4.2 Policy and practice focus: Julie’s literature review
Julie’s literature review, conducted in conjunction with a range of public health academics, focused on the use of financial incentives to stop pregnant women from smoking, thus promoting their health and the future health of their children.
Having reviewed the evidence, I admit that I was surprised to discover that financial incentives appeared to be four times more effective than any other approach. Being concerned about the ethics of this approach and anticipating local (professional) resistance to it, I contacted Professor Theresa Marteau, an expert in financial incentives for behaviour change, for advice.
Theresa Marteau replied to my enquiry (some academics don’t, but it’s always worth a try) and sent me her draft research protocol to pilot financial incentives to help pregnant women quit in a UK setting. I secured the support of Derbyshire’s Director of Public Health, including the funding, to pilot this protocol in Derbyshire. The pilot ran for a 12-month period at Chesterfield Hospital. My literature review and its findings were instrumental in making this happen. Without the evidence from my literature review, I would not have been able to secure the managerial or financial support to develop the pilot.
In previous years the quit rate for smoking among pregnant women using Chesterfield Hospital maternity services was 1% of the total cohort of smokers. The quit rate rose to 8% during our pilot. In summary, a total of 239 (39%) of the 615 women (pregnant smokers) in the pilot enrolled on the scheme, of whom 143 made at least one quit attempt and received an incentive payment, and 97 out of 143 women were still quit six weeks later. Of these, 48 women were biochemically validated as still quit at delivery, 25 of whom remained biochemically quit six months later. These results resulted in a further significant policy change, which involved expansion of the intervention to the remaining areas of Derbyshire.
Here, Julie reports two things, first that the literature review directly fed into a change of policy and practice, in how public health was promoted. Yet, giving smokers money to quit smoking might, for some people, seem morally wrong or bad practice in principle, despite evidence of effectiveness. Another point here is that Julie’s research led to a pilot to test the policy. In other words, both from a scientific and a political point of view, piloting of potentially controversial policies through new primary empirical research is likely to be necessary. In this case, the pilot led to a generalised change in practice in Derbyshire.