The Role of Incentive Design, Incentive Value, Communications Strategy, and Worksite Culture on Health Risk Assessment Participation

Abstract

Purpose.: To examine the impact of financial incentives, communications strategy, and worksite culture on health risk assessment (HRA) participation rates. Design.: A cross-sectional study design was used to examine factors that influence employee participation, including incentive value, incentive design, communications strategy, and worksite culture. Setting.: Large private-sector and public-sector employers. Participants.: Thirty-six employers (n = 559,988 employees) that provided financial incentives to promote employee HRA participation. Intervention.: 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. Measures.: Information on program design and structure, as well as on HRA eligibility and participation, was collected for each organization via standard client report and semi-structured 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. Results.: Incentive value (r² = .433; p < .000), benefits-integrated incentive design (r² = .184; p = .009), culture (r² = .113; p = .045), and communications strategy (r² = .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 R² = .584. Conclusion.: This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.