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

Author

Listed:
  • Gill Thomson
  • Heather Morgan
  • Nicola Crossland
  • Linda Bauld
  • Fiona Dykes
  • Pat Hoddinott
  • on behalf of the BIBS team

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 (n = 497) 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.

Suggested Citation

  • Gill Thomson & Heather Morgan & Nicola Crossland & Linda Bauld & Fiona Dykes & Pat Hoddinott & on behalf of the BIBS team, 2014. "Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-21, October.
    • Handle: RePEc:plo:pone00:0111322
    DOI: 10.1371/journal.pone.0111322
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    References listed on IDEAS

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    1. Emma L Giles & Shannon Robalino & Elaine McColl & Falko F Sniehotta & Jean Adams, 2014. "The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-16, March.
    2. Bruno S. Frey, 1997. "Not Just for the Money," Books, Edward Elgar Publishing, number 1183.
    3. Walsh, R.A. & Redman, S. & Brinsmead, M.W. & Byme, J.M. & Melmelh, A., 1997. "A smoking cessation program at a public antenatal clinic," American Journal of Public Health, American Public Health Association, vol. 87(7), pages 1201-1204.
    4. Matt Sutton & Ross Elder & Bruce Guthrie & Graham Watt, 2010. "Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 1-13, January.
    5. Promberger, Marianne & Dolan, Paul & Marteau, Theresa M., 2012. "“Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour," Social Science & Medicine, Elsevier, vol. 75(12), pages 2509-2514.
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    Cited by:

    1. Barbara Whelan & Clare Relton & Maxine Johnson & Mark Strong & Kate J. Thomas & Darren Umney & Mary Renfrew, 2018. "Valuing Breastfeeding: Health Care Professionals’ Experiences of Delivering a Conditional Cash Transfer Scheme for Breastfeeding in Areas With Low Breastfeeding Rates," SAGE Open, , vol. 8(2), pages 21582440187, May.
    2. Crossland, Nicola & Thomson, Gill & Morgan, Heather & Dombrowski, Stephan U. & Hoddinott, Pat, 2015. "Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings," Social Science & Medicine, Elsevier, vol. 128(C), pages 10-17.
    3. Thierry Hurlimann & Juan Pablo Peña-Rosas & Abha Saxena & Gerardo Zamora & Béatrice Godard, 2017. "Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-25, October.

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