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PLoS One. 2014 Oct 30;9(10):e111322. doi: 10.1371/journal.pone.0111322. eCollection 2014.

Unintended consequences of incentive provision for behaviour change and maintenance around childbirth.

Author information

1
Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England.
2
Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland.
3
Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland.

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 (nā€Š=ā€Š497) 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.

PMID:
25357121
PMCID:
PMC4214733
DOI:
10.1371/journal.pone.0111322
[Indexed for MEDLINE]
Free PMC Article

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