Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
Soc Sci Med. 2015 Mar;128:10-7. doi: 10.1016/j.socscimed.2014.12.019. Epub 2014 Dec 18.
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.
经济或实物激励是改善健康行为的一种策略。激励的作用机制复杂且存在争议。本研究采用多学科综合混合方法，全程与服务使用者合作，针对妊娠和哺乳期戒烟，开发了一种激励类型及其意义的分类法，旨在为激励干预设计提供信息，深入了解激励的可接受性和作用机制。系统地对妊娠或哺乳期戒烟激励干预研究进行证据综合，确定了激励特征，并将其发展为初始类别。关于用户观点和可接受性的已发表定性数据很少。在英国三个地区进行了定性访谈和焦点小组讨论，参与者包括来自目标人群的 88 名女性及其重要他人，53 名服务提供者，24 名专家/决策者和会议代表，具有不同的社会人口统计学特征。确定了新的潜在激励因素和提供者，包括有和没有激励经验的提供者。确定的激励因素（已发表和新兴）分为八类：现金和购物券、产妇幸福感、婴儿和妊娠相关、行为相关、健康相关、通用效用、奖励和证书以及体验。通过同时进行数据收集和主题分析，对分类法进行了反复修订，以探索参与者对“激励”的理解，并比较和对比不同类型的含义。我们的分类法可以从三个维度来理解：限制程度、每一种激励的享乐和/或功利程度，以及每一种激励是否仅具有货币价值还是具有货币价值加社会价值。激励类型的自主权、意义和社会价值的层次影响其可接受性，并与结构、社会和个人因素相互作用。超越简单激励描述的激励含义维度应能为激励计划设计提供信息，并可能影响结果。
