Challenging social norms: discourse analysis of a research project aiming to use financial incentives to change breastfeeding behaviours

Abstract

Background The UK has one of the lowest breastfeeding rates in the world. The NOurishing Start for Health (NOSH) cluster-randomised trial was a trial of a financial incentive scheme that aimed to increase breastfeeding in UK areas where breastfeeding was not the norm (South Yorkshire, Derbyshire, and Nottinghamshire). The announcement of the initial field test of the Vouchers for Breastfeeding scheme generated a substantial amount of (mainly negative) media and social media coverage. Given the media interest and scrutiny in public health research and action (especially where financial incentives are concerned), we aimed to understand negative responses, and the underlying values they represent, to inform future public health research into financial incentives.Methods A researcher (DU) external to the project and the research area led a discourse analysis of the research project archive, drawing upon more than 500 documents that included team briefs, scholarly articles, publicity material, media reports, and online responses. The purpose of the analysis was to identify where conflicting values were apparent, particularly those at critical transition points in the project, which facilitated further content and visual analysis of relevant documents.Findings The analysis exposed fundamental, opposing, and apparently intractable views on the use of financial incentives to increase breastfeeding in the UK. These conflicting positions were apparent from the early stages of the research project and recurred at critical points during the development and delivery of the scheme. In contrast to local stakeholder views, media and social media commentators tended to marginalise the research question and focus instead on discussing why offering incentives for breastfeeding should not be national policy. The analysis also revealed how the project researchers used extensive stakeholder consultation, deployed sensitive language in all public engagements, and adapted well-established visual representations of financial incentives, to navigate through the inherent controversy.Interpretation Projects that challenge societal behavioural norms should anticipate strong and sometimes hostile reactions when planning and progressing their research. Also, researchers should not assume that media and social media reactions represent the considered views of stakeholders directly affected by the research, which in this case were mothers (and their health-care providers) in the areas where the scheme was being trialled. Funding Medical Research Council (MR/J000434/1) via the National Prevention Research Initiative Phase 4 awards. ContributorsCR and DU conceived the idea for the discourse analysis. DU conducted the analysis and wrote the first draft. CR, MS, KT, and MJR contributed to subsequent drafts. CR led the revision of the final version of the abstract. All authors have seen and approved the final version for publication. Declaration of interestsWe declare no competing interests.

Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates

“…Despite these concerns, once the scheme was developed, key stakeholders including midwives and health visitors agreed to test the NOSH CCT scheme in three small areas with low breastfeeding rates (Relton et al, 2014). Although the launch of this field test provoked considerable media and social media attention, much of it negative (Giles, Holmes, McColl, Sniehotta, & Adams, 2015;Relton, Umney, Strong, Thomas, & Renfrew, 2017), the scheme was found to be acceptable to the majority of mothers and HCPs in the feasibility study (Relton et al, 2014). After the feasibility study, the NOSH scheme was evaluated in a large area-based randomized controlled trial (RCT) with 10,010 women in areas with low breastfeeding rates in the United Kingdom (Relton et al, 2016).…”

Is breastfeeding ‘normal’? Using the right language for breastfeeding

“…Today, despite a slow increase, Ireland is believed to have one of the lowest breastfeeding rate in Europe and possibly the world. Similarly, in the United Kingdom in the 21 st century, a country which rivals Ireland for the lowest breastfeeding rate in the world (Relton, Umney, Strong, Thomas & Renfrew, 2017b), mothers continue to lack role models for breastfeeding. Even though they are well aware of promotional messages about breastfeeding and why it is recommended, early-21 stcentury studies confirmed that breastfeeding away from home is considered embarrassing and socially unacceptable.…”

“…Women interviewed before a recent intervention trial in a region of England with low breastfeeding rates knew no one who breastfed and stated they themselves had fed their infants on 'normal' milk (formula) (Relton, Umney, Strong, Thomas & Renfrew, 2017a). In these circumstances, new mothers are unlikely to perceive breastfeeding as the normal way to feed a baby.…”