Counties Manukau Smokefree Pregnancy Incentives Pilot
Goals and objectives
There are high rates of smoking in pregnancy in the Counties Manukau area but low engagement and success rates with current smokefree services. The purpose of the pilot was to see if the provision of incentives increases engagement with smoking cessation services and quit rates. International evidence has suggested that incentives may be the most effective strategy to help pregnant women stop smoking, with clinical trials still being conducted. We wanted to explore how an incentive approach could be implemented, and how this would be perceived by the general public.
South Auckland Māori and Pacific Island young women and women in their first or second trimester who continued to smoke during pregnancy. Whānau were also incentivised to stop smoking and support the smokefree pregnancy.
Project fit with 2025 aims
Reducing smoking in pregnancy by increasing the number of pregnant women who are supported to stop smoking using an innovative intervention. The objective was to increase the number of quit attempts made and the number of smokefree babies born, as well as to promote quitting as the norm within whānau.
A project team and steering group was established to design and guide the pilot. A practitioner was employed solely to deliver the 12 week incentive programme to complement existing behavioural support and medication. Clients received a total of $300 worth of vouchers distributed at different time points (week 1 after Target Quit Date, week 4, week 8 and week 12). Validation was based on abstinence and carbon monoxide (CO) monitor results.
Significant time was spent introducing midwives, GPs and other referring agencies to the concept. Self-referrals were promoted via posters put up in key places, media advertising and targeted facebook promotion. Resources were developed and an evaluation team were contracted to monitor the pilot during its first year. This included interviewing clients and key stakeholders to assess the implementation and acceptability of the pilot.
DHB and community maternity services, primary care services based in the pilot area, Non-Government Organisations (NGOs) connected to teen pregnancy and midwifery services, Māori and Pacific community smokefree services, DHB communications department, teenage mums (for consultation), international researchers and media channels such as local newspapers and radio.
- The pilot was well received by the community as evidenced by the positive responses to the promotion of the pilot, the high percentage of self-referrals (18%) and the increased number of referring agencies.
- Approx. 160 referrals were received over 10 months of service delivery for hapu wahine which is approximately 50% of the estimated number of women smoking during pregnancy in the pilot area.
- Of those referred 70% enrolled in the service, and of those who enrolled 76% set a quit date. Both of these rates are significantly higher compared to those achieved by previous smokefree pregnancy services. The intervention resulted in a 65% quit rate at 4 weeks CO validated and 60% at 12 weeks.
- An increased number of whānau joined the programme to support the smokefree pregnancy, and the service was able to engage with young women (as young as 14) and at an early stage in pregnancy (50% were under 20 weeks pregnant).
- Offering an incentive attracted more people to the service and helped midwives to refer more clients. The types of people who engaged with the service were traditionally harder to engage i.e. young and earlier in pregnancy, and those not engaging with midwifery services.
- Promoting the programme within the community via posters in shopping malls, pharmacies and dairies increased the rate of self-referrals. The 0800 number allowed clients to call the practitioners free of charge and this helped with the transient nature of South Auckland clients and changes in contact details.
- Providing clients with their choice of vouchers and distributing them in a structured format over 12 weeks led to sustained engagement, decreased rates of non-attendance and a sense of obligation to complete the programme.
- Developing a resource for clients to track their progress and keep a record of Carbon Monoxide (CO) readings. The CO monitor was enthusiastically received by clients and often they put their success down to the accountability that the monitor instills. Seeing the visual impact of smoking and the fact that they could see their unborn baby’s reading seems to be very motivating.
- Providing free Quickmist also worked well for many clients, particularly if they had lost confidence with other NRT products.
- Incentivising whānau led to an increase in people supporting the women to engage with the service and overall support of a smokefree pregnancy.
What could be done differently
Evaluation findings are due soon and will help to guide our future work in this area.
- A couple of reccomendations so far are to include non Māori/Pacific clients and to extend the intervention to other localities within South Auckland.