title: Incentives for breastfeeding and for smoking cessation in pregnancy: an exploration of types and meanings.
abstract: Financial or tangible incentives are a strategy for improving health behaviours. The mechanisms of action of incentives are complex and debated. Using a multidisciplinary integrated mixed methods study, with service-user collaboration throughout, we developed a typology of incentives and their meanings for initiating and sustaining smoking cessation in pregnancy and breastfeeding. The ultimate aim was to inform incentive intervention design by providing insights into incentive acceptability and mechanisms of action. Systematic evidence syntheses of incentive intervention studies for smoking cessation in pregnancy or breastfeeding identified incentive characteristics, which were developed into initial categories. Little published qualitative data on user perspectives and acceptability was available. Qualitative interviews and focus groups conducted in three UK regions with a diverse socio-demographic sample of 88 women and significant others from the target population, 53 service providers, 24 experts/decision makers, and conference attendees identified new potential incentives and providers, with and without experience of incentives. Identified incentives (published and emergent) were classified into eight categories: cash and shopping vouchers, maternal wellbeing, baby and pregnancy-related, behaviour-related, health-related, general utility, awards and certificates, and experiences. A typology was refined iteratively through concurrent data collection and thematic analysis to explore participants' understandings of 'incentives' and to compare and contrast meanings across types. Our typology can be understood in three dimensions: the degree of restriction, the extent to which each is hedonic and/or utilitarian, and whether each has solely monetary value versus monetary with added social value. The layers of autonomy, meanings and the social value of incentive types influence their acceptability and interact with structural, social, and personal factors. Dimensions of incentive meaning that go beyond the simple incentive description should inform incentive programme design and are likely to influence outcomes.
authors.affiliation: Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston PR1 2HE, United Kingdom. Electronic address: ncrossland@uclan.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Crossland
authors.affiliation: Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
authors.forename: Gill
authors.initials: G
authors.lastname: Thomson
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom.
authors.forename: Heather
authors.initials: H
authors.lastname: Morgan
authors.affiliation: Division of Psychology, School of Natural Sciences, University of Stirling, Stirling FK9 4LA, United Kingdom.
authors.forename: Stephan U
authors.initials: SU
authors.lastname: Dombrowski
authors.affiliation: Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, FK9 4LA, United Kingdom.
authors.forename: Pat
authors.initials: P
authors.lastname: Hoddinott
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology*; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D009042:Motivation; D011247:Pregnancy; D016540:Smoking Cessation / Q000523:psychology*
keywords: Acceptability; Behaviour change; Breastfeeding; Health behaviour; Incentives; Motivation; Smoking cessation; Typology