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Am J Health Promot. 2009 May-Jun;23(5):343-52. doi: 10.4278/ajhp.08041134.

The role of incentive design, incentive value, communications strategy, and worksite culture on health risk assessment participation.

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  • 1StayWell Health Management, 3000 Ames Crossing Road, Suite 100, Saint Paul, Minnesota 55121, USA.



To examine the impact of financial incentives, communications strategy, and worksite culture on health risk assessment (HRA) participation rates.


A cross-sectional study design was used to examine factors that influence employee participation, including incentive value, incentive design, communications strategy, and worksite culture.


Large private-sector and public-sector employers.


Thirty-six employers (n = 559,988 employees) that provided financial incentives to promote employee HRA participation.


Organizations implemented the HRA as part of a more comprehensive worksite health promotion strategy that included follow-up interventions and a variety of other components. The primary outcome of interest was employee HRA participation.


Information on program design and structure, as well as on HRA eligibility and participation, was collected for each organization via standard client report and semistructured interviews with account managers. General linear regression models were used to examine the extent to which factors influence HRA participation independently and when controlled for other factors.


Incentive value (r2 = .433; p < .000), benefits-integrated incentive design (r2 = .184; p = .009), culture (r2 = .113; p = .045), and communications strategy (r = .300; p = .001) had positive bivariate associations with HRA participation rates. When all factors were included in the model, incentive value (p = .001) and communications strategy (p = .023) were significantly associated with HRA participation. Variance accounted for by all factors combined was R12 = .584.


This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.

[PubMed - indexed for MEDLINE]
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