Incentives attract people; culture determines whether they stay

Most incentives provide extrinsic motivation – they push you to reach a goal with the offer of a reward when you get there. The transaction generally ends here. But extrinsic motivations tend not to stick, because they don’t change people’s habits and more personal (intrinsic) motivations and goals. In other words, an incentive like a monetary reward for weight loss will be effective in getting people to lose weight in the short term, but is generally ineffective in sustaining that weight loss or changing eating habits in the long term. Obesity, prediabetes, and diabetes are chronic, even life-long challenges that require follow-up and sustained commitment to care.

While incentives generally aren’t sufficient to keep people engaged long-term, however, they shouldn’t be written off altogether. In fact, as Dr. Michael P. O’Donnell reminded us, extrinsic motivators are quite effective at getting people’s attention in the first place. Intrinsic motivation, by contrast, drives long-term change but takes time to build, as do habits. Intrinsic motivators are slow-uptake, high-retention while extrinsic motivators tend to be fast-uptake, low-retention; and a well-designed wellness program should incorporate both.

It’s important to have elements that encourage that initial engagement because a health promotion program can only be as good as its ability to get people involved in the first place. This means that, in addition to those incentives that reward employees for behaviors (rather than outcomes), employers should also consider incentives that can attract participation. But the actual value of health promotion programs results from everything that comes after employees get involved. If employers invest all their resources in getting people to show up, with no subsequent emphasis on supporting and encouraging their sustained engagement, they are unlikely to see positive results. It is critical that employers don’t just create excitement upfront; the excitement needs to be justified by a program that aligns with the initial motivation and a workplace culture that supports and reinforces the behaviors that the wellness program encourages.