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dc.contributor.authorMorgan, Heatheren_UK
dc.contributor.authorHoddinott, Paten_UK
dc.contributor.authorThomson, Gillen_UK
dc.contributor.authorCrossland, Nicolaen_UK
dc.contributor.authorFarrar, Shelleyen_UK
dc.contributor.authorYi, Deokheeen_UK
dc.contributor.authorHislop, Jennien_UK
dc.contributor.authorMoran, Victoria Hallen_UK
dc.contributor.authorMacLennan, Graemeen_UK
dc.contributor.authorDombrowski, Stephan Uen_UK
dc.contributor.authorRothnie, Kieranen_UK
dc.contributor.authorStewart, Fionaen_UK
dc.contributor.authorBauld, Lindaen_UK
dc.contributor.authorLudbrook, Anneen_UK
dc.contributor.authorDykes, Fionaen_UK
dc.contributor.authorSniehotta, Falko Fen_UK
dc.contributor.authorTappin, Daviden_UK
dc.contributor.authorCampbell, Marion Ken_UK
dc.description.abstractBackground: Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. Aim: To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. Design: Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. Setting: UK. Participants: The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. Methods: (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. Results: Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A ‘ladder' logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical ‘ladder' towards smoking cessation and breastfeeding. Incentive interventions provide opportunity ‘rungs' to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women's capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave ‘healthily' risk them feeling pressurised and failing. To avoid ‘losing face', women may disengage. Limitations: Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. Conclusions: Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important.en_UK
dc.relationMorgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D & Campbell MK (2015) Benefits of incentives for breastfeeding and smoking cessation in pregnancy (BIBS): A mixed-methods study to inform trial design. Health Technology Assessment, 19 (30), pp. 1-516.
dc.rightsPublisher policy allows this work to be made available in this repository. Published in Health Technol Assess 2015;19(30) by NIHR. The original publication is available at:
dc.titleBenefits of incentives for breastfeeding and smoking cessation in pregnancy (BIBS): A mixed-methods study to inform trial designen_UK
dc.typeJournal Articleen_UK
dc.citation.jtitleHealth Technology Assessmenten_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
dc.contributor.affiliationHealth Sciences Research - Stirling - LEGACYen_UK
dc.contributor.affiliationUniversity of Central Lancashireen_UK
dc.contributor.affiliationUniversity of Central Lancashireen_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
dc.contributor.affiliationKing's College Londonen_UK
dc.contributor.affiliationNewcastle Universityen_UK
dc.contributor.affiliationUniversity of Central Lancashireen_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
dc.contributor.affiliationInstitute for Social Marketingen_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
dc.contributor.affiliationUniversity of Central Lancashireen_UK
dc.contributor.affiliationNewcastle Universityen_UK
dc.contributor.affiliationInstitute for Social Marketingen_UK
dc.contributor.affiliationUniversity of Aberdeenen_UK
rioxxterms.apcnot requireden_UK
rioxxterms.typeJournal Article/Reviewen_UK
local.rioxx.authorMorgan, Heather|en_UK
local.rioxx.authorHoddinott, Pat|0000-0002-4372-9681en_UK
local.rioxx.authorThomson, Gill|en_UK
local.rioxx.authorCrossland, Nicola|en_UK
local.rioxx.authorFarrar, Shelley|en_UK
local.rioxx.authorYi, Deokhee|en_UK
local.rioxx.authorHislop, Jenni|en_UK
local.rioxx.authorMoran, Victoria Hall|en_UK
local.rioxx.authorMacLennan, Graeme|en_UK
local.rioxx.authorDombrowski, Stephan U|0000-0001-9832-2777en_UK
local.rioxx.authorRothnie, Kieran|en_UK
local.rioxx.authorStewart, Fiona|en_UK
local.rioxx.authorBauld, Linda|en_UK
local.rioxx.authorLudbrook, Anne|en_UK
local.rioxx.authorDykes, Fiona|en_UK
local.rioxx.authorSniehotta, Falko F|en_UK
local.rioxx.authorTappin, David|en_UK
local.rioxx.authorCampbell, Marion K|en_UK
local.rioxx.projectInternal Project|University of Stirling|
local.rioxx.filenameBIBS 2015 FullReport-hta19300.pdfen_UK
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles

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