University of Dundee Medical School, Dundee.
J Health Serv Res Policy. 2012 Oct;17(4):212-8. doi: 10.1258/jhsrp.2012.011084. Epub 2012 Aug 24.
In 2009, one Scottish region launched a smoking cessation programme offering a weekly financial incentive of £12.50 over a 12-week period. However, a significant proportion of registered participants dropped out of the programme, some even failing to collect the financial reward they were owed. We explore reasons for disengagement and failure to re-engage within this group.
Individuals (n = 14) were interviewed in depth. Transcripts from recorded interviews formed the dataset and were analysed using the "Framework" method.
Incentives appeared to introduce a potential change/reversal in the felt contractual relationship between service provider and client: the client was now the provider and being paid to quit. This led to an increased sense of obligation towards the service, and enhanced feelings of failure, guilt and shame post-relapse, and reluctance to continue engagement or re-engagement. Other service factors promoting disengagement included issues of practical delivery through location, timing, administrative burden and incentive preference.
The future design of incentive-based schemes should be cognisant of the potential impact on the client-professional relationship. Increasing the value of the incentive may overcome clients' antipathy towards bureaucracy and monitoring, but may simultaneously exacerbate the sense of failure and resultant stigma associated with relapse. It may be more cost-effective to reduce barriers/costs such as inconvenience, lack of privacy, timing and embarrassment of association of attendance at the pharmacy with methadone use. Alternatively, risks may be managed by reframing weekly rewards as three separate month-long stages, increasing a sense of achievement that a particular stage has been achieved before any relapse.
2009 年，苏格兰的一个地区启动了一项戒烟计划，为参与者提供为期 12 周、每周 12.5 英镑的经济奖励。然而，相当一部分注册参与者退出了该计划，甚至有人未能领取他们应得的经济奖励。我们探讨了这一群体中退出和重新参与的原因。
对 14 名个人进行了深入访谈。记录的访谈记录形成了数据集，并使用“框架”方法进行了分析。
激励措施似乎引入了一种潜在的变化/逆转，即服务提供者和客户之间的感觉契约关系：现在客户是提供者，并且为戒烟而获得报酬。这导致参与者对服务的义务感增强，复吸后产生更多的失败感、内疚感和羞耻感，以及不愿继续参与或重新参与的意愿。其他促进脱钩的服务因素包括地理位置、时间安排、行政负担和激励偏好等实际交付问题。
基于激励的计划的未来设计应考虑到其对客户与专业人士关系的潜在影响。增加激励的价值可能会克服客户对官僚主义和监控的反感，但也可能同时加剧与复吸相关的失败感和由此产生的耻辱感。减少不便、缺乏隐私、时间安排和与在药店使用美沙酮相关的尴尬等障碍/成本可能更具成本效益。或者，可以通过将每周奖励重新定义为三个单独的为期一个月的阶段来管理风险，从而增强对某个阶段已经完成的成就感，然后再考虑复吸的可能性。
