title: Healthcare providers' views on the acceptability of financial incentives for breastfeeding: a qualitative study.
abstract: BACKGROUND
  Despite a gradual increase in breastfeeding rates, overall in the UK there are wide variations, with a trend towards breastfeeding rates at 6-8 weeks remaining below 40% in less affluent areas. While financial incentives have been used with varying success to encourage positive health related behaviour change, there is little research on their use in encouraging breastfeeding. In this paper, we report on healthcare providers' views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle. This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster randomised controlled trial.
  
  
  METHODS
  Fifty-three healthcare providers were interviewed about their views on financial incentives for breastfeeding. Participants were purposively sampled to include a wide range of experience and roles associated with supporting mothers with infant feeding. Semi-structured individual and group interviews were conducted. Data were analysed thematically drawing on the principles of Framework Analysis.
  
  
  RESULTS
  The key theme emerging from healthcare providers' views on the acceptability of financial incentives for breastfeeding was their possible impact on 'facilitating or impeding relationships'. Within this theme several additional aspects were discussed: the mother's relationship with her healthcare provider and services, with her baby and her family, and with the wider community. In addition, a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women.
  
  
  CONCLUSIONS
  Healthcare providers believe that financial incentives could have both positive and negative impacts on a mother's relationship with her family, baby and healthcare provider. When designing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted, while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low.
authors.affiliation: Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK. b.whelan@sheffield.ac.uk.
authors.forename: Barbara
authors.initials: B
authors.lastname: Whelan
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Thomas
authors.forename: Patrice
authors.initials: P
authors.lastname: Van Cleemput
authors.forename: Heather
authors.initials: H
authors.lastname: Whitford
authors.forename: Mark
authors.initials: M
authors.lastname: Strong
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Renfrew
authors.forename: Elaine
authors.initials: E
authors.lastname: Scott
authors.forename: Clare
authors.initials: C
authors.lastname: Relton
mesh_terms: D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000191:economics*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery; D009034:Mother-Child Relations; D009042:Motivation; D009723:Nurse-Patient Relations; D036301:Qualitative Research; D066262:Social Norms; D006113:United Kingdom