Journal of Applied Behavior Analysis (Fall) 2020, 53, 1904–1921 NUMBER 4

Technology-based versus in-person deposit contract treatments

for promoting physical activity
Lisa M. Stedman-Falls and Jesse Dallery
Department of Psychology, University of Florida

Deposit contracts involve participants depositing their own money and earning it back contingent
on behavior change. Deposit contracts are empirically supported treatments for promoting health
behavior, but they have a history of poor uptake. We compared the effectiveness and acceptability
of technology-based versus in-person deposit contracts for promoting physical activity with 12 indi-
viduals. Participants’ daily step counts were monitored using Fitbits across 6 weeks, and treatment
preferences were assessed at the end of the study. The 2 types of treatments were equally effective
in increasing physical activity, but the technology-based deposit contracts were preferred by most
participants. Most participants also reported that their preference was related to convenience.
Technology-based implementation may be one way to improve deposit contract uptake, while
maintaining similar effectiveness compared to in-person procedures.
Key words: contingency management, deposit contract, technology, in-person, obesity, social
validity

New approaches are needed for promoting
health behaviors, particularly those which lead
to weight loss. Obesity was declared an epi-
demic within the U.S. over two decades ago
(Mokdad et al., 1999) and continues to be one
of the primary risk factors for heart disease—
the leading cause of death nationally and
worldwide (Heron, 2019; Mayo Foundation
for Medical Education and Research, 2020a;
World Health Organization, 2018). Although a
variety of obesity prevention and weight loss
treatments exist (e.g., Campbell et al., 2001;
Glenny et al., 1997; Lemmens et al., 2008),
most American adults (70.2%) are currently
overweight or obese (National Institute of
Lisa M. Stedman-Falls is now at Ballsbridge Behavior
and Consultation Services, Inc., Denver, CO.
This research was completed in partial fulfillment of
the first author’s requirements for the doctoral degree in
Psychology at the University of Florida. This research was
supported by the Department of Psychology at the Uni-
versity of Florida.
We have no known conflicts of interest to disclose.
Address correspondence to: Jesse Dallery, University of
Florida, P. O. Box 112250, Gainesville, FL 32611.
Email: dallery@ufl.edu
doi: 10.1002/jaba.776
© 2020 Society for the Experimental Analysis of Behavior (SEAB)
1904
Diabetes and Digestive and Kidney
Diseases, 2017). Lack of physical activity is one
of the key factors contributing to obesity, and
only about 23% of American adults meet the
current recommendations for physical activity
(Centers for Disease Control and
Prevention, 2020; Mayo Foundation for Medical
Education and Research, 2020b). Thus, interven-
tions to promote physical activity could have a
marked impact on public health.
Contingency management (CM) is a behav-
ioral treatment approach that can promote
change across a variety of health behavior targets.
CM treatments involve introducing antecedents
to evoke healthy behavior, as well as delivering
consequences to reinforce it. Deposit contract
CM treatments, in particular, have been used fre-
quently to promote weight loss-related health
behavior, and research suggests that they are
more effective than traditional health education
or “self-control” approaches (e.g., Coates
et al., 1982; Harris & Bruner, 1971; Sykes-
Muskett et al., 2015). Deposit contracts (some-
times referred to as “monetary commitment con-
tracts”) are based upon the principle of negative
reinforcement, and they involve individuals
 Technology-Based vs. In-Person Deposit Contracts
submitting monetary deposits and earning the
deposits back contingent on demonstrated
behavior change. As such, deposit contracts may
represent a financially viable method to deliver
CM. Dallery et al. (2008) compared a deposit
contract method to a traditional, reward-based
CM procedure to promote smoking cessation.
Participants in the deposit group (n = 4) depos-
ited $50 and could earn an additional $28.80 for
evidence of abstinence, while participants in the
reward group (n = 4) could earn $78.80 for evi-
dence of abstinence. Both procedures generated
equivalent levels of smoking abstinence, but the
deposit procedure resulted in a surplus of
$43.10, while the reward-based CM procedure
resulted in costs of $178.50.
Deposit contracts are an empirically
supported treatment option, but low partici-
pant uptake has been a longstanding challenge.
For example, in Experiment 1 of Harris and
Bruner’s (1971) deposit contract weight loss
study, seven of the 12 participants assigned to a
deposit contract group withdrew after the mon-
etary deposit requirement was explained. In
Experiment 2 of the same study, all six partici-
pants assigned to a deposit contract group
declined and were assigned to other groups. In
Jeffery et al.’s (1983) largescale evaluation of
employer-supported deposit contract treat-
ments, only 28% of eligible work sites agreed
to be involved. Additionally, only 12% of eligi-
ble employees participated in the deposit con-
tract treatment targeting smoking cessation,
and only 36% participated in the treatment
targeting weight loss. More recently, in
Halpern et al.’s (2015) smoking cessation
study, 13.7% of individuals assigned to deposit
contract groups participated, in contrast to
90% of individuals assigned to groups that
received monetary rewards contingent on
smoking abstinence.
The only method that has been evaluated for
potentially increasing deposit contract appeal
has been deposit matching, which involves the
provision of monetary rewards in addition to
1905
deposit refunds (e.g., Jarvis & Dallery, 2017;
John et al., 2011; Volpp et al., 2008; White
et al., 2013). Although some researchers
hypothesized that higher matching ratios would
increase participant uptake (Halpern
et al., 2012), extant data have not supported
that prediction. For example, Kullgren
et al. (2016) conducted a randomized, con-
trolled trial with 132 participants in which they
compared three deposit contract weight loss
treatments with different matching ratios
(no matching, 1:1 matching, and 2:1
matching). Participants self-selected their
monthly deposit amounts and were informed
of their potential earnings based on their
matching assignments. The overall participation
rate across the three treatments was only
29.3%, and matching had no effect on deposit
frequency or amount, compared to the treat-
ment without matching.
Deposit contract participation can also be
enhanced by technology-based treatment
implementation. Secure, electronic payment
sites can be used to receive and send money
(i.e., deposit submissions and refunds), and
electronic communication (e.g., text messaging,
email) can be used for treatment-related com-
munications. Commercially available wireless
devices (e.g., wearable accelerometers) can also
be used to obtain repeated, objective health
measures remotely. Technology-based proce-
dures have been employed across several studies
involving deposit contract treatments, and high
rates of participant uptake and retention have
been observed. For example, Dallery
et al. (2008) used a website and video monitor-
ing procedures to conduct their deposit con-
tract and reward-based smoking cessation CM
treatments. All four of the participants ran-
domly assigned to the deposit group accepted
their assignment and completed the study. In
2016, Donlin Washington et al. conducted the
first technology-based deposit contract study
targeting physical activity. They compared a
matched deposit contract to a reward-based
1906 Lisa M. Stedman-Falls and Jesse Dallery
CM treatment with 19 individuals. Partici-
pants’ daily step counts were monitored using
Fitbit® wearable accelerometers, and partici-
pants could choose to receive daily goals and
performance feedback via email, mobile text
messaging, or phone calls. All 19 participants
were willing to submit a $25 deposit, and the
10 who were assigned to the deposit group
completed the study. Interestingly, 16 of the
participants (84%) chose text messaging as
their preferred communication modality; only
two chose email, and only one chose phone
calls. In Jarvis and Dallery’s (2017) Internet-
based deposit contract smoking cessation study,
participants submitted deposits electronically
through PayPal®, and acceptability measures
were obtained posttreatment. Similar to other
evaluations, there was no attrition, and post-
treatment acceptability ratings were favorable.
The recent rise in commercial, technology-
based deposit contract programs provides even
more compelling support that technology-based
procedures may increase deposit contract
acceptability. DietBet®, for example, is an
online platform which hosts deposit contract
weight loss “games” and has attracted over
900,000 participants since 2010 (WayBetter,
Inc., 2020a). Leahey and Rosen (2014) publi-
shed a study with results from over 39,000
DietBet participants, which showed robust
effects of the program. WayBetter, Inc., the
company that operates DietBet, also has a
StepBet® platform for increasing physical activ-
ity (WayBetter, Inc., 2020c), a RunBet® plat-
form for running challenges (WayBetter,
Inc., 2020b), and a SweatBet® platform for
exercise routine challenges (WayBetter,
Inc., 2020d). In addition to the WayBetter,
Inc. games, stickK® is an online platform that
allows participants to initiate deposit contracts
for any type of goal, including weight loss and
increased physical activity (stickK.com, 2020).
Results from recent research, coupled with
the rise of commercial programs, signal that
technology-based deposit contract treatments
are effective for promoting health behavior and
may be more acceptable than traditional in-
person deposit contract treatments. However,
technology-based procedures have not been
experimentally isolated in the context of deposit
contracts, and it is unclear whether technology-
based procedures, per se, have been responsible
for favorable rates of participation recently
observed. Authors of a recent technology-based
physical activity deposit contract study
(Kerrigan et al., 2019) observed low participa-
tion rates and mixed posttreatment acceptabil-
ity ratings. Although participants primarily
cited the specific feedback procedures used in
the study as the most negative aspect, some also
cited the deposit requirement. Furthermore,
almost all technology-based deposit contract
studies have still included in-person procedures.
For example, participants in Donlin
Washington et al. (2016) had to attend two to
three in-person meetings each week, so
researchers could charge the Fitbits and upload
data. The studies by Dallery et al. (2008),
Donlin Washington et al., and Kerrigan
et al. (2019) also included in-person deposits
and refunds. Aside from acceptability consider-
ations, it is unclear whether technology-based
deposit contracts would be equally as effective
without the inclusion of in-person procedures.
To our knowledge, only three studies have eval-
uated fully remote technology-based deposit
contract treatments (Dallery et al., 2017; Jar-
vis & Dallery, 2017; Leahey & Rosen, 2014),
and additional research is needed.
The purpose of this study was to isolate the
effects and social validity of technology-based
versus in-person deposit contract procedures.
Specifically, mobile phone-based deposit con-
tract treatments were compared to in-person
deposit contract treatments for promoting
physical activity (as measured by an accelerom-
eter), using within-subject evaluations. Both
types of treatments included the same basic
deposit contract components, and differed only
by the modality through which components
 Technology-Based vs. In-Person Deposit Contracts
were delivered. Mobile phone was chosen as
the technology-based delivery method, in part
because Donlin Washington et al. (2016)
found that most participants preferred to
receive communications through mobile text
messaging.
Method
Participants and Settings
Participants were recruited via flyers posted
around the university campus, local community
(gyms, recreation facilities, churches, and work-
place offices), and on the local Craigslist®
website. The flyers asked if individuals were
interested in increasing their physical activity
and briefly described the deposit contingency.
The flyers also stated that participants would
be loaned Fitbits and earn $10 if they com-
pleted the study. Interested individuals con-
tacted the study team by phone and answered a
series of eligibility questions. To be eligible,
participants must have been between 18 and
80 years old; owned a smartphone capable of
accessing the Internet, downloading a mobile
application, and receiving text and picture mes-
sages; reported having no psychological or med-
ical illness that might make physical activity
unsafe; and answered no to all questions on the
Physical Activity Readiness Questionnaire
(PAR-Q; Hafen & Hoeger, 1994), except ques-
tion number 6. Question number 6 asked if
participants were currently taking blood pres-
sure medication. It was excluded after some
individuals were deemed ineligible, despite doc-
tor recommendations for increased physical
activity to combat high blood pressure.
After eligibility was established, participants
were provided with detailed information about
the study purpose and procedures. They
answered additional demographic questions
(telephone number, first name, sex, reported
frequency and duration of exercise per week,
and whether they had a PayPal account) and
scheduled an in-person intake meeting. All in-
1907
person meetings were conducted privately in a
small laboratory room within the university’s
psychology building. The study included a
total of six in-person meetings: an intake
meeting, two in-person deposit meetings, two
in-person feedback meetings, and a debriefing
meeting.
Dependent Measures
Physical Activity
Physical activity was defined as the average
number of daily steps participants completed
over monitoring periods of 5 consecutive days.
For example, if a participant completed 20,000
total steps across the 5-day period, her or his
daily average was 4,000 steps. Step counts were
monitored using Fitbit Zip® devices, loaned to
each participant. The Zip is a small, wireless
accelerometer that sits inside a silicone encase-
ment with a durable clip. It attaches to an indi-
vidual’s clothing (e.g., pocket, belt, or
waistband) and automatically tracks steps as
long as the 3-volt coin battery is installed
(Fitbit, Inc., n.d.). Previous research has shown
that Fitbit devices worn on the hip are gener-
ally more accurate than those worn on the wrist
(Evenson et al., 2015). The Zip’s screen dis-
plays daily total steps, calories burned, and dis-
tance travelled, which each reset at midnight.
Step count data are stored on the Zip device
until they are synced to the online Fitbit dash-
board. In the current study, participants synced
their data (either automatically through
Bluetooth® or manually) using the Fitbit
mobile application on their smartphones. Pre-
established Fitbit account usernames and pass-
words were assigned to participants, and the
research team tracked daily steps by accessing
participants’ accounts on the Fitbit website.
Social Validity
Social validity was assessed pre- and post-
treatment via questionnaires that consisted of
11 statements regarding the effectiveness of deposit
1908 Lisa M. Stedman-Falls and Jesse Dallery
contract components, and the effectiveness, cost
effectiveness, and time-efficiency of in-person and
technology-based behavioral treatments, for pro-
moting physical activity. The questionnaire and
all other supplementary material may be
obtained by contacting the first author. Partici-
pants were asked to rate their level of agreement
with each statement on a scale of 1 to 5 (where
1 = strongly agree and 5 = strongly disagree).
The pretreatment questionnaire included only
the 11 statements. The posttreatment question-
naire included the 11 statements plus five open-
ended questions. Four of the open-ended ques-
tions asked participants to describe what they
liked and disliked about the in-person and the
mobile deposit contract treatments, respectively.
The last open-ended question asked participants
if they preferred the in-person or mobile deposit
contract treatment, or if they liked both equally,
and the reason for their choice.
Treatment Adherence and Treatment
Integrity
All occurrences of participant nonadherence
to the study procedures and other deviations
from the treatment protocol were documented
(see the Online Supplemental Materials).
Treatment nonadherence included participants
missing a day of wearing the Fitbit, missing a
day of syncing data, missing a scheduled in-
person meeting, missing a scheduled deposit,
or submitting an unscheduled deposit. Devia-
tions from the treatment protocol included
Fitbit device malfunctions and participant-
requested scheduling adjustments. When par-
ticipants missed a day of wearing the Fitbit,
the data were excluded, and (when possible)
the monitoring period was extended.
Design
Within-subject reversal designs were con-
ducted with each participant to compare the
effectiveness of the mobile and in-person
deposit contract treatments for increasing
physical activity. The study consisted of a
6-week ABCACB sequence, where “A” = base-
line or reversal, “B” = mobile or in-person
deposit contract, and “C” = in-person or
mobile deposit contract. The first treatment
condition following each baseline (mobile or
in-person) was counterbalanced equally within
and across participants.
A simple pretest–posttest design was used to
evaluate any potential effects of the mobile and
in-person deposit contract treatments on partic-
ipants’ social validity ratings.
Procedure
Intake
During the initial intake meeting, written
informed consent was obtained, and partici-
pants completed the pretreatment social validity
questionnaire alone in the room. The question-
naire instructions were read to participants, the
rating scale was explained with examples, and
participants were asked to acknowledge that
they understood the instructions. Participants
were also informed that their answers to the
questionnaire would not be viewed until after
they completed the study. Individualized 5-day
monitoring periods were then chosen, which
remained the same throughout all conditions
(barring unanticipated events). Participants also
chose the meeting day and time for their in-
person meetings, which occurred on one of the
two nonmonitored days of the week and
remained the same throughout the study (bar-
ring unanticipated events). All procedures for
the 6-week study period were scheduled, and
participants were sent a copy of the schedule
via picture messaging.
Next, participants were shown how to down-
load the Fitbit mobile application onto their
smartphones, login to their Fitbit accounts,
sync the device to the account, and sync data
from the device to the Fitbit dashboard. They
were also shown the different ways in which
the device could be worn and how to view their
 Technology-Based vs. In-Person Deposit Contracts
daily step count data. Participants were asked
to wear the Fitbit device from wake to sleep
during each monitoring day, and to sync the
data each day, across all conditions. Participants
were informed that they could use the Fitbit
mobile application any way they wished, but
they were not informed of its features.
Participants were then shown how to submit
deposits electronically through their PayPal
accounts. Those who did not have a PayPal
account prior to the study were offered assis-
tance in establishing accounts; however, all
opted to complete the process on their own. To
submit deposits, participants were instructed to
select the “paying for an item or service” option,
which resulted in a small fee for the research
team ($0.59) each time a deposit was received
during the mobile treatment weeks. If partici-
pants met their goals, resulting in a refund of
their deposit, $0.30 was refunded to the study
account. As such, successful mobile deposit con-
tract weeks resulted in study costs of $0.29 each,
and unsuccessful mobile weeks resulted in study
costs of $0.59 each.
Last, participants were provided two hand-
outs to take home: a list of the PAR-Q eligibil-
ity questions, and an adapted printout of
walking tips from the Mayo Clinic (Mayo
Foundation for Medical Education and
Research, 2019). Participants were asked to
refer to the PAR-Q throughout the study and
to contact the study team immediately if any of
their answers changed from “no” to “yes.”
Baseline and Reversal Conditions
Each participant began the study in a base-
line condition, during which they were asked
to go about their typical routines and walk the
same amount as usual. No deposit was made,
and no other contingencies were in place. Par-
ticipants’ baseline step counts were monitored,
and their average daily steps were calculated.
The reversal condition was identical to the ini-
tial baseline and served as a within-subject
control.
1909
Deposit Contract Treatment Conditions
Following the initial baseline, participants
began their first in-person or mobile deposit
contract treatment condition. The same treat-
ment components were delivered across both
conditions, and all programmed interactions
were scripted. Unprogrammed interactions
(e.g., reminders sent to sync data, participant
requests to reschedule meetings) occurred via
text messaging and/or phone calls. On their
chosen nonmonitoring day, participants were
informed of their baseline average step count
and given a goal to increase their physical activ-
ity by an average of 2,000 more daily steps
than their initial baseline average. For example,
if a participant walked an average of 4,000 daily
steps in baseline, his or her goal was to walk an
average of 6,000 daily steps across each treat-
ment condition. Goals were the same through-
out the study and did not change based on
participants’ step counts during the reversal
condition.
To initiate the deposit contract, participants
deposited $10 through the modality that cor-
responded with the current treatment condition.
When deposits were received, participants were
reminded of their goal and told that they would
earn their deposit back if they met their goal.
Participants were informed that their deposit
would be forfeited if they did not meet their
goal, and that lost deposits would be allocated to
study-related costs. When a deposit was not
received by the scheduled date, a reminder was
sent via text messaging, and any necessary adjust-
ments to the monitoring period were made. Step
counts were monitored each day over the treat-
ment period, and average daily step counts were
calculated to determine if goals were met.
On the scheduled nonmonitoring day fol-
lowing each treatment period, participants were
provided with an AB time series graph (where
A = baseline and B = the most recent deposit
contract condition), which depicted their treat-
ment daily step counts compared to their first
baseline. Participants were also given scripted
1910 Lisa M. Stedman-Falls and Jesse Dallery
feedback based on whether they met their goal
or did not meet their goal, and they were told
when their next deposit was due. If the goal
was met, participants’ $10 deposit was ref-
unded the same day.
Mobile Conditions. At the beginning of
each mobile condition, participants submitted
deposits electronically through PayPal. At the
end of each mobile condition, participants
received performance graphs via picture messag-
ing and written feedback via text messaging.
Participants’ deposits were refunded through
PayPal if the goal was met.
In-Person Conditions. At the beginning of
each in-person condition, participants submit-
ted deposits in cash during an in-person meet-
ing. At the end of each in-person condition,
participants met in-person again, received a
print-out of their performance graph, and
received vocal feedback. Participants’ cash
deposits were also refunded if the goal was met.
All in-person deposit and feedback meetings
were completed in less than 5 min.
Debriefing
Study completers attended an in-person deb-
riefing meeting, during which they returned the
Fitbit device, completed the posttreatment social
validity questionnaire, and earned $10 compen-
sation. Study completers were also debriefed
about the most current results of the study.
Individuals who did not complete the study
did not attend a debriefing meeting, complete
the posttreatment questionnaire, or receive
compensation. If a participant discontinued the
study after submitting a deposit, the deposit
was forfeited (except when due to health-related
reasons, based on self-report).
Data Analyses
Tau-U effect sizes were calculated to evaluate
and compare the in-person and mobile deposit
contracts’ effectiveness in increasing step
counts. Tau-U is a common within-subject
effect size measure which incorporates informa-
tion about the proportion of all nonoverlapping
data points between baseline and treatment
phases, in addition to trends within baseline
and treatment phases (Parker et al., 2011).
Tau-U values were calculated using the Single
Case Research online calculator (Vannest
et al., 2016). Participants’ baseline and reversal
conditions were first contrasted with themselves
to identify potential baseline trends. If either
Tau-U value was greater than 0.20, the trend
was corrected for in subsequent contrasts
(Vannest & Ninci, 2015). Participants’ in-
person and mobile conditions were then each
contrasted with the preceding baseline or rever-
sal condition, and Tau-U effect sizes for each
modality were averaged within participants.
Social validity ratings and demographic data
were analyzed using descriptive statistics. Base-
line activity categorizations (e.g., “sedentary”)
were determined based on participants’ average
daily step counts over their initial baseline
period, using the classification system outlined
in Tudor-Locke and Bassett (2004). Specifi-
cally, less than 5,000 average daily steps was
considered “sedentary;” 5,000 to 7,499 steps
was considered “low active;” 7,500 to 9,999
steps was considered “somewhat active;”
10,000 to 12,499 steps was considered “active;”
and 12,500 or more steps was considered
“highly active.” The same classification system
was used to determine treatment activity cate-
gorizations, based on participants’ average daily
step counts across all mobile and in-person
conditions combined.
Results
Table 1 includes demographic characteristics,
baseline and treatment activity categories, and
study completion statuses for the 12 individuals
(nine females and three males) who partici-
pated. Participants ranged from 18 to 65 years
old, but most (nine, 75%) were college stu-
dents ages 18 to 22. The majority of
 Technology-Based vs. In-Person Deposit Contracts 1911

participants (10, 83%) had PayPal accounts
prior to enrollment in the study, including the
two individuals who were over 55 years old.
Reported frequencies and durations of exercise
prior to the study were variable across participants,
but the median was 1 day per week and
30 minutes each day. Based on average daily step
counts measured during initial baselines, 10 of the
12 participants (83%) did not meet the common
recommendation of walking at least 10,000 steps
on average per day (Heart Foundation, 2019;
World Health Organization, 2008). Four partici-
pants (33%) were categorized as sedentary prior to
treatment, three (25%) as low active, three (25%)
as somewhat active, and two (17%) as active.
Nine participants (75%) completed all
6 weeks of the study, and 10 (83.3%) com-
pleted at least one pair of treatment conditions.
P10, P11, and P12 each withdrew early from
the study. P10 reported that an increase in her
school workload rendered her no longer able to
increase her physical activity. P11 withdrew
after submitting her mobile deposit, as she
reported being sick with a virus. As such, her
mobile deposit was refunded. P12 reported that
she withdrew because she did not believe she
could meet her goal.
The total cost of the study was $97 ($90 in
compensation and $7 in PayPal fees for mobile
deposits). After accounting for seven forfeited
$10 deposits, the net cost of the study
was $27.
Figures 1, 2, and 3 display the within-subject
step count graphs for all 12 participants,
grouped based on visual analyses of data pat-
terns. Figure 1 includes graphs for P1 through
P5, whose data showed the most stability and
demonstrated the highest levels of experimental
control. Figure 2 includes graphs for P6
through P9, whose data showed higher
amounts of variability and demonstrated less
experimental control. Figure 3 includes graphs
for the participants who did not complete the
study (P10 through P12).
Overall, 10 of the 12 participants (83.3%)
met their goal during at least one treatment
condition, and eight (67.7%) met their goal
across all treatment conditions in which they
participated. P11 and P12 failed to meet their
goals during any treatment condition in which
they participated. Of the nine participants who
completed the study, seven (77.8%) met their
goals all four weeks, one (P7) meet her goal
three of the weeks, and one (P9) met his goal
only one week. As shown in Table 1, undergo-
ing the deposit contract treatments resulted in
nine (75%) of the 12 participants’ activity sta-
tuses improving by one, or even two,

Table 1
Demographic Characteristics, Activity Categories, and Study Completion Statuses

PayPal Account Initial Baseline Average Treatment Activity Category Finished

P# Sex Age Before Study? Activity Category Activity Category Change Study?
1 F 18 Yes Sedentary Low Active +1 Yes
2 F 59 Yes Sedentary Low Active +1 Yes
3 M 26 Yes Active Highly Active +1 Yes
4 F 19 Yes Sedentary Low Active +1 Yes
5 F 20 Yes Somewhat Active Active +1 Yes
6 M 19 Yes Low Active Low Active 0 Yes
7 F 22 No Sedentary Somewhat Active +2 Yes
8 F 19 Yes Low Active Active +2 Yes
9 M 22 No Somewhat Active Low Active -1 Yes
10 F 18 Yes Somewhat Active Active +1 No
11 F 65 Yes Low Active Low Active 0 No
12 F 20 Yes Active Highly Active +1 No
1912 Lisa M. Stedman-Falls and Jesse Dallery
Figure 1
Step Counts for P1, P2, P3, P4, and P5
categories. P9 was the only participant for
whom the treatments resulted in a downgrade
to his activity status category.
For the 10 participants who completed at
least one pair of treatment conditions, all per-
formed similarly across their mobile and in-
person conditions. Additionally, there were no
clear differences between modalities in terms of
treatment failures. Of the seven total conditions
in which step count goals were not met, four
were mobile conditions and three were in-
person conditions.
Table 2 shows average within-subject, and
median across-subject, mobile and in-person
deposit contract Tau-U effect sizes for the
10 participants who completed at least one pair
of treatment conditions. Participants are grouped
in the table by the treatment modality they
experienced first, and within-subject differences
between average mobile and average in-person
effect sizes are displayed (values = mobile minus
in-person). Based on previous recommendations
and conventional usage throughout single-case
research, Tau-U effect sizes of 0 to .65 were
considered small, .66 to .92 medium, and .93 to
1.00 large (Bruni et al., 2017; Parker et al.,
2009; Soares et al., 2016).
The median mobile and in-person effect
sizes across participants were .48 and .36
respectively (both small), which was repre-
sentative of the fact that individual effect
sizes were small across both modalities for
eight of the 10 participants. P1 and P5’s
mobile effect sizes were medium, and P1’s
 Technology-Based vs. In-Person Deposit Contracts
Figure 2
Step Counts for P6, P7, P8, and P9
in-person effect size was medium. Within-
subject differences between mobile and in-
person effect sizes were also small for all partici-
pants. Overall, the median difference in effect
sizes between mobile and in-person treatments
was .12 across participants (in slight favor of
mobile).
Table 3 shows average pre- and post-
treatment social validity ratings, and differences
between ratings, for each of the 11 statements.
Results are only shown for the nine study com-
pleters, although pretreatment trends were the
same when ratings from the three non-
completers were included. Lower values cor-
responded with stronger agreement, and higher
values corresponded with weaker agreement.
Overall, participants’ average pretreatment
agreement was strong across statements (1.83).
The only statements with average pretreatment
ratings higher than 2 (i.e., weaker agreement)
were those regarding mobile treatment effec-
tiveness, in-person treatment cost effectiveness,
and in-person treatment time efficiency. On
average, participants had stronger pretreatment
agreement with the statement that in-person
1913
treatments were effective than they did with
the statement that mobile treatments were
effective. Average agreement was stronger for
mobile treatments being cost effective than in-
person treatments, and average agreement was
much stronger for mobile treatments being
time efficient than in-person treatments.
Despite these differences, average pretreatment
agreement was nearly identical (and strong)
regarding both mobile and in-person treatment
acceptability.
The average posttreatment rating across
statements was similar to the average pre-
treatment rating. However, agreement regard-
ing in-person treatment effectiveness was much
weaker posttreatment, such that the average rat-
ings for mobile and in-person effectiveness were
nearly identical. In relation to in-person treat-
ments, average agreement was even stronger for
the statements that mobile treatments were cost
effective and time efficient than they were pre-
treatment. Average agreement regarding in-
person and mobile treatment acceptability was
still similar posttreatment, but agreement was
slightly stronger in regard to mobile treatments
1914 Lisa M. Stedman-Falls and Jesse Dallery

Figure 3
Step Counts for Participants Who Withdrew

Note: The horizontal dashed lines on each graph denote participants’ treatment step count goals. The “not met” label
indicates that a participant did not meet their goal during that condition.

being acceptable. Overall, the largest differences posttreatment ratings for the nine study com-
observed between average pre- and posttreatment pleters. Overall, the within-subject results
ratings were for statements regarding in-person shown in Figure 4 corresponded with the
treatment effectiveness (weaker agreement, aggregate results shown in Table 3. Although
change of 0.62) and in-person treatment cost there was variability across participants, many
effectiveness (weaker agreement, change of 0.60). individuals’ ratings were the same pre-and post-
Figure 4 provides information about within- treatment for several of the statements. How-
subject changes between pre- and ever, there were a few areas in which the
majority of participants’ ratings changed post-
Table 2 treatment. The area in which the most change
Tau-U Effect Sizes of the Mobile and In-Person Deposit was observed was for the statement that in-
Contracts Compared to Baseline Conditions person behavioral treatments were effective for
promoting physical activity. The majority of
Average Mobile Average In-Person participants (five out of nine) had weaker agree-
P# Tau-U Tau-U Difference
ment with this statement posttreatment, even
1 0.70 0.72 -0.02 though four of the five had met their goal dur-
2 0.48 0.28 0.20
3 0.48 0.44 0.04 ing every in-person condition. For example, P8’s
4 0.60 0.44 0.16 in-person treatment effectiveness rating changed
5 0.80 0.64 0.16
6 0.60 0.36 0.24 from 1 to 4, despite having met her goal every
7 0.16 0.36 -0.20 week of the study and performing similarly
8 0.40 0.32 0.08
9 0.17 -0.20 0.37
across the mobile and in-person modalities.
12 -0.44 -0.12 -0.32 Another statement with which several partici-
Median 0.48 0.36 0.12 pants had weaker agreement posttreatment was
 Technology-Based vs. In-Person Deposit Contracts 1915

Table 3

Average Pre- and Posttreatment Social Validity Ratings and Changes in Ratings

Pretreatment Posttreatment
Change from Pre- to Weaker or Stronger
Statement Topic (n = 9) (n = 9) Posttreatment Agreement?
Deposit contracts effective 1.40 1.33 -0.07 Stronger
Written feedback effective 1.70 2.11 0.41 Weaker
Performance graphs effective 1.80 2.22 0.42 Weaker
In-person treatments effective 1.60 2.22 0.62 Weaker
Mobile treatments effective 2.30 2.56 0.26 Weaker
In-person treatments cost 2.40 3.00 0.60 Weaker
effective
Mobile treatments cost effective 1.60 1.56 -0.04 Stronger
In-person treatments time 3.00 3.33 0.33 Weaker
efficient
Mobile treatments time 1.30 1.22 -0.08 Stronger
efficient
In-person treatments acceptable 1.40 1.78 0.38 Weaker
Mobile treatments acceptable 1.60 1.44 -0.16 Stronger

Figure 4
Pre-Post Agreement Changes in Social Validity Statements

that performance graphs are effective for pro-
moting physical activity. Four participants had
weaker agreement with this statement after
undergoing the study; although, four others had
stronger agreement. These results indicate that
performance graph acceptability was largely
individual-specific. The statements with which
the highest number of participants (four each)
had stronger agreement posttreatment were
those regarding mobile effectiveness and mobile
acceptability.
Overall, the social validity analyses revealed
that most participants viewed mobile treat-
ments more positively after experiencing both
1916 Lisa M. Stedman-Falls and Jesse Dallery
types of deposit contract procedures. Further-
more, when participants were asked on the
posttreatment questionnaire whether they liked
mobile or in-person deposit contract treatments
better (or both equally), six of the nine (67%)
chose mobile (P1, P2, P3, P4, P7, and P8).
Two participants chose in-person (P5 and P6),
and one (P9) reported that he preferred both
equally. In their written explanations, all six
participants who chose mobile cited conve-
nience as the reason for their choice. Those
who chose in-person cited social accountability
(P5) and the cash deposit modality (P6) as their
reasons. P9 did not provide a rationale for
choosing both treatments equally.
Discussion
This was the first study to directly compare
technology-based versus in-person procedures
during a deposit contract treatment. The mobile
and in-person deposit contracts that were evalu-
ated included identical treatment components
(i.e., goal-setting, deposits, monitoring, feed-
back, and deposit returns) and differed only in
the modality by which the components were
delivered. This was also one of only a few stud-
ies to evaluate the effectiveness and acceptability
of deposit contracts (involving participants’ own
money) for increasing physical activity (Donlin
Washington et al., 2016; Kerrigan et al., 2019).
Participants received goals to increase their activ-
ity by an average of 2,000 steps per day, and
they were asked to make small deposits of $10
each week over four total treatment weeks.
Social validity measures obtained pre- and post-
treatment provided information about partici-
pants’ preconceived views of deposit contracts,
as well as changes in their views after experienc-
ing the treatments.
The results of this study provided additional
evidence that deposit contracts can effectively
promote short-term improvements in physical
activity (Donlin Washington et al., 2016;
Kerrigan et al., 2019). Relative to initial
baseline step counts, individuals increased their
physical activity by an average of 2,384 steps
per day across treatment weeks in which they
participated, and 83% of all step count goals
were met. Ten of the 12 participants (83%)
met their step count goal at least once, and
seven of the nine study completers (78%) met
their goal every week. The experimental design
helped to demonstrate that increases in physical
activity were under the control of the deposit
contract contingencies. Across the 10 partici-
pants who completed both baseline conditions,
step counts during the initial and second base-
lines differed by an average of only 307 steps.
Only one participant (P4)’s step counts
remained at the goal criterion level during the
second baseline. Overall, these results indicate
that a modest deposit amount and a modest
treatment goal produced consistent increases in
step counts across the majority of participants.
It should be noted that most participants
were not expected to meet the common physi-
cal activity recommendation of 10,000 steps
per day. Step count goals were held constant at
2,000 above baseline to compare and replicate
the comparison between the mobile and in-
person deposit contracts, as well as to provide a
safe and effective goal over our 5-day experi-
mental conditions. Other physical activity CM
studies have typically included gradually
increasing step count goals (e.g., Donlin
Washington et al., 2014; Donlin Washington
et al., 2016; Kurti & Dallery, 2013) or an
immediate goal of at least 10,000 daily steps
(Budworth et al., 2019; Burns &
Rothman, 2018; Kerrigan et al., 2019). Requir-
ing more steps in the present study may have
produced more visually detectable changes in
step counts relative to baseline conditions.
Nonetheless, increasing activity by an average
of at least 2,000 steps per day (roughly equiva-
lent to 1 mile; Hoeger et al., 2008) still
resulted in socially significant changes to partic-
ipants’ physical activity statuses. Three partici-
pants who were considered “sedentary” prior to
 Technology-Based vs. In-Person Deposit Contracts
treatment became “low active” during treat-
ment, and one became “somewhat active.”
Three other participants went from being “low
active” or “somewhat active” to “active,” and
two went from “active” to “highly active.”
Consistent with results from the smoking
cessation studies by Dallery et al. (2017) and
Jarvis and Dallery (2017), the fully remote
technology-based deposit contracts were effec-
tive in improving health behavior. Moreover,
the technology-based deposit contracts were
equally as effective as the in-person deposit
contracts, and treatment adherence was similar
across modalities. During mobile deposit con-
tract treatment weeks, participants increased
their activity by an average of 2,490 steps each
day relative to their initial baseline. Step counts
during in-person weeks were nearly identical,
with an average increase of 2,437 steps each day
relative to baseline. One promising implication
of these findings is that participant access to
deposit contract treatment can be broadened
through fully remote procedures, without
compromising effectiveness. Dallery et al.
reached smokers across 26 U.S. states using their
remote, Internet-based deposit contract proce-
dures, and the majority of participants in Jar-
vis & Dallery were located in a different state
than the research team. Commercial deposit
contract programs have reached individuals
across the U.S. and many other countries
throughout the world (e.g., Dietbet, 2020).
Another implication is that technology-
based deposit contract procedures can fully
replace in-person procedures, given that the
delivery modality does not impact effective-
ness. Previous research comparing other types
of technology-based and in-person treatments
has shown mixed results (e.g., Civljak
et al., 2013). However, most studies have not
included the same treatment components
across the two modalities. Rather, it has been
most common to compare a technology-based
treatment or package (including elements such
as static webpages, tailored feedback, self-
1917
monitoring, and/or discussion forums) to a dif-
ferent in-person treatment or “standard care”
procedure (including elements such as print
materials, medication, physician advice, and/or
psychotherapy; e.g., Graham et al., 2016). As
such, much of the extant research speaks less to
the effects of technology-based procedures, and
more to the effects of the specific treatment com-
ponents evaluated. Similar to the present study,
the few experiments that have compared the
same components across modalities have consis-
tently shown equivalent levels of effectiveness
(e.g., Gold et al., 2007; Neuenschwander
et al., 2013).
In addition to comparing levels of effective-
ness across technology-based and in-person
deposit contract modalities, we sought to deter-
mine whether a technology-based deposit con-
tract was more acceptable than an in-person
deposit contract. Results from the pre- and
posttreatment social validity questionnaires
showed that participants found both modalities
to be acceptable, and differences in general
acceptability were negligible. Interestingly,
however, pretreatment ratings indicated that
participants believed in-person treatments were
more effective than mobile treatments. As
alluded to, these perceived differences likely
relate to a prevailing misconception that
technology-based treatments are composed of
inherently different components than in-person
treatments, as opposed to just being different
delivery vehicles. Ratings also indicated that
participants believed mobile treatments were
more cost-effective and time-efficient than in-
person treatments, which are commonly cited
benefits of technology-based treatment delivery
(e.g., Substance Abuse and Mental Health
Services Administration, 2015).
An unexpected finding was that post-
treatment ratings were poorer regarding both
modalities’ effectiveness, especially that of in-
person treatments. Poorer ratings were given by
participants who failed to meet their goal at
least once, but also by several who met their
1918 Lisa M. Stedman-Falls and Jesse Dallery
goal every week. The reason for these changes
is unclear, especially in light of the fact that
pre- and posttreatment agreement ratings were
strong regarding deposit contract effectiveness
in general. Mobile and in-person effectiveness
ratings became similar posttreatment, however,
which was consistent with the objective step
count data. Most notably, the majority of par-
ticipants (six out of nine) had a distinct prefer-
ence for the mobile deposit contract over the
in-person deposit contract at the end of the
study. Written responses from participants who
chose the mobile modality also revealed that
convenience was the most important factor
influencing their treatment choice. So, while
both treatment types were deemed acceptable,
the technology-based deposit contract was
preferred.
One significant limitation to the social valid-
ity analyses was that participants included in
the study rated deposit contracts favorably prior
to undergoing the treatments, which potentially
impacted our ability to detect meaningful post-
treatment differences. The flyers used to recruit
participants included information about the
deposit contingency, and the informed consent
document detailed the mobile and in-person
deposit contract procedures. Individuals who
enrolled already agreed to undergo deposit con-
tract treatments, through both modalities,
which is an indication of acceptability. Addi-
tionally, it is possible that participants’ social
validity ratings were influenced by the ques-
tions being positively framed, which has been
shown in previous research to bias survey
responses towards favorable outcomes
(e.g., Dunsch et al., 2018). Although any bias
would have been consistent across pre- and
posttreatment measures, this study ultimately
did not address whether technology-based treat-
ment delivery was more appealing to individ-
uals who otherwise might not enter into
deposit contracts. However, the results did
show that technology-based deposit contracts
are preferred posttreatment over traditional in-
person deposit contracts. This conclusion, of
course, pertains to conditions used in the cur-
rent study, and future research should continue
to examine the conditions under which deposit
contract acceptability can be modified and
enhanced.
More work needs to be done across several
domains before deposit contracts are likely to
become mainstream treatment options. For
one, researchers should explore additional
methods for increasing deposit contract partici-
pation. Future research could evaluate whether
emphasizing the effectiveness of deposit con-
tract treatments (compared to other treatments)
leads to higher uptake. Previous research has
shown that described effectiveness significantly
impacts participants’ treatment preferences
(e.g., Promberger et al., 2012; Stedman-Falls
et al., 2018). Future research could also explore
whether highlighting deposit contracts’ cost
effectiveness may increase their uptake.
Reduced cost to society is commonly discussed
in the deposit contract literature, but less fre-
quently noted is the fact that deposit contracts
may reduce costs for treatment participants.
Unlike typical fee-for-service treatments,
deposit contracts offer participants the opportu-
nity to have their payments refunded if they
meet behavior change goals.
More research is also needed to identify
methods for increasing the adoption and rec-
ommendation of deposit contract treatments by
stakeholders who provide care to individuals in
need of health behavior change. Raiff
et al. (2013) assessed healthcare providers’ per-
ceptions of a technology-based deposit contract
for smoking cessation. Providers gave high rat-
ings across various acceptability domains, and
they reported being very likely to recommend
the treatment. To our knowledge, this is the
only study to assess providers’ perceptions of a
deposit contract treatment, and no study has
surveyed providers about their use or recom-
mendations of deposit contracts for promoting
physical activity or other behaviors that may
 Technology-Based vs. In-Person Deposit Contracts
promote weight loss. It is important to gain a
better understanding of other stakeholders’ per-
ceptions about deposit contracts relative to
more common physical activity and weight
loss-related treatments, in addition to potential
barriers to implementation, and any other
determinants of preferences and recommenda-
tions in regard to deposit contracts. As the
prevalence of obesity continues to increase
throughout the U.S., there is a dire need for
new approaches to promoting physical activity
and related health behavior. Technology-based
deposit contract treatments may be one way to
address that need.
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Received May 13, 2020
Final acceptance August 30, 2020
Action Editor, Bethany Raiff