Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public

Abstract

ObjectiveTo survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design.DesignCross-sectional survey.Setting and participantsBritish general public.MethodsSeven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models.ResultsAgreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%).ConclusionsWomen and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions.Trial registration numberCRD42012001980.

After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing?

“…This statement is the authors' opinion and is irrelevant to the question at hand, which is regarding efficient spending of public money to improve smoking cessation among pregnant women for the health of themselves and their babies. Financial incentives have been proposed as a valuable addition to the behaviour change toolkit [19,20], with a wide body of experimental evidence supporting their success in abstinence from a range of addictive substances [19][20][21][22][23][24][25], and also in the areas of education and obesity [20,24,26]. Braillon & Bewley conclude that:…”

Incentives to Promote Breastfeeding: A Systematic Review

“…The decision to include breast pumps was recommended by the service users; in a later stage of the study, this decision was endorsed by a survey of the British public as the most acceptable of 7 promising incentive strategies. 42 However, it was not always clear in the study reports whether the breast pump provision was considered as an incentive by the authors. It should also be noted that some studies 18,21,24 had control groups that were provided with formula packs at discharge.…”

“…However, incentive acceptability is likely to affect recruitment, engagement, and attrition and is a potential explanation for the reporting of small sample sizes. The public acceptability of financial incentives for breastfeeding in Great Britain is mixed, 42,43,44 with stronger agreement among those aged #44 years compared with those aged $65 years and among ethnic minority groups compared with white British groups. 42 Women are more likely to disagree with shopping voucher incentives for breastfeeding compared with men because they dislike feeling pressured and because they value autonomy.…”

“…However, before further research into a breast pump as an incentive is undertaken, evidence is required regarding the effect and acceptability of using breast pumps on breastfeeding duration and exclusivity, which is currently uncertain. 42 We also do not understand the mediating or moderating effects of the timing, frequency, and type of breast pump, or the optimal nature of skilled assistance required, on infant feeding outcomes. Head-to-head comparisons of different incentive strategies are required to understand the possible effects and variation in effects of providing different types or combinations of incentives, with or without other behavior change technique components.…”

Adolescent and parent perspectives on the acceptability of financial incentives to promote self‐care in adolescents with type 1 diabetes

“…Although evidence regarding the long‐term behavioral impacts of FI is limited, some predict that providing tangible rewards for health behaviors will erode adolescents' intrinsic motivation . Finally, some parents may view the transfer of incentives within the context of a healthcare provider‐patient relationship as an unacceptable violation of cultural or familial norms …”