Financial Incentives for Health Behavior Change: A Narrative Review of Reviews

Abstract Background Financial incentives (FIs) are increasingly used to promote health behaviors, like smoking cessation, physical activity, healthy eating, vaccination or screening. This review aimed to evaluate the effectiveness of FIs in health promotion and prevention (HP&P) and key factors influencing success. Methods A narrative review of reviews was conducted. Out of 154 articles, 39 met the inclusion criteria after screening title, abstract, and full-texts. Only literature reviews and meta-analyses were included; review protocols, articles with marginal mentions of FIs, and articles focusing on non-financial or self-incentives were excluded. Results FIs are generally effective in promoting health behavior change, but their impact varies depending on several factors (targeted behaviors, populations, type of incentive, duration, outcome measures, context). FIs are more effective when targeting unique or less frequent behaviors (e.g. vaccination or screening) instead of repeated behaviors (e.g. healthy eating, physical activity). Populations with lower socioeconomic status respond more positively. Incentives tied to specific outcomes or structured as deposit contracts are more effective. Combining FIs with behavioral or structural interventions produces better outcomes. However, evidence on their long-term impact remains limited. Conclusions FIs show considerable potential for HP&P. While short-term outcomes are promising, the long-term impact remains uncertain. Combining FIs with other behavioral and structural interventions seems essential to ensure effectiveness. More research is needed to understand the efficacy, acceptability, and broader applicability of this type of interventions. Key messages • Financial incentives can effectively promote short-term health behavior change, with stronger effects for specific behaviors and among low SES groups. • Sustained impact requires combining financial incentives with other behavioral and structural interventions.