promised-retention incentive was cost effective and boosted enrollment.
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Monetary incentives have been found to increase enrolment and assessment completion in online interventions.
“Monetary incentives have been found to increase enrolment and assessment completion in online interventions [64, 65].”
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- Authors
- Alexander, G. L., Divine, G. W., Couper, M. P., McClure, J. B., Stopponi, M. A., Fortman, K. K., Tolsma, D. D., Strecher, V. J., & Johnson, C. C.
- Affiliations
- Henry Ford Health (US)
- University of Michigan (US)
- Group Health Cooperative (US)
- Kaiser Permanente (US)
- HealthPartners (US)
- Corresponding author
- Alexander, Gwen L.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2008-05
- Volume
- 34
- Issue
- 5
- Pages
- 382-388
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC2442737
- OpenAlex
- W2088879312
- Cited by
- 80
- References
- 30
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 4 · 2019: 7 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 11 · 2013: 8 · 2012: 4
- FWCI
- 24.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (U19CA079689)
- Topics
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
- Keywords
- online health program, financial incentives, program enrollment, participant retention, cost-effectiveness, prepaid incentives, gender differences, race and ethnicity, online intervention, integrated health system
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Female, Health Promotion, Humans, Male, Middle Aged, Motivation, Postal Service, Sex Characteristics, Midwestern United States, Logistic Models, Patient Selection, Internet
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