Acceptability of financial incentives for breastfeeding: thematic analysis of readers’ comments to UK online news reports

Giles, Emma L.; Holmes, Matthew; McColl, Elaine; Sniehotta, Falko F.; Adams, Jean

doi:10.1186/s12884-015-0549-5

Cited by 41 publications

(53 citation statements)

References 64 publications

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“…[94][95][96][97] However, this was not a strong finding in the current work. The systematic review was not able to draw generalisable conclusions concerning effectiveness, but did find some instances in which financial incentives were effective at encouraging uptake.…”

Section: Potential Effectivenesscontrasting

confidence: 75%

“…This appears to be a common phenomenon in qualitative work on the acceptability of health-promoting financial incentives. 96,97 It is not clear exactly what this reflects: perhaps that participants dislike the idea of incentives so much that they would rather not talk about them, or perhaps that they dislike them but find it hard to articulate specifically why, choosing instead to move the conversation to easier ground. Furthermore, many of the alternative approaches to maximising vaccination uptake proposed by participants reflect existing guidance and good practice 11 and known attitudes of parents to vaccination.…”

Section: Comparison With Previous Workmentioning

confidence: 99%

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Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Adams

Bateman

Becker

et al. 2015

Health Technol Assess

Self Cite

101

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BackgroundUptake of preschool vaccinations is less than optimal. Financial incentives and quasi-mandatory policies (restricting access to child care or educational settings to fully vaccinated children) have been used to increase uptake internationally, but not in the UK.ObjectiveTo provide evidence on the effectiveness, acceptability and economic costs and consequences of parental financial incentives and quasi-mandatory schemes for increasing the uptake of preschool vaccinations.DesignSystematic review, qualitative study and discrete choice experiment (DCE) with questionnaire.SettingCommunity, health and education settings in England.ParticipantsQualitative study – parents and carers of preschool children, health and educational professionals. DCE – parents and carers of preschool children identified as ‘at high risk’ and ‘not at high risk’ of incompletely vaccinating their children.Data sourcesQualitative study – focus groups and individual interviews. DCE – online questionnaire.Review methodsThe review included studies exploring the effectiveness, acceptability or economic costs and consequences of interventions that offered contingent rewards or penalties with real material value for preschool vaccinations, or quasi-mandatory schemes that restricted access to ‘universal’ services, compared with usual care or no intervention. Electronic database, reference and citation searches were conducted.ResultsSystematic review – there was insufficient evidence to conclude that the interventions considered are effective. There was some evidence that the quasi-mandatory interventions were acceptable. There was insufficient evidence to draw conclusions on economic costs and consequences. Qualitative study – there was little appetite for parental financial incentives. Quasi-mandatory schemes were more acceptable. Optimising current services was consistently preferred to the interventions proposed. DCE and questionnaire – universal parental financial incentives were preferred to quasi-mandatory interventions, which were preferred to targeted incentives. Those reporting that they would need an incentive to vaccinate their children completely required around £110. Those who did not felt that the maximum acceptable incentive was around £70.LimitationsSystematic review – a number of relevant studies were excluded as they did not meet the study design inclusion criteria. Qualitative study – few partially and non-vaccinating parents were recruited. DCE and questionnaire – data were from a convenience sample.ConclusionsThere is little current evidence on the effectiveness or economic costs and consequences of parental financial incentives and quasi-mandatory interventions for preschool vaccinations. Universal incentives are likely to be more acceptable than targeted ones. Preferences concerning incentives versus quasi-mandatory interventions may depend on the context in which these are elicited.Future workFurther evidence is required on (i) the effectiveness and optimal configuration of parental financial incentive and quasi-mandatory interventions for preschool vaccinations – if effectiveness is confirmed, further evidence is required on how to communicate this to stakeholders and the impact on acceptability; and (ii) the acceptability of parental financial incentive and quasi-mandatory interventions for preschool vaccinations to members of the population who are not parents of preschool children or relevant health professionals. Further consideration should be given to (i) incorporating reasons for non-vaccination into new interventions for promoting vaccination uptake; and (ii) how existing services can be optimised.Study registrationThis study is registered as PROSPERO CRD42012003192.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Potential Effectivenesscontrasting

confidence: 75%

Section: Comparison With Previous Workmentioning

confidence: 99%

Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment

Adams

Bateman

Becker

et al. 2015

Health Technol Assess

Self Cite

101

View full text Add to dashboard Cite

show abstract

“…34,38,55 In terms of sources of frames, our media analysis reconfirmed previous results showing that journalists often don't mention their source of information when reporting on health issues. 56 In alignment with previous media analyses, 41,57 the results of this study show that the quantity of media coverage appears to be linked to specific events.…”

Section: Discussionsupporting

confidence: 76%

“…61 Giles and associates' study of public opinions toward financial incentives for breastfeeding found that the public often argued against the policy because they were concerned that the government was interfering with everyday life and the policy reinforced a feeling of failure or guilt in mothers unable to breastfeed. 55 Arguments opposing tobacco policies often frame the issue as restrictions on freedom of choice as well as unnecessary government interference. 34,38 Studies of public health policy have found that Americans often value and adamantly defend the freedom of choice, even unhealthy choices.…”

Section: Discussionmentioning

confidence: 99%

“…18 Similarly, a 2015 analysis of public opinions of financial incentives to encourage breastfeeding in the UK found that a majority of messages from readers opposed the implementation of this policy. 55 Much news media on health and health policy focuses on stories about personal hardship. 41,42 According to Henderson and associates, in the past British newspapers focused on the challenges of breastfeeding, portraying it as problematic, embarrassing, and funny as compared to bottle feeding, which is portrayed as normal and lacking difficulty.…”

Section: Discussionmentioning

confidence: 99%

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