Healthcare providers’ views on the acceptability of financial incentives for breastfeeding: a qualitative study

Whelan, Barbara; Thomas, Kate; Cleemput, Patrice Van; Whitford, Heather; Strong, Mark; Renfrew, Mary J; Scott, Elaine; Relton, Clare

doi:10.1186/1471-2393-14-355

Cited by 25 publications

(23 citation statements)

References 31 publications

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“…Our finding that policymakers prefer shopping vouchers to cash rewards reflects previous qualitative work with both members of the public and health care providers [ 22 , 27 , 41 ]. As previously, we found that participants were particularly concerned about the potential for recipients to use cash rewards to purchase unhealthy commodities such as tobacco and alcohol [ 27 , 42 , 43 ].…”

Section: Discussionsupporting

confidence: 80%

Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study

et al. 2016

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BackgroundProviding financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers.Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI.MethodsWe recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach.ResultsPublic health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential ‘gaming’, and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media.Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for ‘gaming the system’. Secondly, a tension between participants’ own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants’ personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool.ConclusionsThere are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions.

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Section: Discussionsupporting

confidence: 80%

Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study

et al. 2016

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“…Recently, shopping vouchers were offered to disadvantaged women who breastfeed in the United Kingdom [ 129 ], and limited access to maternity leave was a rationale for payment by a breast milk cooperative in the United States [ 95 ]. These strategies, and the debates surrounding them, are unique to the cultural, legal, political and economic settings in which they arise [ 37 , 38 , 130 ].…”

Section: Discussionmentioning

confidence: 99%

Food security for infants and young children: an opportunity for breastfeeding policy?

Salmon

2015

Int Breastfeed J

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BackgroundIncreased global demand for imported breast milk substitutes (infant formula, follow-on formula and toddler milks) in Asia, particularly China, and food safety recalls have led to shortages of these products in high income countries. At the same time, commodification and trade of expressed breast milk have fuelled debate about its regulation, cost and distribution. In many economies suboptimal rates of breastfeeding continue to be perpetuated, at least partially, because of a failure to recognise the time, labour and opportunity costs of breast milk production. To date, these issues have not figured prominently in discussions of food security. Policy responses have been piecemeal and reveal conflicts between promotion and protection of breastfeeding and a deregulated trade environment that facilitates the marketing and consumption of breast milk substitutes.DiscussionThe elements of food security are the availability, accessibility, utilization and stability of supply of nutritionally appropriate and acceptable quantities of food. These concepts have been applied to food sources for infants and young children: breastfeeding, shared breast milk and breast milk substitutes, in accordance with World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) guidelines on infant feeding. A preliminary analysis indicates that a food security framework may be used to respond appropriately to the human rights, ethical, economic and environmental sustainability issues that affect the supply and affordability of different infant foods.SummaryFood security for infants and young children is not possible without high rates of breastfeeding. Existing international and national instruments to protect, promote and support breastfeeding have not been implemented on a wide scale globally. These instruments need review to take into account the emerging trade environment that includes use of the internet, breast milk markets and globalised supply chains for breast milk substitutes. New approaches are required to handle the long-standing policy conflicts that surround infant and young child feeding. Placing breastfeeding in a food security framework may achieve the political attention and policy co-ordination required to accelerate breastfeeding rates in a range of economies.

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“…Financial incentives provided to women contingent on breast feeding evoke concerns about the positive and negative consequences on relationships. 31 Our ecological approach to understanding incentives as events within complex systems suggests that causal pathways are not linear and straightforward. Meanings of incentives and the context in which they are delivered is likely to impact on feasibility, effectiveness and future implementation in the real world.…”

Section: Discussionmentioning

confidence: 99%

Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

et al. 2015

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ObjectiveTo explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study.DesignCross-sectional survey and qualitative interviews.SettingScotland and North West England.ParticipantsEarly years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees.MethodsEarly years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data.ResultsHealth professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were ‘moral tensions around acceptability’, ‘need for incentives’, ‘goals’, ‘collective or divisive action’ and ‘monitoring and proof’. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits.ConclusionsProvider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required.

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Healthcare providers’ views on the acceptability of financial incentives for breastfeeding: a qualitative study

Cited by 25 publications

References 31 publications

Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study

Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study

Food security for infants and young children: an opportunity for breastfeeding policy?

Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

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