„Walk to Beijing‟ – A mixed methods evaluation of a financial incentive scheme aimed at encouraging physical activity participation in Sandwell, West Midlands. Gemma Louise Hurst A thesis submitted in partial fulfilment of the requirement of Staffordshire University for the degree of Doctor of Philosophy May 2013

Abstract

Background. The many health benefits of physical activity are well established. In response to the
low levels of activity in Sandwell, UK, the ‗Walk to Beijing‘ (WTB) intervention aimed to increase
lifestyle physical activity using financial incentives (in combination with a health assessment,
pedometer and brief advice). Aim. To examine the benefits of a financial incentive scheme to
promote physical activity, specifically walking, in sedentary adults. Methods. A mixed methods
evaluation comprised: (1) outcome evaluation employing a pre-post intervention design to measure
three- and six- month changes in physical activity, physiological and self-reported health; (2)
process evaluation using semi-structured interviews to explore participant experiences, motivations
towards physical activity, incentivised health schemes and WTB participation; and (3) mixed methods
case-study approach using data at collected at six- and 12-month follow-up to further explore
sustainability of behaviour change. Results. Three-month data were available for 1082 participants
(64.5% of baseline sample). A statistically significant positive change from baseline to
three-month follow-up was observed for stage of change (p<.001, d=.63), which was maintained (but
not further improved) at six-months (p<.001, d=.64). Significant three- and six-month improvements
were also found in objective (e.g., BMI, waist-hip ratio, waist circumference and blood pressure)
and subjective (e.g., EQ-5D, SF12v2 and Theory of Planned Behaviour constructs) measures of health
status. At baseline, 41.7% of participants cited the financial incentive as influencing their
decision to take part. Qualitative data also identified that the financial incentive was the
primary motivator for some, but not all, individuals; other intervention components were also
motivators. Conclusion. Data suggested that financial incentives may promote participation in
lifestyle physical activity through aiding uptake and sustaining engagement, however, other
intervention components were also important. This research is the first to conduct an evaluation of
a financial incentive scheme to promote physical activity comprising a combination of quantitative,
qualitative and longitudinal case study methods to gain a unique and detailed insight into the
area. Important implications for future research and practice were identified.