To Reward? … Or Not to Reward?: Questioning the Wisdom of Using External Reinforcement in Health Promotion Programs

Abstract

Positive reinforcement through the use of rewards and incentives is generally accepted as an effective technique to change behavior and is regularly used to help raise children, teach students, and motivate workers. Ironically, research does not support the contention that rewards and incentives promote lasting behavior change. Nevertheless, many health promotion programs, from smoking cessation classes to exercise and weight loss competitions to worksite initiatives for lowering blood pressure and cholesterol, have incorporated the use of rewards and incentives to help promote participation and health behavior change. This article summarizes four major problems associated with the use of positive reinforcement strategies: 1) the improper use of positive reinforcement, 2) the failure to address the underlying causes of problems, 3) the lack of long-term effectiveness of externally applied rewards and incentives, and 4) the potential detrimental effect of such approaches on internal motivation. We place specific emphasis on the implications of these problems for promoting health behavior change, and we discuss future research considerations for health promotion. BACKGROUND