Rewards are an inherent part of life. I remember how much I looked forward to getting my weekly allowance as a kid. It was the 'reward' or incentive for doing household chores. As I did my chores, I thought about how I was going to spend my allowance. The allowance was what kept me motivated to do my chores.

Rewards are an inherent part of worksite health promotion programs. We provide incentives for employees who participate in programs or who achieve standards for maintaining or achieving a specific health standard. Incentives have been that 'carrot' that encourages employees to take part in the worksite health promotion program. Without participation, there is no hope of behavior change, improved health status or return on investment.

When designing incentive programs, it is important to remember keep the following in mind:

• Not everyone is motivated by the same thing. Consider designing your incentive program with a number of choices. For example, if getting a preventative screening is the requirement, provide the option for any type of age and gender appropriate screening, rather than just a flu shot.
• Incentive criteria should motivate behavior change or health status improvement. Not all activities that might be considered criteria for your incentive program may influence behavior changes or improve health status. For example, taking a health assessment or participating in a biometric screening event alone will not improve an individual's health. While they both are awareness or education events, they typically do not lead to changes in lifestyle or action that improves health status. Awareness and education events are worthwhile investments, but should be paired with programs that foster behavior change.
• Ensure rewards are positive and not negative. People respond far better to positive rewards than negative rewards. Design your incentives with the positive in mind. For example, if your program penalizes people who have a Body Mass Index (BMI) of more than 25 (considered overweight or obese), it may discourage those individuals from participating. For some people, no matter how hard they try, they may never achieve a BMI of less than 25. An alternative would be to offer an incentive for improving BMI.
• Tie incentives to other health benefit programs. Traditionally, incentive programs have been given in the form of merchandise or cash rewards. Increasingly, incentives are tied to other health benefit programs. For example, design the program to offer discounts on health care premiums, as contributions to health reimbursement or health savings accounts, or for non-health plan participants, to flexible spending accounts. This helps make the connection for employees between their own health and the use of their other health benefits.

Mari Ryan, MBA, MHP, CWWPC, CWP