Reward cards & healthy choices: A London scoping study

Objectives
Reward card schemes are a near-ubiquitous feature of modern British life and lifestyle choices are a major determinant of health outcomes. Together, these observations raise the question: could one or more reward card schemes be designed and implemented so as to encourage healthier lifestyle choices among one or more target groups? This scoping study explored this question; highlighted the many subsidiary questions that lay beneath it; and, via a programme of possible pilot projects, set out a route map for establishing the answers.

Methodology
Research was conducted in three areas: firstly, we examined existing reward card schemes in a variety of contexts; secondly, healthy behaviours were grouped around 'life circumstance' themes; and thirdly, socially or geographically based groups displaying low levels of healthy behaviour were identified.  As a result, the study was able to propose four pilot projects in London using different reward card schemes, aimed at different target audiences, around particular healthy behaviours.

Conclusions
Different types of technology were identified as mechanisms to record behaviours and redeem rewards, with varying degrees of sophistication, benefit and ultimately, cost (e.g. stamp cards, paper vouchers and smart cards).

Four pilot schemes were advocated. Each scheme would incorporate a certain target group, in a clearly defined socially disadvantaged community: a secondary school; an entire NDC area; a housing estate within a NDC area; and a black Caribbean-dominated community. (This scoping study worked on the assumption that any proposed health reward card scheme would target groups which experience high levels of ill health, often concentrated in disadvantaged areas/communities amongst the lowest socio-economic groups). Each scheme would operate with different technological solutions. Given the socio-economic background of London, any scheme concentrating on disadvantaged groups/communities will include a higher than average proportion of BAME individuals, so all of our proposed schemes were designed to take account of the relevant racial and cultural dimensions.

The potential participants ranged from over 8,000 people to just over 100, with the largest schemes assigned the most sophisticated technologies. The methods of earning points were related to the specific health behavioural priorities for the intended target group and the available facilities. The rewards were a mixture of healthy and health-neutral factors based on the current spending and health behaviour patterns of the target group, e.g. secondary school children are spending a large percentage of their money on mobile phones, so these were included in our reward scheme. They all encompassed the same core partners, in the form of healthcare providers and local councils, and a differing range of voluntary, social, public and private partners in the local community.