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Policy Research Programme - Evaluation of Government Health Incentives Scheme

Published

10 May 2022

Version

1.0 - May 2022

Contents

This document provides guidance on completing an application for the NIHR Policy Research Programme (PRP) call for the Evaluation of Government Health Incentives Scheme.

Timetable and Budget

DescriptionDeadline/Limit
Deadline for Stage 1 Applications 14 June 2022, 1 PM
Notification of outcome of Stage 1 Application August 2022
Project Start October 2022
Budget £200,000

Introduction

The NIHR Policy Research Programme (PRP) invites proposals for a multi-disciplinary team of researchers to provide evidence informed advice to the design of the second phase of a Government Health Incentives Scheme; and to provide an independent evaluation of its implementation and effectiveness. Based on the findings of this evaluation, the team will support policymakers in the Office for Health Improvement and Disparities (OHID) to shape future policy on health incentives.

This is a significant opportunity to contribute to building an evidence base on a high profile and important policy area of significant interest to the Government and other countries around the world.

Background

Background and Objectives of the Health Incentives Scheme

Obesity is one of the biggest long-term health problems England faces. NHS Digital data shows that nearly two thirds of adults are above a healthy weight, and around half of these live with obesity [1]. The data shows that people living in areas of deprivation are more likely to have overweight or be living with obesity compared to those living in the least deprived areas.

Obesity is a risk factor for a range of chronic diseases including type 2 diabetes, cardiovascular disease, and some cancers. Obesity related illnesses cost the NHS £6 billion a year, for a more detailed breakdown of these costs read more at Health matters: obesity and the food environment [2]. The issue has become even more pressing recently as evidence shows that excess weight increases the risk of poor outcomes from COVID-19.

Obesity is a complex problem, caused by many different factors, to which there is no single solution. The Government is delivering an ambitious programme of work to create a healthier environment to help people achieve and maintain a healthy weight.

The Health Incentives programme aims to encourage healthier behaviours through financial incentives. As part of a package of government support to help those living with obesity to move closer towards a healthier weight, the Department has commissioned a £6 million six month ‘pilot’ digital voluntary programme that will explore the best ways to incentivise adults to make healthier choices using a mobile application.

There is a broad range of poor health outcomes associated with physical inactivity and unhealthy diets. Nearly 40% of adults do not reach the CMO’s recommended 150 minutes of physical activity per week (51% for those in lower socio-economic groups) [3]. For diet, the vast majority (72%) of adults do not eat the recommended five portions of fruit and vegetables per day [4], and those on low incomes are a third less likely than those on higher incomes [5].

There is existing evidence that incentives are effective at leading to short-term change in physical activity [6], weight loss [7], and healthy eating [8] for the duration of the intervention. There are also international examples of health incentive schemes such as the Singapore National Steps scheme [9]. The objectives for this programme are to support the Government’s commitment to addressing health disparities and to support a wider and emerging approach to public health and prevention that is more personalised, data-driven and digital in nature. The programme is also an opportunity to harness the best innovation and thinking from across the public, private and third sectors. The aims of the pilot are to:

  • understand whether a government supported scheme can incentivise people to positively change their physical activity and diet behaviours.
  • understand the optimum level/value of incentive that can achieve behaviour change.

Health Incentives Scheme Phase 1 (Pilot)

HeadUp Systems has been awarded a contract to develop a new app to help people make positive changes to their diet and physical activity. The pilot will run in Wolverhampton from Spring 2022 for six months, and users will wear wrist-worn devices and complete dietary surveys which will generate personalised health recommendations, such as increasing their step count and eating more fruit and vegetables. Users will collect points for these healthy behaviours which will unlock rewards, which can be redeemed for a cash value in a variety of popular retailers and leisure outlets.

The target health behaviours for the pilot are:

  • physical activity (in line with CMO recommendations)
  • diet (in line with the Eatwell Guide)

The pilot aims to target the following populations: those who do not already engage in the healthy behaviours of interests and ‘under-served’ groups (for example low SES, those from an ethnic minority background).

The evaluation of the Phase 1 is being carried out by the Behavioural Insights Team. The primary objective is to assess the effectiveness of the financial incentive scheme at increasing physical activity and healthy eating among adults. This is being assessed using a Randomised Controlled Trial comparing the behaviour of users allocated to a control group (no financial incentives offered) to the behaviour of users given a low, medium or high level of incentive. An implementation and process evaluation (IPE) will look at mechanisms underlying the results of the scheme and understand issues relating to engagement, implementation, acceptability and potential for scaling up. The IPE will also explore potential unintended consequences. Further information on the evaluation of the pilot will be shared with the successful applicants.

Health Incentives Scheme Phase 2

The Department intends to develop a second phase of the Health Incentives Scheme. The exact aims and structure of Phase 2 of the Scheme are yet to be determined. There will be regular reporting of the pilot outputs while the pilot is live and a final evaluation of the pilot is expected to be delivered in March 2023. The insights from the pilot will be used to set the direction for Phase 2 and will be used to inform the Government procurement processes to commission a team to design and deliver Phase 2.

An independent, robust evaluation of Phase 2 of the Health Incentives programme is required to ensure we continue to learn, and that policy development to expand the programme to improve health behaviours and health outcomes is evidence-informed.

Given details of Phase 2 are yet to be determined, as they will be informed by the findings of the pilot, a full specification which sets out the specific intervention and requirements for an evaluation is not possible at this time. Therefore, we are inviting applications for a research team, with broad expertise in public health trials, large-scale evaluation, behavioural science, the subject area, and quantitative and qualitative research methods, to conduct the Phase 2 evaluation.

It is anticipated that commissioning research for this programme will comprise two parts overall:

  1. commission of a research team with broad expertise to work with the Department to develop Phase 2 of the Health Incentives programme (through this call)
  2. additional funding to a full scale evaluation of Phase 2 of the programme, with the possibility of bolt-on RCTs (to be developed in a subsequent application)

The Phase 2 Trial or Evaluation

While the exact details of Phase 2 are unknown, work has been undertaken to map broad requirements for the evaluation. Evaluation plans will need to maintain a degree of flexibility depending on the Phase 2 approach, but we expect the evaluation to be designed to:

  • answer critical questions e.g., on scheme effectiveness, value for money and unintended consequences; and
  • understand more nuanced questions about scheme design, which arise as the scheme responds to emerging evidence, for example through additional bolt-on Randomised Controlled Trials (RCTs).

The main aims of Phase 2 will be determined by the outcomes of the pilot and the evaluation will need to reflect these aims. The expectation is that the evaluation will be an RCT with an implementation and process evaluation, however, the policy team remains open to alternative approaches that would achieve similar results. Policy questions which the evaluation should expect to answer are included below. The successful applicant will have the opportunity to further develop these in line with the project aims:

  • How effective is the scheme at changing the behaviours of interest, and does this represent value for money?
  • How long do participants stay engaged with the scheme?
  • If the scheme is successful at changing the behaviours of interest, under what circumstances do participants maintain the level of change?
  • What is the optimum duration of participation on the scheme for effective behaviour change in the short and medium-term?
  • How successful is the incentives scheme at recruiting, engaging, and retaining participants from ‘under-served’ groups? What are the barriers and factors that influence take up by these groups?
  • How successful is the incentives scheme at achieving positive behaviour change in participants from ‘under-served’ groups?
  • What are the unintended consequences, if any? For which groups are these apparent?

We would like to build capability in the evaluation to continue to test and iterate different features of scheme design in order to personalise and optimise the scheme. For example, having the evaluation team able to design, run and analyse RCTs which take learning from the core evaluation. Policy questions include:

  • What are the optimum features of scheme design for achieving positive behaviour change?
  • How can the scheme best be personalised for participants to achieve impact and value for money? Which design features of the scheme are best personalised?
    • Can frequency of rewards be tailored for individuals to improve change in target behaviours?
    • Can timing of rewards be tailored for individuals to improve change in target behaviours?
    • Can messaging be targeted for individuals to improve change in target behaviours?
    • Are there participant characteristics on which personalisation of the scheme be based in order maximise effectiveness and value for money?

Given that an objective for the programme is to support the Government’s commitment to addressing health disparities, the evaluation should focus on health inequalities and consider ways in which the Health Incentives scheme could be used to address health inequalities and how the scheme can be optimised for ‘under-served’ groups.

Research Team

The expectation would be that the research team would work with the policy team in OHID to ensure the design of Phase 2 of the scheme is evidence-informed and evaluable; and then to design and deliver an evaluation of Phase 2. The successful team will therefore need expertise in:

  • Designing and delivering public health trials and large scale evaluations, taking a mixed-method approach
  • Experience in iterative design evaluation, e.g. designing and running bolt-on RCTs
  • Implementation and process evaluation
  • Inclusive studies that identify, recruit and retain participants from under-served populations
  • Quantitative research methods including:
    • analysis of secondary data,
    • conducting descriptive analysis (including summary statistics and data visualisation)
    • advanced statistical techniques (including regression analysis)
  • Qualitative research methods including:
    • in-depth interviews
    • focus groups

The successful team should have expertise in behavioural science, diet and nutrition, healthy weight, physical activity, financial incentives, and/or preferably in policy research to provide evidence to underpin and support national policy decisions. The team must be willing to extend the range of topic activity by working with collaborators where necessary, as expertise needs emerge over the course of the programme.

The team should be flexible in working with policy makers and will need to demonstrate that they are able to produce outputs to agreed timeframes that give policymakers easy access to key findings.

To facilitate comparison between bids, we invite applicants to produce a proposal which sets out, in broad terms, an approach to designing an evaluation of a Health Incentives scheme, which answers the policy questions set out in the specification.

Process and timings

A research team will be commissioned through this one-stage process. Applicants will complete an extended stage one application form; additional space is provided to show how they meet the criteria set out below and a proposed research design, methodology and analysis for a full evaluation of phase 2.

Applicants will be assessed according to the following criteria at this stage:

  1. an awareness of the needs of the policy team, and proven experience of policy research, and/or working with Government or national policymakers;
  2. relevant methodological and design expertise and a proven track record of carrying out complex, large-scale trials or evaluation (as set out in paragraphs 20 and 21); and
  3. ability to identify and respond to potential risks and challenges arising from delivering such evaluations

The expectation is that the successful applicant will work with officials at DHSC in an advisory role for the design of Phase 2 from October 2022. We expect Phase 2 would be launched in the financial year 2023/24.

Outputs for the Phase 2 evaluation

The points below give applicants an idea of the outputs expected for the Phase 2 trial or evaluation, for completeness:

  • regular reporting as well as a detailed interim reports every six months. expected in Summer 2024. Updates to be agreed at the project inception meeting once contracted with the expectation an interim report will be required in Spring 2024;
  • draft publishable report and final publishable report, with executive and lay summary in a form suitable for policy colleagues in a 1:3:25 forma. It is anticipated that the final report will be submitted in Spring/Summer 2025; and
  • a presentation of findings to DHSC colleagues and key stakeholders.

The successful applicant will produce a final report, fully accessible to policymakers and members of the public and circulate to DHSC. When the study is complete, the successful applicants will place a final report summary on the NIHR PRP website, where outputs resulting from public expenditure are available for public scrutiny. It is important the final report summaries are easily accessible to lay readers.

Applicants should consider the full range of potential audiences and describe how to disseminate research findings most effectively so lessons from this research affect policy and practice.

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Budget and duration

A total of up to £200k is available to set up the core research team to provide support to inform the development of Phase 2 of the Health Incentives programme; and act as the senior leadership team for the Phase 2 evaluation. Costing for additional members of the team and costs associated with the trial/evaluation itself will be requested at Stage 2 and assessed by an independent Research Steering Group.

Costings for stage 1 can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

We expect that the core research team will need to be in place for 36 months.

Management arrangements

A Research Steering Group will be set up, including independent members with subject matter knowledge, trial and/or evaluation expertise and statisticians, in addition to representatives of DHSC, and the successful applicants for the research. The Steering Group will provide advice and guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  1. Provide regular feedback on progress
  2. Produce timely reports to the advisory group
  3. Produce a final report for sign off

The independent members of the Research Steering Group will also assess the design and methodology for the Phase 2 trial or evaluation. The PRP also reserves the right to have this assessed by peer reviewers and the PRP Funding Committee.

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR Policy Research Programme Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

References

  1. NHS Digital (2020). Part 3: Adult overweight and obesity - NHS Digital. [Accessed April 2022]
  2. Public Health England (2017). Health matters: obesity and the food environment - GOV.UK. [Accessed May 2022] 
  3. Sport England (2021). Active Lives Adult Survey November 2019/20 Report. [Accessed May 2022]  
  4. NHS Digital (2020). Health Survey for England: Fruit and vegetables. [Accessed May 2022]  
  5. Department for Environment, Food & Rural Affairs (2020). The National Food Strategy. [Accessed May 2022] 
  6. Mitchell, Orstad, Biswas, Oh, Jay, Pakosh and Faulkner (2019). Financial incentives for physical activity in adults: systematic review and meta-analysis | British Journal of Sports Medicine. [Accessed May 2022]  
  7. Ananthapavan, Peterson and Sacks (2017). Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity - a systematic review. [Accessed May 2022]  
  8. Wall, Ni Mhurchu, Blakely, Rodgers and Wilton (2006). Effectiveness of monetary incentives in modifying dietary behavior:a review of randomized, controlled trials. [Accessed May 2022]  
  9. Chew, Tavitian-Exley, Lim and Ong (2021). Can a multi-level intervention approach, combining behavioural disciplines, novel technology and incentives increase physical activity at population-level?. [Accessed May 2022]