National Institute of Health Research

HTA - 10/31/02: Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Project title Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design
Research type Primary Research
Status Project complete
Start date February 2012
Publication date

April 2015

Link to journal publication
Cost £ 321,973.82
Chief Investigator Professor Pat Hoddinott
Co-investigators Professor Linda Bauld (University of Stirling), Professor Marion Campbell (University Court of the University of Aberdeen), Mrs Helen Cook (Blackpool Council), Professor Fiona Dykes (University of Central Lancashire), Professor Anne Ludbrook (University Court of the University of Aberdeen), Wendy Ratcliffe (NHS Grampian), Dr Falko Sniehotta (University of Newcastle upon Tyne), Professor David Tappin (University of Glasgow)
Contractor University Court of the University of Aberdeen
Plain English summary The aim of this research is to try and find out which incentives (financial or non-financial), if any, are most likely to help women to stop smoking in pregnancy (and not restart) and to breastfeed their babies until 6 months, to benefit the health of both mothers and babies. We will start by finding research studies and reports about the different types of incentives that have been used. We will see whether they work, how much incentive is needed, the timing and how best to deliver it. We will produce a classification and summary of different types and combinations of incentive, how they work and how they fit with all the other pros and cons or motivating factors for breastfeeding and smoking. This will produce a short-list of the most promising incentives. The next stage is to see how acceptable this short-list is and decide which incentive is the most likely to work in a future research trial. To do this, we will interview women, their partners, health professionals and experts in breastfeeding and smoking. We will seek views on different examples of incentives, how they could be improved and factors that might prevent them working or make them more likely to work. We will choose one or two incentives and will send a web survey by e mail to doctors, midwives, health visitors; government departments and research funding bodies; members of health service ethics committees and the general public who would probably pay for incentives through taxation. Finally, we will use a type of economic questionnaire called a Discrete Choice Experiment (DCE) that asks women (or others) about the likelihood of the incentive working for them to help finalise the design of a future trial.
Scientific summary Our definition of incentives includes financial (positive or negative) and non financial tangible incentives or rewards. Recipients may be women, families and/or NHS or non-NHS service providers at local, regional or national level. Setting: Primary and secondary health and community (including pharmacy) care at three sites: Aberdeen, where there are no incentive schemes; Lancashire, which has incentive schemes to promote breastfeeding and Glasgow, which is about to start a research trial of financial incentives for stopping smoking in pregnancy. Stage 1. We will synthesize the evidence for incentives delivered to women, families and NHS or non NHS providers and their associated theories of behaviour change, using focused research questions to inform the design of a trial. This will produce: i) evidence synthesis reports ii) a taxonomy of incentive characteristics, behaviour change theory, mechanisms of action and the barriers/facilitators to stopping smoking in pregnancy and breastfeeding iii) a short list of promising incentives. Stage 2. For the incentive short-list we will investigate recipient, provider and public acceptability and any unintended effects. Mixed method data will refine the incentive characteristics, timing, quantity, delivery processes, recipient monitoring, organisational, environmental and contextual factors that are likely to increase effectiveness. Stage 3. A DCE survey will refine the most promising intervention(s) to trial. The DCE will identify the relative probabilities of behaviour change for different types and level of incentive intervention and inform effect sizes. If probabilities vary across individuals with different characteristics, and affect outcomes, then a range of incentives may be more effective than a one-size-fits-all approach. Combining all aspects of this study will enable us to define a trial intervention, recruitment and delivery strategies, provide a sample size calculation, model effect sizes and define outcome measurements. This will inform the design of a trial.
Outputs
  1. Conference abstracts from MAINN 2015

    Authors: Authors of 3 abstracts include: Hoddinott P, Thomson G, Morgan H, Crossland N, MacLennan G, Dykes F, Stewart F, Bauld L,Campbell MK, Dombrowski SU.

    Reference: Maternal and Child Nutrition 2015;Maternal and Child Nutrition 2015; Supplement 2: 1-127

  2. Incentive interventions for smoking cessation in pregnancy: a mixed methods evidence synthesis

    Authors: Hoddinott P, Hislop J, Morgan H, Stewart F, Farrar S, Rothnie K, Bauld L, Thomson G

    Reference: Lancet The 2012;380: S48

  3. A ladder logic model to inform the design of incentive trials for women around childbirth.

    Authors: Hoddinott P, Morgan H, Thomson G, Crossland N, Dombrowski SU.

    Reference: International Journal of Behavioural Medicine 2014;1,Supp.1,139. ISSN: 1070-5503

  4. Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings

    Authors: Crossland N, Thomson G, Morgan H, Dombrowski SU, Hoddinott P on behalf of the BIBS study team

    Reference: Social Science & Medicine 2015;128(3):10-17

  5. Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings.

    Authors: Crossland N, Thomson G, Morgan H, Dombrowski SU, Hoddinott P on behalf of the BIBS study team.

    Reference: Social Science & Medicine 2015;128(3):10-17.

  6. Perspectives on financial incentives to health service providers for increasing breastfeeding and smoking quit rates during pregnancy: a mixed methods study

    Authors: Hoddinott, P., Thomson, G., Morgan, H., Crossland, N., MacLennan, G., Dykes, F., Stewart, F., Bauld, L., Campbell, M.K.

    Reference: BMJ Open 2015;BMJ Open 2015;5:e008492 doi:10.1136/bmjopen-2015-008492

  7. Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding.

    Authors: Hoddinott P, Morgan H, MacLennan G, Sewel K, Thomson G, Bauld L, Yi DPat , Ludbrook A, Campbell M.

    Reference: International Journal of Behavioural Medicine 2014;21,Supp.1,61. ISSN: 1070-5503

  8. Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding: a survey of the British public

    Authors: Hoddinott P, Morgan H, MacLennan G, Sewel K, Thomson G, Bauld L, Yi D, Ludbrook A, Campbell M

    Reference: BMJ Open 2014;4:e005524

  9. The effectiveness of incentives to promote breastfeeding: a systematic review.

    Authors: Moran V, Morgan H, Rothnie K, MacLennan G, Stewart F, Thomson G, Crossland N, Tappin D, Campbell M, Hoddinott P.

    Reference: Pediatrics 2015;10.1542/peds.2014-2221

  10. The push me, pull you of financial incentives and health inequalities: a mixed methods study investigating smoking cessation in pregnancy and breastfeeding

    Authors: MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D, Campbell M.

    Reference: Lancet The 2014;Volume 384, Page S37,

  11. Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth.

    Authors: Thomson G, Morgan H, Crossland N, Bauld L, Dykes F, Hoddinott P.

    Reference: PLOS One 2014;DOI: 10.1371/journal.pone.0111322

  12. Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth.

    Authors: Thomson G, Morgan H, Crossland N, Bauld L, Dykes F, Hoddinott P.

    Reference: PLOS One 2014;doi:10.1371/journal.pone.0111322

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