title: Acceptability of financial incentives for breastfeeding: thematic analysis of readers' comments to UK online news reports.
abstract: BACKGROUND
  Whilst it is recommended that babies are breastfed exclusively for the first six months, many mothers do not maintain breastfeeding for this length of time. Previous research confirms that women and midwives value financial incentives for breastfeeding, but limited research has explored the wider acceptability of these interventions to the general public. This paper examines opinion towards financial incentives for breastfeeding using reader responses to UK on-line media coverage of a study undertaken in this area.
  
  
  METHODS
  This study used netnography to undertake a thematic analysis of 3,373 reader comments posted in response to thirteen articles, published in November 2013, which reported findings from a feasibility study of financial incentives for breastfeeding. All articles were published on one of six UK news websites that achieved a monthly audience of at least five million viewers across laptop and desktop computers and mobile devices during April-May 2013.
  
  
  RESULTS
  Nine analytical themes were identified, with a majority view that financial incentives for breastfeeding are unacceptable. These themes cover a range of opinions: from negligent parents unable to take responsibility for their own actions; through to psychologically vulnerable members of society who should be protected from coercion and manipulation; to capable and responsible women who can, and should be allowed to, make their own decisions. Many views focused on the immediate costs of the intervention, concluding that this was something that was currently unaffordable to fund (e.g. by the NHS). Others contrasted the value of the incentive against other 'costs' of breastfeeding. There was some consideration of the issue of cost-effectiveness and cost-saving, where the potential future benefit from initial investment was identified. Many commenters identified that financial incentives do not address the many structural and cultural barriers to breastfeeding.
  
  
  CONCLUSIONS
  Overall, those commenting on the on-line UK news articles viewed financial incentives for breastfeeding as unacceptable and that alternative, structural, interventions were likely to be more effective. Further consideration of how best to conduct internet-based qualitative research to elicit opinion towards public health issues is required.
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, TS1 3BA, UK. e.giles@tees.ac.uk.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Giles
authors.affiliation: The Medical School, Newcastle University, Framlington Place, NE2 4HH, Newcastle upon Tyne, Tyne and Wear, UK. m.holmes@ncl.ac.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Holmes
authors.affiliation: Institute of Health & Society, Newcastle Clinical Trials Unit, The Medical School, Newcastle University, 4th Floor, William Leech Building, Framlington Place, NE2 4HH, Newcastle upon Tyne, Tyne and Wear, UK. elaine.mccoll@ncl.ac.uk.
authors.forename: Elaine
authors.initials: E
authors.lastname: McColl
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, TS1 3BA, UK. falko.sniehotta@ncl.ac.uk.
authors.forename: Falko F
authors.initials: FF
authors.lastname: Sniehotta
authors.affiliation: Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Level 3 Institute of Metabolic Science, Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge, CB2 0SL, UK. jma79@medschl.cam.ac.uk.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Adams
mesh_terms: D001942:Breast Feeding / Q000191:economics* / Q000523:psychology; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D007223:Infant; D020407:Internet; D009035:Mothers; D009042:Motivation; D011247:Pregnancy; D036301:Qualitative Research; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom