The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid?

Abstract

BackgroundFinancial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women's experiences of trying to stop smoking, within and outside of a financial incentives scheme.MethodsThirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data.ResultsWomen in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts.ConclusionWomen participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals' motivation and self-regulation, changing engagement with and provision of support services, or a combination of these.

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

“…For example, the studies by Edwards and colleagues 142 and Morgan and colleagues 148 considered the effect of the interventions at a population level and the studies by Mantzari and colleagues, 109 Nichter and colleagues 110 and Ripley-Moffitt and colleagues 111 were predominantly qualitative with additional quantitative results mentioned. In addition, several studies, including those by Cluss and colleagues 140 and Ussher and colleagues, 150 did not have comparator groups and therefore some of the questions considering the appropriateness of how groups were selected and treated did not apply.…”

“…In total, the full texts of 222 studies were therefore screened. In total, 23 studies (34 reports 25,68,104,105,[108][109][110][111]113, ) met our inclusion criteria. A flow diagram of the screening process is provided in Figure 4.…”

“…104,105,[108][109][110][111]113,[138][139][140][141][142][143][144][145][146][147][148][149][150] One study was included in the process review only as it was a survey of acceptability and feasibility and did not provide incentives to women. 151 One study 152 provided reimbursement to organisations providing care and one study included a question in a survey about reimbursement.…”

828 – Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study

“…[27][28][29] However, the lower quit rates and the additional barriers described by pregnant women with mental disorders are consistent with research on people with mental disorders outside pregnancy; this may be because they are more heavily addicted. 30 In addition, health professionals have not traditionally prioritised smoking cessation in people with mental disorders, possibly because of beliefs that people with mental disorders are less likely to want to stop smoking or that it will worsen the disorder.…”

Incentives to Promote Breastfeeding: A Systematic Review

“…[48][49][50] As with all complex intervention studies, there was much variation in the other intervention components being provided; for smoking cessation, questions have been raised about whether the incentive or the additional support is responsible for effectiveness. 51 The underreporting of intervention delivery processes for included studies, the absence of reported observations or recordings of interactions, and the sparse qualitative data on patient experiences are potentially important. 10 For example, relationships and communication with incentive intervention providers could be crucial in terms of empowering and encouraging women or, conversely, providers could be perceived as functional or disempowering.…”