Research and analysis

Better Health: Rewards pilot - summary of results

Published 1 August 2025

Applies to England

Background

Shifting from treatment to prevention and focusing on driving health improvement will help people live healthily for longer, and support our health and care services to be sustainable for the future. As part of this, the government is committed to looking at the best available evidence here and around the world, and thinking radically about how to ease pressure on the NHS and build a healthier economy.

The Better Health: Rewards pilot was launched in Wolverhampton on 17 February 2023 and closed on 13 October 2023. The innovative digital pilot - the first of its kind in England - was structured as a randomised control trial, and tested whether a government-backed financial health incentives scheme could support people to improve their diet and physical activity.

The pilot was funded by the Department of Health and Social Care (DHSC) and was delivered in partnership with the City of Wolverhampton Council, which was appointed after an expression of interest, and digital health specialists HeadUp Systems Limited. The pilot underwent evaluation by the Behavioural Insights Team (BIT). BIT is an independent consultancy who acted as an evaluator of the pilot scheme.

This document provides an overview of the pilot and the key findings. It should be read alongside the full evaluation report on the BIT website.

How the pilot worked

Wolverhampton residents aged 18 and over were eligible to take part in the pilot.

Participants were given free fitness trackers that were linked to the free Better Health: Rewards app.

Following registration, participants completed a baseline period to record their usual physical activity and diet behaviour. They were then randomised into 4 research arms:

• control
• low reward
• medium reward
• high reward

The app generated personalised health goals for every participant - such as increasing their step count or eating more fruit and vegetables - in line with the Chief Medical Officer’s physical activity guidelines and the Eatwell Guide for a healthy balanced diet. Twelve different health challenges were available, which were designed to be completed anywhere, with no gym required.

Over 5 months, participants took on these challenges and collected points for each goal they completed.

While all participants received the app and, if they needed it, the wearable fitness tracker, participants received different levels of financial rewards in exchange for their points depending on which research arm they were randomised to. The control arm received no financial rewards for completing health challenges. This made it possible to evaluate the impact of the financial incentives alone.

Table 1: monetary equivalent of one point across trial arms

Trial arm	Control arm	Low reward arm	Medium reward arm	High reward arm
Monetary equivalent	£0	£0.005	£0.025	£0.035

Participants were asked to select up to 2 challenges per week and were required to validate these on completion to earn points. The app assessed whether participants met their goals through multiple mechanisms, including fitness tracker data, photos and quizzes.

To keep participants motivated, participants could receive more points for harder challenges and could still receive some of these points if they only partially achieved the harder challenges. Points were also allocated to encourage habit formation and improve health behaviours.

For evaluation purposes, all participants, regardless of trial arm, were asked to submit diet and physical activity data at months 1, 3 and 5, and were rewarded equally for doing so.

All participants were able to spend the money they earned through challenges or by providing their physical activity or diet data in the in-app e-store, which offered a range of rewards.

Participants could choose from a catalogue of thousands of rewards through the in-app store. Gyms and leisure centres across Wolverhampton, including PureGym, Places Leisure, Complexions and WV Active, offered vouchers and discounts. Vouchers for Wolverhampton Wanderers FC, cinema tickets or family activities were also available.

National supermarkets including Sainsburys, ALDI, Morrisons, Tesco and Asda also participated in the scheme so participants could redeem vouchers for money off their food shop. We worked with supermarkets to restrict vouchers from being spent on tobacco, gambling or alcohol products. Other rewards included vouchers and merchandise from retailers including Amazon, Argos, Primark, M&S, John Lewis and Currys.

The app also included budget-friendly tips that supported participants to develop healthier habits.

Results

The following results are based on the evaluation results from BIT and DHSC internal analysis. Unless stated otherwise, data is taken from evaluation results provided by BIT.

Overall, the results showed a small but statistically significant impact of financial incentives on physical activity and some diet behaviours.

Participation

The pilot exceeded both its targets for sign-up and retention at the end of the scheme (in month 5). It largely met targets across demographic groups.

Of the entire adult population (those aged 18 and above) of Wolverhampton local authority, 17% (34,900 adults) consented to take part in the study.

Table 2: target and actual number of participants for registration and at end of pilot

Participant numbers	Number of participants at registration	Number of participants engaging with the app at end of pilot (month 5)
Target	25,800	4,200
Actual	28,281	7,387

Note: by ‘Number of participants engaging with the app at end of pilot (month 5)’, this means the participant opened the app at least once in the previous 30 days.

Of the participants who consented to the study, 37% (12,767 participants) proceeded to randomisation. This represents 6.4% (or 1 in 16) of the entire adult population of Wolverhampton local authority. Participant attrition (drop-out rate) is expected with digital apps and participants can drop out for various reasons. The final sample at the end of month 5 was 7,387, which exceeded our target.   

Table 3: demographic data for those who registered, proceeded to randomisation and were still engaging with the app at month 5, against demographic targets

Sub-group	Target (% in each category)	Participants who completed registration (%)	Participants who were randomised (%)	Participants engaging with the app at month 5 (%)
White	68	58	68	67
Asian or Asian British	18	25	18	18
Black, African, Caribbean or Black British	7	8	7	7
Mixed or of multiple ethnic backgrounds	5	4	4	3
Female	50	64	67	68
Male	50	36	33	32
Most deprived (scoring 1 or 2 on the Index of Multiple Deprivation)	51	54	50	48
Other (scoring above 2 on the Index of Multiple Deprivation)	49	46	50	51
Aged 45 or over	45	41	42	46
Control arm	50	Not applicable	61	57
Low reward arm	17	Not applicable	15	16
Medium reward arm	17	Not applicable	12	13
High reward arm	17	Not applicable	12	14

Note: percentages may not add up to 100% due to rounding and some categories not being listed. Targets were set to ensure the sample was representative.

Challenges

There were 12 challenges participants could undertake: 2 physical activity and 10 diet challenges. Participants still engaging with the app at month 5 completed over 130,000 challenges throughout the pilot.

Nearly 8 billion steps (7,993,769,514) were taken by participants through the challenges and over 24 million minutes (24,187,384) of physical activity. The pilot saw participants enjoy nearly 450,000 portions (447,815) of fruits and vegetables through the diet challenges (according to internal analysis conducted by HeadUp Systems Limited at request of DHSC).

Physical activity challenges (‘Let’s get moving’ and ‘Step it up’) were the most popular - however, more diet challenges were undertaken overall.

Table 4: number of times each challenge was completed by participants still engaging with the app at month 5

Challenge	Total number of times challenge completed
Let’s get moving	21,759
Step it up	19,699
Boost fruit and veggie intakes	17,670
Switch up your drinks	14,189
Snack attack	12,566
Go lower fat	10,784
Fibre fix	7,904
Brilliant breakfast	6,082
Say no to fried food	5,731
Dessert swapper	6,131
Eat leaner meat	5,207
Have healthier food on the go	4,409
Total completed	132,131

Engagement

Overall, we saw participants in the higher reward arm engage more with the app across most of the metrics analysed. Those on the high reward arm would:

• log into the app more often
• select and complete more challenges
• earn more points per week and redeem more rewards

Table 5: summary of points earned and value of redeemed rewards per person across different reward arms (sample still engaging with the app at month 5)

Participant	Control arm	Low reward arm	Medium reward arm	High reward arm
Average points earned per participants per week	48	66	88	98
Total value of redeemed rewards per participant on average over 5 months (£)	51.87	58.28	102.30	131.82

Note: the control group was able to redeem rewards from data completion but received no money (only points) for completing challenges.

Partners and rewards

The pilot offered thousands of rewards from local and national rewards partners to ensure that there was an attractive, appealing and relevant rewards offer. An engagement panel was held with Wolverhampton residents to inform the reward strategy.

The report shows that grocery gift cards were the most commonly selected reward. This translated into the most popular spend category (according to internal DHSC analysis).  

Impact of financial incentives on behaviour change

The evaluation looked at the impact of financial incentives alone on behaviour change. This means it compared those in the control arm (who received the app and wearable fitness tracker, and received points without financial value for challenge completion) with those in the low, medium and high reward arms. This comparison is used for primary and secondary outcomes as well as a range of exploratory outcomes. It was not designed to evaluate any change from the participant’s baseline to the end of the pilot.

The primary outcomes for physical activity and diet are listed below.

For physical activity:

• daily steps
• moderate-to-vigorous physical activity (MVPA) in minutes per day

For diet:

• fruit and vegetables: in grams per day
• fibre: in grams per day
• free sugars: taken as the percentage of energy derived from food
• saturated fat: in grams and calculated as a percentage of energy derived from food

Below is a summary of the main findings but it is not exhaustive. The full evaluation report is available on the BIT website.

Physical activity

When conducting a full analysis irrespective of how long users wore their wearable fitness trackers for, there was a small but statistically significant improvement in both MVPA and step count. This is published within the full evaluation report under ‘Sensitivity analysis’.

Table 6: summary of physical activity behaviour change

Physical activity - primary outcome	Difference between the control arm and the pooled reward arms
MVPA	+ 1.9 minutes per day
Steps	+ 256 steps per day

The main body of the evaluation presents findings from a smaller sample, as it only considered data from participants who wore their fitness tracker for 6 or more hours, as set out in the trial protocol. This metric was chosen as an indicator of valid data.  

As a result, it found that offering financial incentives did not impact participants’ levels of physical activity. However, at an early stage of data collection, it became clear to the evaluator that wear time was deemed to not be an accurate indicator of data validity and, as a result, this analysis was potentially excluding a large amount of reliable data.

To ensure policy can be informed by a larger, more complete set of data, DHSC extended this fuller analysis, with agreement from BIT (including those who wore a wearable fitness tracker for less than 6 hours a day), to consider the impact of financial incentives on a range of secondary and exploratory outcomes. A more detailed description of this approach and the analysis is published alongside this report in ‘Annex A: supplementary physical activity analysis’.

When looking at the impact of the intervention on different groups (sub-group analysis), DHSC’s supplementary analysis shows that there is a greater impact on physical activity for:

• women
• those that are from more deprived areas
• those with lower baseline health behaviours at the beginning of the pilot

Most deprived refers to areas with an Index of Multiple Deprivation (IMD) decile of 1 or 2. By lower baseline health behaviours, this means participants who undertook less than 30 minutes of MVPA during the baseline week for physical activity, and consumed less than 240 grams of fruit and vegetables during the baseline week for diet.

Analysis of the financial reward values carried out by DHSC demonstrated that the medium reward arm saw the strongest impact (for both steps and MVPA), while the lower and higher rewards also drove change for MVPA but not steps.

This does not offer a clear interpretation in the relationship between incentive level on physical activity outcomes.

Diet

Overall, offering financial incentives had a small but statistically significant improvement on some diet behaviours. There was no significant difference for sugar or saturated fat.

Table 7: summary of diet behaviour change

Diet - primary outcome	Difference between the control arm and the pooled reward arms
Fruit and vegetables	+ 21g per day, equivalent to almost 2 extra portions per week
Fibre	+ 0.35g per day, equivalent to just over 1% increase towards recommended fibre intakes

Note: equivalents were calculated from the Eatwell Guide.

Sub-group analysis shows that, although there is a statistically significant impact on fruit and vegetable consumption across most groups, there is a greater impact for:

• those that are from less deprived areas
• those aged over 41
• those that are of white ethnicity
• those with higher baseline health behaviours at the beginning of the pilot

Analysis of the financial rewards values suggested that the higher the incentive level, the more substantial the behaviour change for dietary outcomes, including fibre, fruit and vegetables, and saturated fat intake. However, not all effects were statistically significant.

Other findings

While not incentivised, the study considered the impact of financial incentives on wider outcomes. The pilot was not a weight-loss programme, and participants were not offered any financial incentive to lose weight or enter their weight into the app. However, the evaluation reviewed over the course of the pilot:

• weight
• a healthy eating score
• energy intake
• energy expenditure

No significant differences were detected between the pooled reward arms and the control arm on these outcomes. While we did not see any weight change in the quantitative data, some participants in qualitative work reported experiencing weight loss following participation in the intervention. For some, this represented further incentive to continue engaging with the programme.

While not the purpose of the study, there were no substantial findings on the impact of the intervention on:

• sleep
• mental health
• motivation to change physical activity and diet
• whether the intervention is more effective in the short term

Next steps

DHSC will now consider the results of this pilot and the potential of financial incentives to play a role in the government’s ambition to put prevention first and empower people to lead healthier lives.