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When we actually looked at the evidence of similar projects that had been published
we found that traditional methods of smoking cessation support in this group provided
on average a difference of 6 quitters per 100 women that engaged and
this simply wasn't good enough to turn around the population statistic that we’d been given.
However the incentive plus social support idea clearly provided a difference
of around 30 mothers per 100 engaging and so provided
a much better investment for us in terms of value for money.
When we were scoping the project we brought together a stakeholder group
of all the people that we thought might have a role to play in the delivery of the intervention.
And it seemed that we were quite successful in imagining who we’d need
to successfully bring the idea that we had to fruition.
And particular interest, the community pharmacist as a contractor service,
we had to negotiate with the contractor committee and agree a price for their involvement.
And also because the pharmacy contractors were members of different commercial companies
we had to effectively communicate with all of these commercial companies
in order to make sure that the staff were informed and that they understood what they were doing for what cost.
We wanted to understand how the smokers themselves,
the pregnant women would react to this offer of an incentive.
And so we organised a whole series of focus groups to explore the questions
through the community development agency, the Dundee Healthy Living Initiative.
Through talking to women that were in the scheme,
we found out that the incentive actually provided a socially reasonable excuse for not smoking
and we knew that in some of our poorest communities over 50% of the population smoked
and we hadn’t quite tied up the notion that smoking was the social norm.
We’d heard from our colleagues in midwifery that smoking was often thought to be beneficial,
you know the anecdotal stories about mothers and their daughters, about if you smoke during pregnancy
you’ll have a smaller baby and an easier birth. And we hadn’t figured out that
smoking was part of the social norm of behaviour that was expected and that people within a close social group
who didn’t smoke during their pregnancy were setting themselves out
as something different or special,
however the ability to say, “Oh I’m getting money for this, for stopping smoking”
provided a socially acceptable excuse amongst a poorer community for not smoking.