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Results (A2): Thematic Analysis
Six factors were associated with retention and drop out
1.Level of client motivation (findings confounded by programme experience but corroborated by CP)
T1 & T3 high, T4 & T6 low
“To be honest you can usually tell quite quickly whether people actually have any intention of trying to give up smoking or not” CP 6
2.Life events and familial support (often conspired to effect engagement) Especially pertinent to T5
“I had stopped all the way through until, the reason I started again is her dad walked out when she was three weeks old (...) I was left with two bairns on my own, I just turned to the fags again (….) I was smoking about 40 a day. I’ve never smoked that much in my life” Client 7
3.Client screening procedure (some registered out of a sense of obligation) Typified by T6
“I just kind of, I mean I only went in there to get patches and I was getting hit with all this stuff and I was like “Just put my name down, whatever””Client 2
4.Registration process (for some characterised by delays and frustration) Impacted negatively on T5
“I just got kind of embarrassed having to go into the chemist and stand there like a bit of a wally kind of explaining to them why I was there and they didn’t really seem to know what to do. I just thought you know what I can’t be bothered with this anymore”Client 19
Analysis
5.Service package(esp. role played by incentives: not part of decision to quit but instead encouraged attendance) Critical to engaging T3“If the scheme was done without the £12.50 then I probably wouldn’t make as much effort to go to the chemist and I wouldn’t make as much effort to speak to (the smoking advisor) and say how I’m doing and all this kind of stuff”Client 1
6.Continuity and quality of support(receiving support from the same member of the pharmacy team a major strength)Again valued by T3“She (the pharmacist) was great. She was never condescending, she never told you off if you had failed, you know? She was just like a friend that you could sit and chat to about anything”Client 11
Conclusions
•Monetary incentives can have an important role:
–Doesn’t effect motivation to quit
–But promotes engagement and loyalty
•Value limited to specific sub-groups, esp. ‘enthusiastic amateurs’ (T3)
•Success associated with dependence on the reward6:
–Works best with those moderately dependent
–Most and least dependent fair less well
•Structured research approaches needed to test these relationships
References
1.Lumley J, Oliver SS, Chamberlain C, et al.(2004) Interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews2004, Issue 4. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub2
2. MacAskill S, Bauld L, Tappin D and Eadie D (2008). Smoking cessation support in pregnancy in Scotland, NHS Health Scotland, Glasgow. ISBN: 978-1-84485-424-7
3.Cahill K and Perera R (2008). Competitions and incentives for smoking cessation. Cochrane Database of Systematic Reviews2008, 16;(3):CD004307.
4.Heil SH, Higgins ST, Berstein IM et al (2008). Effects of voucher-based incentives on abstinence from cigarette smoking and foetal growth among pregnant women. Addiction103, 1009-10018.
5. Lowry RJ, Hardy S, Jordan C, and Wayman G (2004). Using social marketing to increase recruitment of pregnant smokers to smoking cessation service: a success story. Public Health11