Background

The Vitality Active Rewards (VAR) programme is a smartphone-based application that sets weekly, personalised physical activity goals and rewards individuals for achieving these goals.

In South Africa, VAR has been activated by over 415 000 members of Vitality, a comprehensive health promotion and disease management programme with more than 1.12 million adult members who are also on Discovery insurance plans. Vitality (and VAR) is also offered by insurers in various countries across the world. Vitality offers a new, shared-value model of health and life insurance.1 We have previously reported on the association between engagement with various options on the Vitality programme and improved health behaviour.2–4 Here, we report on our experience with VAR, a relatively new intervention on the South African Vitality programme.

Description of the programme

VAR was launched in South Africa in September 2015 and was designed to encourage members of Vitality to increase their activity level by setting personalised and progressive weekly physical activity targets. The VAR benefit is accessed as a smartphone application (app) on Apple and Android phones. Individuals who download the app and sign up with the programme are given a personalised weekly fitness ‘points’ goal. Figure 1 gives a diagrammatic overview of the VAR programme.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

Vitality active rewards.

The weekly goal can be achieved by engaging with an of array physical activity options offered by Vitality, including using partner gyms, taking part in a social running programme (parkrun) and completing organised endurance events.

Members can also engage in self-chosen activities, which are recorded with various wearable activity tracking devices that measure heart rate, duration of activity and/or steps. The workout data from various devices such the Fitbit, Garmin, Polar and Apple Watch are transferred seamlessly via an online platform to the VAR app. The number of points allocated for an activity measured by wearable devices depends on the type, intensity and duration of the activity. For instance, members who accumulate more than 10 000 steps a day are allocated 100 points whereas those who use a heart rate monitor and achieve more than 80% of maximum heart rate for more than 30 min will receive 300 points.

Individuals who achieve their weekly goal qualify for a range of rewards including smoothie and coffee vouchers, which can be redeemed at partnering stores. Members can also choose to donate the equivalent value of the voucher to a charity. In addition, members obtain supplementary, larger rewards such as gym subscription subsidies and discounts on airplane flights, running shoes and fitness tracking devices based on the number of weekly goals that they achieve each month. Vitality has also established a global partnership with Apple to offer the Apple Watch to Vitality members.

Why the VAR programme works

Since launching, approximately 412 000 members have downloaded the app and signed up with the programme. Three hundred thousand members are recording activity using a device and approximately 100 000 of these members are recording their activities using a heart rate monitor.

We looked at all the members who had downloaded the Discovery app to assess the persistency of using the app to track and monitor their physical activity progress. Over a 1-year period, just over a third of members logged on to the app on a monthly basis for a year; just under one-third used the app on a monthly basis over a period of 7–11 months; 13% of the people who downloaded the app logged on monthly for a period of 4–6 months, and a further 13% used the app monthly for just 1–3 months; 8% of members who downloaded the app did not log on at all.

Our experience suggests that members on VAR are appreciably changing physical activity behaviour (see table 1). Among members who have been on the programme for a year or longer, the frequency of physical activity has more than doubled (from an average of 5 to 11 events a month) when compared with an equivalent period before the launch of the programme. This is also true for older adult members who have lifestyle-related chronic disease (table 1). Members who have obtained an Apple Watch are engaged in 50% more activity than members who did not obtain the watch.

What is novel about the VAR programme?

The VAR programme has several inbuilt structural and behavioural features intended to overcome motivational impediments and also appeal to diverse sections of the Vitality membership. These are:

• A smartphone app that makes tracking activity and redeeming vouchers a seamless process. The app is supported by numerous other physical activity options on the Vitality programme.

• Personalised and tailored options that are more effective at changing behaviour than options that are generic and impersonal. The programme encourages incremental changes to achieve persistent behaviour change.5 Moreover, externally imposed goals complement the innate tendency by individuals to self-impose goals.6

• Incentivising and rewarding physical activity behaviour. There is accumulating evidence that incentives and rewards are effective in reinforcing intrinsic motivation.7 In the VAR programme, smaller, weekly, contingent rewards are combined with larger rewards, which are conferred monthly to entrench habit formation.

• Loss aversion and the Apple Watch. The purchase of the watch is financed by Vitality and members are required to repay the purchase price in 24 monthly instalments. Members who achieve all their goals in a month are exempt from the monthly repayment. Members who do not meet all their weekly goals are charged a variable percentage of the repayment, depending on how many goals they achieve. ‘Loss aversion’,8 which describes a powerful behavioural trait where people assign a greater value to loss than to gain, may motivate members who have obtained the watch to more frequently achieve their targets.