Degree Name

Doctor of Philosophy


Faculty of Health and Behavioural Sciences


Chronic diseases have been growing in prevalence in the twentieth century and several factors have contributed to the emergence of what is now described as an “epidemic” (Crews and Gerber, 1994). These factors include complex social, cultural and technological changes, which have exerted a significant impact on the health of the population and have become large contributors of illness, disability and premature mortality (Swinburn, Egger and Raza, 1999). Currently in Australia, an estimated three million people suffer from one or more chronic conditions with the most common being cardiovascular disease, some forms of cancers, diabetes, asthma and mental illnesses such as depression (Australian Institute of Health and Welfare, 2004). Disease management programs were developed as a means of overcoming many of the burdens associated with the mounting chronic disease rate and this is primarily achieved by reducing the incidence of chronic diseases through prevention strategies, delaying the onset of disability, alleviating the severity of disease and prolonging the individual’s life (Brownson, Remington and Davis, 1998). However, participation rates in such programs are well below their desired level and often reported as being a particularly problematic and complex issue (for example: Foster, Kendall, Dickson, Chaboyer, Hunter and Gee, 2003). This study aimed to determine the most effective strategies for increasing participation rates in disease management programs using prospect theory (via message framing) and incentives. Members of a private health insurance company received, on a random basis, either a letter or phone call inviting them to join a health program. The letter or phone call contained a framed message: positive, negative or neutral. In addition, half the sample population was also offered a small incentive upon enrolment in the Total Health program, that is, a post-action incentive. The results of the study found no framing effects. Given the results, the use of tailoring should be examined as an alternative, and potentially more persuasive, means of communication. In relation to incentives, the use of a small gift or chance to enter a competition prize draw was found to be effective in influencing re-enrolment rates in two health programs. However, these same effects were not seen in relation to the use of a small monetary incentive. As a result, it is recommended that future studies test different types of incentives, both momentary and non-monetary, to determine the most optimum.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.