TO REWARD ... OR NOT TO REWARD - QUESTIONING THE WISDOM OF USING EXTERNAL REINFORCEMENT IN HEALTH PROMOTION PROGRAMS

Positive reinforcement through the use of rewards and incentives is ge nerally accepted as an effective technique to change behavior and is r egularly used to help raise children, teach students, and motivate wor kers. Ironically, research does not support the contention that reward s and incentives promote lasting behavior change. Nevertheless, many h ealth promotion programs, from smoking cessation classes to exercise a nd weight loss competitions to worksite initiatives for lowering blood pressure and cholesterol, have incorporated the use of rewards and in centives to help promote participation and health behavior change. Thi s article summarizes four major problems associated with the use of po sitive reinforcement strategies: 1) the improper use of positive reinf orcement, 2) the failure to address the underlying causes of problems, 3) the lack of long-term effectiveness of externally applied rewards and incentives, and 4) the potential detrimental effect of such approa ches on internal motivation. We place specific emphasis on the implica tions of these problems for promoting health behavior change, and we d iscuss future research considerations for health promotion.