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

Nicola Crossland, Gill Thomson, Heather Morgan, Stephan U. Dombrowski, Pat Hoddinott

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)
10 Downloads (Pure)


Financial or tangible incentives are a strategy for improving health behaviours. The mechanisms of action of incentives are complex and debated. Using a multidisciplinary integrated mixed methods study, with service-user collaboration throughout, we developed a typology of incentives and their meanings for initiating and sustaining smoking cessation in pregnancy and breastfeeding. The ultimate aim was to inform incentive intervention design by providing insights into incentive acceptability and mechanisms of action.

Systematic evidence syntheses of incentive intervention studies for smoking cessation in pregnancy or breastfeeding identified incentive characteristics, which were developed into initial categories. Little published qualitative data on user perspectives and acceptability was available. Qualitative interviews and focus groups conducted in three UK regions with a diverse socio-demographic sample of 88 women and significant others from the target population, 53 service providers, 24 experts/decision makers, and conference attendees identified new potential incentives and providers, with and without experience of incentives.

Identified incentives (published and emergent) were classified into eight categories: cash and shopping vouchers, maternal wellbeing, baby and pregnancy-related, behaviour-related, health-related, general utility, awards and certificates, and experiences. A typology was refined iteratively through concurrent data collection and thematic analysis to explore participants' understandings of ‘incentives’ and to compare and contrast meanings across types. Our typology can be understood in three dimensions: the degree of restriction, the extent to which each is hedonic and/or utilitarian, and whether each has solely monetary value versus monetary with added social value.

The layers of autonomy, meanings and the social value of incentive types influence their acceptability and interact with structural, social, and personal factors. Dimensions of incentive meaning that go beyond the simple incentive description should inform incentive programme design and are likely to influence outcomes.
Original languageEnglish
Pages (from-to)10-17
Number of pages8
JournalSocial Science & Medicine
Early online date18 Dec 2014
Publication statusPublished - Mar 2015

Bibliographical note

We thank all members of the BIBS research team and our grant co-applicants: Professor Fiona Dykes, Professor Linda Bauld, Professor David Tappin, Professor Anne Ludbrook, Dr Shelley Farrar, Professor Falko Sniehotta, Graeme MacLennan and Professor Marion Campbell for their collaboration and input into the BIBS study design. Additional thanks to Fiona Stewart at the University of Aberdeen and for providing guidance with literature searching and reference management. We also thank our co-applicant collaborators: Mastrick Cafe Creche, Aberdeen and Wendy Ratcliffe, who facilitated access; and St Cuthbert's and Palatine Children's Centre, Blackpool and Helen Cook.


  • incentives
  • breastfeeding
  • smoking cessation
  • typology
  • behaviour change
  • health behaviour
  • acceptability
  • motivation


Dive into the research topics of 'Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings'. Together they form a unique fingerprint.

Cite this