Hoddinott Pat, Thomson Gill, Morgan Heather, Crossland Nicola, MacLennan Graeme, Dykes Fiona, Stewart Fiona, Bauld Linda, Campbell Marion K
Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK.
Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK.
BMJ Open. 2015 Nov 13;5(11):e008492. doi: 10.1136/bmjopen-2015-008492.
To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study.
Cross-sectional survey and qualitative interviews.
Scotland and North West England.
Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees.
Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data.
Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits.
Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required.
作为孕期母乳喂养与戒烟激励措施的益处（BIBS）研究的一部分，探讨针对戒烟和母乳喂养的提供者激励措施的可接受性、机制及后果。
横断面调查和定性访谈。
苏格兰和英格兰西北部。
早期教育专业人员：497名调查受访者包括156名医生；197名健康访视员/产科工作人员；144名其他卫生工作人员。对68名孕妇/产后妇女/家庭成员、32名服务提供者、22名专家/决策者、63名会议参与者进行了定性访谈或焦点小组讨论。
通过电子邮件对早期教育专业人员进行调查，询问向当地卫生服务机构支付款项以实现孕期戒烟和母乳喂养目标的可接受性。使用多变量有序logit模型以5分制衡量一致性。采用框架法分析自由文本调查回复和定性数据。
卫生专业人员对提供者戒烟激励目标的净同意率为52.9%（263/497）；净不同意率为28.6%（142/497）。健康访视员/产科工作人员比医生更有可能表示同意：比值比2.35（95%置信区间1.51至3.64；p<0.001）。对提供者母乳喂养激励目标的净同意率为44.1%（219/497），净不同意率为38.6%（192/497）。女性（与男性相比）更有可能表示同意：比值比1.81（1.09至3.00；p=0.023），健康访视员/产科工作人员（与医生相比）更有可能表示同意：比值比2.54（95%置信区间1.65至3.91；p<0.001）。出现的关键主题包括“可接受性方面的道德困境”“激励措施的必要性”“目标”“集体或分裂行动”以及“监测与证据”。虽然提供者激励措施可以集中行动和资源，但对关系的影响所带来的紧张关系引发了担忧。压力、举证责任、投机行为、形式主义官僚作风和健康不平等是潜在益处的制衡因素。
非医务人员赞成提供者激励措施。需要找到能够增强对共同目标的信任与合作，同时又不会对关系产生负面影响或增加官僚作风的解决方案。
