Title : Money doesn't mean anything to me: How a financial incentive for tobacco smoking cessation is experienced by women in pregnancy
Abstract:
Financial incentives as a method of contingency management have been employed recently to promote smoking cessation in pregnancy. While there has been some success, there is limited understanding of women’s perception and experience of being offered an incentive for behaviour change. Women (n=12) who smoked tobacco during pregnancy were recruited from an Adelaide hospital. They were offered a $100 gift-card for 4-weeks smoking abstinence in pregnancy, verified by carbon monoxide monitor. Two interviews were conducted, ~4-weeks apart over an incentive initiated cessation attempt. They were audio-recorded, transcribed and thematically analysed against behaviour change models considering, but not limited to, motivation, intention, control and self-efficacy. A financial incentive for smoking cessation was ineffective for over 90% of the participants. Four qualitative themes were generated: 1) initial optimism but with trepidation about committing to success, 2) women describe the ‘use-value’ of smoking in pregnancy within the context of their caring roles, while devaluing the significance of money in their lives, 3) women expressed having limited control over smoking behaviour in pregnancy that lead to decreased self-efficacy and disempowerment, culminating in stress, anxiety and shame with the financial incentive offered, and 4) women ultimately felt devalued and therefore lacked the autonomous motivation required for successful cessation. Several large trials offering financial incentives for smoking cessation in pregnancy have reported challenges with recruitment and ‘lack of involvement’ of the target population. Thus, the perspectives from this trial provide a valuable foundation for understanding the experience of participants for whom a financial incentive is ineffective, as well as those who may be reluctant to engage with the intervention at all.
