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Zeleke EA, Fikadu T, Bekele M, Sidamo NB, Temesgen Worsa K. Physical activity status among adolescents in Southern Ethiopia: A mixed methods study. PLoS One 2023; 18:e0293757. [PMID: 37943792 PMCID: PMC10635445 DOI: 10.1371/journal.pone.0293757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Adolescents physical activity is associated with current and future health benefits, reduction of cardio-vascular risk factors, improved bone mineral density, and mental health. The aim of the current study is to assess physical activity status and its factors among adolescents in Arba Minch and Jinka towns, Southern Ethiopia. METHODS The study was conducted on 1255 randomly selected schools adolescents of Arba Minch and Jinka town by employing a mixed method. The qualitative data was obtained by Focus Group Discussion. Multiple linear regressions were done to identify factors affecting physical activity. Codes, sub-categories, and main categories were derived from the transcripts and presented in narrative ways to describe adolescent student's perception on physical activity, its barriers and facilitators by comparing with quantitative findings. RESULTS The mean physical activity level was 2.08 (95% CI: 2.04-2.12). A student's self-perception about being physically active, being a member of a sport or fitness team, and engaging in after-school activity to earn money, being older, sex, a self-perception of being healthy, higher levels of vegetable and fruit consumption, having someone who encouraged physical activity, perceiving one's family as being active, self-perception of not being overweight and attending schools that have a sports/playground were factors associated with physical activity. The qualitative finding showed a related finding. Poor awareness on the recommended physical activity, benefits of physical activity, lack of interest, restrictions from family members, peers and the community, uncomfortable environment were barriers to physical activity. CONCLUSION AND RECOMMENDATION The physical activity level of adolescents was low. Age, sex, a positive self-perception about PA and general health, and perception about one's family PA, healthy eating practice, and the presence of role model were associated factors. Lack of self-motivation, interest and family restrictions were barriers to physical activity. PA promotion should be made by incorporating PA into school health programs and strengthening the existing school curriculum.
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Affiliation(s)
- Eshetu Andarge Zeleke
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- Flinders Health and Medical Research Institute, Discipline of Population Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Teshale Fikadu
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Muluken Bekele
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Negussie Boti Sidamo
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Kidus Temesgen Worsa
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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Cosgrave E, Sheridan A, Murphy E, Blake M, Siersbaek R, Parker S, Burke S, Doyle F, Kavanagh P. Public attitudes to implementing financial incentives in stopsmoking services in Ireland. Tob Prev Cessat 2023; 9:09. [PMID: 37020632 PMCID: PMC10068872 DOI: 10.18332/tpc/162364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Financial incentives improve stop-smoking service outcomes. Views on acceptability can influence implementation success. To inform implementation planning in Ireland, public attitudes on financial incentives to stop smoking were measured. METHODS A cross-sectional telephone survey was administered to 1000 people in Ireland aged ≥15 years in 2022, sampled through random digit dialing. The questionnaire included items on support for financial incentives under different conditions. Prevalence of support was calculated with 95% Confidence Intervals (CIs) and multiple logistic regression identified associated factors using adjusted odds ratios (AORs) with 95% CIs. RESULTS Almost half (47.0%, 95% CI: 43.9–50.1) of the participants supported at least one type of financial incentive to stop smoking, with support more prevalent for shopping vouchers (43.3%, 95% CI: 40.3–46.5) than cash payments (32.1%, 95% CI: 29.2–35.0). Support was similar for universal and income-restricted schemes. Of those who supported financial incentives, the majority (60.6%) believed the maximum amount given on proof of stopping smoking should be under €250 (median=100, range: 1–7000). Compared to their counterparts, those of lower education level (AOR=1.49; 95% CI: 1.10–2.03, p=0.010) and tobacco/e-cigarette users (AOR=1.43; 95% CI: 1.02–2.03, p=0.041) were significantly more likely to support either financial incentive type, as were younger people. CONCLUSIONS While views on financial incentives to stop smoking in Ireland were mixed, the intervention is more acceptable in groups experiencing the heaviest burden of smoking-related harm and most capacity to benefit. Engagement and communication must be integral to planning for successful implementation to improve stop-smoking service outcomes.
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Affiliation(s)
- Ellen Cosgrave
- HSE Tobacco Free Ireland Programme, Strategy and Research, HSE, Ireland
| | - Aishling Sheridan
- HSE Tobacco Free Ireland Programme, Strategy and Research, HSE, Ireland
| | - Edward Murphy
- HSE Tobacco Free Ireland Programme, Strategy and Research, HSE, Ireland
| | - Martina Blake
- HSE Tobacco Free Ireland Programme, Strategy and Research, HSE, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sarah Parker
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Paul Kavanagh
- HSE Tobacco Free Ireland Programme, Strategy and Research, HSE, Ireland
- Department of Public Health and Epidemiology, School of Population Health, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Breen RJ, Palmer MA, Frandsen M, Ferguson SG. OUP accepted manuscript. Nicotine Tob Res 2022; 24:1661-1668. [PMID: 35165733 PMCID: PMC9575978 DOI: 10.1093/ntr/ntac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 11/14/2022]
Abstract
Introduction Financial incentive programs promote smoking cessation. However, the incentive amount which should be provided—and how this may interact with other program characteristics—is unknown. The objective of this study was to evaluate the influence of the design of incentive programs for smoking cessation on current smokers’ perceptions of programs and willingness to enroll. Method An online discrete choice experiment was conducted amongst adult current smokers residing in the United Kingdom (N = 430). Hypothetical incentive programs were described using five attributes (incentive amount, incentive type, frequency of sessions, reward schedules, program location). Participants responded to a series of choice sets comprised of two hypothetical programs. For each set, participants selected their preferred program. They then specified whether they would enroll in their preferred program if it were available. Analyses also considered the effect of participant income on preferences. Results Overall, participants preferred higher amounts over lower amounts, cash over vouchers, healthcare settings over workplaces, and consistent amounts over an escalating schedule. One session per week was the most preferred session frequency. Willingness to enroll increased quadratically with the incentive amount, although this increase slowed for higher amounts. Although middle- and high-income smokers preferred slightly higher amounts (cf. low-income participants), enrollment choices did not differ by income. Conclusion The characteristics of incentive programs influence smokers’ perceptions of programs and willingness to enroll. Higher amounts may encourage greater enrollment rates, but there will likely be a ceiling point beyond which increasing the incentive amount does not meaningfully increase enrollments. Implications There is increasing evidence incentive programs aid smoking cessation. Yet, the variety in previous program designs means how to best structure programs, including optimal incentive amount and the impact of the design on potential enrollment rates, remains unclear. This study suggests enrollments may be highest when incentive amounts are higher, rewards of a consistent amount in cash are provided, and sessions occur once per week in a healthcare setting. Although higher-income participants may desire higher incentive amounts compared to lower-income participants, this may not translate into differences in willingness to enroll.
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Affiliation(s)
- Rachel J Breen
- Corresponding Author: Rachel Breen, BPsych (Hons), College of Health and Medicine University of Tasmania Locked Bag 1342 Launceston, Tasmania 7250, Australia. E-mail:
| | - Matthew A Palmer
- College of Health & Medicine, University of Tasmania, Tasmania, Australia
| | - Mai Frandsen
- College of Health & Medicine, University of Tasmania, Tasmania, Australia
| | - Stuart G Ferguson
- College of Health & Medicine, University of Tasmania, Tasmania, Australia
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Can Weight Watchers (WW) Help Address Maternal Obesity? An Audit of Weight Change in Women of Childbearing Age and Mothers-To-Be, Referred into a Commercial Slimming Programme. Matern Child Health J 2021; 26:1038-1048. [PMID: 34741246 PMCID: PMC9023388 DOI: 10.1007/s10995-021-03204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/04/2022]
Abstract
Objectives The scale of overweight and obesity amongst women of childbearing age or mothers to be, living in Wales, places a considerable burden on the NHS and public health. High BMI (over 30) during pregnancy increases the health risks for mother and baby. Policy advice recommends weight management services are available to help women lose weight before and whilst planning pregnancy. In parts of Wales, NHS partnerships with commercial companies provide weight management services for women considering or planning pregnancy. This study evaluates whether an established referral Weight Watchers (WW) programme, known to be effective in adults in England, can help mothers-to-be living in North Wales lose weight. Methods Analysis used routine data from 82 referrals to WW between June 2013 and January 2015. Participants received a referral letter inviting them to attend face-to-face group workshops combined with a digital experience. The programme encompassed healthy eating, physical activity and positive mind-set. Trained WW staff measured bodyweight before, during and at 12 weeks. On entry to the course, participants had a median age of 31.4 years (interquartile range (IQR) 28–34) with a median BMI of 36.8 kg/m2 (IQR 33.3–43.7). Results Women completing the course (n = 34) had a median weight loss of 5.65 kg (IQR 0.45–10.85), equating to 5.7% (SD 3.46) of initial body weight. Intention-to-treat analysis (last observation carried forward), which included lapsed courses n = 66, showed a median weight loss of 3.6 kg (IQR − 2.53 to 9.73), equating to 3.7% (SD 3.62) of initial body weight. Overall, there was significant weight loss during the WW programme (Wilcoxon signed rank test Z = − 6.16; p < 0.001). Weight loss was significantly correlated with the number of workshops attended (Spearman correlation coefficient 0.61 p < 0.001). The proportion of all 82 participants (intention to treat, baseline observation carried forward) that achieved a weight loss of ≥ 5% initial weight was 30.5%. Conclusions for Practice Referral of obese mothers-to-be into WW can successfully achieve short-term weight loss, at or above 5%, in approximately one third of participants. The dose–response effect supports a causal inference. Successful weight loss at this critical life stage may provide women with the necessary motivation to initiate weight loss for healthy pregnancy, however further research is required.
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de Buisonjé D, Van der Geer J, Keesman M, Van der Vaart R, Reijnders T, Wentzel J, Kemps H, Kraaijenhagen R, Janssen V, Evers A. Financial Incentives for Healthy Living for Patients With Cardiac Disease From the Perspective of Health Care Professionals: Interview Study. JMIR Cardio 2021; 5:e27867. [PMID: 34459748 PMCID: PMC8438607 DOI: 10.2196/27867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background A promising new approach to support lifestyle changes in patients with cardiovascular disease (CVD) is the use of financial incentives. Although financial incentives have proven to be effective, their implementation remains controversial, and ethical objections have been raised. It is unknown whether health care professionals (HCPs) involved in CVD care find it acceptable to provide financial incentives to patients with CVD as support for lifestyle change. Objective This study aims to investigate HCPs’ perspectives on using financial incentives to support healthy living for patients with CVD. More specifically, we aim to provide insight into attitudes toward using financial incentives as well as obstacles and facilitators of implementing financial incentives in current CVD care. Methods A total of 16 semistructured, in-depth, face-to-face interviews were conducted with Dutch HCPs involved in supporting patients with CVD with lifestyle changes. The topics discussed were attitudes toward an incentive system, obstacles to using an incentive system, and possible solutions to facilitate the use of an incentive system. Results HCPs perceived an incentive system for healthy living for patients with CVD as possibly effective and showed generally high acceptance. However, there were concerns related to focusing too much on the extrinsic aspects of lifestyle change, disengagement when rewards are insignificant, paternalization and threatening autonomy, and low digital literacy in the target group. According to HCPs, solutions to mitigate these concerns included emphasizing intrinsic aspects of healthy living while giving extrinsic rewards, integrating social aspects to increase engagement, supporting autonomy by allowing freedom of choice in rewards, and aiming for a target group that can work with the necessary technology. Conclusions This study mapped perspectives of Dutch HCPs and showed that attitudes are predominantly positive, provided that contextual factors, design, and target groups are accurately considered. Concerns about digital literacy in the target group are novel findings that warrant further investigation. Follow-up research is needed to validate these insights among patients with CVD.
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Affiliation(s)
- David de Buisonjé
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Jessica Van der Geer
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Mike Keesman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Roos Van der Vaart
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, Netherlands
| | | | - Veronica Janssen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Andrea Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Leiden University Medical Center, Leiden University, Leiden, Netherlands.,Medical Delta, Leiden-Delft-Erasmus Universities, Delft, Netherlands
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Malik FS, Senturia KD, Lind CD, Chalmers KD, Yi-Frazier JP, Shah SK, Pihoker C, Wright DR. Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:533-551. [PMID: 31863541 PMCID: PMC7663046 DOI: 10.1111/pedi.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | - Cara D. Lind
- Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | | | - Seema K. Shah
- Northwestern University, 680 N Lake Shore Drive, Chicago, IL, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | - Davene R. Wright
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
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Sinclair L, McFadden M, Tilbrook H, Mitchell A, Keding A, Watson J, Bauld L, Kee F, Torgerson D, Hewitt C, McKell J, Hoddinott P, Harris FM, Uny I, Boyd K, McMeekin N, Ussher M, Tappin DM. The smoking cessation in pregnancy incentives trial (CPIT): study protocol for a phase III randomised controlled trial. Trials 2020; 21:183. [PMID: 32059684 PMCID: PMC7023794 DOI: 10.1186/s13063-019-4042-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Eighty per cent of UK women have at least one baby, making pregnancy an opportunity to help women stop smoking before their health is irreparably compromised. Smoking cessation during pregnancy helps protect infants from miscarriage, still birth, low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. UK national guidelines highlight lack of evidence for effectiveness of financial incentives to help pregnant smokers quit. This includes a research recommendation: within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? METHODS The Cessation in Pregnancy Incentives Trial (CPIT) III is a pragmatic, 42-month, multi-centre, parallel-group, individually randomised controlled superiority trial of the effect on smoking status of adding to usual Stop Smoking Services (SSS) support, the offer of up to £400 of financial voucher incentives, compared with usual support alone, to quit smoking during pregnancy. Participants (n = 940) are pregnant smokers (age > 16 years, < 24 weeks pregnant, English speaking), who consent via telephone to take part and are willing to be followed-up in late pregnancy and 6 months after birth. The primary outcome is cotinine/anabasine-validated abstinence from smoking in late pregnancy. Secondary outcomes include engagement with SSS, quit rates at 4 weeks from agreed quit date and 6 months after birth, and birth weight. Outcomes will be analysed by intention to treat, and regression models will be used to compare treatment effects on outcomes. A meta-analysis will include data from the feasibility study in Glasgow. An economic evaluation will assess cost-effectiveness from a UK NHS perspective. Process evaluation using a case-study approach will identify opportunities to improve recruitment and learning for future implementation. Research questions include: what is the therapeutic efficacy of incentives; are incentives cost-effective; and what are the potential facilitators and barriers to implementing incentives in different parts of the UK? DISCUSSION This phase III trial in Scotland, England and Northern Ireland follows a successful phase II trial in Glasgow, UK. The participating sites have diverse SSS that represent most cessation services in the UK and serve demographically varied populations. If found to be acceptable and cost-effective, this trial could demonstrate that financial incentives are effective and transferable to most UK SSS for pregnant women. TRIAL REGISTRATION Current Controlled Trials, ISRCTN15236311. Registered on 9 October 2017.
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Affiliation(s)
- Lesley Sinclair
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Margaret McFadden
- Clinical R&D, Dykebar Hospital, Grahamstone Road, Paisley, PA2 7DE UK
| | - Helen Tilbrook
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Frank Kee
- Centre of Excellence for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Pat Hoddinott
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Fiona M. Harris
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Isabelle Uny
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Kathleen Boyd
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Nicola McMeekin
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Michael Ussher
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - David M. Tappin
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, Glasgow University, 5th Floor, Glasgow, G3 8SJ UK
| | - for the CPIT III local research teams
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
- Clinical R&D, Dykebar Hospital, Grahamstone Road, Paisley, PA2 7DE UK
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
- Centre of Excellence for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, Glasgow University, 5th Floor, Glasgow, G3 8SJ UK
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Robertson L, Gendall P, Hoek J, Marsh L, McGee R. Perceptions of Financial Incentives for Smoking Cessation: A Survey of Smokers in a Country With an Endgame Goal. Nicotine Tob Res 2019; 20:1481-1488. [PMID: 29253215 DOI: 10.1093/ntr/ntx268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022]
Abstract
Introduction Financial incentives can support smoking cessation, yet low acceptability may limit the wider implementation of such schemes. Few studies have examined how smokers view financial-incentive interventions aimed at reducing smoking prevalence. Methods We recruited a sample of 623 smokers from an internet panel to a survey assessing support for, and perceived effectiveness of, financial incentives for smoking cessation. We used descriptive statistics, plus logistic regression, to test associations between demographics and smoking, and support. We used qualitative content analysis to analyze open-ended responses to a question that invited respondents to comment on financial incentives. Results Financial incentives were supported by 38.4% of smokers; 42.2% did not support and 19.4% had no opinion. Support was higher among heavy (OR = 3.96, 95% CI = 2.39 to 6.58) and moderate smokers (OR = 1.68, 95% CI = 1.13 to 2.49), and those with a recent quit attempt (OR = 1.47, 95% CI = 1.04 to 2.07). Support was strongly associated with perceived effectiveness. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 26.6% of participants), followed by a Government-funded deposit-based scheme (20.6%); few respondents supported employer-funded schemes. Open-ended responses (n = 301) indicated three overarching themes expressing opposition to financial incentives: smokers' individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness. Conclusion Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is muted, despite the evidence of their effectiveness. Media advocacy and health education could be used to increase the understanding of, and support for, financial incentives for smoking cessation. Implications Given the absolute effectiveness and cost effectiveness of financial-incentive schemes for smoking cessation amongst pregnant smokers and in workplaces, implementing such schemes at a national-level could help reduce overall smoking prevalence and contribute to endgame goals. Our study found that similar proportions of smokers supported and opposed financial-incentive schemes and suggests that much of the opposition was underpinned by information gaps, which could be addressed using education and media advocacy.
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Affiliation(s)
- Lindsay Robertson
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, South Island, New Zealand
| | - Philip Gendall
- Department of Marketing, University of Otago, South Island, New Zealand
| | - Janet Hoek
- Department of Marketing, University of Otago, South Island, New Zealand
| | - Louise Marsh
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, South Island, New Zealand
| | - Rob McGee
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, South Island, New Zealand
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Hoskins K, Ulrich CM, Shinnick J, Buttenheim AM. Acceptability of financial incentives for health-related behavior change: An updated systematic review. Prev Med 2019; 126:105762. [PMID: 31271816 DOI: 10.1016/j.ypmed.2019.105762] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/03/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
Despite the successes of financial incentives in increasing uptake of evidence-based interventions, acceptability is polarized. Given widespread interest in the use of financial incentives, we update findings from Giles and colleagues' 2015 systematic review (n = 81). The objectives of this systematic review are to identify what is known about financial incentives directed to patients for health-related behavior change, assess how acceptability varies, and address which aspects and features of financial incentives are potentially acceptable and not acceptable, and why. PRISMA guidelines were used for searching peer-reviewed journals across 10 electronic databases. We included empirical and non-empirical papers published between 1/1/14 and 6/1/18. After removal of duplicates, abstract screening, and full-text reviews, 47 papers (n = 31 empirical, n = 16 scholarly) met inclusion criteria. We assessed empirical papers for risk of bias and conducted a content analysis of extracted data to synthesize key findings. Five themes related to acceptability emerged from the data: fairness, messaging, character, liberty, and tradeoffs. The wide range of stakeholders generally preferred rewards over penalties, vouchers over cash, smaller values over large, and certain rewards over lotteries. Deposits were viewed unfavorably. Findings were mixed on acceptability of targeting specific populations. Breastfeeding, medication adherence, smoking cessation, and vaccination presented as more complicated incentive targets than physical activity, weight loss, and self-management. As researchers, clinicians, and policymakers explore the use of financial incentives for challenging health behaviors, additional research is needed to understand how acceptability influences uptake and ultimately health outcomes.
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Affiliation(s)
- Katelin Hoskins
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America.
| | - Connie M Ulrich
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America; University of Pennsylvania, School of Nursing, Department of Biobehavioral Health Sciences, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America
| | - Julianna Shinnick
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America
| | - Alison M Buttenheim
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Boulevard, Philadelphia, PA 19104, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, United States of America; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States of America
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10
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Notley C, Gentry S, Livingstone‐Banks J, Bauld L, Perera R, Hartmann‐Boyce J. Incentives for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD004307. [PMID: 31313293 PMCID: PMC6635501 DOI: 10.1002/14651858.cd004307.pub6] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes. OBJECTIVES To determine the long-term effect of incentives and contingency management programmes for smoking cessation. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018. SELECTION CRITERIA We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinic- or institution-based), and also studies in pregnant smokers. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. MAIN RESULTS Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits.We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow-up (up to 24 weeks post-partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. AUTHORS' CONCLUSIONS Overall there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow-up occurs after the withdrawal of incentives. There is also moderate-certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post-partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations.
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Affiliation(s)
- Caitlin Notley
- University of East AngliaNorwich Medical SchoolNorwichUK
| | - Sarah Gentry
- University of East AngliaNorwich Medical SchoolNorwichUK
| | | | - Linda Bauld
- University of EdinburghUsher Institute, College of Medicine and Veterinary MedicineEdinburghUK
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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11
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Wilson SM, Newins AR, Medenblik AM, Kimbrel NA, Dedert EA, Hicks TA, Neal LC, Beckham JC, Calhoun PS. Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials. Womens Health Issues 2018; 28:514-523. [PMID: 30061033 PMCID: PMC6215492 DOI: 10.1016/j.whi.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy. METHODS A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum. RESULTS The search yielded 22 studies, and meta-analytic results indicated that interventions (compared with control groups) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management vs. psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly greater than those of psychotherapeutic interventions. Although psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points. CONCLUSIONS Contingency management seems to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation.
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Affiliation(s)
- Sarah M Wilson
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina.
| | | | | | - Nathan A Kimbrel
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Eric A Dedert
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | | | - Lydia C Neal
- Duke University School of Medicine, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jean C Beckham
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Patrick S Calhoun
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina
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12
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Berlin N, Goldzahl L, Bauld L, Hoddinott P, Berlin I. Public acceptability of financial incentives to reward pregnant smokers who quit smoking: a United Kingdom-France comparison. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:697-708. [PMID: 28646249 PMCID: PMC5948294 DOI: 10.1007/s10198-017-0914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/06/2017] [Indexed: 08/15/2023]
Abstract
A substantial amount of research has been conducted on financial incentives to increase abstinence from smoking among pregnant smokers. If demonstrated to be effective, financial incentives could be proposed as part of health care interventions to help pregnant smokers quit. Public acceptability is important; as such interventions could be publicly funded. Concerns remain about the acceptability of these interventions in the general population. We aimed to assess the acceptability of financial incentives to reward pregnant smokers who stop smoking using a survey conducted in the UK and then subsequently in France, two developed countries with different cultural and social backgrounds. More French than British respondents agreed with financial incentives for rewarding quitting smoking during pregnancy, not smoking after delivery, keeping a smoke-free household, health service payment for meeting target and the maximum amount of the reward. However, fully adjusted models showed significant differences only for the two latter items. More British than French respondents were neutral toward financial incentives. Differences between the representative samples of French and British individuals demonstrate that implementation of financial incentive policies may not be transferable from one country to another.
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Affiliation(s)
- Noémi Berlin
- Department of Economics, European University Institute, Villa la Fonte, Via delle Fontanelle, 18, 50014 San Domenico Di Fiesole, Italy
| | | | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies and Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpetrière, Faculté de médecine-Université P. & M. Curie, INSERM U1018, Paris, France
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13
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Bardou M, Crépon B, Bertaux AC, Godard-Marceaux A, Eckman-Lacroix A, Thellier E, Falchier F, Deruelle P, Doret M, Carcopino-Tusoli X, Schmitz T, Barjat T, Morin M, Perrotin F, Hatem G, Deneux-Tharaux C, Fournel I, Laforet L, Meunier-Beillard N, Duflo E, Le Ray I. NAITRE study on the impact of conditional cash transfer on poor pregnancy outcomes in underprivileged women: protocol for a nationwide pragmatic cluster-randomised superiority clinical trial in France. BMJ Open 2017; 7:e017321. [PMID: 29084796 PMCID: PMC5665235 DOI: 10.1136/bmjopen-2017-017321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Prenatal care is recommended during pregnancy to improve neonatal and maternal outcomes. Women of lower socioeconomic status (SES) are less compliant to recommended prenatal care and suffer a higher risk of adverse perinatal outcomes. Several attempts to encourage optimal pregnancy follow-up have shown controversial results, particularly in high-income countries. Few studies have assessed financial incentives to encourage prenatal care, and none reported materno-fetal events as the primary outcome. Our study aims to determine whether financial incentives could improve pregnancy outcomes in women with low SES in a high-income country. METHODS AND ANALYSIS This pragmatic cluster-randomised clinical trial includes pregnant women with the following criteria: (1) age above 18 years, (2) first pregnancy visit before 26 weeks of gestation and (3) belonging to a socioeconomically disadvantaged group. The intervention consists in offering financial incentives conditional on attending scheduled pregnancy follow-up consultations. Clusters are 2-month periods with random turnover across centres. A composite outcome of maternal and neonatal morbidity and mortality is the primary endpoint. Secondary endpoints include maternal or neonatal outcomes assessed separately, qualitative assessment of the perception of the intervention and cost-effectiveness analysis for which children will be followed to the end of their first year through the French health insurance database. The study started in June 2016, and based on an expected decrease in the primary endpoint from 18% to 14% in the intervention group, we plan to include 2000 women in each group. ETHICS AND DISSEMINATION Ethics approval was first gained on 28 September 2014. An independent data security and monitoring committee has been established. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02402855; pre-results.
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Affiliation(s)
- Marc Bardou
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
- Centre de Recherche INSERM LNC-UMR1231, UFR Sciences Santé, Dijon, France
- Université Bourgogne-Franche Comté, Dijon, France
| | - Bruno Crépon
- Centre de Recherche en Economie Statistique (CREST), Malakoff, France
| | - Anne-Claire Bertaux
- Unité de Soutien Méthodologique à la Recherche, CHU Dijon-Bourgogne, Dijon, Bourgogne, France
| | - Aurélie Godard-Marceaux
- Neurosciences Intégratives et cliniques EA 481, Université Bourgogne Franche-Comté, Besançon, France
- “Ethique et Progrès médical”, CIC INSERM 1431, Centre Hospitalier et Universitaire de Besançon, Besançon, France
| | | | - Elise Thellier
- Service de Gynécologie Obstétrique, CHU de Bicetre, Paris, France
| | | | | | - Muriel Doret
- Service de Gynécologie Obstétrique, Hospices Civils de Lyon—Hôpital Femme Mère Enfant, Lyon, Rhône-Alpes, France
| | - Xavier Carcopino-Tusoli
- Service de Gynécologie Obstétrique, CHU de Marseille Hôpital Nord, Marseille, Provence-Alpes-Côte d’Azu, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, CHU Robert Debré, Paris, Île-de-France, France
| | - Thiphaine Barjat
- Service de Gynécologie Obstétrique, CHU de Saint Etienne, Saint Etienne, France
| | - Mathieu Morin
- Service de Gynécologie Obstétrique, CHU de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Franck Perrotin
- Service de Gynécologie Obstétrique, CHU Bretonneau, Tours, France
| | - Ghada Hatem
- Service de Gynécologie Obstétrique, Centre Hospitalier de Saint Denis, Saint Denis, Île-de-France, France
| | - Catherine Deneux-Tharaux
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris France, Paris, France
| | - Isabelle Fournel
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Laurent Laforet
- Centre d’Investigation Clinique INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Nicolas Meunier-Beillard
- Neurosciences Intégratives et cliniques EA 481, Université Bourgogne Franche-Comté, Besançon, France
| | - Esther Duflo
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Isabelle Le Ray
- Service de Gynécologie Obstétrique, CHRU Strasbourg, Strasbourg, Alsace, France
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Crossland N, Thomson G, Morgan H, MacLennan G, Campbell M, Dykes F, Hoddinott P. Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability. MATERNAL AND CHILD NUTRITION 2016; 12:726-39. [PMID: 27502101 PMCID: PMC5096021 DOI: 10.1111/mcn.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around £40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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15
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Boyd KA, Tappin DM, Bauld L. Cost-effectiveness of financial incentives for smoking cessation in pregnancy. Addiction 2016; 111:115-7. [PMID: 27157899 DOI: 10.1111/add.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kathleen A Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | | | - Linda Bauld
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
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Boyd KA, Briggs AH, Bauld L, Sinclair L, Tappin D. Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction 2016; 111:360-70. [PMID: 26370095 DOI: 10.1111/add.13160] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/03/2015] [Accepted: 09/07/2015] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the cost-effectiveness of up to £400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care. DESIGN Cost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model. SETTING The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective. PARTICIPANTS A total of 612 pregnant women randomized to receive usual cessation support plus or minus financial incentives of up to £400 vouchers (US $609), contingent upon smoking cessation. MEASUREMENTS Comparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS. FINDINGS The incremental cost per quitter at 34-38 weeks pregnant was £1127 ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, £1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (£157) and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of £17 [95% confidence interval (CI) = -£93, £107] and a gain of 0.04 QALYs (95% CI = -0.058, 0.145), giving an ICER of £482/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was £30 million (at a willingness to pay of £30 000/QALY), so given current uncertainty, additional research is potentially worthwhile. CONCLUSION Financial incentives for smoking cessation in pregnancy are highly cost-effective, with an incremental cost per quality-adjusted life years of £482, which is well below recommended decision thresholds.
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Affiliation(s)
- Kathleen A Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Andrew H Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Linda Bauld
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - Lesley Sinclair
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - David Tappin
- Paediatric Epidemiology and Community Health Unit, University of Glasgow, Glasgow, UK
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Yu CH, Guarna G, Tsao P, Jesuthasan JR, Lau ANC, Siddiqi FS, Gilmour JA, Ladha D, Halapy H, Advani A. Incentivizing health care behaviors in emerging adults: a systematic review. Patient Prefer Adherence 2016; 10:371-81. [PMID: 27069356 PMCID: PMC4818043 DOI: 10.2147/ppa.s102574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases. METHODS The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years) with chronic medical conditions including addictions, were included. RESULTS A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated. CONCLUSION While the majority of studies reported positive outcomes, these studies focused on promoting the cessation of adverse behaviors rather than promoting positive behaviors. In addition, conclusions were limited by the high risk of bias present in the majority of studies, as well as lack of follow-up after the incentive period. Whether behavioral incentives facilitate the adoption of positive health choices in this population remains to be determined.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Correspondence: Catherine H Yu, Li, Ka Shing Knowledge Institute, St Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada, Tel +1 416 864 6060, Fax +1 416 867 3679, Email
| | - Giuliana Guarna
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Pamela Tsao
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jude R Jesuthasan
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Adrian NC Lau
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Ferhan S Siddiqi
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Julie Anne Gilmour
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Danyal Ladha
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Halapy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Andrew Advani
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Morgan H, Thomson G, Crossland N, Dykes F, Hoddinott P. Combining PPI with qualitative research to engage 'harder-to-reach' populations: service user groups as co-applicants on a platform study for a trial. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:7. [PMID: 29062508 PMCID: PMC5611582 DOI: 10.1186/s40900-016-0023-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/13/2016] [Indexed: 05/22/2023]
Abstract
PLAIN ENGLISH SUMMARY It is recommended that research studies are carried out with or by patients and the public through their involvement from the beginning and in as many stages as possible (known as PPI). Some studies formally invite patients and the public to participate in interviews and focused group discussions to collect views about topics (known as qualitative research). In our study on financial incentives for giving up smoking in pregnancy and breastfeeding, we combined both PPI and qualitative research to include the views of women with a range of experiences of smoking and breastfeeding. We involved two mother and baby groups in disadvantaged areas of North East Scotland and North West England as research partners on our team. First, we asked members to comment on our research plans and documents, which is standard PPI. Second, we asked members to participate in voice recorded discussions, contributing to qualitative research data. These discussions revealed different views from those that we heard through research interviews. They allowed us to develop more relevant research tools and resources. Members also helped us to identify people outside the groups who we could interview. Combining involvement and participation helped us to include the views of a wide range of women from 'harder-to-reach' groups who don't usually take part in research. This was important because the research was intended for women who could benefit from incentives to stop smoking in pregnancy and breastfeed, often present in such groups. Positive continuing relationships and trust improved on involvement or participation alone. BACKGROUND Patient and public involvement (PPI) in all research studies is recommended from the earliest point and in as many stages as possible. Qualitative research is also recommended in the early stages of designing complex intervention trials. Combining both together might enable inclusion of 'harder-to-reach' perspectives from the target population(s), particularly when the research is intended for their benefit. However, the interface between PPI and qualitative research has received little attention. In a multi-disciplinary, mixed methods study to inform the design of incentive trials for smoking cessation in pregnancy and breastfeeding, we combined PPI and qualitative research, with some overlap. Mother and baby groups from two geographically separate disadvantaged areas, with diverse experiences of the smoking and breastfeeding, but no training or previous involvement in research, were recruited as PPI research grant co-applicants. An iterative partnership approach facilitated involvement in research conduct and design across all project phases. Group PPI members were also invited to contribute to more formal qualitative data collection, as and when indicated by the research questions, and emerging analysis. RESULTS We engaged with 'harder-to-reach' women in mother and baby group settings, rather than in academic or home environments. These settings were relaxed and informal, which facilitated rapport-building, disclosures of unexpected information and maintained trust. Twenty-one women participated in standard PPI activities: feedback on study protocols and documents; piloting questionnaires and interview schedules. PPI members voiced some different perspectives from those captured within the qualitative dataset. Nineteen participated in focused qualitative research. Novel aspects were audio recorded PPI discussions, which contributed qualitative data; first, to interpret systematic review findings and construct intervention vignettes for use in the qualitative research; second, to assist with recruitment to improve sample diversity in the formal qualitative dataset; and third, to translate theory and findings presented in a researcher generated logic model into a lay tool. This had face validity for potential trial participants and used the metaphor of a ladder. CONCLUSIONS Combining and overlapping PPI and qualitative research added 'harder-to-reach' contributions, sample diversity, trust and engagement in creative approaches beyond what could be achieved through PPI or qualitative research alone.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland, UK
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA Scotland, UK
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Hoddinott P, Thomson G, Morgan H, Crossland N, MacLennan G, Dykes F, Stewart F, Bauld L, Campbell MK. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study. BMJ Open 2015; 5:e008492. [PMID: 26567253 PMCID: PMC4654300 DOI: 10.1136/bmjopen-2015-008492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. DESIGN Cross-sectional survey and qualitative interviews. SETTING Scotland and North West England. PARTICIPANTS Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. METHODS Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. RESULTS Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. CONCLUSIONS Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required.
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Affiliation(s)
- Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- Department of Health Policy and Social Marketing, University of Stirling, Stirling, UK
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Wen X, Higgins ST, Xie C, Epstein LH. Improving Public Acceptability of Using Financial Incentives for Smoking Cessation During Pregnancy: A Randomized Controlled Experiment. Nicotine Tob Res 2015; 18:913-8. [PMID: 26385928 DOI: 10.1093/ntr/ntv204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/07/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Financial incentives are effective for smoking cessation during pregnancy. Public opinion is important for successful dissemination of this approach from research into clinical practice. We developed a brief information-based intervention to improve public acceptability. METHODS We recruited 166 adult participants (54.2% females [6.7% pregnant], 25.3% smokers, mean age 32.4 years [SD, 9.9]) currently living the United States from Amazon Mechanical Turk. They were randomized to either intervention (N = 84) or control (N = 82). The control group read educational materials on car safety for pregnant women and young children. The intervention group read educational materials on the rationale behind using financial incentives for smoking cessation during pregnancy. Key outcomes were 11 opinion items regarding whether using financial incentives to help pregnant smokers to quit is a good idea; its effectiveness, fairness, cost, health benefits, and saved healthcare cost; and pregnant women's responsibility and difficulty of quitting smoking. RESULTS Intervention and control groups had similar pretest opinion on using financial incentives for smoking cessation during pregnancy. All 11 mean opinion scores significantly increased in the intervention group, but remained stable in the control group. After the intervention, 27.7% more of participants (from 62.6% to 90.3%; P value < .001) in the intervention group and only 4.8% more (from 64.6% to 69.4%; P value = .557) in the control group agreed that "Paying pregnant women who smoke to quit smoking is a good idea" (interaction P value = .015). CONCLUSIONS Our low-cost information-based intervention has the potential to improve public acceptability of this efficacious approach to promoting smoking cessation during pregnancy. IMPLICATIONS In this sample of educated young adults, our low-cost information-based intervention substantially improved their acceptability of using financial incentives for smoking cessation during pregnancy. Our intervention can be used to gain public support before implementing this approach as a policy in the general population. One potential concern that needs to be further addressed by future intervention is unfairness of this smoking cessation approach to pregnant nonsmokers.
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Affiliation(s)
- Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY;
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
| | - Chuanbo Xie
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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Abstract
BACKGROUND Material or financial incentives are widely used in an attempt to precipitate or reinforce behaviour change, including smoking cessation. They operate in workplaces, in clinics and hospitals, and to a lesser extent within community programmes. In this third update of our review we now include trials conducted in pregnant women, to reflect the increasing activity and resources now targeting this high-risk group of smokers. OBJECTIVES To determine whether incentives and contingency management programmes lead to higher long-term quit rates. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. The most recent searches were in December 2014, although we also include two trials published in 2015. SELECTION CRITERIA We considered randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. We include studies in a mixed-population setting (e.g. community-, work-, institution-based), and also, for this update, trials in pregnant smokers. DATA COLLECTION AND ANALYSIS One author (KC) extracted data and a second (JH-B) checked them. We contacted study authors for additional data where necessary. The main outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up, and at least six months from the start of the intervention. In the trials of pregnant smokers abstinence was measured at the longest follow-up, and at least to the end of the pregnancy. MAIN RESULTS Twenty-one mixed-population studies met our inclusion criteria, covering more than 8400 participants. Ten studies were set in clinics or health centres, one in Thai villages served by community health workers, two in academic institutions, and the rest in worksites. All but six of the trials were run in the USA. The incentives included lottery tickets or prize draws, cash payments, vouchers for goods and groceries, and in six trials the recovery of money deposited by those taking part. The odds ratio (OR) for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.42 (95% confidence interval (CI) 1.19 to 1.69; 17 trials, [20 comparisons], 7715 participants). Only three studies demonstrated significantly higher quit rates for the incentives group than for the control group at or beyond the six-month assessment: One five-arm USA trial compared rewards- and deposit-based interventions at individual and group level, with incentives available up to USD 800 per quitter, and demonstrated a quit rate in the rewards groups of 8.1% at 12 months, compared with 4.7% in the deposits groups. A direct comparison between the rewards-based and the deposit-based groups found a benefit for the rewards arms, with an OR at 12 months of 1.76 (95% CI 1.22 to 2.53; 2070 participants). Although more people in this trial accepted the rewards programmes than the deposit programmes, the proportion of quitters in each group favoured the deposit-refund programme. Another USA study rewarded both participation and quitting up to USD 750, and achieved sustained quit rates of 9.4% in the incentives group compared with 3.6% for the controls. A deposit-refund trial in Thailand also achieved significantly higher quit rates in the intervention group (44.2%) compared with the control group (18.8%), but uptake was relatively low, at 10.5%. In the remaining trials, there was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that contingent rewards enhanced success rates over fixed payment schedules. We rated the overall quality of the older studies as low, but with later trials (post-2000) more likely to meet current standards of methodology and reporting.Eight of nine trials with usable data in pregnant smokers (seven conducted in the USA and one in the UK) delivered an adjusted OR at longest follow-up (up to 24 weeks post-partum) of 3.60 (95% CI 2.39 to 5.43; 1295 participants, moderate-quality studies) in favour of incentives. Three of the trials demonstrated a clear benefit for contingent rewards; one delivered monthly vouchers to confirmed quitters and to their designated 'significant other supporter', achieving a quit rate in the intervention group of 21.4% at two months post-partum, compared with 5.9% among the controls. Another trial offered a scaled programme of rewards for the percentage of smoking reduction achieved over the course of the 12-week intervention, and achieved an intervention quit rate of 31% at six weeks post-partum, compared with no quitters in the control group. The largest (UK-based) trial provided intervention quitters with up to GBP 400-worth of vouchers, and achieved a quit rate of 15.4% at longest follow-up, compared to the control quit rate of 4%. Four trials confirmed that payments made to reward a successful quit attempt (i.e. contingent), compared to fixed payments for attending the antenatal appointment (non-contingent), resulted in higher quit rates. Front-loading of rewards to counteract early withdrawal symptoms made little difference to quit rates. AUTHORS' CONCLUSIONS Incentives appear to boost cessation rates while they are in place. The two trials recruiting from work sites that achieved sustained success rates beyond the reward schedule concentrated their resources into substantial cash payments for abstinence. Such an approach may only be feasible where independently-funded smoking cessation programmes are already available, and within a relatively affluent and educated population. Deposit-refund trials can suffer from relatively low rates of uptake, but those who do sign up and contribute their own money may achieve higher quit rates than reward-only participants. Incentive schemes conducted among pregnant smokers improved the cessation rates, both at the end-of-pregnancy and post-partum assessments. Current and future research might continue to explore the scale, loading and longevity of possible cash or voucher reward schedules, within a variety of smoking populations.
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Affiliation(s)
- Kate Cahill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
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Giles EL, Holmes M, McColl E, Sniehotta FF, Adams JM. Acceptability of financial incentives for breastfeeding: thematic analysis of readers' comments to UK online news reports. BMC Pregnancy Childbirth 2015; 15:116. [PMID: 25982305 PMCID: PMC4475305 DOI: 10.1186/s12884-015-0549-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 05/05/2015] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Emma L Giles
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, TS1 3BA, UK.
| | - Matthew Holmes
- The Medical School, Newcastle University, Framlington Place, NE2 4HH, Newcastle upon Tyne, Tyne and Wear, UK.
| | - Elaine McColl
- 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.
| | - Falko F Sniehotta
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, TS1 3BA, UK.
| | - Jean M Adams
- 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.
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Nagata N, Sakamoto K, Arai T, Niikura R, Shimbo T, Shinozaki M, Ihana N, Sekine K, Okubo H, Watanabe K, Sakurai T, Yokoi C, Yanase M, Akiyama J, Uemura N, Noda M. Effect of body mass index and intra-abdominal fat measured by computed tomography on the risk of bowel symptoms. PLoS One 2015; 10:e0123993. [PMID: 25906052 PMCID: PMC4408111 DOI: 10.1371/journal.pone.0123993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/25/2015] [Indexed: 12/15/2022] Open
Abstract
Background This study aims to investigate the association between body mass index (BMI) or intra-abdominal fat measured by computed tomography (CT) and bowel symptoms. Method A cohort of 958 Japanese adults who underwent colonoscopy and CT and completed questionnaires after excluding colorectal diseases was analyzed. Six symptoms (constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation) using a 7-point Likert scale were evaluated between baseline and second questionnaire for test-retest reliability. Associations between BMI, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and symptom score were analyzed by a rank-ordered logistic model, adjusting for age, sex, smoking, and alcohol consumption, hypertension, diabetes mellitus, and dyslipidemia. Results Some bowel symptom scores were significantly (p<0.05) different between the age groups, sexes, smoking, and alcohol consumption. In multivariate analysis, constipation was associated with low BMI (p<0.01), low VAT area (p = 0.01), and low SAT area (p<0.01). Moreover, hard stools was associated with low BMI (p<0.01) and low SAT area (p<0.01). The remaining symptoms were not significantly associated with BMI or intra-abdominal fat. Test-retest reliability of bowel symptom scores with a mean duration of 7.5 months was good (mean kappa, 0.672). Conclusions Both low BMI and low abdominal fat accumulation appears to be useful indicators of increased risk for constipation and hard stools. The long-term test-retest reliability of symptom score suggests that bowel symptoms relevant to BMI or visceral fat remain consistent over several months.
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Affiliation(s)
- Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
- * E-mail:
| | - Kayo Sakamoto
- Department of Diagnostic Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Tomohiro Arai
- Department of Diagnostic Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Ryota Niikura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Takuro Shimbo
- Department of Clinical Research and Informatics, International Clinical Research Center Research Institute, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Masafumi Shinozaki
- Department of Diagnostic Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Noriko Ihana
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1, Kohnodai, Ichikawa, Chiba, 272–8516, Japan
| | - Katsunori Sekine
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Hidetaka Okubo
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Chizu Yokoi
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Mikio Yanase
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1, Kohnodai, Ichikawa, Chiba, 272–8516, Japan
| | - Mitsuhiko Noda
- Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162–8655, Japan
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McInnes RJ, Arbuckle A, Hoddinott P. How UK internet websites portray breast milk expression and breast pumps: a qualitative study of content. BMC Pregnancy Childbirth 2015; 15:81. [PMID: 25881251 PMCID: PMC4429834 DOI: 10.1186/s12884-015-0509-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive breastfeeding for six months is recommended but few parents achieve this; particularly younger and less well-educated mothers. Many parents introduce infant formula milk to manage feeding but describe a desire to express breastmilk alongside a lack of support or information. The Internet is highlighted as a key resource. This study aimed to examine UK websites on expressing breastmilk to identify key messages and how information is provided. Methods We used search terms in Google to identify websites with information rich content on expressing breastmilk and breast pumps. Ten sites were purposively selected at two time points in 2013 and 2014 to represent 3 categories: commercial, NHS or 3rd sector (voluntary or not for profit). Each site was reviewed by two researchers, data and reflective analytical notes were uploaded into NVivo and thematic data analysis undertaken. Results Sites varied considerably in their design, use of images, videos, audio files, product placement and marketing opportunities. Three key themes emerged: depiction of expressing; reasons to express; and recommendations about expressing. Inconsistent and conflicting information was common within and between sites. Expressing was portrayed as similar to, but easier than, breastfeeding although at the same time difficult and requiring to be learned. Expressed breastmilk is promoted by mainly commercial sites as immediately available, although pumps were also presented as needing to be concealed, not heard or seen. Health benefits were the overarching reason for expressing. Although predicated on separation from the baby, commercial sites identified this as a positive choice while other sites focused on separation due to circumstance. Commercial sites emphasised restrictions related to breastfeeding, lack of sleep and bonding with the father and wider family. Non-commercial sites emphasised hand expression, with some not mentioning breast pumps. Practical information about starting expressing in relation to infant age or duration of breastfeeding was conflicting. Conclusions Internet information about expressing breastmilk is inconsistent, incomplete and not evidence informed. The lack of research evidence on the relationship between expressing and feeding outcomes has provided opportunities for commercial companies, which have the potential to further exacerbate observed health inequalities. Access to good quality information based on robust evidence is urgently required.
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Affiliation(s)
- Rhona J McInnes
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Alix Arbuckle
- Master of Health Research (MRes) programme, School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK.
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Giles EL, Robalino S, Sniehotta FF, Adams J, McColl E. Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods. Prev Med 2015; 73:145-58. [PMID: 25600881 DOI: 10.1016/j.ypmed.2014.12.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/28/2014] [Accepted: 12/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Financial incentives are effective in encouraging healthy behaviours, yet concerns about acceptability remain. We conducted a systematic review exploring acceptability of financial incentives for encouraging healthy behaviours. METHODS Database, reference, and citation searches were conducted from the earliest available date to October 2014, to identify empirical studies and scholarly writing that: had an English language title, were published in a peer-reviewed journal, and explored acceptability of financial incentives for healthy behaviours in members of the public, potential recipients, potential practitioners or policy makers. Data was analysed using thematic analysis. RESULTS Eighty one papers were included: 59 pieces of scholarly writing and 22 empirical studies, primarily exploring acceptability to the public. Five themes were identified: fair exchange, design and delivery, effectiveness and cost-effectiveness, recipients, and impact on individuals and wider society. Although there was consensus that if financial incentives are effective and cost effective they are likely to be considered acceptable, a number of other factors also influenced acceptability. CONCLUSIONS Financial incentives tend to be acceptable to the public when they are effective and cost-effective. Programmes that benefit recipients and wider society; are considered fair; and are delivered to individuals deemed appropriate are likely to be considered more acceptable.
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Affiliation(s)
- Emma L Giles
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Jean Adams
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, 4th Floor William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, Tyne and Wear NE2 4HH, UK.
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Moran VH, Morgan H, Rothnie K, MacLennan G, Stewart F, Thomson G, Crossland N, Tappin D, Campbell M, Hoddinott P. Incentives to promote breastfeeding: a systematic review. Pediatrics 2015; 135:e687-702. [PMID: 25647672 DOI: 10.1542/peds.2014-2221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few women in industrialized countries achieve the World Health Organization's recommendation to breastfeed exclusively for 6 months. Governments are increasingly seeking new interventions to address this problem, including the use of incentives. The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions, delivered within or outside of health care settings, to individuals and/or their families seeking to increase and sustain breastfeeding in the first 6 months after birth. METHODS Searches of electronic databases, reference lists, and grey literature were conducted to identify relevant reports of published, unpublished, and ongoing studies. All study designs published in English, which met our definition of incentives and that were from a developed country, were eligible for inclusion. Abstract and full-text article review with sequential data extraction were conducted by 2 independent authors. RESULTS Sixteen full reports were included in the review. The majority evaluated multicomponent interventions of varying frequency, intensity, and duration. Incentives involved providing access to breast pumps, gifts, vouchers, money, food packages, and help with household tasks, but little consensus in findings was revealed. The lack of high-quality, randomized controlled trials identified by this review and the multicomponent nature of the interventions prohibited meta-analysis. CONCLUSIONS This review found that the overall effect of providing incentives for breastfeeding compared with no incentives is unclear due to study heterogeneity and the variation in study quality. Further evidence on breastfeeding incentives offered to women is required to understand the possible effects of these interventions.
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Affiliation(s)
- Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom;
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Gillian Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom
| | - David Tappin
- David Tappin, School of Medicine, University of Glasgow, United Kingdom; and
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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Abstract
This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women. Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world's poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits? Breastfeeding is a global food production system with unsurpassed capacity to promote children's food security and maternal and child health, but it is side-lined by trade negotiators who seek instead to expand world markets for cow's milk-based formula. Regulators focus on potential risks of feeding donated human milk, rather than on health risks of exposing infants and young children to highly processed bovine milk. Similarly, policymakers aspire to provide universal health care access that may be unaffordable when two thirds of the world's children are not optimally nourished in infancy, resulting in a global double burden of infectious and chronic disease. Universal breastfeeding requires greater commitment of resources, but such investment remains lacking despite the cost effectiveness of breastfeeding protection, support and promotion in and beyond health services. Women invest substantially in breastfeeding but current policy - epitomised by the G20 approach to the 'gender gap' - fails to acknowledge the economic value of this unpaid care work. Economic incentives for mothers to optimally breastfeed are dwarfed by health system and commercial incentives promoting formula feeding and by government fiscal policies which ignore the resulting economic costs. 'The market' fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding.
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Giles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups. BMC Public Health 2015; 15:58. [PMID: 25636330 PMCID: PMC4318173 DOI: 10.1186/s12889-015-1409-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/13/2015] [Indexed: 11/21/2022] Open
Abstract
Background There is evidence that financial incentive interventions, which include both financial rewards and also penalties, are effective in encouraging healthy behaviours. However, concerns about the acceptability of such interventions remain. We report on focus groups with a cross-section of adults from North East England exploring their acceptance of financial incentive interventions for encouraging healthy behaviours amongst adults. Such information should help guide the design and development of acceptable, and effective, financial incentive interventions. Methods Eight focus groups with a total of 74 adults were conducted between November 2013 and January 2014 in Newcastle upon Tyne, UK. Focus groups lasted approximately 60 minutes and explored factors that made financial incentives acceptable and unacceptable to participants, together with discussions on preferred formats for financial incentives. Verbatim transcripts were thematically coded and analysed in Nvivo 10. Results Participants largely distrusted health promoting financial incentives, with a concern that individuals may abuse such schemes. There was, however, evidence that health promoting financial incentives may be more acceptable if they are fair to all recipients and members of the public; if they are closely monitored and evaluated; if they are shown to be effective and cost-effective; and if clear health education is provided alongside health promoting financial incentives. There was also a preference for positive rewards rather than negative penalties, and for shopping vouchers rather than cash incentives. Conclusions This qualitative empirical research has highlighted clear suggestions on how to design health promoting financial incentives to maximise acceptability to the general public. It will also be important to determine the acceptability of health promoting financial incentives in a range of stakeholders, and in particular, those who fund such schemes, and policy-makers who are likely to be involved with the design, implementation and evaluation of health promoting financial incentive schemes. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1409-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma L Giles
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK.
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK.
| | - Elaine McColl
- Newcastle Clinical Trials Unit, 4th Floor William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - Jean Adams
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK. .,Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Thomson G, Morgan H, Crossland N, Bauld L, Dykes F, Hoddinott P. Unintended consequences of incentive provision for behaviour change and maintenance around childbirth. PLoS One 2014; 9:e111322. [PMID: 25357121 PMCID: PMC4214733 DOI: 10.1371/journal.pone.0111322] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022] Open
Abstract
Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
- * E-mail:
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
| | - Linda Bauld
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
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Whelan B, Thomas KJ, Van Cleemput P, Whitford H, Strong M, Renfrew MJ, Scott E, Relton C. Healthcare providers' views on the acceptability of financial incentives for breastfeeding: a qualitative study. BMC Pregnancy Childbirth 2014; 14:355. [PMID: 25296687 PMCID: PMC4288621 DOI: 10.1186/1471-2393-14-355] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/22/2014] [Indexed: 11/17/2022] Open
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. Conclusion 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.
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Affiliation(s)
- Barbara Whelan
- Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK.
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