Discrete choice experiments on preferences for financial incentives and nudges in health promotion and disease prevention: a systematic review

Background Financial incentives and nudges are increasingly used to promote preventive activities, but little is known about individuals’ preferences for their design characteristics or how these characteristics are valued relative to other components of preventive interventions. We conducted a systematic review of discrete choice experiments (DCEs) examining preferences for financial incentives and nudges in health promotion and disease prevention. Methods We searched PubMed, Web of Science, and Scopus for DCEs published between January 2000 and May 2025 and conducted in upper-middle- and high-income countries. Eligible studies examined health-promotion or disease prevention interventions and included at least one financial incentive- or nudge-related attribute. Data were extracted at the DCE level, adherence to methodologically good research practices was assessed using the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) checklist. We tabulated attribute frequencies and how often attributes ranked first by behavioral target. Relative attribute importance was extracted or calculated as each attribute’s range of level coefficients divided by the sum of attribute ranges within each DCE. Pairwise comparison matrices summarized the proportion of within-DCE comparisons in which financial incentive or nudge attributes outranked other attributes. Results Fifty-two studies, corresponding to 64 DCEs, were included. Financial incentive attributes accounted for 91 of the 300 identified attributes (30%) and were included in 47 DCEs (77%); nudge attributes accounted for 30 attributes (10%) and were included in 18 DCEs (30%). Preferences for financial incentive- and nudge-related attributes varied across preventive contexts. Financial incentives were more likely to rank highly in determining individual preferences when compared with intervention delivery and administration characteristics, but less so when outcome or cost attributes were included. Magnitude and delivery form emerged as the most salient financial incentive dimensions in terms of relative attribute importance. Most studies were of moderate-to-high quality and commonly used fractional factorial designs, four to six attributes, blocking, and mixed logit models. Conclusions Preferences for financial incentives and nudges are context-dependent and strongly shaped by intervention design. These findings can inform their incorporation into health promotion and disease prevention programs.