Motivating Factors for Continuous Participation in a Municipality-Initiated Incentive-Based Health Promotion Program: A Qualitative Study.

Background: Noncommunicable diseases (NCDs) are the leading global cause of death, with physical inactivity being a major modifiable risk factor. In Japan, high NCD mortality and low physical activity rates prompted municipalities to launch incentive programs promoting healthier behaviors. However, long-term experiences and motivations beyond immediate rewards remain unclear. Methods: A qualitative descriptive study was conducted in Nakasatsunai Village, Hokkaido, Japan. In 2022, 17 individual and one focus group interviews were held with 21 participants continuously engaged in the Health Point Project. Participants earned points through step tracking, health checkups, and events, which could be exchanged for vouchers. Data were analyzed using inductive content analysis with co-author review and member checking. Results: Participants' mean age was 60.3 years. Eight categories described continued participation: looking forward to the benefits without active effort; being encouraged to engage in physical activity within well-designed environments; hoping to maintain good health; recognizing the benefits and impacts of exercise; engaging in activities in their own way or style; adopting exercise and health care as habits; being inspired by peers; and feeling a sense of community. Incentives motivated initial participation, while habit formation, health improvements, social interaction, and community involvement sustained long-term engagement. Conclusions: Participants' sustained involvement was driven not only by financial incentives but also by experiences of personal connection and community belonging. Thus, municipal incentive programs may enhance both individual health behaviors and social well-being, underscoring the importance of integrating opportunities for social interaction alongside financial incentives in sustainable health promotion initiatives.