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.
Original language | English |
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Article number | e008492 |
Number of pages | 13 |
Journal | BMJ Open |
Volume | 5 |
Issue number | 11 |
Early online date | 13 Nov 2015 |
DOIs | |
Publication status | Published - 13 Nov 2015 |
Bibliographical note
FundingThis project was commissioned by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (10/31/02) and will be published in full in Health Technology Assessment. Further information including the protocol is available at: http://www.nets.nihr.ac.uk/projects/hta/103102. This report presents independent research commissioned by the NIHR. The Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling and the Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen are both core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The views expressed are those of the authors alone.
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Marion Campbell
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Chair in HSRU
- Institute of Applied Health Sciences
Person: Academic
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Graeme MacLennan
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Director (CHaRT)
- School of Medicine, Medical Sciences & Nutrition, Centre for Healthcare Randomised Trials (CHaRT)
- Institute of Applied Health Sciences
Person: Academic, Academic Related - Research