Perspectives on financial incentives to health service providers for increasing breastfeeding and smoking quit rates during pregnancy

a mixed methods study

Pat Hoddinott, Gill Thomson, Heather Morgan, Nicola Crossland, Graeme MacLennan, Fiona Dykes, Fiona Stewart, Linda Bauld, Marion K Campbell

Research output: Contribution to journalArticle

3 Citations (Scopus)
9 Downloads (Pure)

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 languageEnglish
Article numbere008492
Number of pages13
JournalBMJ Open
Volume5
Issue number11
Early online date13 Nov 2015
DOIs
Publication statusPublished - 13 Nov 2015

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Pregnancy Rate
Breast Feeding
Health Services
Motivation
Smoking
Smoking Cessation
Community Health Nurses
Health
Interviews
Pregnancy
Scotland
Focus Groups
England
Pregnant Women
Cross-Sectional Studies
Logistic Models
Pressure
Surveys and Questionnaires

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Perspectives on financial incentives to health service providers for increasing breastfeeding and smoking quit rates during pregnancy : a mixed methods study. / Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K.

In: BMJ Open, Vol. 5, No. 11, e008492, 13.11.2015.

Research output: Contribution to journalArticle

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title = "Perspectives on financial incentives to health service providers for increasing breastfeeding and smoking quit rates during pregnancy: a mixed methods study",
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.",
author = "Pat Hoddinott and Gill Thomson and Heather Morgan and Nicola Crossland and Graeme MacLennan and Fiona Dykes and Fiona Stewart and Linda Bauld and Campbell, {Marion K}",
note = "Funding This 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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T1 - Perspectives on financial incentives to health service providers for increasing breastfeeding and smoking quit rates during pregnancy

T2 - a mixed methods study

AU - Hoddinott, Pat

AU - Thomson, Gill

AU - Morgan, Heather

AU - Crossland, Nicola

AU - MacLennan, Graeme

AU - Dykes, Fiona

AU - Stewart, Fiona

AU - Bauld, Linda

AU - Campbell, Marion K

N1 - Funding This 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.

PY - 2015/11/13

Y1 - 2015/11/13

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2015-008492

DO - 10.1136/bmjopen-2015-008492

M3 - Article

VL - 5

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 11

M1 - e008492

ER -