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. 2022 Dec 24;22(1):963.
doi: 10.1186/s12884-022-05292-9.

Smoking cessation in pregnant women using financial incentives: a feasibility study

T A Kroder  1 , L L Peters  2   3 , A L Roggeveld  1 , M Holtrop  1 , L Harshagen  1 , L M Klein  1 , J J H M Erwich  4
Affiliations

Smoking cessation in pregnant women using financial incentives: a feasibility study

T A Kroder et al. BMC Pregnancy Childbirth. .

Abstract

Background: The high prevalence of smoking pregnant women in Dutch areas with lower socioeconomic status and the consecutively harmful exposure to tobacco to both mother and child, depicted a high need for a novel intervention. According to other studies, the utilisation of financial incentives appeared to be a promising method for smoking cessation in pregnant women. Therefore, the aim of this study was to investigate the feasibility of implementing contingent financial incentives as smoking cessation support for pregnant women in the Netherlands.

Methods: Feasibility study consisting of four developmental phases: (1) acceptability of Dutch population regarding financial-incentive-intervention by conducting an online questionnaire, (2) composing a pilot study utilising the financial-incentive-intervention in clinical practice, (3) execution of the composed pilot study and (4) evaluation of the executed pilot study utilising a mixed-methods approach. A financial-incentive-intervention, given in a contingent financial scheme (during five consequential appointments, respectively €25/€50/€100/€150/€250), if smoking abstinence was proven by the amount of cotinine in the urine of the pregnant women measured utilising a urine dipstick test. The public acceptability for the financial-incentive-intervention was assessed using 5-Likert scales. The number of pregnant women able to abstain from smoking during the pilot study and utilising the financial-incentive-intervention in clinical practice were used to assess the prosperity and practicality of the pilot study respectively. The pilot study was evaluated using a mixed-methods approach.

Results: In total, 55.1% of the Dutch population sample (n = 328) found a financial incentive inappropriate for smoking cessation in pregnant women, while the healthcare professionals and pilot study participants thought the financial-incentive-intervention to be a helpful approach. Eleven vouchers were given during the pilot study, and one woman completed all test points and tested negative for cotinine at the end of the pilot study.

Conclusion: Although the financial-incentive-intervention appeared to be a promising approach for smoking cessation in pregnant women, the acceptability of the Dutch population and the number of pregnant women able to abstain smoking during this pilot study was low. Despite the limited study population, this study proved the concept of this financial-incentive-intervention to be feasible for implementation in the Netherlands.

Trial registration: Not applicable since this is a feasibility study prior to a trial.

Keywords: Contingent; Cotinine; Feasibility study; Financial incentives; Intervention; Pregnancy; Public acceptability; Smoking cessation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design for the pilot study. Illustrating the time points of the interview and cotinine urine tests plus the amount of money the participants could receive at each time point. The green cotinine urine tests represent negative tests indicating no exposure to smoking. The Figure illustrates the amount of money the vouchers would represent if a participant would be present at the interview and consecutively would have four negative cotinine urine tests indicating she had stopped smoking. In case a participant would have a positive cotinine urine test in week 7, this would result in no voucher at that appointment and consequently a final voucher of €150 euros in week 10 if the cotinine urine test would then again be negative
Fig. 2
Fig. 2
Flowchart inclusion of responses to the online questionnaire
See this image and copyright information in PMC

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