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

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.