Facilitators of and Barriers to Implementation of Financial Incentive Interventions for Health Behaviour Change: A Systematic Review

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Lasheen, Brian Doyle, Cheyenne Downey, Debbi Stanistreet, and 22 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8059982/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Behavioural risk factors contribute significantly to the development of disease and ill-health. Financial incentive interventions have shown promise in promoting behaviour change across several health-related behaviours. Despite well-documented evidence of effectiveness and widespread implementation efforts, uncertainty remains about how and under which circumstances these interventions achieve desired success and can be effectively sustained. To facilitate effective and theory-informed implementation, we conducted a systematic review of evidence addressing the barriers and facilitators to successful implementation of incentive-based interventions targeted at health behaviour change in mixed populations, and mapped these to theory. Methods We conducted a systematic search to identify scientific and grey literature across nine electronic databases, from inception to 3rd June 2025. Search terms included combinations of terms related to “health behaviours” and “incentive”. Eligible records reported and/or described the implementation of financial incentive programmes with incentives for various health behaviours change. Deductive framework analysis identified barriers and facilitators, relevant intervention functions and policy categories. A narrative synthesis of findings, mapped against the Theoretical Domains Framework, with relevant intervention functions and policy categories identified through the Behaviour Change Wheel, was conducted. Subgroup analysis explored patterns across countries of diverse income status and those specific to smoking cessation. Results Of 13135 unique records identified, 63 met the inclusion criteria. Studies predominantly reported on implementation in high-income countries (n = 47). Incentive-specific barriers included political and legal ambiguities, incentive design challenges pertaining to the amount, form and timing of incentives, incompatibility with the implementation agents and surrounding context, as well as relationship struggles and role violations undermining participants’ identity. Facilitators included participatory evidence-led planning and implementation processes, high acceptability and recipient-tailored FI recruitment processes and designs. Conclusion This first systematic and theory-guided synthesis of the barriers and facilitators to actual implementation of financial incentive interventions, targeted at various health behaviours among mixed populations and contexts, provides comprehensive, valuable guidance for advancing incentive implementation efforts. Registration: PROSPERO, Registration no.: CRD42024557290. Financial Incentives Health Behaviours Smoking Cessation Behaviour Change Theoretical Domains Framework COM-B Behaviour Change Wheel Implementation Science Figures Figure 1 Contributions to the Literature Financial incentive interventions are promising, yet complex, tools in driving health behaviour change for better health outcomes, and factors influencing their implementation are unclear. We identified general barriers and facilitators to financial incentive interventions implementation, as well as distinct incentive-specific elements. This is the first attempt to apply theory-based, behavioural frameworks, in the context of policy to identify influences on financial incentive interventions implementation regardless of setting, the incentivised population, or behaviour. Background Behavioural risk factors such as smoking, poor diet, and physical inactivity, contribute significantly to the development of major diseases and ill-health [ 1 , 2 ] . Yet effective promotion of healthy behaviours is quite difficult to achieve [ 3 ] . Hence, substantial efforts have been employed towards identifying effective strategies to promote positive health behaviour change [ 3 , 4 ] . One increasingly recognised strategy is the use of external rewards to influence behaviour [ 5 , 6 ] . This encompasses the use of financial incentives (FI) [ 5 , 7 – 9 ] . In the field of public health and healthcare delivery, FI interventions have shown promising levels of success in encouraging change across several health-related behaviours, including complex and one-off behaviours, albeit with varying effect sizes and subject to some uncertainties [ 8 , 10 – 13 ] . For example, Giles et al. [ 8 ] in their meta-analysis of 16 studies, found that individuals offered incentives of various sizes were 2.48 times (relative risk), more likely to quit smoking short-term, with lower effects for smoking cessation long-term (1.50), or for attendance at vaccinations or screenings (1.92). The use of FI in real-life settings, although limited, is also well documented. For example, between 2011 and 2016, up to $ 1454995 of disbursed incentives were offered to the US Medicaid population to encourage uptake of and adherence to healthier behaviours and participation in prevention programmes for conditions like diabetes, obesity, hypertension, and tobacco use [ 14 ] . Similarly, in lower income countries, multiple conditional cash transfer programmes rewarded adoption of healthier behaviours [ 15 , 16 ] . Such programmes were often linked to noticeable reductions in mortality and morbidity indices [ 16 ] . Whilst such substantial evidence on FI interventions’ effectiveness across various health behaviours and in multiple settings exists, these initiatives can also encounter multiple challenges during implementation, which likely reduce their efficacy and can sometimes result in early termination [ 5 , 12 , 13 , 17 ] . Concerns and uncertainties remain on how and under which circumstances these interventions achieve desired success and could be effectively sustained [ 5 , 11 , 12 , 16 – 8 ] . That is largely due to the complexity of FI interventions. Wide variations in implementation processes, as well as limited understanding of mediators, e.g., social context, can hinder FI programmes [ 9 , 17 , 19 , 20 ] . Additionally, FI implementation is often challenging, for example, due to barriers concerning design, cost-effectiveness, ethical concerns and impact on wider society [ 17 , 21 , 22 ] . It is therefore important to move beyond questions of whether incentives work, but instead elucidate the determinants of FI intervention implementation through systematic and theory-informed inquiry barriers and facilitators to actual implementation efforts [ 4 , 22 ] . A recent systematic review by van der Spek et al. [ 23 ] marked the first step towards strengthening FI implementation, by exploring FI intervention determinants; however it was limited to those targeted at smoking cessation among (expectant) parents in high-income countries while looking at both proposed and actual implementation efforts. Findings were mapped to the Consolidated Framework for Implementation Research (CIFR) [ 24 ] , which is argued to be limited in scope and breadth compared to other applied frameworks for understanding and informing intervention implementation specifically intended for behaviour change [ 25 , 26 ] . The application of the Theoretical Domains Framework (TDF) [ 27 ] together with the Behaviour Change Wheel (BCW) [ 28 ] to investigate behaviour change interventions determinants should allow robust, efficient and systematic identification of domains most relevant for understanding health behaviour change, intervention strategies and potential contraindications, across a range of contexts [ 26 – 28 ] . We therefore aimed to conduct a systematic review to: a) identify and consolidate barriers and facilitators to FI interventions targeted at health behaviour change among mixed populations; b) map these determinants using the TDF and BCW; and c) explore differences specific to smoking cessation, given its global burden [ 29 ] , compared to other behaviours. Methods The systematic review was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (see Additional file 1) [ 30 ] . The protocol was registered on PROSPERO [ 31 ] . A detailed description of the methodology is available in our published protocol [ 32 ] . Search strategy and selection criteria The search was initially conducted up to the 29th of May 2024 and updated on 3rd June 2025, through seven primary databases (See Additional file 2 for full search strategy). To supplement our search, grey literature was sought through Overton and citing papers of included studies were retrieved using Citation Chaser [ 33 ] . Key authors in the field were also contacted for any unpublished findings from November 2024 onwards, with a reminder sent after 15 days in case of no initial response. Table 1 shows the selection criteria. Multiple publications presenting new and/or complementary findings from a specific intervention were included, but each unique barrier/facilitator was accounted for once. Table 1 Adopted definitions, inclusion and exclusion criteria for article selection. Definitions Stakeholders : People who are involved in (e.g., service providers) and/or impacted by (e.g., service users) the actual implementation of an intervention Financial incentives : Cash or cash-like rewards (e.g., vouchers exchangeable for goods or services) or penalties provided contingent on performance of healthy behaviours [ 8 ] . Domain being studied : Health behaviours among any population group (e.g., smoking, healthy eating, physical activity, immunisation, substance use). Eligibility : Reported stakeholders’ self-reported issues to actual FI implementation targeted at a health behaviour change. Inclusion criteria Exclusion criteria Population : Relevant stakeholder groups who are involved in/ impacted by the actual implementation processes of the intervention. These include implementation agents and/or intervention users as those who received any form of FI in order to change their behaviour regardless of age, gender, socioeconomic status or context. Those not directly involved in or impacted by the implementation. Intervention : FI as part of promoting health-related behaviour change. Unconditional, non-contingent, symbolic or non-monetary incentives. Interventions without sufficient detail on the FI component (or those that could not be found elsewhere) Outcome : The description and/or reflection on reported barriers or facilitators to actual FI interventions implementation. Preferences, associations, correlations related to the intervention/health behaviour. Issues reported by those not involved in / impacted by the (proposed) implementation. Types of publications : Any English language only Conference abstracts, letters, news releases, reviews, study protocols, dissertations. Context : Research in any country regardless of income status. Title and abstract as well as full-text screening of retrieved records were conducted by RL while 50% each were independently screened by BD and CD. Inter-rater agreement on screening decisions was high (98% for title-abstracts). Disagreements were resolved through discussion in consultation with FD. Corresponding authors were contacted for clarification on any ambiguities regarding inclusion. Data Extraction and quality assessment Items extracted pertained to seven key domains:1) article/study details; 2) population and settings; 3) methods; 4) stakeholder types; 5) intervention details; 6) study outcomes; 8) review outcomes. FI intervention items were informed by Adams’ et al. nine-domains framework [ 9 ] . The quality of the included studies was assessed using the Mixed-methods Appraisal tool (MMAT, version 2018) [ 34 ] . Where the desired outcome was reported following a specific method of inquiry distinct from the overall study design, only the domain linked to that method was assessed (e.g., when barriers and facilitators were investigated via qualitative methods in a mixed-methods study, only the qualitative study design appraisal section in the MMAT was completed). Data analysis and synthesis Narrative synthesis was undertaken with implementation determinants deductively mapped to TDF domains using the six constructs of the COM-B model, following the framework analysis method [ 35 , 36 ] . A coding manual was developed a priori to guide the process based on established guidelines for TDF and BCW application [ 27 , 28 ] . RL coded all items using Excel and 10% of data were coded independently by BD to assess reliability [ 37 ] . Coding conflicts were resolved through discussion. All TDF domains were then mapped to relevant intervention functions and policy categories layers of the BCW [ 28 ] . Given the magnitude of information yielded, one primary domain per item was assigned utilising simple counts to identify the most frequently reported TDF domains, aligning with other reviews [ 38 , 39 ] . Distribution patterns of barriers and facilitators across countries based on income status and those focusing on smoking cessation was explored by calculating the relative frequency of TDF domains within each group. Assessment of Confidence in the Evidence The Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach [ 40 ] was used by CD, BD and RL to assess the confidence we can place in our findings prior to an overall assessment being made. Results Figure 1(also see Additional file 3) summarises the study selection process. In brief, from an initial pool of 13850 records, 63 were included in the final analysis, representing 60 distinct studies. Figure 1 : Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of study selection. G, Grey Literature; S, Scientific literature. a Primary databases search update; b one unpublished record obtained through author contact added to original publication retrieved through primary searching; c i.e., non-contingent, of no monetary value, for non-health behaviour/ providers, not explicitly detailed incentives. General characteristics Table 2 presents the characteristics of included records and a brief description of the provided FI intervention. Forty-seven of the retrieved records were conducted in high-income countries (70.1%), with most undertaken in the USA (32/47) and of mixed-methods design (n=31). Articles were published between 2009 and 2025. There were a wide range of primary intervention populations, including: patient groups, pregnant women, employees, school-aged children, and mixed groups. Targeted health-behaviours were equally diverse representing seven groups: substance use (n=18), smoking (n=12), patient management (n=12), healthy eating and/or physical activity (n=11), maternal/child health seeking (n=8), and two programmes addressed multiple behaviours. Incentive amounts ranged from approximately $7.70 to $2000 representing the maximum possible amount earned over the duration of the intervention, considering that not all studies reported clear incentive structures to aid the calculation of this estimate. The highest value indicates a potential 20% saving on out-of-pocket medical costs from employees’ insurance providers [41] . Regarding methodological quality, 44 of 60 original research publications met at least 60% of the MMAT criteria and were considered of good quality (see Additional file 4). Reports were not subject to methodological quality assessment. Table 2: Characteristics of studies included in the review, ordered by targeted behaviour Barriers and facilitators to financial incentives implementation Across all studies, 374 items were recognised as an implementation determinant representing 12 TDF domains covering all COM-B subcategories with all records reporting on barriers and 84.4% (n=54) on facilitators. Inter-coder reliability of 78.8% agreement was achieved. Table 3 presents a summary of these including both FI-specific and more general programme issues while, narratively, we report on FI-specific barriers/facilitators at length. Additional files 5 and 6 offer further elaboration, providing supporting excerpts and verbatim quotes from original reports, as well as detailed GRADE-CERQual assessment. Table 3: Summary of barriers (type “B”) and facilitators (type “F”) to FI interventions implementation 1. Environmental Context and resources (Physical opportunity) (n=63, 100%) Barriers Policy constraints (e.g., anti-kickback laws), regulatory (e.g., funding caps) and/or bureaucratic requisites hindered adoption and implementation efforts [14,41,47,48,66,69,78,83,93,94,97,101] . Ambiguities around existing policies for digitally-delivered FI interventions [100] and limited resources [43] also curtailed scope for their development as initially envisioned. Incentive designs themselves experienced and/or acted as barriers owing to their complexity(e.g., confusing structure, multi-step pay-outs) [57,73,82–84,94,96–98] . Eligibility criteria that were too broad, [58] , too restrictive [45,92,102] or unclear [66,90] reduced impact, led to misinterpretation and consequent implementation inconsistencies. The form and/or method of incentive delivery (e.g., bank transfers) posed extra hurdles (e.g., hidden charges) [43–45,47–49,68,73,100] indirectly excluding certain eligible groups, such as migrants or those with low digital literacy occasionally resulting in lower utilisation [14,75,88] , unused funds and/or reduced reinforcement. Overly ambitious and/or unrealistic goals [88,94] , coupled with perceived inadequate incentive value further hindered behaviour change efforts [47,67,71,74,81] . Limited duration or frequency of delivery also acted as barriers to achieve full integration or meaningful behavioural outcomes [89,102] . Suboptimal timing of incentive delivery [14,48,55,88,89,98] undermined effectiveness while inappropriate setting (e.g., work/public spaces) [53,55,60,75] deterred engagement or disrupted the intervention continuity. Infrequently, cumbersome test kits for substance abstinence verification [98] and physical testing requirements(e.g., fingerstick tests) [96] generated frustration, especially among the physically impaired. It was also noted that group-based interventions exacerbated challenges [57,59,84] . Intervention integration into existing workflows/systems was cited as a barrier for multiple reasons [64,69] including employing an incongruent model of behaviour change/incentive structure (e.g., unjustified clinical tests) with care pathways, user needs or service capacities [50,51,53,59,78,82,88,89,93–95,97,98,100,101] . Intervention-related training, administration or management processes were cumbersome and resource-intensive [41,45,48,50,54,56,59,62,72,74,76,79,80,84,87,88,91,91,93,100,102] . One study reported false claims of target behaviours, fund misuse and skimming [66] by staff. Facilitators Intervention planning through benchmarking [41] and participatory/collaborative approaches with key stakeholders [41,60,77,84,86,89,94,101] facilitated the execution of legally and context informed interventions. Effective (or efficient) FI operationalisation was better achieved when aligned with existing policies, organisational aims/branding [77,79] , target population [59,100] and workflows/systems in place [51,58,75,77,85,96,100] . Ease of intervention use [46,53,79,92,98,100] also facilitated utilisation. On FI structure, bank transfers were favoured as they ensured incentives were administered and used as intended, reducing corruption [44] while other incentive forms (cards, digital transfers) were found convenient with minimal issues [61,71] . Users valued staff’s flexible scheduling of appointments [102] while robust behaviour verification methods [58] deterred deception and motivated adherence. A wide assortment of additional participant-centred elements [46,57,60,71] further enhanced engagement/adherence including: unconditional cash transportation support [46] , peer support [60] , reminders [46,53] and discreet non-stigmatising app designs (for HIV, TB patients) [46,53] . Optimisation of interventions was ensured through diverse mechanisms as piloting [75] and feedback methods [43,48,60,73,77,85] enabling continuous refinements. Utilisation of relevant data was equally important [14,75] for target population prioritisation, outreach, and buy-in efforts. Interventions granting a degree of autonomy and/or flexibility permitted attuning processes to evolving needs [14,48,50,66,75,82,87,91,97,99,100] and provided a space to develop creative innovations [48,49,91] that supported continuity. Finally, to enhance staff capacity for implementation, comprehensive training systems [62,73,79,87,96] peer learning strategies [78,86,94] , evidence-based protocols [58,87] , and expert input [94] were vital. Moreover, maintaining stable and adequate workforces [44,62,85,100] , alongside securing readily-available dedicated members and/or contacts [52,62,73,77,96,99] sustained knowledge and ensured smooth execution. 2. Beliefs about consequences (Reflective motivation) (n=38; 60%) Barriers Providers commonly expressed conflict and/or discomfort over incentivising certain behaviours [14,51,88,89] , particularly due to the possibility of acting as perverse incentives [42,43,95,96] most evident for interventions aimed at individuals who use drugs [43,95,96] and MEDICAID participants [14] . Others simply questioned their necessity and/or effectiveness [51,54,56,63,88–90] in driving meaningful outcomes, especially for those intrinsically ambivalent/resistant to change, adding to the fact that incentives were seen as new and controversial [14] . Incentives were thought to compromise personal agency, subsequent to “policing” of behaviours, posing as “paternalistic bribes” [51,95] or potentially exploiting individual’s economic/emotional desperation [51,59] . Participants’ perceptions of unfairness [42,51,59,66,95] brought about by interventions’ restrictive eligibility criteria also discouraged acceptability. Improper FI administration, withholding incentives or misleading beneficiaries, resulted from harbouring negative views on FI interventions processes (e.g., perceived irrational administration mechanisms, inaccuracy of behaviour validation methods) and their implications (e.g., sustainability and associated costs, associated burden) [56,63,66,72,85,91,97,98] . Uncommonly, concerns about integrating the intervention in clinical settings (i.e., addressing alcohol use in HIV clinics) [96] fearing patients might be reluctant to discuss it if linked to their broader medical care were raised. Similarly, users held many – comparable yet distinct – perceptions surrounding FIs, sometimes leading them to disengage including: opposing incentivising behaviours [51] , or simply deeming the associated cost to engagement (e.g., effort to support behaviour change/ access the incentive) to outweigh its benefits [55,72] . Rarely, factors such as anticipated reprimand of poor service use in case of failure to change [55] or due to witnessed deviations from expected incentive delivery [66,72] perpetuated mistrust and decreased acceptability. Occasionally, participants from affluent backgrounds considered the incentive insignificant given the requirement of confidential disclosure [44,45,47] . Some also believed behavioural targets to be unattainable [79] while others assumed intervention/treatment ineffectiveness [98] . Facilitators Stakeholders valued interventions for their (anticipated or observed) multifaceted benefits both for users (e.g., positive health and emotional outcomes) and health systems (e.g., having better access to health information) [48,50,52,54,73,74,78,81,83,85,95,96,98,100] which was critical for boosting acceptability, enabling adoption and maintaining engagement. This reduced scepticism and shifted initially unfavourable views [52,53,95] . Holding positive perceptions on certain aspects of the FI design was also important where direct transfers-instead of cash, were seen as a legitimate to limit pilferage [48,66,72,73] and avoiding high-value prizes to prevent risks for patients with substance use issues [89] . 3. Social influences (Social opportunity) (n=35; 56%) Barriers Mismatches between FI objectives and existing cultural norms or populations’ circumstances [48,66,67,69–71] shaped decisions towards (not) seeking behaviour change, and left interventions irrelevant and oftentimes, ineffective. This partly stemmed from cultural dissonance with the sought behaviour-in this case, institutional childbirth [67,69–71] , using banking systems among ethnic groups [48] , concerns about gender-based incentive misuse [66] or altered household dynamics [72] . It also became apparent that stigma was a key deterrent for engagement, often driven by fear of being linked to, or identified as part of, stigmatised populations [43,47,55,78] . Power imbalances and interpersonal struggles reported at multiple levels threatened implementation as seen through staff role violations (e.g., demanding side-payments) [68,69,72] undermining users’ autonomy while negative interactions disrupted engagement [102] . Providers were also concerned being the "face of the intervention" could damage their community relationships [72] specifically when incentive administration failed. At organisational level, negative views on external social agents challenged partnership efforts [100] mostly due to known resistance to non-abstinence-based models or due to their perceived limited influence over clinical practices. Facilitators State-driven dissemination efforts [93] conveyed validation to participants while incorporating community-oriented elements (e.g., including family members/peers), [43,48,57,60,68,81–83,102] fostered solidarity, boosted acceptability thus improving behavioural outcomes. Trusted figures (e.g., community leaders/religious figures) approving of incentives use [46,68,71] , having doctors/insurance providers as a referral point [102] or a trusted party for service delivery [83] lent legitimacy to the interventions. Non-judgemental and supportive providers [14,63,96,102] who cushioned the intervention while avoiding negative inferences [46] encouraged engagement. Also, ongoing and consistent communications alongside fixed provider-user pairings fostered stronger rapport and primed staff to engage in discussions surrounding the intervention [99] . Among providers, factors such as: fellow staff enthusiasm and positive attitudes [41,85,86] , expert-led training [94] , open dialogue and peer support [97] , local champions, social modelling (e.g. sharing patient success stories [87] ) as well as “the sense of shared commitment” [84] , were key to overcome resistance to implementation. 4. Reinforcement (Automatic motivation) (n=32; 51 %) Barriers Incentives that were deemed insufficient [45,48,49,66,81] relative to costs encountered or to population needs, or simply being too low [44,71,97,98] to drive change or those unfulfilled, often due to delays in incentives receipt, [43,82] disrupted reinforcement loops. In ‘fishbowl’ prize draw models, the chance of getting a non-monetary reward proved demotivating [96] , while remote intervention delivery [97] was not favoured by some. Infrequently, a transactional provider-participant relationship [51] was reinforced as financial expectations became a condition for engagement. Misreporting of behaviour targets was identified allegedly bypassing the eligibility criteria [70] thus led to “fudging data”. Inadequate or delayed providers’ compensation compared to the added workloads/costs of intervention implementation [69,72,76] hampered proper delivery and, sometimes, led to non-adherence to its protocol. Facilitators Behaviour change efforts were better supported through various mechanisms including: real-time monitoring and reminders [46] , educational materials [83] , fun competitive and game-like aspects [41,79,81] , de-escalating incentives [53] , unconditional tailored packages e.g., baby supplies) [64] and family/staff support [57,64,65] . Visual, immediate and/or regular testing and feedback on behaviour change (e.g., CO breath test) [63,64,84] built accountability and motivated change. The act of goal-setting and achieving targets [83] and the use of physical tracking tools (i.e., tokens, slips) [89,96] were also perceived as rewarding/meaningful symbols of progress. Overall favourability and high acceptability encapsulated in a “positive experience” [50,53,54,57,65,79,84,96] was equally critical. Some providers found incentives an empowering reinforcement strategy [57] , enabling regular feedback on users’ outcomes [87] which encouraged implementation. Positive reinforcers over punitive-based approaches [93] or receiving recognition for their role [82] were also valued. 5. Knowledge (Psychological Capability) (n=31; 49%) Barriers Limited existing evidence on population-specific incentive designs [43] , legal ambiguities surrounding validation methods i.e. fentanyl test strips [93] , or knowledge/understanding gaps on intervention aims, positioning, processes(e.g., payment mechanisms, referral pathways) and/or eligibility criteria [14,41,45,66,69–71,74,77,82,83,94] hampered implementation/utilisation. Uncertainties amongst providers about intervention policies [66] , timelines [72,102] , modifications [94] or their/other’s specified roles [45,66,82] hindered the ability to effectively deliver a service that “they themselves did not understand” and/or led to implementation variations. Limited awareness of the interventions [44,45,47,48,56,76] and of the associated services/resources [44,48,70,71] was also reported as a barrier. Rarely, users’ limited comprehension of messaging on the intervention [48,65] delayed use and led to disengagement. Facilitators High awareness and understanding of interventions and related services [49,73] facilitated use while familiarity with the evidence-base [52,58,84,87] for staff and leadership was pivotal. Providers also valued clear practice guidance and training resources on FI principles, effectiveness, designs and procedures [58,87,101] while staff with prior knowledge and experience of said interventions [52,87] were valuable. Maintained knowledge on implementation processes and outcome data [52,91] were equally important. Such information was occasionally leveraged for advocacy and to secure buy-in/resources. Finally, complementary educational and/or information dissemination activities [43,76,81] enhanced awareness, thus increasing participation. 6. Role and identity (Reflective Motivation) (n=27; 43%) Barriers Participants of high socioeconomic status [42,44,45] refused to engage with the services and/or decided not to avail of the incentive. Providers frequently subverted incentive protocols due to their personal/ professional values around equity/justice or what entails an “appropriate” treatment model [14,42,48,50,81,84,94,95,97,101] . Grappling multiple responsibilities, particularly those incompatible with their role/standards of care, [48,50,56,80,84,88,94] was challenging. Ethical quandaries regarding eligibility [48,50] were reported and at times acted upon as seen through incentives rationing behaviours [14,42] . Rarely, preoccupation with achieving targets and ensuring “coverage” [70] led to an observed shift from supposedly being a supporter of change to a reinforcer hampering recruitment. Finally, a perceived shift in the provider-user roles from a collaborative relationship to a transactional one (provider as "buyer", patient as "provider") [55] disrupted therapeutic rapport. At an organisational level, cultural clashes emerged when intervention goals conflicted with institutional identities [54] or when implementation agents held distinct views surrounding intervention philosophies and/or role responsibility. [81,94,97] Facilitators Proper alignment with organisational, professional and/or social identities and associated responsibilities promoted intervention adoption and continued implementation [41,50,57,77,84,86,91,95] . That included those of a collaborator, educator, and/or supporter in achieving better health outcomes [50,77,84,95] . For some, being able to satisfy professional performance targets [72] through the intervention was key. Finally, role expansion and redefining strategies reportedly increased acceptability and ensured smooth execution/integration [84,86,91,99] . That included posing the intervention as a core responsibility rather than an add-on [84] as well as assigning dedicated incentive staff [86,99] . 7. Skills (Physical, Cognitive and Interpersonal Capability) (n=19; 30%) Barriers Providers with operational motor limitations [77,79] found incentive transaction processes challenging, while participants with physical impairment [47] were unable to access their incentive. Digital illiteracy among users was also reported [48,79,92] . Challenges related to providers’ gaps in design skills of context-appropriate, yet operationally simple, interventions [43] , digital and technical literacy gaps, limited data management, and/or administration [48,56,74,79,82,88,94,98] . Limited interpersonal and communication skills were also identified as barriers [51,64,80,95,102] , specifically the capacity for holding nuanced dialogue on the incentivised behaviours. Facilitators Well-trained staff with relevant skill-sets [14,50,79,94] aided smooth implementation. 8. Behavioural regulation (Psychological Capability) (n=17; 27%) Barriers Challenges occurred due to weak monitoring and poor budgetary planning [66] . Users struggled with self-tracking behaviours [102] in line with intervention requirements. Facilitators Clear planning, feedback and monitoring strategies (e.g., review/serial outcome assessments) [41,58,77,80,86,87,100,101] offered a space for iterative refinement of intervention design and procedures whilst balancing scientific/clinical needs. For users, incorporating elements such as e-trackers, random behaviour verification tests and readily accessible outcome data [46,53,81–83,96,98] were considered useful for promoting accountability and adherence. 9. Emotion (Automatic Motivation) (n=15; 24%) Barriers Diverse emotions impacted providers and participants alike [51,52,54,55,57,63,68,71,79,83,89,98] . Providers faced burnout [52] balancing intervention demands with their clinical roles, as frustrations emerged [98] due to complex processes. At the user level, fear and/or anger [68,71,83] due to safety concerns or anticipated reprimand in case of failure were reported. Feelings of guilt of failure [55] or receiving incentives while others did not [63] , discouraged engagement. Others felt daunted and/or demotivated with impersonal program elements [63,89] . In school settings, students felt embarrassed receiving incentives in front of peers [79] , while stressful workplace environment [54] hindered change efforts. Few felt offended [51] due to ill-timed intervention briefing. Facilitators Positive emotional reactions facilitated implementation and boosted engagement [50,51,55,57,89,96,98] as some providers reported “feeling good” [50] and having "fun” [96] working on the intervention or as feeling appreciated, respected, satisfied, less alone or stressed [51,53,89,98] . 10. Memory, attention and decision processes (Psychological Capability) (n=9; 14 %) Barriers Cognitive overload brought about by procedural demands and/or uncertainties (e.g., complex processes around enrolling, record-keeping or incentive redemption) [41,46,51,77,82,83,88,89,98] , particularly among populations with complex needs or substance use histories, [89,98] made it difficult for users to remain engaged and/or integrate new habits and for providers to keep up with intervention demands. 11. Beliefs about Capabilities (Reflective Motivation) (n=7; 11%) Barriers Lack of confidence [60,93] among providers to administer group-based intervention or enforce protocols challenged delivery. Intervention systems overestimating a level of service users’ capabilities [48,52] – who are mostly vulnerable – reduced perceived feasibility of behaviour change. Facilitators Stronger belief in providers’ own abilities towards implementation [85] improved prospects for sustained delivery. Self-efficacy (empowerment) [43,53] brought about by the intervention processes (e.g., opening a bank account, ability to manage own’s health) enhanced users’ motivation to change. 12. Goals and motivation (Reflective Motivation (n=7; 11%) Barriers Goal-setting misalignment (e.g., intervention enrolment targets) [14,44,74] in the face of real-life constraints and competing priorities was demotivating and/or necessitated repeated adjustments. Facilitators Participants driven by personal health goals [82] or incentives directly aligned with patients’ recovery objectives [89] enhanced engagement. Providers were also motivated to facilitate and prioritise implementation [94,98] for its value to potentially address treatment gaps. 13. Intention, Optimism (Reflective Motivation) (n=0) No barriers or facilitators relating to either domain were identified. Implementation issues by target behaviour Subgroup analysis showed differences in reported smoking cessation FI intervention implementation issues. “Emotion” domain was more prominent at 13%; third-ranked barrier, compared to only 4% for other behaviours. “Reinforcement” was also frequently reported as a facilitator (23%; second-ranked domain) relative to other behaviours (9%; fifth-ranked). Notably, “Goals” as well as “Memory, Attention and Decision Processes” were not identified in smoking-specific interventions. See Additional file 6 for more results/details. BCW intervention functions and policy categories Intervention functions and policy categories linked to the TDF domains are shown in Additional file 6. In brief, seven intervention functions were recognised as significant enablers to the FI implementation: environmental restructuring, enablement, education, persuasion, modelling, restriction and training. The policy categories frequently associated with supporting these functions included: guidelines, service provision and environmental/social planning. Discussion To our knowledge, this is the first comprehensive review of stakeholder-reported barriers and facilitators surrounding the implementation of financial incentive interventions across diverse health behaviours and multiple populations. We identified 374 barriers and facilitators and applied the TDF and BCW frameworks to identify critical intervention functions and policy categories for future incentive programme design. These findings include a range of viewpoints from perspectives of incentive recipients, FI providers, administrators, managers, high-level stakeholder groups and researchers involved in/exposed to the implementation process. Our findings detail both general programme issues, which can be common across multiple health programme interventions, but also those specific to incentives. Although our review findings align in a broader sense with those of van der Spek et al., [ 23 ] unique divergences emerge. van der Spek et. al. highlight the importance of programme fit with participants’ cultural and personal circumstances, accessibility and acceptability issues, as well as feelings of bribery and distrust. We expand on these findings detailing which and how each component of the intervention and incentive design, starting from its framing through its execution, hinder or contribute to uptake. We found less emphasis on issues relating to incentives for engagement than for validation of behaviour, while the form of incentive was valued mainly for reliability, security and convenience rather than freedom of choice or lack thereof. Although gaming was also reported in our review, we found that this was instead acted upon by service providers to a larger extent than those from participants, hence the importance of auditing and oversight mechanisms. Our focus on implementation across diverse population groups, health behaviours and income settings, adds depth. Distinct factors found included those related to political, legal and organisational pitfalls, planning and execution mechanisms, power struggles, role and autonomy violations, physical, interpersonal and cognitive limitations as well as stakeholders’ internal and external motivators towards implementation whilst unveiling a spectrum of emotions such as those related to shame, guilt and anger among others. Thus, we provide a single, comprehensive source that should be valuable to researchers and health providers. Key incentive-specific issues. Many studies in this review underscored policy and regulatory constraints as major barriers to adoption of evidence-based FI interventions. Deviations from evidence-based FI practices are indeed common and have been linked to poor outcomes [ 103 , 104 ] . In the United States for example, patient incentive programmes are governed by several laws and regulations including the Beneficiary Inducement Prohibition and Anti-Kickback Statute which limits the dollar amount/value and type of the incentive with multiple other considerations e.g., whether it’s part of a grant fund and/or a clinically-proven programme [ 105 ] , which might not necessarily align with evidence of what is deemed effective [ 106 , 107 ] . Our review furthermore underscores the significance of appropriate incentive design, given their multi-faceted nature with multiple interacting components, each of which when made user/provider unfriendly had the ability to influence its implementation and utilisation, let alone effectiveness [ 107 – 109 ] . Specifically, issues related to the type, the timing and magnitude of the reported incentives were emphasised. On incentive type, there seemed to be a preference for methods that are secure, convenient, and corrupt-proof (e.g., cards or bank transfers), with the latter empowering groups who typically do not enjoy financial independence. On timing of the incentives our review showed that delays in receiving the incentives, as well as inappropriate timing, provoked negative sentiments, perpetrated mistrust and hindered reinforcement of behaviour change. That aligns with the theoretical understanding of present bias [ 110 ] ; when an intertemporal decision is to be taken in the present moment, individuals discount future payoffs even more than when two future points are involved in that same decision [ 22 , 109 ] . Therefore, to increase efficacy of behaviour change, incentives must be given earlier [ 109 ] . A meta-review of incentive-based drug treatment programmes also found that more immediate voucher delivery had a better effect [ 111 ] . However, vast individual differences exist in the extent one discounts future outcomes, thus more empirical evidence is needed [ 109 ] . On incentives size, several studies reported issues regardless of the recipient’s socioeconomic standing. For example, some individuals in need of financial support did not pursue the incentive if the challenge to get it outweighed the benefits. Furthermore, people of higher affluence had reservations about being included in such schemes – which alludes to the importance of perceived “value” and relevance for its recipient [ 112 ] , rather than its absolute amount. As Gneezy et al. (2000) [ 113 ] argued, the performance of a behaviour varies in a nonmonotonic way with incentives, meaning one cannot simply expect a proportional relationship between the size of an incentive and adherence to a behaviour, as other factors do play a role in the decision of the individual. These factors could be referred to as “switching costs” e.g., time, social standing in relation to others, to drive change [ 109 , 114 ] which was observed in this study. That might also explain the inconsistent effectiveness of FI across behaviours as incentive amount increased, as found by meta-analysis [ 8 ] . Our review findings implied a strong link between cultural acceptance of the incentivised behaviour and better implementation outcomes. This was achieved by leveraging trusted and key social proxies and established networks; those included healthcare providers, family and peers among others, as champions approving of incentives use, and sometimes as participants. Results are consistent with previous research [ 23 , 115 – 117 ] indicating that positive benefits may be derived from social support as demonstrated, for example, in a randomised controlled trial [ 118 ] including 220 pregnant women, which showed that the combination of bolstered social support with FI nearly doubled smoking quit rates during pregnancy and more than doubled quit rates postpartum. Philosophical, moral or ethical considerations were important determinants of implementation. These were often tied to concerns around justice, exploitation and perceived or witnessed benefits brought about by the intervention, either at an individual, organisation or community level. Indeed, FI as “controversial” tools have been long discussed, as some would view then as unfair, coercive, paternalistic, or generally inconsistent with shared social values [ 17 , 21 , 119 – 121 ] . One often cited concern is on the impact FI would impose on the therapeutic relationship [ 95 , 122 , 123 ] . However, only two studies reported that a contractual relationship emerged while five others reported negative interactions and/or coercion which stemmed from professional pressure to meet targets. Generally, our findings support evidence suggesting that FI can be acceptable when embedded within an ethical provision framework where the agency of the recipient is not threatened and the incentive is relevant to the behaviour or population. [ 122 , 124 ] Our findings also emphasised that efficient FI integration is only feasible when compatible incentive structures are aligned with the inner and outer contexts, be it political, organisational, institutional, cultural or at the individual-level. Furthermore, flexibility and autonomy of implementation agents allowed interventions to be adaptable and person-centred. Participatory and collaborative approaches encompassing all stages of implementation life cycle from incentive design to optimal execution with relevant stakeholder groups were also identified across several studies as important. This clearly aligns with current recommended best practice. [ 125 ] Strengths and limitations Our research findings are supported by a systematic review approach [ 30 ] underpinned by gold-standard behavioural science frameworks [ 27 , 28 ] to classify barriers and facilitators to FI. The inclusion of studies of various methodological approaches without set limitations allowed for a comprehensive understanding of these issues. It is possible, however, like any systematic review, that some records might have been missed. Details on intervention functions and policy categories that could act as viable mechanisms to address such issues were additionally provided, thereby closing the gap to implementation. A comprehensive data source to allow researchers and policy makers recognise nuanced differences spanning various variables was provided that, if considered, could make significant contributions to optimising FI interventions. Although TDF and BCW coding was carried out in line with best practice procedures [ 28 ] , it is possible that an item could fit more than one domain and/or be coded differently. These issues are unlikely to have impacted our overall findings. Consistent with previous literature, we have identified general barriers to such interventions whereas our focus on actual implementation provided a realistic view to real-world operational challenges while recognising distinct populations, behaviours and FI specific factors that influence implementation. FI interventions and future research implications FI interventions involve many moving parts to their design, each of which could influence their effectiveness [ 109 , 126 , 127 ] while broadly, barriers served as facilitators and vice versa dependant on context, suggesting that FI in themselves are not the issue, but rather how they are planned, constructed, governed and executed. Our recommendations are as follows: A transparent and consistent method towards FI intervention planning, implementation to reporting e.g., guided by Adam’s et al [ 9 ] framework, is critical so inquiries into their impact on outcomes are possible. Alignment with the surrounding community and climate, be it political or organisational. Participatory methods alongside theory/evidence-based decision-making processes are integral as this provides an expansive space for context-sensitive and responsive interventions. Education of key stakeholders on the effectiveness, cost-effectiveness and potential benefits of FI interventions [ 108 , 120 ] . Recognition of deciding on the “value” of incentives rather than amount is key. Ensuring acceptability across stakeholder groups is key, that could include leveraging social networks to legitimise such interventions or increasing accessibility. Conclusion This review provided a comprehensive, in-depth understanding on determinants to FI intervention implementation, guided by theory. In doing so, it provides an evidence-informed foundation for designing future context-specific interventions. Our findings highlight the need to consider factors related to political and organisational pitfalls; stakeholder involvement in the implementation processes, intervention and incentive design; social and professional identity violations; and underlying internal and external motivators of stakeholders towards implementation, with emphasis on its proper alignment with the surrounding context. Abbreviations FI Financial incentives CIFR Consolidated Framework for Implementation Research TDF Theoretical Domains Framework BCW Behaviour Change Wheel PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines MMAT Mixed-methods Appraisal tool COM-B Capability, Opportunity, Motivation of Behaviour model GRADE-CERQAUL Confidence in the Evidence from Reviews of Qualitative research USA United States of America SPiCG smoking in pregnancy challenge group RTINASHP research triangle and national academy for state health policy Ql qualitative MM mixed methods RCT randomised controlled trial nRQ non-randomised quantitative QD quantitative descriptive TB tuberculosis HIV human immunodeficiency virus infection PWID people who inject drugs SUD substance use disorders DBT direct benefit transfer CO Carbon Monoxide CM contingency management PrEP pre-exposure prophylaxis CCT conditional cash transfer A/PNC ante/postnatal care MNCH maternal and child health SNAP supplemental nutrition assistance program VHA veterans health administration VCS Veterans Canteen Service MIPCD Medicaid Incentives for the Prevention of Chronic Diseases Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials All data generated or analysed during this study are included in this published article and its additional information files. Additional datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding RL is a doctoral candidate under the SPHeRE Programme funded by the Health Research Board under grant SPHERE/2022/001. This research was funded by the Health Research Board APA-2022-029. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors' contributions RL drafted the manuscript, carried out formal data analysis and interpretation of findings. RL, BD and CD collaboratively conducted the literature search, screening, extraction of data as well as quality and confidence in evidence assessment. FD provided methodological oversight and overall supervision. FD, PK and DS provided substantial and critical revisions to the manuscript. All authors contributed to the conceptualisation of this review, read and approved the final manuscript. Acknowledgements We would like to express appreciation for Mr Killian Walsh, the information specialist at the Royal College of Surgeons in Ireland, for his assistance in the development of the search strategy. We would also like to thank the following: Professor Kevin A. Hallgren, Drs Adam Ketron and Yanni Chang (University of Washington); Jennifer McKell (University of Stirling) and colleagues from the CPIT II trial team who generously shared unpublished materials/reports that contributed to the development of this review as well as Maria Jones (RCSI) who helped guide TDF/COM-B coding. Finally, we are sincerely grateful to our Patient and Public Involvement (PPI) contributors: Sarah Halpin, Steve Moore, Tony O’Reilly and Pauline Williams for their valuable input and perspectives, which played a crucial role in shaping the direction and relevance of this study. 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N) Intervention Summary b Target behaviour : Patient management Lutge 2014 [ 42 ] Ql South Africa 4091 (48) A voucher, valued at ≈ $ 15 was offered to patients by nurses every month (max. 8 months) contingent upon collection of their treatment. Wingfield 2015 [ 43 ] MM Peru 782 (75) A multi-component intervention provided cash transfers contingent on screening household contacts and TB diagnosis in patients; adhering to treatment and chemoprophylaxis. Incentives were tiered: up to $ 230 for optimal, and $ 115 for acceptable compliance. Patel 2019 [ 44 ] MM India 1826 (19) DBT provided incentives in instalments of ≈ $ 14.20 each contingent on medication adherence in Vadodara, Western India. Nirgude 2019 [ 45 ] MM India 417 (20) DBT scheme provides incentives as a cash transfer of ≈ $ 7.10/month during treatment contingent on being a notified (diagnosed) TB patient and adhering to treatment protocols in South India. Musiimenta 2024 [ 46 ] MM Uganda 39 (30) A multi-component incentive intervention provided incentives (mobile money) via an app valued at ≈ $ 1.50 conditional achieving a medication adherence rate of ≥ 90%. Verma 2024 [ 47 ] MM India 3373(13+) DBT scheme provides incentives as a cash transfer of ≈ $ 7.10/month during treatment contingent on adhering to treatment protocols in Pune, Western India. Mohan 2024 [ 48 ] Ql India 36 DBT scheme provided a cash transfer of ≈ $ 5.98/month contingent on registration and ongoing treatment across thirty districts. Chadhar 2025 [ 49 ] MM India 251(-) DBT scheme provided cash transfers of ≈ $ 7.10/month contingent on their registration and ongoing treatment in Northern India. Greene 2017 [ 50 ] Ql USA 96 An incentive of a $ 70 gift card provided quarterly contingent on achieving or maintaining viral suppression- defined as HIV RNA < 400 copies/mL. through medication adherence. Shelus 2018 [ 51 ] Ql USA 19 (44) A multi-component incentive for newly diagnosed/out-of-care patients contingent on linkage to care, defined as attendance at two medical visits after HIV diagnosis specifically upon blood tests ( $ 25 gift card) and upon meeting with a clinician to review lab results and develop a care plan ( $ 100). Warnock 2025 [ 52 ] Ql USA 20 A multicomponent CM and pre-exposure prophylaxis (PrEP) adherence support programme provided escalating incentives via “draws” from a fishbowl (up to. average $ 608 total) contingent on achieving individualized goals on the PrEP/medications continuums. Wagner 2025 [ 53 ] Ql USA 18 A mobile app intervention provided incentives of $ 1/day contingent on verified medication adherence over 3 months. Behaviour : Smoking Cessation Kim 2012 [ 54 ] MM USA 878(20+) A multi-component intervention for smoking cessation provided incentives of $ 100 for completing a smoking cessation program, $ 250 for biochemically verified cessation within six months, and $ 400 for maintaining abstinence for another six months. Allan 2012 [ 55 ] Ql UK 14 Quit4u (Quit for you) provided incentives (supermarket card) contingent on verified CO testing ≈ $ 19.82/week (up to≈ $ 237.78 total). McKell 2013 [ 56 ] Ql UK 20 A Multi-component cessation intervention provided incentives (gift cards) for attending and setting a quit date (≈ $ 78.24); post CO validated quit at 4 weeks ≈ $ 156.47 and at 12 weeks≈ $ 156.47; and at 38 weeks (≈ $ 312.94) . Passey 2018 [ 57 ] MM Australia 22(13) A multi- component culturally tailored smoking cessation program provided incentives contingent on multiple behaviours as fixed vouchers valued at ≈ $ 7.46-≈ $ 22.37. SiPCG 2019 [ 58 ] Report UK ─ Four National Health Services (NHS) incentive schemes for smoking cessation provided incentives (usually shopping vouchers) of variable value (up to $ 383.01- $ 960.41) and frequency. Typically, contingent on engagement and biologically validated quits. Hefler 2013 [ 59 ] Report Mixed ─ Roundtable discussion on various incentive interventions for smoking cessation during pregnancy mainly from studies originating in Australia and New Zealand. Apata 2019 [ 60 ] MM USA 42 A multi-component smoking cessation program provided incentives contingent on milestones achievement ranging from $ 10–25 per target behaviour (e.g., $ 25 for one-month quit). Joyce 2021 [ 61 ] RCT USA 39 A multi-component smartwatch-enabled smoking cessation program provided streak-based incentives for watch recorded abstinence monitoring, of up to $ 112–315/ week. Too 2021 [ 62 ] nRQ UK 652 A multicomponent smoking cessation scheme provided incentives (up to ≈ $ 220.13) upon a CO validated quit. Breunis 2023 [ 63 ] MM The Netherlands 39 (18) A multicomponent smoking cessation web-based service provided vouchers and group incentives for a validated CO quit (or self-report quit during the pandemic) with individual incentives up to ≈ $ 199.80 earned. Yon 2024 [ 64 ] QD USA 20 A multi-component smoking cessation programme provided gift cards (up to $ 1,115 total) contingent upon biochemically verified quit during pregnancy and up to 3 months post-partum. Tranby 2025 [ 65 ] QD USA 20 A remotely delivered, culturally tailored, family-based smoking cessation intervention provided incentives (up to $ 750 total) contingent on quit status (CO, cotinine, self-report). Behaviour : Maternal and child care Powell-Jackson 2009 [ 66 ] ─ Nepal 55+ A multi-component CCT programme provided incentives for institutional delivery across 10 districts of varying amounts depending on region (≈ $ 6.65–19.95). Lama 2014 [ 67 ] Ql Nepal 48–60 A multi-component CCT scheme provided incentives of varying amounts contingent on select behaviours e.g., ANC visits (≈ $ 4.08), institutional delivery and post-natal care e.g., immunisation. Sidney 2016 [ 68 ] Ql India 24 A national CCT programme provided incentives contingent on institutional delivery equating to $ 23. Gupta 2018 [ 69 ] Ql India 50 A national CCT programme provided incentives contingent on institutional delivery of varying amounts depending on location ranged between ≈ $ 5.48- ≈ 6.39. Contractor 2018 [ 70 ] Ql India 45+ Two national CCT schemes: 1) for institutional delivery; 2) of up to $ 80 for ANC and infant care related behaviours, given in four instalments. Baba-Ari 2018 [ 71 ] Ql Nigeria 12 A multi-component CCT programme provided incentives (up to $ 30 total) contingent on going through the full continuum of MNCH services (e.g., ANC, skilled birth delivery, and PNC incl. immunisation). Dickin 2022 [ 72 ] MM Kenya 2522 (65–75) A multi-component CCT intervention provided incentives of $ 4.5/appointment contingent on attendance for ANC, delivery, PNC and childhood immunisation. Banerjee 2025 [ 73 ] MM India 1290 (70) A CCT programme provided cash incentive of ≈ $ 62 contingent on meeting specific health-related behaviours e.g. early pregnancy registration, at least one antenatal check-up, completion of the first cycle of child immunization. Behaviour : Healthy eating/drinking and/or physical activity Brown 2019 [ 74 ] MM Australia 34 A community store programme provided incentives (voucher) of ≈ $ 6.96 per minimum amount spend on fruit and vegetables. Evans 2022 [ 75 ] QD USA ? A year-round mobile market provided a price-matching incentive for SNAP recipient’s contingent on fruits and vegetables purchase as gift cards/a 50% discount. Silva 2023 [ 76 ] MM USA 41 A multi-component incentive program provided physical matching tokens representing 2 times the monetary amount (dollar) of benefits spent on eligible healthy items at a ratio of 1:2 Franckle 2023 [ 77 ] MM USA 1006 (13) A 2-for-1 intervention provided incentives as discount coupons (up to $ 10/ trip) contingent on the purchase of F&V items rated as two-three stars (good- best nutritional quality). Parks 2020 [ 78 ] Ql USA 38 Multiple Healthy Food incentive programs among low-income populations and SNAP participants. Incentive structure and rules varied by site. Moore 2024 [ 79 ] MM UK 481 (39) A Multi-component programme provided food-based incentives contingent on healthy on food choices via a point system with better nutritional choices having a higher point value. Points could be exchanged for rewards (e.g., vouchers) Reese 2024 [ 80 ] RCT USA 1658 A multi-component incentive intervention provided $ 1.50/day contingent on increasing daily fluid intake by meeting verified prescribed goals. Zulman 2013 [ 41 ] MM USA 6548 A multi-component web-based lifestyle program offered incentives of up to $ 2,000 in savings for walking 5,000 steps daily over each 3-month period. Gilson 2017 [ 81 ] MM Australia 26 (17) A multi-component m(mobile)-Health program provided incentives via a point-system equating to $ 30 - $ 200 per milestone for increased fruit and veg uptake and physical activity Corder 2021 [ 82 ] MM UK 2862 (122) A multi-component intervention provided individual and class-level incentives via points exchanged for rewards contingent on engagement in physical activities. Jose 2022 [ 83 ] MM Australia 110 (11) A multi-component intervention provided increasing incentives of varying values for transport-related physical activity increase contingent on meeting escalating trip targets. Behaviour : Substance (including alcohol) abstinence Hagedorn 2014 [ 84 ] MM USA 157 (12) An intervention provided escalating prize draw ( $ 1, $ 20, or $ 80 vouchers) incentives redeemed at a VHA cafeteria or gift shop contingent on negative alcohol/ drug screens. . Hartzler 2015 [ 85 ] MM USA 22(24) Adoption phase (90 days) for trained staff of a CM intervention targeting several treatment-adherent behaviours using tangible re-inforcers e.g. low-cost gift cards/ a voucher-based ‘point-system.’ Hartzler 2016 [ 86 ] QD USA 4 Multiple SUD CM interventions and associated pragmatic considerations. DePhilippis 2023 [ 87 ] QD USA ? Three prize-draw CM programs for verified drug abstinence ( $ 0- $ 100), in-person medication adherence (up to $ 373 avg. total), and verified smoking cessation via CO test. Brolin 2017 [ 88 ] MM USA 2667 (61) A multi-component CM intervention provided incentives of up to $ 240 in gift cards contingent on completing recovery-oriented behaviours within 90 days post-discharge. Desrosiers 2019 [ 89 ] MM Canada 24 A CM programme provided prize draw tokens (4 tokens/ draw) contingent on attending group therapy equating to on average $ 42 per participant. Becker 2019 [ 90 ] MM USA 39 (32) Multiple SUD CM interventions adoption/ implementation phases using an escalating prize draws model contingent on patient attendance. Becker 2021 [ 91 ] MM USA 8 A CM intervention provided incentives using a 500-slip fishbowl (50% prize chance) to reinforce attendance or engagement goals (e.g., counselling, dosing). Metrebian 2021 [ 92 ] MM UK 8 (7+) A phone-delivered CM program provided incentives contingent on methadone adherence of up to ≈ $ 132.08 total over 12 weeks. Winograd 2022 [ 93 ] MM USA 29 A multi-component CM program provided incentives as voucher of up to $ 75 total /client/year contingent on treatment engagement, limited to the first 4–6 weeks. Green 2023 [ 94 ] Ql USA 70 (18) A multi-component treatment program provided incentives of up to $ 315/participant total, contingent on drug abstinence as gift cards for stimulant-negative urine tests. Curran 2023 [ 95 ] Ql UK 47 A multicomponent CM intervention provided incentives as shopping vouchers of up to $ 298.56 total contingent on abstinence or reduced cannabis use verified via urinalysis. Cohen 2023 [ 96 ] Ql USA 56 (22) A multi-component CM intervention provided escalating incentives as restricted VCS coupons/ smart debit cards contingent on verified alcohol abstinence and/or completing selected activities. Parent 2023 [ 97 ] QD USA 154 (154+) Multiple CM interventions across 17 sites in two states provided incentives of up to $ 315/ $ 528 total as gift cards, with a “banking” option contingent on verified stimulant abstinence. Hallgren 2023 a[ 98 ] MM USA 28 (27) A multi-component m(mobile)-Health intervention contingent on verified stimulant abstinence provided incentives of $ 8.42/ negative result. Gorman 2024 [ 99 ] QD USA 3 A hybrid telehealth CM program provided incentives via prize draws as VCS vouchers contingent on verified treatment adherence up to max. avg. of $ 372.86 for full adherence. Jakubowski 2024 [ 100 ] QD USA 28 A digital CM intervention implemented across six clinics provided incentives (up to $ 599 over 6 months) for meeting health behaviours e.g., negative toxicology screens, and attending treatment. Smoker 2025 [ 101 ] MM USA 72 A Multi-component CM intervention provided incentives (e.g., gift cards) contingent on objectively verified completion of target health behaviours e.g. drug abstinence, therapy attendance, or medication adherence. Behaviour : Multiple Perry 2019 [ 102 ] Ql USA 235 The MIPCD program implemented across 10 states provided incentives of variable forms, focus, design and structure contingent on adopting healthier behaviours/ chronic disease management e.g. tobacco use, obesity, hypertension and diabetes. RTINASHP 2017 [ 14 ] Report USA ─ Multiple state MIPCD programs. SPiCG: smoking in pregnancy challenge group; RTINASHP: research triangle and national academy for state health policy; Ql: qualitative; MM: mixed methods; RCT: randomised controlled trial; nRQ: non-randomised quantitative; QD: quantitative descriptive; TB: tuberculosis; HIV: human immunodeficiency virus infection; PWID: people who inject drugs; SUD: substance use disorders; DBT: direct benefit transfer; CO: Carbon Monoxide; CM: contingency management; PrEP: pre-exposure prophylaxis; CCT: conditional cash transfer; A/PNC: ante/postnatal care; MNCH: maternal and child health; SNAP: supplemental nutrition assistance program; VHA: veterans health administration; VCS: Veterans Canteen Service; MIPCD: Medicaid Incentives for the Prevention of Chronic Diseases; a Unpublished data were obtained via author contact and linked to main study. b Incentives are shown in USD, either as reported or converted using the average exchange rate at the time equivalent at the time of the study/publication. C included additional populations other than pregnant only e.g., lactating women, new born or supporting other. d with history of urinary tract infections including non-adult patients e specifically among people with HIV and unhealthy alcohol use Table 3 Summary of barriers (type “B”) and facilitators (type “F”) to FI interventions implementations Domain Type n % Summary Environmental context and resources B 60 (95%) • Ambiguities around/lack of existing policies for digitally-delivered FI interventions [ 100 ] . • Policy constraints, regulatory and/or bureaucratic requisites [ 14 , 41 , 47 , 48 , 66 , 69 , 78 , 83 , 93 , 94 , 97 , 101 ] . • Incentive designs complexity and inflexibility [ 57 , 73 , 82 – 84 , 94 , 96 , 96 – 98 ] including inappropriate/unclear eligibility criteria [ 45 , 58 , 66 , 90 , 92 , 102 ] and issues linked to the form and/or method of incentives delivery [ 14 , 43 – 45 , 47 – 49 , 68 , 73 , 75 , 88 , 100 ] , incentive amount/value [ 47 , 67 , 71 , 74 , 81 ] , limited duration or frequency of intervention delivery to achieve full integration or meaningful behavioural outcomes [ 89 , 102 ] , suboptimal timing of incentive delivery [ 14 , 48 , 55 , 88 , 89 , 98 ] or setting of delivery [ 53 , 55 , 60 , 75 ] . • Ambitious and/or unrealistic goals [ 88 , 94 ] . • Poorly-tailored platforms [ 63 , 100 ] . • Cumbersome test kits [ 98 ] and physical testing requirements) [ 96 ] . • Group-based interventions exacerbated challenges [ 57 , 59 , 84 ] . • Limited time until rollout and/or lengthy procedural requirements [ 56 , 66 , 79 , 89 , 90 ] . • Limited resources preventing alignment with evidence-based design [ 43 ] . • Ineffective stakeholder partnerships [ 14 , 58 , 82 , 90 , 91 , 100 , 101 ] . • Undefined roles, guidelines and strategies, communication and feedback protocols or reliance on ad-hoc decision making [ 60 , 66 , 69 , 72 , 82 , 100 ] . • Intervention integration challenges [ 64 , 69 ] [ 50 , 51 , 53 , 59 , 78 , 82 , 88 , 89 , 93 – 95 , 97 , 98 , 100 , 101 ] . • Limited funding or competing financial priorities [ 14 , 48 , 53 , 66 , 73 – 76 , 78 , 78 , 84 , 87 , 90 , 91 , 95 , 98 , 100 ] . • Logistical and procedural impediments [ 14 , 14 , 42 – 45 , 47 – 51 , 57 , 65 , 66 , 68 , 71 – 73 , 75 , 79 , 79 , 89 , 91 , 94 , 96 , 99 , 101 , 102 ] . • Technological shortcomings [ 14 , 41 , 44 , 45 , 47 – 49 , 53 , 56 , 61 , 65 , 72 , 73 , 77 – 80 , 83 , 91 , 92 , 98 ] . • Data management issues [ 62 , 77 , 79 ] . • Workforce crises [ 14 , 44 , 45 , 48 , 51 – 54 , 56 , 57 , 59 , 64 , 68 , 69 , 72 – 74 , 82 , 84 , 88 , 90 , 91 , 91 – 94 , 99 , 101 , 102 ] . • Intervention-related training, administration or management processes issues [ 41 , 45 , 48 , 50 , 54 , 56 , 59 , 62 , 72 , 74 , 76 , 79 , 80 , 84 , 87 , 88 , 91 , 91 , 93 , 100 , 102 ] . • Restricted access to participants’ progress [ 60 ] . False claims of target behaviours, and fund skimming [ 66 ] . • Contextual factors secondary to pre-existing geodemographic factors including transportation issues [ 43 , 48 , 57 , 61 , 66 – 71 , 73 , 87 , 93 , 97 , 101 , 102 ] . • Lack of tailored and/or effective recruitment methods [ 59 , 63 , 101 ] . • Intervention-unfriendly institutional environments [ 54 , 70 , 79 – 81 ] . • Poor infrastructure and service gaps [ 44 , 48 , 60 , 67 , 69 – 71 , 74 , 78 , 82 , 83 , 87 , 88 ] . • Competing priorities of both providers and/or service users [ 52 – 55 , 64 , 70 , 79 , 80 , 82 , 83 , 91 , 94 , 95 , 100 , 102 ] . • Unforeseen external events [ 49 , 52 , 54 , 63 , 64 , 72 – 74 , 83 , 87 , 91 , 94 , 96 , 99 , 101 ] . F 44 (70%) • Benchmarking [ 41 ] , participatory/collaborative approaches with key stakeholders [ 41 , 60 , 77 , 84 , 86 , 89 , 94 , 101 ] for intervention planning. • Ease of intervention use [ 46 , 53 , 79 , 92 , 98 , 100 ] . • FI broad eligibility criteria [ 86 ] . • Bank transfers [ 44 ] , cards/digital transfers as secure or convenient forms with minimal issues [ 61 , 71 ] . • Schedule flexibility [ 102 ] . • Robust behaviour verification methods (e.g., CO monitoring) [ 58 ] . • A wide assortment of additional participant-centred elements [ 46 , 57 , 60 , 71 ] such as: unconditional cash transportation support [ 46 ] , peer support [ 60 ] , reminders [ 46 , 53 ] and discreet non-stigmatising app designs (for HIV, TB patients) [ 46 , 53 ] . • Piloting [ 75 ] and incorporating stakeholder/participant feedback [ 43 , 48 , 60 , 73 , 77 , 85 ] for intervention optimisation. • Data-driven decision making [ 14 , 75 ] . • Autonomy and/or flexibility to refine FI to evolving needs [ 48 , 50 , 66 , 75 , 82 , 87 , 97 , 99 , 100 ] , and enhance adaptability/creativity [ 14 , 48 , 49 , 91 ] . • Robust infrastructure [ 44 , 46 , 49 , 58 , 61 , 73 , 75 , 77 , 78 , 85 , 87 , 98 , 101 ] alongside accessible and reliable services [ 44 , 46 , 48 , 83 ] . • Easy referral processes [ 63 , 98 ] . • Strategic, population-oriented and readily implementable awareness campaigns and/or outreach activities [ 14 , 52 , 54 , 57 , 59 , 60 , 71 , 73 , 77 – 80 ] . • Comprehensive training systems [ 62 , 73 , 79 , 87 , 96 ] incorporating peer learning [ 78 , 86 , 94 ] , evidence-based protocols [ 58 , 87 ] , and expert input [ 94 ] . • Stable and adequate workforces [ 44 , 62 , 85 , 100 ] , alongside readily-available dedicated members and/or contacts [ 52 , 62 , 73 , 77 , 96 , 99 ] . • Robust, diverse and multi-level systems with cross-sector collaborations [ 14 , 43 , 48 , 58 , 63 , 73 , 77 , 78 , 100 ] . • Commitment and/or strong leadership [ 48 , 73 , 77 , 78 , 82 , 85 , 87 , 94 , 96 , 100 , 101 ] . • Funding that is sustainable, adequate and/or timely [ 44 , 52 , 66 , 75 , 77 , 87 , 87 , 94 , 97 ] . • Alignment with existing policies, organisational aims/branding [ 77 , 79 ] , target population [ 59 , 100 ] and workflows/systems [ 51 , 58 , 75 , 77 , 85 , 96 , 100 ] . • Minimal administrative burden [ 48 , 51 , 57 , 84 , 89 ] and resource input [ 83 ] . • Performance-based incentives to promote providers’ participation in intervention delivery [ 87 ] . Beliefs about consequences B 27 (43%) • Conflict and/or discomfort over incentivising behaviours [ 14 , 51 , 88 , 89 ] , particularly due to the possibility of acting as perverse incentives [ 42 , 43 , 95 , 96 ] even more when aimed towards specific groups. [ 14 , 43 , 95 , 96 ] . • Questioning FI necessity and/or effectiveness [ 51 , 54 , 56 , 63 , 88 – 90 ] . • Concerns over FI as a new concept/controversial [ 14 ] . • Comprising personal agency subsequent to “policing” of behaviours, posing as “paternalistic bribes” [ 51 , 95 ] . • Exploiting individual’s economic/emotional desperation [ 51 , 59 ] . • Concerns about integrating the intervention in clinical settings [ 96 ] . • Negative views/assumptions on FI interventions processes [ 56 , 63 , 66 , 72 , 85 , 91 , 97 , 98 ] . • Participants’ perceptions of unfairness and at times exacerbating disparities [ 42 , 51 , 59 , 66 , 95 ] brought about by FI interventions’ eligibility criteria. Opposing incentivising behaviours [ 51 ] . • The associated cost of engagement outweighing its perceived benefits [ 55 , 72 ] . • Anticipated reprimand of poor service use in case of failure to change [ 55 ] . • Witnessed deviations from expected incentive delivery [ 66 , 72 ] . • Affluent participants viewed FI as insignificant when faced with sharing confidential information [ 44 , 45 , 47 ] . • Perceived unattainable behavioural targets/ incentives [ 79 ] . • Assumptions around intervention/treatment ineffectiveness [ 98 ] . • Concerns over anticipated added admin burden [ 85 ] , overcommitting resources [ 88 ] • Concerns over being challenged by users who held strong beliefs about the health behaviour i.e., cannabis use [ 95 ] . • Holding unfavourable views on government-led initiatives [ 47 , 70 , 71 ] . • Potential poor outcomes due to recognised low quality services [ 68 , 70 , 71 ] . F 19 (30%) • Valued anticipated /observed benefits [ 48 , 50 , 52 , 54 , 73 , 74 , 78 , 81 , 83 , 85 , 95 , 96 , 98 , 100 ] , reducing scepticism [ 52 , 53 , 95 ] . • Direct transfers seen as legitimate way of incentive delivery [ 48 , 66 , 72 , 73 ] . • No high-value prizes for patients with substance use issues [ 89 ] . Social influences B 18 (29%) • FI objectives and existing cultural norms or populations’ reality mismatches [ 48 , 66 , 67 , 69 – 71 ] . • Cultural dissonance with the target health behaviour [ 67 , 69 – 71 ] or from banking systems in ethnic groups [ 48 ] . • Experienced gender-based incentive misuse [ 66 ] or altered household dynamics [ 72 ] . • Stigma [ 43 , 47 , 55 , 78 ] . • Staff role violations [ 68 , 69 , 72 ] . • Providers’ concerns over damaging their community relationships as the "face of the intervention" [ 72 ] . • Group-based FII interventions and peer pressure [ 63 ] . • Negative views on external social agents challenged partnership efforts [ 100 ] due to anticipated resistance to incentive-based models/ perceived limited influence. • Negative interactions [ 102 ] . • Coercion into participation [ 41 ] . • Mentor-user peer hierarchy [ 82 ] . • Challenges to leverage relationships for engagement [ 80 ] . F 25 (40%) • Community-oriented elements [ 43 , 48 , 57 , 60 , 68 , 81 – 83 , 102 ] . • Trusted figures approving of incentives use [ 46 , 68 , 71 ] , having doctors/insurance providers as a referral point [ 102 ] or a trusted party for service delivery [ 83 ] . • Non-judgemental and supportive providers [ 14 , 63 , 96 , 102 ] who cushioned the intervention while avoiding negative inferences [ 46 ] . • Ongoing and consistent communications alongside fixed provider-user pairings [ 99 ] . • Expert-led training [ 94 ] , local champions, social modelling ( e.g. sharing patient success stories [ 87 ] as well as teamwork and “the sense of shared commitment” [ 84 ] . • Established community ties [ 74 ] . • State-sponsored dissemination efforts [ 93 ] . • Fellow staff and managers enthusiasm and positive attitudes [ 41 , 85 , 86 ] . • Open dialogue and peer support among providers [ 97 ] . • Teacher support for student mentors,(?) recruitment and social connection with peers [ 82 ] . Reinforcement B 17 (27%) • Insufficient incentives [ 45 , 48 , 49 , 66 , 81 ] relative to costs/needs. • Low incentives amount [ 44 , 71 , 97 , 98 ] . • Significant delays between achieving the target behaviours and incentives receipt [ 43 , 82 ] . • Non-monetary rewards (e.g., "good job" slips) [ 96 ] . • Remote delivery [ 97 ] . Reinforcing a transactional provider-participant relationship [ 51 ] . • Misreporting of behaviour targets to bypass the eligibility criteria [ 70 ] . • Providers’ inadequate or delayed compensation for implementation efforts [ 69 , 72 , 76 ] F 18 (29%) • Real-time monitoring and reminders [ 46 ] educational materials [ 83 ] , fun, competitive and game-like aspects [ 41 , 79 , 81 ] , deescalating incentives [ 53 ] , unconditional tailored packages [ 64 ] , family/staff support [ 57 , 64 , 65 ] . • Visual, immediate and/or regular testing as well as receiving feedback on behaviour change [ 63 , 64 , 84 ] . • The act of goal-setting and achieving targets [ 83 ] , the use of physical tracking tools [ 89 , 96 ] . • Favourability and high acceptability of the intervention/its components [ 50 , 53 , 54 , 57 , 65 , 79 , 84 , 96 ] . • Providers viewing incentives as an empowering reinforcement [ 57 ] . • Regular feedback on participants’ outcomes [ 87 ] . • Positive reinforcers over punitive-based approaches [ 93 ] • Receiving recognition for their role [ 82 ] . Knowledge B 22 (35%) • Limited evidence on population/context-specific incentive designs [ 43 ] . • Legal ambiguities [ 93 ] . • Knowledge and understanding gaps on intervention aims, positioning, processes and/or eligibility criteria [ 14 , 41 , 45 , 66 , 69 – 71 , 74 , 77 , 82 , 83 , 94 ] . • Uncertainties amongst providers about the FI programmes policies [ 66 ] , timelines [ 72 , 102 ] , modifications [ 94 ] or their/other’s roles [ 45 , 66 , 82 ] . • General limited awareness of the FI interventions across clients and providers [ 44 , 45 , 47 , 48 , 56 , 76 ] and of the associated services/resources [ 44 , 48 , 70 , 71 ] . • Participant’s limited comprehension of messaging on the intervention [ 48 , 65 ] . F 11 (17%) • High awareness and understanding surrounding FI interventions and relevant services [ 49 , 73 ] . • Familiarity with the evidence-base [ 52 , 58 , 84 , 87 ] . • Clear practice guidance and training resources on FI principles, effectiveness, designs and procedures [ 58 , 87 , 101 ] . • Staff with prior knowledge and experience [ 52 , 87 ] . • Regular updates on implementation processes/outcome data [ 52 , 91 ] . • Complementary education components and/or information dissemination activities on the health-behaviour, the FI interventions and associated or their potential impact [ 43 , 76 , 81 ] . Role and Identity B 20 (32%) • Providers’ personal/ professional values around equity/justice or what entails an “appropriate” treatment model [ 14 , 42 , 48 , 50 , 81 , 84 , 94 , 95 , 97 , 101 ] . • Grappling with multiple responsibilities -that are incompatible with their role or professional standards of care, [ 48 , 50 , 56 , 80 , 84 , 88 , 94 ] . • Ethical quandaries regarding eligibility vs those truly in need [ 48 , 50 ] . Rationing incentives [ 14 , 42 ] . • Preoccupation with achieving targets and ensuring “coverage” [ 70 ] . • Perceived shift in the provider-user roles from a collaborative care relationship to a transactional one [ 55 ] . • Intervention goals conflict with institutional identities [ 54 ] . • Stakeholders holding diverse views surrounding intervention philosophies and/or role responsibility [ 81 , 94 , 97 ] . • Perceived undervalued key stakeholder groups (e.g., clinical and traditional service providers) roles and expertise [ 66 , 70 , 89 ] . • High socioeconomic status participants’ social standing [ 42 , 44 , 45 ] . F 10 (16%) • Alignment with organisational, professional and/or social identities and associated responsibilities [ 41 , 50 , 57 , 77 , 84 , 86 , 91 , 95 ] . • Being able to satisfy professional performance targets [ 72 ] . • Role expansion and redefining strategies [ 84 , 86 , 91 , 99 ] . Skills B 18 (29%) • Operational motor skills limitations [ 77 , 79 ] . • Physical impairment [ 47 ] . • Digital illiteracy [ 48 , 79 , 92 ] . • Deficiencies in design skills [ 43 ] . • Providers’ digital and technical literacy gaps, limited data management, and/or administration skills [ 48 , 56 , 74 , 79 , 82 , 88 , 94 , 98 ] . • Limited interpersonal and communication skills [ 51 , 64 , 80 , 95 , 102 ] . F 4 (6%) • Well-trained staff with relevant skill-sets [ 14 , 50 , 79 , 94 ] . Behavioural Regulation B 2 (3%) • Weak monitoring and poor budgetary planning [ 66 ] . Challenges with self-tracking behaviour change goals [ 102 ] . F 15 (24%) • Clear planning and monitoring strategies with/out stakeholders’ feedback [ 41 , 58 , 77 , 80 , 86 , 87 , 100 , 101 ] . • Elements such as: reminder systems, e-trackers, random behaviour verification tests as well as readily accessible outcome data among others [ 46 , 53 , 81 – 83 , 96 , 98 ] . Emotion B 12 (19%) • Providers’ burnout [ 52 ] and frustrations [ 98 ] . • Participants’ fear, anger [ 68 , 71 , 83 ] and/or feelings of guilt [ 55 , 63 ] . • Others felt daunted and/or demotivated with impersonal program elements [ 63 , 89 ] . • Students felt embarrassed [ 79 ] , while employees were too stressed [ 54 ] . • Few felt offended [ 51 ] due to ill-timed intervention briefing. F 8 (13%) • Strong positive emotions on test validation [ 57 ] . • Providers “feeling good” [ 50 ] and having "fun” [ 96 ] . • Feeling appreciated, respected, satisfied, less alone or stressed [ 51 , 53 , 89 , 98 ] . • Reduced shame [ 55 ] when failures were contextualized. Memory, Attention and decision processes B 9 (14%) • Cognitive overload due to procedural demands and/or uncertainties in the decision-making processes [ 41 , 46 , 51 , 77 , 82 , 83 , 88 , 89 , 98 ] . Beliefs about capabilities B 4(6%) • Self-perceived incompetence and lack of confidence [ 60 , 93 ] among providers. • Systems overestimating a level of service users’ capabilities [ 48 , 52 ] . F 3(5%) • Stronger belief in providers’ own abilities towards implementation [ 85 ] . • Self-efficacy (empowerment) [ 43 , 53 ] . Goals B 4 (6%) • Goal-setting misalignment [ 14 , 44 ] . • Participants’ competing priorities overriding intervention goals [ 74 ] . F 4 (6%) • Personal health goals [ 82 ] . • FI alignment with recovery objectives [ 89 ] . • Providers motivated to facilitate and prioritise implementation [ 94 , 98 ] . Additional Declarations No competing interests reported. Supplementary Files Additionalfile6DeterminantstoFIinterventionssummarydataset.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 May, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviews received at journal 21 Jan, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers invited by journal 09 Jan, 2026 Editor assigned by journal 18 Nov, 2025 Submission checks completed at journal 10 Nov, 2025 First submitted to journal 07 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Ward","email":"","orcid":"","institution":"University of New Mexico","correspondingAuthor":false,"prefix":"","firstName":"Kenneth","middleName":"D.","lastName":"Ward","suffix":""},{"id":579475934,"identity":"398ac1a4-655c-4d62-aac4-907161fa23d9","order_by":24,"name":"Paul Kavanagh","email":"","orcid":"","institution":"Royal College of Surgeons in Ireland","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Kavanagh","suffix":""},{"id":579475935,"identity":"3e04580b-906c-40a9-bb31-90e21bd72079","order_by":25,"name":"Frank Doyle","email":"","orcid":"","institution":"Royal College of Surgeons in Ireland","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Doyle","suffix":""}],"badges":[],"createdAt":"2025-11-07 20:23:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8059982/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8059982/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101633225,"identity":"ad1bfbea-1cd8-496a-8a73-3265cf833e57","added_by":"auto","created_at":"2026-02-02 05:59:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153178,"visible":true,"origin":"","legend":"\u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of study selection.\u003c/p\u003e\n\u003cp\u003eG, Grey Literature; S, Scientific literature. \u003csup\u003ea \u003c/sup\u003ePrimary databases search update; \u003csup\u003eb \u003c/sup\u003eone unpublished record obtained through author contact added to original publication retrieved through primary searching; \u003csup\u003ec\u003c/sup\u003e i.e., non-contingent, of no monetary value, for non-health behaviour/ providers, not explicitly detailed incentives.\u003c/p\u003e","description":"","filename":"FigureFile1PRISMADiagram.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8059982/v1/220b22d1194d64b21475816a.jpg"},{"id":101753605,"identity":"c4caa37d-41d8-463c-bd83-b5e9e6db4ca0","added_by":"auto","created_at":"2026-02-03 10:40:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3060344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8059982/v1/b1b08762-d41f-4f06-b7d3-29e32fa5fa14.pdf"},{"id":101633226,"identity":"909135ed-2880-44dd-9ef2-db8c8c74641f","added_by":"auto","created_at":"2026-02-02 05:59:06","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":494208,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile6DeterminantstoFIinterventionssummarydataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8059982/v1/7bf83682da97089d92ff7c1c.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Facilitators of and Barriers to Implementation of Financial Incentive Interventions for Health Behaviour Change: A Systematic Review","fulltext":[{"header":"Contributions to the Literature","content":"\u003cul\u003e\n \u003cli\u003eFinancial incentive interventions are promising, yet complex, tools in driving health behaviour change for better health outcomes, and factors influencing their implementation are unclear.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWe identified general barriers and facilitators to financial incentive interventions implementation, as well as distinct incentive-specific elements. \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThis is the first attempt to apply theory-based, behavioural frameworks, in the context of policy to identify influences on financial incentive interventions implementation regardless of setting, the incentivised population, or behaviour.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Background","content":"\u003cp\u003eBehavioural risk factors such as smoking, poor diet, and physical inactivity, contribute significantly to the development of major diseases and ill-health\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Yet effective promotion of healthy behaviours is quite difficult to achieve\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Hence, substantial efforts have been employed towards identifying effective strategies to promote positive health behaviour change\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOne increasingly recognised strategy is the use of external rewards to influence behaviour\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This encompasses the use of financial incentives (FI)\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In the field of public health and healthcare delivery, FI interventions have shown promising levels of success in encouraging change across several health-related behaviours, including complex and one-off behaviours, albeit with varying effect sizes and subject to some uncertainties \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. For example, Giles et al.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e in their meta-analysis of 16 studies, found that individuals offered incentives of various sizes were 2.48 times (relative risk), more likely to quit smoking short-term, with lower effects for smoking cessation long-term (1.50), or for attendance at vaccinations or screenings (1.92).\u003c/p\u003e \u003cp\u003eThe use of FI in real-life settings, although limited, is also well documented. For example, between 2011 and 2016, up to \u003cspan\u003e$\u003c/span\u003e1454995 of disbursed incentives were offered to the US Medicaid population to encourage uptake of and adherence to healthier behaviours and participation in prevention programmes for conditions like diabetes, obesity, hypertension, and tobacco use\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Similarly, in lower income countries, multiple conditional cash transfer programmes rewarded adoption of healthier behaviours\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Such programmes were often linked to noticeable reductions in mortality and morbidity indices\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhilst such substantial evidence on FI interventions\u0026rsquo; effectiveness across various health behaviours and in multiple settings exists, these initiatives can also encounter multiple challenges during implementation, which likely reduce their efficacy and can sometimes result in early termination\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Concerns and uncertainties remain on how and under which circumstances these interventions achieve desired success and could be effectively sustained\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. That is largely due to the complexity of FI interventions. Wide variations in implementation processes, as well as limited understanding of mediators, e.g., social context, can hinder FI programmes\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Additionally, FI implementation is often challenging, for example, due to barriers concerning design, cost-effectiveness, ethical concerns and impact on wider society\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. It is therefore important to move beyond questions of whether incentives work, but instead elucidate the determinants of FI intervention implementation through systematic and theory-informed inquiry barriers and facilitators to actual implementation efforts\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA recent systematic review by van der Spek et al.\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e marked the first step towards strengthening FI implementation, by exploring FI intervention determinants; however it was limited to those targeted at smoking cessation among (expectant) parents in high-income countries while looking at both proposed and actual implementation efforts. Findings were mapped to the Consolidated Framework for Implementation Research (CIFR)\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, which is argued to be limited in scope and breadth compared to other applied frameworks for understanding and informing intervention implementation specifically intended for behaviour change \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The application of the Theoretical Domains Framework (TDF)\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e together with the Behaviour Change Wheel (BCW)\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e to investigate behaviour change interventions determinants should allow robust, efficient and systematic identification of domains most relevant for understanding health behaviour change, intervention strategies and potential contraindications, across a range of contexts\u003csup\u003e[\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe therefore aimed to conduct a systematic review to: a) identify and consolidate barriers and facilitators to FI interventions targeted at health behaviour change among mixed populations; b) map these determinants using the TDF and BCW; and c) explore differences specific to smoking cessation, given its global burden\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e, compared to other behaviours.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe systematic review was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (see Additional file 1)\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. The protocol was registered on PROSPERO\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. A detailed description of the methodology is available in our published protocol\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy and selection criteria\u003c/h2\u003e \u003cp\u003eThe search was initially conducted up to the 29th of May 2024 and updated on 3rd June 2025, through seven primary databases (See Additional file 2 for full search strategy). To supplement our search, grey literature was sought through Overton and citing papers of included studies were retrieved using Citation Chaser\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Key authors in the field were also contacted for any unpublished findings from November 2024 onwards, with a reminder sent after 15 days in case of no initial response. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the selection criteria. Multiple publications presenting new and/or complementary findings from a specific intervention were included, but each unique barrier/facilitator was accounted for once.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdopted definitions, inclusion and exclusion criteria for article selection.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDefinitions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStakeholders\u003c/b\u003e: People who are involved in (e.g., service providers) and/or impacted by (e.g., service users) the actual implementation of an intervention\u003c/p\u003e \u003cp\u003e\u003cb\u003eFinancial incentives\u003c/b\u003e: Cash or cash-like rewards (e.g., vouchers exchangeable for goods or services) or penalties provided contingent on performance of healthy behaviours\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomain being studied\u003c/b\u003e: Health behaviours among any population group (e.g., smoking, healthy eating, physical activity, immunisation, substance use).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEligibility\u003c/b\u003e: Reported stakeholders\u0026rsquo; self-reported issues to actual FI implementation targeted at a health behaviour change.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExclusion criteria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePopulation\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelevant stakeholder groups who are involved in/ impacted by the actual implementation processes of the intervention. These include implementation agents and/or intervention users as those who received any form of FI in order to change their behaviour regardless of age, gender, socioeconomic status or context.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThose not directly involved in or impacted by the implementation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFI as part of promoting health-related behaviour change.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnconditional, non-contingent, symbolic or non-monetary incentives. Interventions without sufficient detail on the FI component (or those that could not be found elsewhere)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe description and/or reflection on reported barriers or facilitators to actual FI interventions implementation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreferences, associations, correlations related to the intervention/health behaviour. Issues reported by those not involved in / impacted by the (proposed) implementation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTypes of publications\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny\u003c/p\u003e \u003cp\u003eEnglish language only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConference abstracts, letters, news releases, reviews, study protocols, dissertations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContext\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch in any country regardless of income status.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTitle and abstract as well as full-text screening of retrieved records were conducted by RL while 50% each were independently screened by BD and CD. Inter-rater agreement on screening decisions was high (98% for title-abstracts). Disagreements were resolved through discussion in consultation with FD. Corresponding authors were contacted for clarification on any ambiguities regarding inclusion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Extraction and quality assessment\u003c/h3\u003e\n\u003cp\u003eItems extracted pertained to seven key domains:1) article/study details; 2) population and settings; 3) methods; 4) stakeholder types; 5) intervention details; 6) study outcomes; 8) review outcomes. FI intervention items were informed by Adams\u0026rsquo; et al. nine-domains framework\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The quality of the included studies was assessed using the Mixed-methods Appraisal tool (MMAT, version 2018)\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Where the desired outcome was reported following a specific method of inquiry distinct from the overall study design, only the domain linked to that method was assessed (e.g., when barriers and facilitators were investigated via qualitative methods in a mixed-methods study, only the qualitative study design appraisal section in the MMAT was completed).\u003c/p\u003e\n\u003ch3\u003eData analysis and synthesis\u003c/h3\u003e\n\u003cp\u003eNarrative synthesis was undertaken with implementation determinants deductively mapped to TDF domains using the six constructs of the COM-B model, following the framework analysis method\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. A coding manual was developed a priori to guide the process based on established guidelines for TDF and BCW application\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. RL coded all items using Excel and 10% of data were coded independently by BD to assess reliability\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. Coding conflicts were resolved through discussion. All TDF domains were then mapped to relevant intervention functions and policy categories layers of the BCW\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Given the magnitude of information yielded, one primary domain per item was assigned utilising simple counts to identify the most frequently reported TDF domains, aligning with other reviews\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. Distribution patterns of barriers and facilitators across countries based on income status and those focusing on smoking cessation was explored by calculating the relative frequency of TDF domains within each group.\u003c/p\u003e\n\u003ch3\u003eAssessment of Confidence in the Evidence\u003c/h3\u003e\n\u003cp\u003eThe Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e was used by CD, BD and RL to assess the confidence we can place in our findings prior to an overall assessment being made.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigure 1(also see Additional file 3) summarises the study selection process. In brief, from an initial pool of 13850 records, 63 were included in the final analysis, representing 60 distinct studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e: Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of study selection.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;G, Grey Literature; S, Scientific literature. \u003csup\u003ea\u0026nbsp;\u003c/sup\u003ePrimary databases search update; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eone unpublished record obtained through author contact added to original publication retrieved through primary searching; \u003csup\u003ec\u003c/sup\u003e i.e., non-contingent, of no monetary value, for non-health behaviour/ providers, not explicitly detailed incentives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the characteristics of included records and a brief description of the provided FI intervention. Forty-seven of the retrieved records were conducted in high-income countries (70.1%), with most undertaken in the USA (32/47) and of mixed-methods design (n=31). Articles were published between 2009 and 2025. There were a wide range of primary intervention populations, including: patient groups, pregnant women, employees, school-aged children, and mixed groups. Targeted health-behaviours were equally diverse representing seven groups: substance use (n=18), smoking (n=12), patient management (n=12), healthy eating and/or physical activity (n=11), maternal/child health seeking (n=8), and two programmes addressed multiple behaviours. Incentive amounts ranged from approximately $7.70 to $2000 representing the maximum possible amount earned over the duration of the intervention, considering that not all studies reported clear incentive structures to aid the calculation of this estimate. The highest value indicates a potential 20% saving on out-of-pocket medical costs from employees\u0026rsquo; insurance providers\u003csup\u003e[41]\u003c/sup\u003e. Regarding methodological quality, 44 of 60 original research publications met at least 60% of the MMAT criteria and were considered of good quality (see Additional file 4). Reports were not subject to methodological quality assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eCharacteristics of studies included in the review, ordered by targeted behaviour\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers and facilitators to financial incentives implementation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross all studies, 374 items were recognised as an implementation determinant representing 12 TDF domains covering all COM-B subcategories with all records reporting on barriers and 84.4% (n=54) on facilitators. Inter-coder reliability of 78.8% agreement was achieved. Table 3 presents a summary of these including both FI-specific and more general programme issues while, narratively, we report on FI-specific barriers/facilitators at length. \u0026nbsp;Additional files 5 and 6 offer further elaboration, providing supporting excerpts and verbatim quotes from original reports, as well as detailed GRADE-CERQual assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Summary of barriers (type \u0026ldquo;B\u0026rdquo;) and facilitators (type \u0026ldquo;F\u0026rdquo;) to FI interventions implementation\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eEnvironmental Context and resources (Physical opportunity) (n=63, 100%)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePolicy constraints (e.g., anti-kickback laws), regulatory (e.g., funding caps) and/or bureaucratic requisites hindered adoption and implementation efforts\u003csup\u003e[14,41,47,48,66,69,78,83,93,94,97,101]\u003c/sup\u003e. Ambiguities around existing policies for digitally-delivered FI interventions\u003csup\u003e[100]\u003c/sup\u003e and limited resources\u003csup\u003e[43]\u003c/sup\u003e also curtailed scope for their development as initially envisioned. Incentive designs themselves experienced and/or acted as barriers owing to their complexity(e.g., confusing structure, multi-step pay-outs)\u003csup\u003e[57,73,82\u0026ndash;84,94,96\u0026ndash;98]\u003c/sup\u003e. Eligibility criteria that were too broad,\u003csup\u003e[58]\u003c/sup\u003e, too restrictive\u003csup\u003e[45,92,102]\u003c/sup\u003e or unclear\u0026nbsp;\u003csup\u003e[66,90]\u003c/sup\u003e reduced impact, led to misinterpretation and consequent implementation inconsistencies. The form and/or method of incentive delivery (e.g., bank transfers) posed extra hurdles (e.g., hidden charges)\u003csup\u003e[43\u0026ndash;45,47\u0026ndash;49,68,73,100]\u003c/sup\u003e indirectly excluding certain eligible groups, such as migrants or those with low digital literacy occasionally resulting in lower utilisation\u003csup\u003e[14,75,88]\u003c/sup\u003e,\u0026nbsp;unused funds and/or reduced reinforcement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverly ambitious and/or unrealistic goals\u003csup\u003e[88,94]\u003c/sup\u003e,\u0026nbsp;coupled with perceived inadequate incentive value further hindered behaviour change efforts\u003csup\u003e[47,67,71,74,81]\u003c/sup\u003e. Limited duration or frequency of delivery also acted as barriers to achieve full integration or meaningful behavioural outcomes\u003csup\u003e[89,102]\u003c/sup\u003e.\u0026nbsp;Suboptimal timing of incentive delivery\u003csup\u003e[14,48,55,88,89,98]\u003c/sup\u003e undermined effectiveness while inappropriate setting (e.g., work/public spaces)\u003csup\u003e[53,55,60,75]\u003c/sup\u003e deterred engagement\u0026nbsp;or disrupted the intervention continuity. Infrequently, cumbersome test kits for substance abstinence verification\u003csup\u003e[98]\u003c/sup\u003e and physical testing requirements(e.g., fingerstick tests)\u003csup\u003e[96]\u003c/sup\u003e generated frustration, especially among the physically impaired. It was also noted that group-based interventions exacerbated challenges\u003csup\u003e[57,59,84]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIntervention integration into existing workflows/systems was cited as a barrier for multiple reasons\u003csup\u003e[64,69]\u003c/sup\u003e including employing an incongruent model of behaviour change/incentive structure (e.g., unjustified clinical tests) with care pathways, user needs or service capacities\u003csup\u003e[50,51,53,59,78,82,88,89,93\u0026ndash;95,97,98,100,101]\u003c/sup\u003e. Intervention-related training, administration or management processes were cumbersome and resource-intensive\u0026nbsp;\u003csup\u003e[41,45,48,50,54,56,59,62,72,74,76,79,80,84,87,88,91,91,93,100,102]\u003c/sup\u003e. One study reported false claims of target behaviours, fund misuse and skimming\u003csup\u003e[66]\u003c/sup\u003e by staff.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntervention planning through benchmarking\u003csup\u003e[41]\u003c/sup\u003e and \u0026nbsp;participatory/collaborative approaches with key stakeholders\u0026nbsp;\u003csup\u003e[41,60,77,84,86,89,94,101]\u003c/sup\u003e facilitated the execution of legally and context informed interventions. Effective (or efficient) FI operationalisation was better achieved when aligned with existing policies, organisational aims/branding\u003csup\u003e[77,79]\u003c/sup\u003e, target population\u003csup\u003e[59,100]\u003c/sup\u003e and workflows/systems in place\u003csup\u003e[51,58,75,77,85,96,100]\u003c/sup\u003e. Ease of intervention use\u0026nbsp;\u003csup\u003e[46,53,79,92,98,100]\u003c/sup\u003e also facilitated utilisation. \u0026nbsp;On FI structure, bank transfers were favoured as they ensured incentives were administered and used as intended, reducing corruption\u003csup\u003e[44]\u003c/sup\u003e while other incentive forms (cards, digital transfers) were found convenient with minimal issues\u003csup\u003e[61,71]\u003c/sup\u003e. Users valued staff\u0026rsquo;s flexible scheduling of appointments\u0026nbsp;\u003csup\u003e[102]\u003c/sup\u003e while robust behaviour verification methods\u003csup\u003e[58]\u003c/sup\u003e deterred deception and motivated adherence. \u0026nbsp;A wide assortment of additional participant-centred elements\u003csup\u003e[46,57,60,71]\u003c/sup\u003e further enhanced engagement/adherence including: unconditional cash transportation support\u003csup\u003e[46]\u003c/sup\u003e, peer support\u003csup\u003e[60]\u003c/sup\u003e, reminders\u003csup\u003e[46,53]\u003c/sup\u003e and discreet non-stigmatising app designs (for HIV, TB patients)\u003csup\u003e[46,53]\u003c/sup\u003e.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOptimisation of interventions was ensured through diverse mechanisms as \u0026nbsp;piloting\u003csup\u003e[75]\u003c/sup\u003e and feedback methods\u003csup\u003e[43,48,60,73,77,85]\u003c/sup\u003e enabling continuous refinements. Utilisation of relevant data was equally important\u003csup\u003e[14,75]\u003c/sup\u003e for target population prioritisation, outreach, and buy-in efforts. Interventions granting a degree of autonomy and/or flexibility permitted attuning processes to evolving needs\u003csup\u003e[14,48,50,66,75,82,87,91,97,99,100]\u003c/sup\u003e and provided a space to develop creative innovations\u0026nbsp;\u003csup\u003e[48,49,91]\u003c/sup\u003e that supported continuity. Finally, to enhance staff capacity for implementation, comprehensive training systems\u0026nbsp;\u003csup\u003e[62,73,79,87,96]\u003c/sup\u003e peer learning strategies\u0026nbsp;\u003csup\u003e[78,86,94]\u003c/sup\u003e, evidence-based protocols\u003csup\u003e[58,87]\u003c/sup\u003e, and expert input\u003csup\u003e[94]\u003c/sup\u003e were vital. Moreover, maintaining stable and adequate workforces\u003csup\u003e[44,62,85,100]\u003c/sup\u003e,\u0026nbsp;alongside securing readily-available dedicated members and/or contacts\u003csup\u003e[52,62,73,77,96,99]\u003c/sup\u003e sustained knowledge and ensured smooth execution. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp; \u0026nbsp;Beliefs about consequences (Reflective motivation) (n=38; 60%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProviders commonly expressed conflict and/or discomfort over incentivising certain behaviours\u003csup\u003e[14,51,88,89]\u003c/sup\u003e,\u0026nbsp;particularly due to the possibility of acting as perverse incentives\u003csup\u003e[42,43,95,96]\u003c/sup\u003e most evident for interventions aimed at individuals who use drugs\u003csup\u003e[43,95,96]\u003c/sup\u003e and MEDICAID participants\u003csup\u003e[14]\u003c/sup\u003e.\u0026nbsp;Others simply questioned their necessity and/or effectiveness\u003csup\u003e[51,54,56,63,88\u0026ndash;90]\u003c/sup\u003e in driving meaningful outcomes, especially for those intrinsically ambivalent/resistant to change, adding to the fact that incentives were seen as \u0026nbsp;new and controversial\u003csup\u003e[14]\u003c/sup\u003e. Incentives were thought to compromise personal agency, subsequent to \u0026ldquo;policing\u0026rdquo; of behaviours, posing as \u0026ldquo;paternalistic bribes\u0026rdquo;\u003csup\u003e[51,95]\u003c/sup\u003e or potentially exploiting individual\u0026rsquo;s economic/emotional desperation\u003csup\u003e[51,59]\u003c/sup\u003e.\u0026nbsp;Participants\u0026rsquo; perceptions of unfairness\u003csup\u003e[42,51,59,66,95]\u003c/sup\u003e brought about by interventions\u0026rsquo; restrictive eligibility criteria also discouraged acceptability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImproper FI administration, withholding incentives or misleading beneficiaries, resulted from harbouring negative views on FI interventions processes (e.g., perceived irrational administration mechanisms, inaccuracy of behaviour validation methods) and their implications (e.g., sustainability and associated costs, \u0026nbsp;associated burden)\u003csup\u003e[56,63,66,72,85,91,97,98]\u003c/sup\u003e. Uncommonly, concerns about integrating the intervention in clinical settings (i.e., addressing alcohol use in HIV clinics)\u003csup\u003e[96]\u003c/sup\u003e fearing patients might be reluctant to discuss it if linked to their broader medical care were raised. Similarly, users held many \u0026ndash; comparable yet distinct \u0026ndash; perceptions surrounding FIs, sometimes \u0026nbsp;leading them to disengage including: opposing incentivising behaviours\u003csup\u003e[51]\u003c/sup\u003e, or \u0026nbsp;simply\u0026nbsp;deeming the associated cost to engagement (e.g., effort to support behaviour change/ access the incentive) to outweigh its benefits\u003csup\u003e[55,72]\u003c/sup\u003e. Rarely, factors such as anticipated reprimand of poor service use in case of failure to change\u003csup\u003e[55]\u003c/sup\u003e or due to witnessed deviations from expected incentive delivery\u003csup\u003e[66,72]\u003c/sup\u003e perpetuated mistrust and decreased acceptability. Occasionally, participants from affluent backgrounds considered the incentive insignificant given the requirement of confidential disclosure\u003csup\u003e[44,45,47]\u003c/sup\u003e.\u0026nbsp;Some also believed behavioural targets to be unattainable\u003csup\u003e[79]\u003c/sup\u003e while others assumed intervention/treatment ineffectiveness\u003csup\u003e[98]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStakeholders valued interventions for their (anticipated or observed) multifaceted benefits both for users (e.g., positive health and emotional outcomes) and health \u0026nbsp;systems (e.g., having better access to health information)\u003csup\u003e[48,50,52,54,73,74,78,81,83,85,95,96,98,100]\u003c/sup\u003e which was critical for boosting acceptability, enabling adoption and maintaining engagement. This reduced scepticism \u0026nbsp;and shifted initially unfavourable views\u003csup\u003e[52,53,95]\u003c/sup\u003e. Holding positive perceptions on certain aspects of the FI design was also important where direct transfers-instead of cash, were seen as a legitimate to limit pilferage\u003csup\u003e[48,66,72,73]\u003c/sup\u003e and avoiding high-value prizes to prevent risks for patients with substance use issues\u003csup\u003e[89]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp; \u0026nbsp;Social influences (Social opportunity) (n=35; 56%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMismatches between FI objectives and existing cultural norms or populations\u0026rsquo; circumstances\u003csup\u003e[48,66,67,69\u0026ndash;71]\u003c/sup\u003e shaped decisions towards (not) seeking behaviour change, and left interventions irrelevant and oftentimes, ineffective.\u0026nbsp;This partly stemmed from cultural dissonance with the sought behaviour-in this case, institutional childbirth\u003csup\u003e[67,69\u0026ndash;71]\u003c/sup\u003e, using banking systems among ethnic groups\u003csup\u003e[48]\u003c/sup\u003e,\u0026nbsp;concerns about gender-based incentive misuse\u003csup\u003e[66]\u003c/sup\u003e or altered household dynamics\u003csup\u003e[72]\u003c/sup\u003e.\u0026nbsp; It also became apparent that stigma was a key deterrent for engagement, often driven by fear of being linked to, or identified as part of, stigmatised populations\u003csup\u003e[43,47,55,78]\u003c/sup\u003e.\u0026nbsp;Power imbalances and interpersonal struggles reported at multiple levels threatened implementation as seen through staff role violations (e.g., demanding side-payments)\u003csup\u003e[68,69,72]\u003c/sup\u003e undermining users\u0026rsquo; autonomy while negative interactions disrupted engagement\u003csup\u003e[102]\u003c/sup\u003e.\u0026nbsp;Providers were also concerned being the \u003cem\u003e\u0026quot;face of the intervention\u0026quot;\u0026nbsp;\u003c/em\u003ecould damage their community relationships\u003csup\u003e[72]\u003c/sup\u003e specifically when incentive administration failed. At organisational level, negative views on external social agents challenged partnership efforts\u003csup\u003e[100]\u003c/sup\u003e mostly due to known resistance to non-abstinence-based models or due to their perceived limited influence over clinical practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eState-driven dissemination efforts\u003csup\u003e[93]\u003c/sup\u003e conveyed validation to participants while incorporating community-oriented elements (e.g., including family members/peers),\u003csup\u003e[43,48,57,60,68,81\u0026ndash;83,102]\u003c/sup\u003e fostered solidarity, boosted acceptability thus improving behavioural outcomes. Trusted figures (e.g., community leaders/religious figures) approving of incentives use\u0026nbsp;\u003csup\u003e[46,68,71]\u003c/sup\u003e,\u0026nbsp;having doctors/insurance providers as a referral point\u003csup\u003e[102]\u003c/sup\u003e or a trusted party for service delivery\u003csup\u003e[83]\u003c/sup\u003e lent legitimacy to the interventions. Non-judgemental and supportive providers\u003csup\u003e[14,63,96,102]\u003c/sup\u003e who cushioned the intervention while avoiding negative inferences\u003csup\u003e[46]\u003c/sup\u003e encouraged engagement. Also, ongoing and consistent communications alongside fixed provider-user pairings fostered stronger rapport and primed staff to engage in discussions surrounding the intervention\u003csup\u003e[99]\u003c/sup\u003e.\u0026nbsp; \u0026nbsp;Among providers, factors such as: fellow staff enthusiasm and positive attitudes\u003csup\u003e[41,85,86]\u003c/sup\u003e, \u0026nbsp;expert-led training\u003csup\u003e[94]\u003c/sup\u003e, \u0026nbsp;open dialogue and peer support\u003csup\u003e[97]\u003c/sup\u003e,\u003csup\u003e\u0026nbsp;\u003c/sup\u003e local champions, \u0026nbsp;social modelling (e.g. sharing patient success stories\u003csup\u003e[87]\u003c/sup\u003e) as well as \u003cem\u003e\u0026ldquo;the sense of shared commitment\u0026rdquo;\u003c/em\u003e\u003csup\u003e[84]\u003c/sup\u003e, \u0026nbsp;were key to overcome resistance to implementation. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp; \u0026nbsp;Reinforcement (Automatic motivation) (n=32; 51 %)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncentives that were deemed insufficient\u003csup\u003e[45,48,49,66,81]\u003c/sup\u003e relative to costs encountered or to population needs, or simply being too low\u003csup\u003e[44,71,97,98]\u003c/sup\u003e to drive change or those unfulfilled, often due to delays in incentives receipt,\u003csup\u003e[43,82]\u003c/sup\u003e disrupted reinforcement loops. In \u0026lsquo;fishbowl\u0026rsquo; prize draw models, the chance of getting a non-monetary reward proved demotivating\u003csup\u003e[96]\u003c/sup\u003e,\u0026nbsp;while remote intervention delivery\u003csup\u003e[97]\u003c/sup\u003e was not favoured by some. Infrequently, a transactional provider-participant relationship\u003csup\u003e[51]\u003c/sup\u003e was reinforced as financial expectations became a condition for engagement. Misreporting of behaviour targets was identified allegedly bypassing the eligibility criteria\u003csup\u003e[70]\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethus led to \u0026ldquo;fudging data\u0026rdquo;.\u0026nbsp;Inadequate or delayed providers\u0026rsquo; compensation compared to the added workloads/costs of intervention implementation\u003csup\u003e[69,72,76]\u003c/sup\u003e hampered proper delivery and, sometimes, led to non-adherence to its protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBehaviour change efforts were better supported through various mechanisms including: \u0026nbsp;real-time monitoring and reminders\u003csup\u003e[46]\u003c/sup\u003e,\u0026nbsp;educational materials\u003csup\u003e[83]\u003c/sup\u003e, fun competitive and game-like aspects\u003csup\u003e[41,79,81]\u003c/sup\u003e,\u0026nbsp;de-escalating incentives\u003csup\u003e[53]\u003c/sup\u003e,\u0026nbsp;unconditional tailored packages e.g., baby supplies)\u003csup\u003e[64]\u003c/sup\u003e \u0026nbsp;and family/staff support\u003csup\u003e[57,64,65]\u003c/sup\u003e. Visual, immediate and/or regular testing and feedback on behaviour change (e.g., CO breath test)\u003csup\u003e[63,64,84]\u003c/sup\u003e built accountability and motivated change. The act of goal-setting and achieving targets\u003csup\u003e[83]\u003c/sup\u003e and the use of physical tracking tools (i.e., tokens, slips)\u003csup\u003e[89,96]\u003c/sup\u003ewere also perceived as rewarding/meaningful symbols of progress. Overall favourability and high acceptability encapsulated in a \u003cem\u003e\u0026ldquo;positive experience\u0026rdquo;\u003c/em\u003e\u003csup\u003e[50,53,54,57,65,79,84,96]\u003c/sup\u003e was equally critical. Some providers found incentives an empowering reinforcement strategy\u003csup\u003e[57]\u003c/sup\u003e, enabling regular feedback on users\u0026rsquo; outcomes\u003csup\u003e[87]\u003c/sup\u003e which encouraged implementation. Positive reinforcers over punitive-based approaches\u003csup\u003e[93]\u003c/sup\u003e or receiving recognition for their role\u003csup\u003e[82]\u003c/sup\u003e were also valued. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.\u0026nbsp; \u0026nbsp;Knowledge (Psychological Capability) (n=31; 49%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLimited existing evidence on population-specific incentive designs\u003csup\u003e[43]\u003c/sup\u003e, legal ambiguities surrounding validation methods i.e. \u0026nbsp;fentanyl test strips\u003csup\u003e[93]\u003c/sup\u003e, or knowledge/understanding gaps on intervention aims, positioning, processes(e.g., payment mechanisms, referral pathways) and/or eligibility criteria\u003csup\u003e[14,41,45,66,69\u0026ndash;71,74,77,82,83,94]\u003c/sup\u003ehampered implementation/utilisation. Uncertainties amongst providers about intervention policies\u003csup\u003e[66]\u003c/sup\u003e, timelines\u003csup\u003e[72,102]\u003c/sup\u003e, modifications\u003csup\u003e[94]\u003c/sup\u003e or their/other\u0026rsquo;s specified roles\u003csup\u003e[45,66,82]\u003c/sup\u003ehindered the ability to effectively deliver a service that \u0026ldquo;they themselves did not understand\u0026rdquo; and/or led to implementation variations. \u0026nbsp;Limited awareness of the interventions\u003csup\u003e[44,45,47,48,56,76]\u003c/sup\u003e and of the associated services/resources\u003csup\u003e[44,48,70,71]\u003c/sup\u003e was also reported as a barrier. Rarely, users\u0026rsquo; limited comprehension of \u0026nbsp;messaging on the intervention\u003csup\u003e[48,65]\u003c/sup\u003e delayed use and led to disengagement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigh awareness and understanding of interventions and related services\u003csup\u003e[49,73]\u003c/sup\u003e facilitated use while familiarity with the evidence-base\u003csup\u003e[52,58,84,87]\u003c/sup\u003e for staff and leadership was pivotal. Providers also valued clear practice guidance and training resources on FI principles, effectiveness, designs and procedures\u003csup\u003e[58,87,101]\u003c/sup\u003e while staff with prior knowledge and experience of said interventions\u003csup\u003e[52,87]\u003c/sup\u003e were valuable. Maintained knowledge on implementation processes and outcome data\u003csup\u003e[52,91]\u003c/sup\u003e were equally important. Such information was occasionally leveraged for advocacy and to secure buy-in/resources. Finally, complementary educational and/or information dissemination activities\u003csup\u003e[43,76,81]\u003c/sup\u003e enhanced awareness, thus increasing participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.\u0026nbsp; \u0026nbsp;Role and identity (Reflective Motivation) (n=27; 43%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants of high socioeconomic status\u003csup\u003e[42,44,45]\u003c/sup\u003e refused to engage with the services and/or decided not to avail of the incentive. Providers frequently subverted incentive protocols due to their personal/ professional values around equity/justice or what entails an \u0026ldquo;appropriate\u0026rdquo; treatment model\u003csup\u003e[14,42,48,50,81,84,94,95,97,101]\u003c/sup\u003e. Grappling multiple responsibilities, particularly those incompatible with their role/standards of care,\u003csup\u003e[48,50,56,80,84,88,94]\u003c/sup\u003e was challenging. Ethical quandaries regarding eligibility\u003csup\u003e[48,50]\u003c/sup\u003e were reported and at times acted upon as seen through incentives rationing behaviours\u003csup\u003e[14,42]\u003c/sup\u003e. Rarely, preoccupation with achieving targets and ensuring \u0026ldquo;coverage\u0026rdquo;\u003csup\u003e[70]\u003c/sup\u003e led to an observed shift from supposedly being a supporter of change to a reinforcer hampering recruitment. Finally, a perceived shift in the provider-user roles from a\u0026nbsp;collaborative relationship\u0026nbsp;to a\u0026nbsp;transactional one\u0026nbsp;(provider as \u0026quot;buyer\u0026quot;, patient as \u0026quot;provider\u0026quot;)\u003csup\u003e[55]\u003c/sup\u003e disrupted therapeutic rapport. At an organisational level, cultural clashes emerged when intervention goals conflicted with institutional identities\u003csup\u003e[54]\u003c/sup\u003e or when implementation agents held distinct views surrounding intervention philosophies and/or role responsibility.\u003csup\u003e[81,94,97]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProper alignment with organisational, professional and/or social identities and associated responsibilities promoted intervention adoption and continued implementation\u003csup\u003e[41,50,57,77,84,86,91,95]\u003c/sup\u003e. That included those of a collaborator, educator, and/or supporter in achieving better health outcomes\u003csup\u003e[50,77,84,95]\u003c/sup\u003e. \u0026nbsp;For some, being able to satisfy professional performance targets\u003csup\u003e[72]\u003c/sup\u003e through the intervention was key. Finally, role expansion and redefining strategies reportedly increased acceptability and ensured smooth execution/integration\u003csup\u003e[84,86,91,99]\u003c/sup\u003e. That included posing the intervention as a core responsibility rather than an add-on\u003csup\u003e[84]\u003c/sup\u003e as well as assigning dedicated incentive staff\u003csup\u003e[86,99]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7.\u0026nbsp; \u0026nbsp;Skills (Physical, Cognitive and Interpersonal Capability) (n=19; 30%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProviders with operational motor limitations\u003csup\u003e[77,79]\u003c/sup\u003e found incentive transaction processes challenging, while participants with physical impairment\u003csup\u003e[47]\u003c/sup\u003e were unable to access their incentive. Digital illiteracy among users was also reported\u003csup\u003e[48,79,92]\u003c/sup\u003e.\u0026nbsp;Challenges related to providers\u0026rsquo; gaps in design skills of context-appropriate, yet operationally simple, interventions\u003csup\u003e[43]\u003c/sup\u003e, digital and technical literacy gaps, limited data management, and/or administration\u003csup\u003e[48,56,74,79,82,88,94,98]\u003c/sup\u003e. Limited interpersonal and communication skills were also identified as barriers\u003csup\u003e[51,64,80,95,102]\u003c/sup\u003e,\u0026nbsp;specifically the capacity for holding nuanced dialogue on the incentivised behaviours.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWell-trained staff with relevant skill-sets\u003csup\u003e[14,50,79,94]\u003c/sup\u003e aided smooth implementation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8.\u0026nbsp; \u0026nbsp;Behavioural regulation (Psychological Capability) (n=17; 27%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChallenges occurred due to weak monitoring and poor budgetary planning\u003csup\u003e[66]\u003c/sup\u003e.\u0026nbsp;Users \u0026nbsp;struggled with self-tracking behaviours\u003csup\u003e[102]\u003c/sup\u003e in line with intervention requirements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClear planning, feedback and monitoring strategies (e.g., review/serial outcome assessments)\u003csup\u003e[41,58,77,80,86,87,100,101]\u003c/sup\u003e offered a space for iterative refinement of intervention design and procedures whilst balancing scientific/clinical needs. \u0026nbsp;For users, incorporating elements such as e-trackers, random behaviour verification tests and readily accessible outcome data\u0026nbsp;\u003csup\u003e[46,53,81\u0026ndash;83,96,98]\u003c/sup\u003e were considered useful for promoting accountability and adherence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e9.\u0026nbsp; \u0026nbsp;Emotion (Automatic Motivation) (n=15; 24%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDiverse emotions impacted providers and participants alike\u003csup\u003e[51,52,54,55,57,63,68,71,79,83,89,98]\u003c/sup\u003e. Providers faced burnout\u003csup\u003e[52]\u003c/sup\u003e balancing intervention demands with their clinical roles, as frustrations emerged\u003csup\u003e[98]\u003c/sup\u003e due to complex processes.\u0026nbsp;At the user level,\u0026nbsp;fear and/or anger\u003csup\u003e[68,71,83]\u003c/sup\u003e due to safety concerns or \u0026nbsp;anticipated reprimand in case of failure were reported. Feelings of guilt of failure\u003csup\u003e[55]\u003c/sup\u003e or receiving incentives while others did not\u003csup\u003e[63]\u003c/sup\u003e,\u0026nbsp;discouraged engagement. Others felt daunted and/or demotivated with impersonal program elements\u003csup\u003e[63,89]\u003c/sup\u003e. In school settings, students felt embarrassed receiving incentives in front of peers\u003csup\u003e[79]\u003c/sup\u003e,\u0026nbsp;while stressful workplace environment\u0026nbsp;\u003csup\u003e[54]\u003c/sup\u003e hindered change efforts. Few felt offended\u0026nbsp;\u003csup\u003e[51]\u003c/sup\u003edue to ill-timed intervention briefing. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePositive emotional reactions facilitated implementation and boosted engagement\u003csup\u003e[50,51,55,57,89,96,98]\u003c/sup\u003e as some providers reported \u0026ldquo;feeling good\u0026rdquo;\u003csup\u003e[50]\u003c/sup\u003e and having \u0026quot;fun\u0026rdquo;\u003csup\u003e[96]\u003c/sup\u003e working on the intervention or as feeling appreciated, respected, satisfied, less alone or stressed\u003csup\u003e[51,53,89,98]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e10.\u0026nbsp;Memory, attention and decision processes (Psychological Capability) (n=9; 14 %)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCognitive overload brought about by procedural demands and/or uncertainties (e.g., complex processes around enrolling, record-keeping or incentive redemption)\u003csup\u003e[41,46,51,77,82,83,88,89,98]\u003c/sup\u003e, particularly among populations with complex needs or substance use histories,\u003csup\u003e[89,98]\u003c/sup\u003e made it difficult for users to remain engaged and/or integrate new habits and for providers to keep up with intervention demands.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e11.\u0026nbsp;Beliefs about Capabilities (Reflective Motivation) (n=7; 11%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLack of confidence\u003csup\u003e[60,93]\u003c/sup\u003e among providers to administer group-based intervention or enforce protocols challenged delivery.\u0026nbsp;Intervention systems overestimating a level of service users\u0026rsquo; capabilities\u003csup\u003e[48,52]\u003c/sup\u003e \u0026ndash; who are mostly vulnerable \u0026ndash; reduced perceived feasibility of behaviour change.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStronger belief in providers\u0026rsquo; own abilities towards implementation\u003csup\u003e[85]\u003c/sup\u003e improved prospects for sustained delivery. Self-efficacy (empowerment)\u003csup\u003e[43,53]\u003c/sup\u003e brought about by the intervention processes (e.g., opening a bank account, ability to manage own\u0026rsquo;s health) enhanced users\u0026rsquo; motivation to change.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e12.\u0026nbsp;Goals and motivation (Reflective Motivation (n=7; 11%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGoal-setting misalignment (e.g., intervention enrolment targets)\u003csup\u003e[14,44,74]\u003c/sup\u003e in the face of real-life constraints and competing priorities was demotivating and/or necessitated repeated adjustments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants driven by personal health goals\u003csup\u003e[82]\u003c/sup\u003e \u0026nbsp;or \u0026nbsp;incentives directly aligned with patients\u0026rsquo; recovery objectives\u003csup\u003e[89]\u003c/sup\u003e enhanced engagement. \u0026nbsp; Providers were also motivated to facilitate and prioritise implementation\u003csup\u003e[94,98]\u003c/sup\u003e for its value to potentially address treatment gaps.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e13.\u0026nbsp;Intention, Optimism (Reflective Motivation) (n=0)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo barriers or facilitators relating to either domain were identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation issues by target behaviour\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubgroup analysis showed differences in reported smoking cessation FI intervention implementation issues. \u0026ldquo;Emotion\u0026rdquo; domain was more prominent at 13%; third-ranked barrier, compared to only 4% for other behaviours. \u0026ldquo;Reinforcement\u0026rdquo; was also frequently reported as a facilitator (23%; second-ranked domain) relative to other behaviours (9%; fifth-ranked). \u0026nbsp;Notably, \u0026ldquo;Goals\u0026rdquo; as well as \u0026ldquo;Memory, Attention and Decision Processes\u0026rdquo; were not identified in smoking-specific interventions. See Additional file 6 for more results/details.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBCW intervention functions and policy categories\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntervention functions and policy categories linked to the TDF domains are shown in Additional file 6. In brief, seven intervention functions were recognised as significant enablers to the FI implementation: \u0026nbsp; environmental restructuring, enablement, education, persuasion, modelling, restriction and training. \u0026nbsp;The policy categories frequently associated with supporting these functions included: guidelines, service provision and environmental/social planning. \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e To our knowledge, this is the first comprehensive review of stakeholder-reported barriers and facilitators surrounding the implementation of financial incentive interventions across diverse health behaviours and multiple populations. We identified 374 barriers and facilitators and applied the TDF and BCW frameworks to identify critical intervention functions and policy categories for future incentive programme design. These findings include a range of viewpoints from perspectives of incentive recipients, FI providers, administrators, managers, high-level stakeholder groups and researchers involved in/exposed to the implementation process. Our findings detail both general programme issues, which can be common across multiple health programme interventions, but also those specific to incentives.\u003c/p\u003e\u003cp\u003eAlthough our review findings align in a broader sense with those of van der Spek et al.,\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e unique divergences emerge. van der Spek et. al. highlight the importance of programme fit with participants\u0026rsquo; cultural and personal circumstances, accessibility and acceptability issues, as well as feelings of bribery and distrust. We expand on these findings detailing which and how each component of the intervention and incentive design, starting from its framing through its execution, hinder or contribute to uptake. We found less emphasis on issues relating to incentives for engagement than for validation of behaviour, while the form of incentive was valued mainly for reliability, security and convenience rather than freedom of choice or lack thereof. Although gaming was also reported in our review, we found that this was instead acted upon by service providers to a larger extent than those from participants, hence the importance of auditing and oversight mechanisms. Our focus on implementation across diverse population groups, health behaviours and income settings, adds depth. Distinct factors found included those related to political, legal and organisational pitfalls, planning and execution mechanisms, power struggles, role and autonomy violations, physical, interpersonal and cognitive limitations as well as stakeholders\u0026rsquo; internal and external motivators towards implementation whilst unveiling a spectrum of emotions such as those related to shame, guilt and anger among others. Thus, we provide a single, comprehensive source that should be valuable to researchers and health providers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eKey incentive-specific issues.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMany studies in this review underscored policy and regulatory constraints as major barriers to adoption of evidence-based FI interventions. Deviations from evidence-based FI practices are indeed common and have been linked to poor outcomes\u003csup\u003e[\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e, \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e]\u003c/sup\u003e. In the United States for example, patient incentive programmes are governed by several laws and regulations including the Beneficiary Inducement Prohibition and Anti-Kickback Statute which limits the dollar amount/value and type of the incentive with multiple other considerations e.g., whether it\u0026rsquo;s part of a grant fund and/or a clinically-proven programme\u003csup\u003e[\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e]\u003c/sup\u003e, which might not necessarily align with evidence of what is deemed effective\u003csup\u003e[\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e]\u003c/sup\u003e. Our review furthermore underscores the significance of appropriate incentive design, given their multi-faceted nature with multiple interacting components, each of which when made user/provider unfriendly had the ability to influence its implementation and utilisation, let alone effectiveness\u003csup\u003e[\u003cspan additionalcitationids=\"CR108\" citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]\u003c/sup\u003e. Specifically, issues related to the type, the timing and magnitude of the reported incentives were emphasised. On incentive type, there seemed to be a preference for methods that are secure, convenient, and corrupt-proof (e.g., cards or bank transfers), with the latter empowering groups who typically do not enjoy financial independence. On timing of the incentives our review showed that delays in receiving the incentives, as well as inappropriate timing, provoked negative sentiments, perpetrated mistrust and hindered reinforcement of behaviour change. That aligns with the theoretical understanding of present bias\u003csup\u003e[\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e]\u003c/sup\u003e; when an intertemporal decision is to be taken in the present moment, individuals discount future payoffs even more than when two future points are involved in that same decision\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]\u003c/sup\u003e. Therefore, to increase efficacy of behaviour change, incentives must be given earlier\u003csup\u003e[\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]\u003c/sup\u003e. A meta-review of incentive-based drug treatment programmes also found that more immediate voucher delivery had a better effect\u003csup\u003e[\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e]\u003c/sup\u003e. However, vast individual differences exist in the extent one discounts future outcomes, thus more empirical evidence is needed\u003csup\u003e[\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOn incentives size, several studies reported issues regardless of the recipient\u0026rsquo;s socioeconomic standing. For example, some individuals in need of financial support did not pursue the incentive if the challenge to get it outweighed the benefits. Furthermore, people of higher affluence had reservations about being included in such schemes \u0026ndash; which alludes to the importance of perceived \u0026ldquo;value\u0026rdquo; and relevance for its recipient\u003csup\u003e[\u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e]\u003c/sup\u003e, rather than its absolute amount. As Gneezy et al. (2000) \u003csup\u003e[\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e]\u003c/sup\u003eargued, the performance of a behaviour varies in a nonmonotonic way with incentives, meaning one cannot simply expect a proportional relationship between the size of an incentive and adherence to a behaviour, as other factors do play a role in the decision of the individual. These factors could be referred to as \u003cem\u003e\u0026ldquo;switching costs\u0026rdquo;\u003c/em\u003e e.g., time, social standing in relation to others, to drive change\u003csup\u003e[\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e]\u003c/sup\u003e which was observed in this study. That might also explain the inconsistent effectiveness of FI across behaviours as incentive amount increased, as found by meta-analysis\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e Our review findings implied a strong link between cultural acceptance of the incentivised behaviour and better implementation outcomes. This was achieved by leveraging trusted and key social proxies and established networks; those included healthcare providers, family and peers among others, as champions approving of incentives use, and sometimes as participants. Results are consistent with previous research\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR116\" citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e]\u003c/sup\u003e indicating that positive benefits may be derived from social support as demonstrated, for example, in a randomised controlled trial\u003csup\u003e[\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e]\u003c/sup\u003e including 220 pregnant women, which showed that the combination of bolstered social support with FI nearly doubled smoking quit rates during pregnancy and more than doubled quit rates postpartum.\u003c/p\u003e\u003cp\u003ePhilosophical, moral or ethical considerations were important determinants of implementation. These were often tied to concerns around justice, exploitation and perceived or witnessed benefits brought about by the intervention, either at an individual, organisation or community level. Indeed, FI as \u0026ldquo;controversial\u0026rdquo; tools have been long discussed, as some would view then as unfair, coercive, paternalistic, or generally inconsistent with shared social values\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR120\" citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e]\u003c/sup\u003e. One often cited concern is on the impact FI would impose on the therapeutic relationship\u003csup\u003e[\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e]\u003c/sup\u003e. However, only two studies reported that a contractual relationship emerged while five others reported negative interactions and/or coercion which stemmed from professional pressure to meet targets. Generally, our findings support evidence suggesting that FI can be acceptable when embedded within an ethical provision framework where the agency of the recipient is not threatened and the incentive is relevant to the behaviour or population.\u003csup\u003e[\u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOur findings also emphasised that efficient FI integration is only feasible when compatible incentive structures are aligned with the inner and outer contexts, be it political, organisational, institutional, cultural or at the individual-level. Furthermore, flexibility and autonomy of implementation agents allowed interventions to be adaptable and person-centred. Participatory and collaborative approaches encompassing all stages of implementation life cycle from incentive design to optimal execution with relevant stakeholder groups were also identified across several studies as important. This clearly aligns with current recommended best practice.\u003csup\u003e[\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eOur research findings are supported by a systematic review approach\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e underpinned by gold-standard behavioural science frameworks\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e to classify barriers and facilitators to FI. The inclusion of studies of various methodological approaches without set limitations allowed for a comprehensive understanding of these issues. It is possible, however, like any systematic review, that some records might have been missed. Details on intervention functions and policy categories that could act as viable mechanisms to address such issues were additionally provided, thereby closing the gap to implementation. A comprehensive data source to allow researchers and policy makers recognise nuanced differences spanning various variables was provided that, if considered, could make significant contributions to optimising FI interventions. Although TDF and BCW coding was carried out in line with best practice procedures\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e, it is possible that an item could fit more than one domain and/or be coded differently. These issues are unlikely to have impacted our overall findings. Consistent with previous literature, we have identified general barriers to such interventions whereas our focus on actual implementation provided a realistic view to real-world operational challenges while recognising distinct populations, behaviours and FI specific factors that influence implementation.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eFI interventions and future research implications\u003c/h2\u003e \u003cp\u003eFI interventions involve many moving parts to their design, each of which could influence their effectiveness\u003csup\u003e[\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e, \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e, \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e]\u003c/sup\u003e while broadly, barriers served as facilitators and vice versa dependant on context, suggesting that FI in themselves are not the issue, but rather how they are planned, constructed, governed and executed. Our recommendations are as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA transparent and consistent method towards FI intervention planning, implementation to reporting e.g., guided by Adam\u0026rsquo;s et al\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e framework, is critical so inquiries into their impact on outcomes are possible.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAlignment with the surrounding community and climate, be it political or organisational.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eParticipatory methods alongside theory/evidence-based decision-making processes are integral as this provides an expansive space for context-sensitive and responsive interventions.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEducation of key stakeholders on the effectiveness, cost-effectiveness and potential benefits of FI interventions\u003csup\u003e[\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecognition of deciding on the \u0026ldquo;value\u0026rdquo; of incentives rather than amount is key.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEnsuring acceptability across stakeholder groups is key, that could include leveraging social networks to legitimise such interventions or increasing accessibility.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review provided a comprehensive, in-depth understanding on determinants to FI intervention implementation, guided by theory. In doing so, it provides an evidence-informed foundation for designing future context-specific interventions. Our findings highlight the need to consider factors related to political and organisational pitfalls; stakeholder involvement in the implementation processes, intervention and incentive design; social and professional identity violations; and underlying internal and external motivators of stakeholders towards implementation, with emphasis on its proper alignment with the surrounding context.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFinancial incentives\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCIFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConsolidated Framework for Implementation Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTDF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTheoretical Domains Framework\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBCW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBehaviour Change Wheel\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRISMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMixed-methods Appraisal tool\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOM-B\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCapability, Opportunity, Motivation of Behaviour model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGRADE-CERQAUL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence in the Evidence from Reviews of Qualitative research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPiCG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esmoking in pregnancy challenge group\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTINASHP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eresearch triangle and national academy for state health policy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQl\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003equalitative\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emixed methods\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erandomised controlled trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003enRQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003enon-randomised quantitative\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003equantitative descriptive\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etuberculosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehuman immunodeficiency virus infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePWID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epeople who inject drugs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSUD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esubstance use disorders\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDBT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edirect benefit transfer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCarbon Monoxide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econtingency management\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePrEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epre-exposure prophylaxis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econditional cash transfer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eA/PNC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eante/postnatal care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMNCH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ematernal and child health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esupplemental nutrition assistance program\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eveterans health administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVeterans Canteen Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMIPCD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedicaid Incentives for the Prevention of Chronic Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and its additional information files. Additional datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRL is a doctoral candidate under the SPHeRE Programme funded by the Health Research Board under grant SPHERE/2022/001. This research was funded by the Health Research Board APA-2022-029. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRL drafted the manuscript, carried out formal data analysis and interpretation of findings. RL, BD and CD collaboratively conducted the literature search, screening, extraction of data as well as quality and confidence in evidence assessment. FD provided methodological oversight and overall supervision. FD, PK and DS provided substantial and critical revisions to the manuscript. All authors contributed to the conceptualisation of this review, read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express appreciation for Mr Killian Walsh, the information specialist at the Royal College of Surgeons in Ireland, for his assistance in the development of the search strategy. We would also like to thank the following: Professor Kevin A. Hallgren, Drs Adam Ketron and Yanni Chang (University of Washington); Jennifer McKell (University of Stirling) and colleagues from the CPIT II trial team who generously shared unpublished materials/reports that contributed to the development of this review as well as Maria Jones (RCSI) who helped guide TDF/COM-B coding. Finally, we are sincerely grateful to our Patient and Public Involvement (PPI) contributors: Sarah Halpin, Steve Moore, Tony O\u0026rsquo;Reilly and Pauline Williams for their valuable input and perspectives, which played a crucial role in shaping the direction and relevance of this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). Non-communicable diseases: fact sheet. 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Addiction 2006;101(2):192\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study. BMC Public Health 2016;16(1):989.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGneezy U, Rustichini A. Pay Enough or Don\u0026rsquo;t Pay at All*. Quarterly Journal of Economics 2000;115(3):791\u0026ndash;810.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurnham TA, Frels JK, Mahajan V. Consumer Switching Costs: A Typology, Antecedents, and Consequences. Journal of the Academy of Marketing Science 2003;31(2):109\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanis IL. The role of social support in adherence to stressful decisions. American Psychologist 1983;38(2):143\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBauld L, Graham H, Sinclair L, Flemming K, Naughton F, Ford A, et al. Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study. Health Technol Assess 2017;21(36):1\u0026ndash;158.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, et al. Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design. Health Technology Assessment 2015;19(30):1\u0026ndash;522.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonatelle RJ. Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant Other Supporter (SOS) program. Tobacco Control 2000;9(90003):67iii\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaw J. Is it acceptable for people to be paid to adhere to medication? No. BMJ 2007;335(7613):233\u0026ndash;233.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Den Brand FA, Magn\u0026eacute;e T, De Haan-Bouma L, Barendregt C, Chavannes NH, Van Schayck OCP, et al. Implementation of Financial Incentives for Successful Smoking Cessation in Real-Life Company Settings: A Qualitative Needs Assessment among Employers. IJERPH 2019;16(24):5135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClaassen D. Financial incentives for antipsychotic depot medication: ethical issues: Table 1. J Med Ethics 2007;33(4):189\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoordraven EL, Schermer MHN, Blanken P, Mulder CL, Wierdsma AI. Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients\u0026rsquo; and clinicians\u0026rsquo; perspectives after a 12-month randomized controlled trial. BMC Psychiatry 2017;17(1):313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePriebe S, Sinclair J, Burton A, Marougka S, Larsen J, Firn M, et al. Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study: Fig. 1. J Med Ethics 2010;36(8):463\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAre Financial Incentives Appropriate Means of Encouraging Medication Adherence Among People Living With HIV? AMA Journal of Ethics 2021;23(5):E394-401.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\"Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner KM, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open 2019;9(8):e029954.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiranda JJ, Pesantes MA, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Carrillo-Larco RM, et al. Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review. Wellcome Open Res 2021;6:163.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJochelson K. Kicking bad habits. Paying the patient: improving health using financial incentives. [Internet]. Internet: London: King\u0026rsquo;s Fund; 2007. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://archive.kingsfund.org.uk/concern/published_works/000039355\u003c/span\u003e\u003cspan address=\"https://archive.kingsfund.org.uk/concern/published_works/000039355\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of studies included in the review, ordered by targeted behaviour\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFirst author\u003c/p\u003e\n \u003cp\u003eyear\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDesign\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCountry\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQn. N\u003c/p\u003e\n \u003cp\u003e(Ql. N)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention Summary \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eTarget behaviour\u003c/strong\u003e: Patient management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLutge 2014\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSouth Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4091 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA voucher, valued at \u0026asymp; \u003cspan\u003e$\u003c/span\u003e15 was offered to patients by nurses every month (max. 8 months) contingent upon collection of their treatment.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWingfield 2015\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePeru\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e782 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component intervention provided cash transfers contingent on screening household contacts and TB diagnosis in patients; adhering to treatment and chemoprophylaxis. Incentives were tiered: up to \u003cspan\u003e$\u003c/span\u003e230 for optimal, and \u003cspan\u003e$\u003c/span\u003e115 for acceptable compliance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatel 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1826 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBT provided incentives in instalments of \u0026asymp; \u003cspan\u003e$\u003c/span\u003e14.20 each contingent on medication adherence in Vadodara, Western India.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNirgude 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e417 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBT scheme provides incentives as a cash transfer of \u0026asymp; \u003cspan\u003e$\u003c/span\u003e7.10/month during treatment contingent on being a notified (diagnosed) TB patient and adhering to treatment protocols in South India.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMusiimenta 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component incentive intervention provided incentives (mobile money) via an app valued at \u0026asymp;\u003cspan\u003e$\u003c/span\u003e1.50 conditional achieving a medication adherence rate of \u0026ge;\u0026thinsp;90%.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVerma 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3373(13+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBT scheme provides incentives as a cash transfer of \u0026asymp; \u003cspan\u003e$\u003c/span\u003e7.10/month during treatment contingent on adhering to treatment protocols in Pune, Western India.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMohan 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBT scheme provided a cash transfer of \u0026asymp; \u003cspan\u003e$\u003c/span\u003e5.98/month contingent on registration and ongoing treatment across thirty districts.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChadhar 2025\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251(-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBT scheme provided cash transfers of \u0026asymp; \u003cspan\u003e$\u003c/span\u003e7.10/month contingent on their registration and ongoing treatment in Northern India.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGreene 2017\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAn incentive of a \u003cspan\u003e$\u003c/span\u003e70 gift card provided quarterly contingent on achieving or maintaining viral suppression- defined as HIV RNA\u0026thinsp;\u0026lt;\u0026thinsp;400 copies/mL. through medication adherence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShelus 2018\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component incentive for newly diagnosed/out-of-care patients contingent on linkage to care, defined as attendance at two medical visits after HIV diagnosis specifically upon blood tests (\u003cspan\u003e$\u003c/span\u003e25 gift card) and upon meeting with a clinician to review lab results and develop a care plan (\u003cspan\u003e$\u003c/span\u003e100).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWarnock 2025\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multicomponent CM and pre-exposure prophylaxis (PrEP) adherence support programme provided escalating incentives via \u0026ldquo;draws\u0026rdquo; from a fishbowl (up to. average \u003cspan\u003e$\u003c/span\u003e608 total) contingent on achieving individualized goals on the PrEP/medications continuums.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWagner 2025\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA mobile app intervention provided incentives of \u003cspan\u003e$\u003c/span\u003e1/day contingent on verified medication adherence over 3 months.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviour\u003c/strong\u003e: Smoking Cessation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKim 2012\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e878(20+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component intervention for smoking cessation provided incentives of \u003cspan\u003e$\u003c/span\u003e100 for completing a smoking cessation program, \u003cspan\u003e$\u003c/span\u003e250 for biochemically verified cessation within six months, and \u003cspan\u003e$\u003c/span\u003e400\u0026nbsp;for maintaining abstinence for another six months.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAllan 2012\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQuit4u (Quit for you) provided incentives (supermarket card) contingent on verified CO testing \u0026asymp; \u003cspan\u003e$\u003c/span\u003e19.82/week (up to\u0026asymp; \u003cspan\u003e$\u003c/span\u003e237.78 total).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMcKell 2013\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA Multi-component cessation intervention provided incentives (gift cards) for attending and setting a quit date (\u0026asymp; \u003cspan\u003e$\u003c/span\u003e78.24); post CO validated quit at 4 weeks \u0026asymp; \u003cspan\u003e$\u003c/span\u003e156.47 and at 12 weeks\u0026asymp; \u003cspan\u003e$\u003c/span\u003e156.47; and at 38 weeks (\u0026asymp; \u003cspan\u003e$\u003c/span\u003e312.94) .\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePassey 2018\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi- component culturally tailored smoking cessation program provided incentives contingent on multiple behaviours as fixed vouchers valued at \u0026asymp; \u003cspan\u003e$\u003c/span\u003e7.46-\u0026asymp; \u003cspan\u003e$\u003c/span\u003e22.37.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSiPCG 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e─\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFour National Health Services (NHS) incentive schemes for smoking cessation provided incentives (usually shopping vouchers) of variable value (up to \u003cspan\u003e$\u003c/span\u003e383.01-\u003cspan\u003e$\u003c/span\u003e960.41) and frequency. Typically, contingent on engagement and biologically validated quits.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHefler 2013\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e─\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRoundtable discussion on various incentive interventions for smoking cessation during pregnancy mainly from studies originating in Australia and New Zealand.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApata 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component smoking cessation program provided incentives contingent on milestones achievement ranging from \u003cspan\u003e$\u003c/span\u003e10\u0026ndash;25 per target behaviour (e.g., \u003cspan\u003e$\u003c/span\u003e 25 for one-month quit).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJoyce 2021\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component smartwatch-enabled smoking cessation program provided streak-based incentives for watch recorded abstinence monitoring, of up to \u003cspan\u003e$\u003c/span\u003e112\u0026ndash;315/ week.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eToo 2021\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enRQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multicomponent smoking cessation scheme provided incentives (up to \u0026asymp; \u003cspan\u003e$\u003c/span\u003e220.13) upon a CO validated quit.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreunis 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe Netherlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multicomponent smoking cessation web-based service provided vouchers and group incentives for a validated CO quit (or self-report quit during the pandemic) with individual incentives up to \u0026asymp; \u003cspan\u003e$\u003c/span\u003e199.80 earned.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYon 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component smoking cessation programme provided gift cards (up to \u003cspan\u003e$\u003c/span\u003e1,115 total) contingent upon biochemically verified quit during pregnancy and up to 3 months post-partum.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTranby 2025\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA remotely delivered, culturally tailored, family-based smoking cessation intervention provided incentives (up to \u003cspan\u003e$\u003c/span\u003e750 total) contingent on quit status (CO, cotinine, self-report).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviour\u003c/strong\u003e: Maternal and child care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePowell-Jackson 2009\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e─\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNepal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CCT programme provided incentives for institutional delivery across 10 districts of varying amounts depending on region (\u0026asymp; \u003cspan\u003e$\u003c/span\u003e6.65\u0026ndash;19.95).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLama 2014\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNepal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CCT scheme provided incentives of varying amounts contingent on select behaviours e.g., ANC visits (\u0026asymp; \u003cspan\u003e$\u003c/span\u003e4.08), institutional delivery and post-natal care e.g., immunisation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSidney 2016\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA national CCT programme provided incentives contingent on institutional delivery equating to \u003cspan\u003e$\u003c/span\u003e23.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGupta 2018\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA national CCT programme provided incentives contingent on institutional delivery of varying amounts depending on location ranged between \u0026asymp;\u003cspan\u003e$\u003c/span\u003e 5.48- \u0026asymp; 6.39.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContractor 2018\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTwo national CCT schemes: 1) for institutional delivery; 2) of up to \u003cspan\u003e$\u003c/span\u003e80 for ANC and infant care related behaviours, given in four instalments.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaba-Ari 2018\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CCT programme provided incentives (up to \u003cspan\u003e$\u003c/span\u003e30 total) contingent on going through the full continuum of MNCH services (e.g., ANC, skilled birth delivery, and PNC incl. immunisation).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDickin 2022\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2522 (65\u0026ndash;75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CCT intervention provided incentives of \u003cspan\u003e$\u003c/span\u003e4.5/appointment contingent on attendance for ANC, delivery, PNC and childhood immunisation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBanerjee 2025\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1290 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA CCT programme provided cash incentive of \u0026asymp;\u003cspan\u003e$\u003c/span\u003e62 contingent on meeting specific health-related behaviours e.g. early pregnancy registration, at least one antenatal check-up, completion of the first cycle of child immunization.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviour\u003c/strong\u003e: Healthy eating/drinking and/or physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrown 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA community store programme provided incentives (voucher) of \u0026asymp;\u003cspan\u003e$\u003c/span\u003e6.96 per minimum amount spend on fruit and vegetables.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEvans 2022\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA year-round mobile market provided a price-matching incentive for SNAP recipient\u0026rsquo;s contingent on fruits and vegetables purchase as gift cards/a 50% discount.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSilva 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component incentive program provided physical matching tokens representing 2 times the monetary amount (dollar) of benefits spent on eligible healthy items at a ratio of 1:2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFranckle 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1006 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA 2-for-1 intervention provided incentives as discount coupons (up to \u003cspan\u003e$\u003c/span\u003e10/ trip) contingent on the purchase of F\u0026amp;V items rated as two-three stars (good- best nutritional quality).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParks 2020\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple Healthy Food incentive programs among low-income populations and SNAP participants. Incentive structure and rules varied by site.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMoore 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e481 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA Multi-component programme provided food-based incentives contingent on healthy on food choices via a point system with better nutritional choices having a higher point value. Points could be exchanged for rewards (e.g., vouchers)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReese 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component incentive intervention provided \u003cspan\u003e$\u003c/span\u003e1.50/day contingent on increasing daily fluid intake by meeting verified prescribed goals.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZulman 2013\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component web-based lifestyle program offered incentives of up to \u003cspan\u003e$\u003c/span\u003e2,000 in savings for walking 5,000 steps daily over each 3-month period.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGilson 2017\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component m(mobile)-Health program provided incentives via a point-system equating to \u003cspan\u003e$\u003c/span\u003e30 - \u003cspan\u003e$\u003c/span\u003e200 per milestone for increased fruit and veg uptake and physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorder 2021\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2862 (122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component intervention provided individual and class-level incentives via points exchanged for rewards contingent on engagement in physical activities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJose 2022\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAustralia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component intervention provided increasing incentives of varying values for transport-related physical activity increase contingent on meeting escalating trip targets.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviour\u003c/strong\u003e: Substance (including alcohol) abstinence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHagedorn 2014\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAn intervention provided escalating prize draw (\u003cspan\u003e$\u003c/span\u003e1, \u003cspan\u003e$\u003c/span\u003e20, or \u003cspan\u003e$\u003c/span\u003e80 vouchers) incentives redeemed at a VHA cafeteria or gift shop contingent on negative alcohol/ drug screens. .\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHartzler 2015\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdoption phase (90 days) for trained staff of a CM intervention targeting several treatment-adherent behaviours using tangible re-inforcers e.g. low-cost gift cards/ a voucher-based \u0026lsquo;point-system.\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHartzler 2016\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple SUD CM interventions and associated pragmatic considerations.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDePhilippis 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThree prize-draw CM programs for verified drug abstinence (\u003cspan\u003e$\u003c/span\u003e0-\u003cspan\u003e$\u003c/span\u003e100), in-person medication adherence (up to \u003cspan\u003e$\u003c/span\u003e373 avg. total), and verified smoking cessation via CO test.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrolin 2017\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2667 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CM intervention provided incentives of up to \u003cspan\u003e$\u003c/span\u003e240 in gift cards contingent on completing recovery-oriented behaviours within 90 days post-discharge.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDesrosiers 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA CM programme provided prize draw tokens (4 tokens/ draw) contingent on attending group therapy equating to on average \u003cspan\u003e$\u003c/span\u003e42 per participant.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBecker 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple SUD CM interventions adoption/ implementation phases using an escalating prize draws model contingent on patient attendance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBecker 2021\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA CM intervention provided incentives using a 500-slip fishbowl (50% prize chance) to reinforce attendance or engagement goals (e.g., counselling, dosing).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMetrebian 2021\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (7+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA phone-delivered CM program provided incentives contingent on methadone adherence of up to \u0026asymp; \u003cspan\u003e$\u003c/span\u003e132.08 total over 12 weeks.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWinograd 2022\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CM program provided incentives as voucher of up to \u003cspan\u003e$\u003c/span\u003e75 total /client/year contingent on treatment engagement, limited to the first 4\u0026ndash;6 weeks.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGreen 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component treatment program provided incentives of up to \u003cspan\u003e$\u003c/span\u003e315/participant total, contingent on drug abstinence as gift cards for stimulant-negative urine tests.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurran 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multicomponent CM intervention provided incentives as shopping vouchers of up to \u003cspan\u003e$\u003c/span\u003e298.56 total contingent on abstinence or reduced cannabis use verified via urinalysis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCohen 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component CM intervention provided escalating incentives as restricted VCS coupons/ smart debit cards contingent on verified alcohol abstinence and/or completing selected activities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParent 2023\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e154 (154+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple CM interventions across 17 sites in two states provided incentives of up to \u003cspan\u003e$\u003c/span\u003e315/ \u003cspan\u003e$\u003c/span\u003e528 total as gift cards, with a \u0026ldquo;banking\u0026rdquo; option contingent on verified stimulant abstinence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHallgren 2023\u003csup\u003ea[\u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA multi-component m(mobile)-Health intervention contingent on verified stimulant abstinence provided incentives of \u003cspan\u003e$\u003c/span\u003e8.42/ negative result.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGorman 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA hybrid telehealth CM program provided incentives via prize draws as VCS vouchers contingent on verified treatment adherence up to max. avg. of \u003cspan\u003e$\u003c/span\u003e372.86\u0026nbsp;for full adherence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJakubowski 2024\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA digital CM intervention implemented across six clinics provided incentives (up to \u003cspan\u003e$\u003c/span\u003e599 over 6 months) for meeting health behaviours e.g., negative toxicology screens, and attending treatment.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoker 2025\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA Multi-component CM intervention provided incentives (e.g., gift cards) contingent on objectively verified completion of target health behaviours e.g. drug abstinence, therapy attendance, or medication adherence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviour\u003c/strong\u003e: Multiple\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerry 2019\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe MIPCD program implemented across 10 states provided incentives of variable forms, focus, design and structure contingent on adopting healthier behaviours/ chronic disease management e.g. tobacco use, obesity, hypertension and diabetes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRTINASHP\u003c/p\u003e\n \u003cp\u003e2017\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e─\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple state MIPCD programs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eSPiCG: smoking in pregnancy challenge group; RTINASHP: research triangle and national academy for state health policy; Ql: qualitative; MM: mixed methods; RCT: randomised controlled trial; nRQ: non-randomised quantitative; QD: quantitative descriptive; TB: tuberculosis; HIV: human immunodeficiency virus infection; PWID: people who inject drugs; SUD: substance use disorders; DBT: direct benefit transfer; CO: Carbon Monoxide; CM: contingency management; PrEP: pre-exposure prophylaxis; CCT: conditional cash transfer; A/PNC: ante/postnatal care; MNCH: maternal and child health; SNAP: supplemental nutrition assistance program; VHA: veterans health administration; VCS: Veterans Canteen Service; MIPCD: Medicaid Incentives for the Prevention of Chronic Diseases; a Unpublished data were obtained via author contact and linked to main study. b Incentives are shown in USD, either as reported or converted using the average exchange rate at the time equivalent at the time of the study/publication. C included additional populations other than pregnant only e.g., lactating women, new born or supporting other. d with history of urinary tract infections including non-adult patients e specifically among people with HIV and unhealthy alcohol use\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of barriers (type \u0026ldquo;B\u0026rdquo;) and facilitators (type \u0026ldquo;F\u0026rdquo;) to FI interventions implementations\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDomain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en %\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSummary\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironmental context and resources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Ambiguities around/lack of existing policies for digitally-delivered FI interventions\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Policy constraints, regulatory and/or bureaucratic requisites\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Incentive designs complexity and inflexibility\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e including inappropriate/unclear eligibility criteria \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e and issues linked to the form and/or method of incentives delivery\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e, incentive amount/value \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/sup\u003e, limited duration or frequency of intervention delivery to achieve full integration or meaningful behavioural outcomes\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e, suboptimal timing of incentive delivery\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e or setting of delivery\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Ambitious and/or unrealistic goals\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Poorly-tailored platforms\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Cumbersome test kits \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e and physical testing requirements)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Group-based interventions exacerbated challenges \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Limited time until rollout and/or lengthy procedural requirements\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Limited resources preventing alignment with evidence-based design\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Ineffective stakeholder partnerships\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Undefined roles, guidelines and strategies, communication and feedback protocols or reliance on ad-hoc decision making\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Intervention integration challenges \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Limited funding or competing financial priorities\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Logistical and procedural impediments\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Technological shortcomings\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Data management issues\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Workforce crises\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Intervention-related training, administration or management processes issues \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Restricted access to participants\u0026rsquo; progress\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e. False claims of target behaviours, and fund skimming\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Contextual factors secondary to pre-existing geodemographic factors including transportation issues\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Lack of tailored and/or effective recruitment methods\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Intervention-unfriendly institutional environments \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Poor infrastructure and service gaps\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Competing priorities of both providers and/or service users \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Unforeseen external events \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Benchmarking\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e, participatory/collaborative approaches with key stakeholders \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e for intervention planning.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Ease of intervention use \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; FI broad eligibility criteria \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Bank transfers \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e, cards/digital transfers as secure or convenient forms with minimal issues \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Schedule flexibility \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Robust behaviour verification methods (e.g., CO monitoring)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; A wide assortment of additional participant-centred elements\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e such as: unconditional cash transportation support\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e, peer support\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e, reminders\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e and discreet non-stigmatising app designs (for HIV, TB patients)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Piloting\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/sup\u003e and incorporating stakeholder/participant feedback\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e]\u003c/sup\u003e for intervention optimisation.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Data-driven decision making\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Autonomy and/or flexibility to refine FI to evolving needs\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e, and enhance adaptability/creativity \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Robust infrastructure \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e alongside accessible and reliable services\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Easy referral processes \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Strategic, population-oriented and readily implementable awareness campaigns and/or outreach activities\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Comprehensive training systems\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e incorporating peer learning\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e, evidence-based protocols\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e, and expert input\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Stable and adequate workforces\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e, alongside readily-available dedicated members and/or contacts\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Robust, diverse and multi-level systems with cross-sector collaborations \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Commitment and/or strong leadership \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Funding that is sustainable, adequate and/or timely\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Alignment with existing policies, organisational aims/branding\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/sup\u003e, target population\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e and workflows/systems\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Minimal administrative burden\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e and resource input\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Performance-based incentives to promote providers\u0026rsquo; participation in intervention delivery\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeliefs about consequences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Conflict and/or discomfort over incentivising behaviours\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e, particularly due to the possibility of acting as perverse incentives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e even more when aimed towards specific groups. \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Questioning FI necessity and/or effectiveness\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Concerns over FI as a new concept/controversial \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Comprising personal agency subsequent to \u0026ldquo;policing\u0026rdquo; of behaviours, posing as \u0026ldquo;paternalistic bribes\u0026rdquo;\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Exploiting individual\u0026rsquo;s economic/emotional desperation\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Concerns about integrating the intervention in clinical settings\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Negative views/assumptions on FI interventions processes \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Participants\u0026rsquo; perceptions of unfairness and at times exacerbating disparities\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e brought about by FI interventions\u0026rsquo; eligibility criteria. Opposing incentivising behaviours\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; The associated cost of engagement outweighing its perceived benefits\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Anticipated reprimand of poor service use in case of failure to change\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Witnessed deviations from expected incentive delivery\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Affluent participants viewed FI as insignificant when faced with sharing confidential information\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Perceived unattainable behavioural targets/ incentives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Assumptions around intervention/treatment ineffectiveness\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Concerns over anticipated added admin burden\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e]\u003c/sup\u003e, overcommitting resources \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Concerns over being challenged by users who held strong beliefs about the health behaviour i.e., cannabis use\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Holding unfavourable views on government-led initiatives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Potential poor outcomes due to recognised low quality services\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Valued anticipated /observed benefits\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e, reducing scepticism\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Direct transfers seen as legitimate way of incentive delivery \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; No high-value prizes for patients with substance use issues \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial influences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; FI objectives and existing cultural norms or populations\u0026rsquo; reality mismatches\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Cultural dissonance with the target health behaviour\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e or from banking systems in ethnic groups\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Experienced gender-based incentive misuse\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e or altered household dynamics\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Stigma \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Staff role violations \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Providers\u0026rsquo; concerns over damaging their community relationships as the \u0026quot;face of the intervention\u0026quot;\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Group-based FII interventions and peer pressure\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Negative views on external social agents challenged partnership efforts\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e]\u003c/sup\u003e due to anticipated resistance to incentive-based models/ perceived limited influence.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Negative interactions\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Coercion into participation\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Mentor-user peer hierarchy \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Challenges to leverage relationships for engagement \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Community-oriented elements\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Trusted figures approving of incentives use\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e, having doctors/insurance providers as a referral point\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e or a trusted party for service delivery\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Non-judgemental and supportive providers\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e who cushioned the intervention while avoiding negative inferences\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Ongoing and consistent communications alongside fixed provider-user pairings \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Expert-led training\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e, local champions, social modelling ( e.g. sharing patient success stories\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e as well as teamwork and \u0026ldquo;the sense of shared commitment\u0026rdquo;\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Established community ties \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; State-sponsored dissemination efforts\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Fellow staff and managers enthusiasm and positive attitudes\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Open dialogue and peer support among providers\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Teacher support for student mentors,(?) recruitment and social connection with peers \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eReinforcement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Insufficient incentives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/sup\u003e relative to costs/needs.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Low incentives amount\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Significant delays between achieving the target behaviours and incentives receipt\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Non-monetary rewards (e.g., \u0026quot;good job\u0026quot; slips) \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Remote delivery \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e]\u003c/sup\u003e. Reinforcing a transactional provider-participant relationship\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Misreporting of behaviour targets to bypass the eligibility criteria\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Providers\u0026rsquo; inadequate or delayed compensation for implementation efforts \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Real-time monitoring and reminders\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e educational materials\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e, fun, competitive and game-like aspects\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/sup\u003e, deescalating incentives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e, unconditional tailored packages\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/sup\u003e, family/staff support\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Visual, immediate and/or regular testing as well as receiving feedback on behaviour change \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; The act of goal-setting and achieving targets\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e, the use of physical tracking tools\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Favourability and high acceptability of the intervention/its components\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Providers viewing incentives as an empowering reinforcement\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Regular feedback on participants\u0026rsquo; outcomes\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Positive reinforcers over punitive-based approaches\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026bull; Receiving recognition for their role\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Limited evidence on population/context-specific incentive designs \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Legal ambiguities \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Knowledge and understanding gaps on intervention aims, positioning, processes and/or eligibility criteria\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Uncertainties amongst providers about the FI programmes policies\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e, timelines\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e, modifications\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e or their/other\u0026rsquo;s roles \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; General limited awareness of the FI interventions across clients and providers\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/sup\u003e and of the associated services/resources\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Participant\u0026rsquo;s limited comprehension of messaging on the intervention\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; High awareness and understanding surrounding FI interventions and relevant services\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Familiarity with the evidence-base\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Clear practice guidance and training resources on FI principles, effectiveness, designs and procedures\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Staff with prior knowledge and experience\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Regular updates on implementation processes/outcome data\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Complementary education components and/or information dissemination activities on the health-behaviour, the FI interventions and associated or their potential impact\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eRole and Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Providers\u0026rsquo; personal/ professional values around equity/justice or what entails an \u0026ldquo;appropriate\u0026rdquo; treatment model\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Grappling with multiple responsibilities -that are incompatible with their role or professional standards of care, \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Ethical quandaries regarding eligibility vs those truly in need\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e. Rationing incentives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Preoccupation with achieving targets and ensuring \u0026ldquo;coverage\u0026rdquo; \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Perceived shift in the provider-user roles from a\u0026nbsp;collaborative care relationship\u0026nbsp;to a\u0026nbsp;transactional one\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Intervention goals conflict with institutional identities\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Stakeholders holding diverse views surrounding intervention philosophies and/or role responsibility\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Perceived undervalued key stakeholder groups (e.g., clinical and traditional service providers) roles and expertise\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; High socioeconomic status participants\u0026rsquo; social standing\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Alignment with organisational, professional and/or social identities and associated responsibilities\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Being able to satisfy professional performance targets\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Role expansion and redefining strategies\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkills\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Operational motor skills limitations\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Physical impairment\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Digital illiteracy\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Deficiencies in design skills\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Providers\u0026rsquo; digital and technical literacy gaps, limited data management, and/or administration skills\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Limited interpersonal and communication skills \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Well-trained staff with relevant skill-sets\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehavioural Regulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Weak monitoring and poor budgetary planning\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/sup\u003e. Challenges with self-tracking behaviour change goals\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Clear planning and monitoring strategies with/out stakeholders\u0026rsquo; feedback\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\n \u003cp\u003e\u0026bull; Elements such as: reminder systems, e-trackers, random behaviour verification tests as well as readily accessible outcome data among others\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Providers\u0026rsquo; burnout \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e and frustrations \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Participants\u0026rsquo; fear, anger\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/sup\u003e and/or feelings of guilt \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Others felt daunted and/or demotivated with impersonal program elements \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Students felt embarrassed \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e]\u003c/sup\u003e, while employees were too stressed \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Few felt offended \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003edue to ill-timed intervention briefing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Strong positive emotions on test validation \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Providers \u0026ldquo;feeling good\u0026rdquo; \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e and having \u0026quot;fun\u0026rdquo;\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Feeling appreciated, respected, satisfied, less alone or stressed\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\n \u003cp\u003e\u0026bull; Reduced shame\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e when failures were contextualized.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMemory, Attention and decision processes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Cognitive overload due to procedural demands and/or uncertainties in the decision-making processes\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeliefs about capabilities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Self-perceived incompetence and lack of confidence\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e]\u003c/sup\u003e among providers.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Systems overestimating a level of service users\u0026rsquo; capabilities \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Stronger belief in providers\u0026rsquo; own abilities towards implementation\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Self-efficacy (empowerment)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGoals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Goal-setting misalignment \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Participants\u0026rsquo; competing priorities overriding intervention goals\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Personal health goals\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\n \u003cp\u003e\u0026bull; FI alignment with recovery objectives\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Providers motivated to facilitate and prioritise implementation\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"implementation-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"imps","sideBox":"Learn more about [Implementation Science](http://implementationscience.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/IMPS/default.aspx","title":"Implementation Science","twitterHandle":"@ImplementSci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Financial Incentives, Health Behaviours, Smoking Cessation, Behaviour Change, Theoretical Domains Framework, COM-B, Behaviour Change Wheel, Implementation Science","lastPublishedDoi":"10.21203/rs.3.rs-8059982/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8059982/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBehavioural risk factors contribute significantly to the development of disease and ill-health. Financial incentive interventions have shown promise in promoting behaviour change across several health-related behaviours. Despite well-documented evidence of effectiveness and widespread implementation efforts, uncertainty remains about how and under which circumstances these interventions achieve desired success and can be effectively sustained. To facilitate effective and theory-informed implementation, we conducted a systematic review of evidence addressing the barriers and facilitators to successful implementation of incentive-based interventions targeted at health behaviour change in mixed populations, and mapped these to theory.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe conducted a systematic search to identify scientific and grey literature across nine electronic databases, from inception to 3rd June 2025. Search terms included combinations of terms related to \u0026ldquo;health behaviours\u0026rdquo; and \u0026ldquo;incentive\u0026rdquo;. Eligible records reported and/or described the implementation of financial incentive programmes with incentives for various health behaviours change. Deductive framework analysis identified barriers and facilitators, relevant intervention functions and policy categories. A narrative synthesis of findings, mapped against the Theoretical Domains Framework, with relevant intervention functions and policy categories identified through the Behaviour Change Wheel, was conducted. Subgroup analysis explored patterns across countries of diverse income status and those specific to smoking cessation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOf 13135 unique records identified, 63 met the inclusion criteria. Studies predominantly reported on implementation in high-income countries (n\u0026thinsp;=\u0026thinsp;47). Incentive-specific barriers included political and legal ambiguities, incentive design challenges pertaining to the amount, form and timing of incentives, incompatibility with the implementation agents and surrounding context, as well as relationship struggles and role violations undermining participants\u0026rsquo; identity. Facilitators included participatory evidence-led planning and implementation processes, high acceptability and recipient-tailored FI recruitment processes and designs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003e This first systematic and theory-guided synthesis of the barriers and facilitators to actual implementation of financial incentive interventions, targeted at various health behaviours among mixed populations and contexts, provides comprehensive, valuable guidance for advancing incentive implementation efforts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRegistration:\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePROSPERO, Registration no.: CRD42024557290.\u003c/p\u003e","manuscriptTitle":"Facilitators of and Barriers to Implementation of Financial Incentive Interventions for Health Behaviour Change: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 05:59:02","doi":"10.21203/rs.3.rs-8059982/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T15:34:34+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"288948424276000371319506073656347526791","date":"2026-01-22T23:56:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-21T06:08:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283102315241688267576086012837371678682","date":"2026-01-14T20:02:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-09T17:25:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T07:41:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-11T04:59:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Implementation Science","date":"2025-11-07T20:07:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"implementation-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"imps","sideBox":"Learn more about [Implementation Science](http://implementationscience.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/IMPS/default.aspx","title":"Implementation Science","twitterHandle":"@ImplementSci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0937bd38-e200-43ab-9ce7-b9f3f13c8cea","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T15:34:34+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T16:38:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 05:59:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8059982","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8059982","identity":"rs-8059982","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}