Behavioural insights into stigma-free relational support for pregnant smokers

Purpose This study aims to present behavioural insights from a pilot stigma-free, incentive-supported pregnancy smoking cessation intervention implemented within one of the NHS trusts in Nottinghamshire, England, UK. Design/methodology/approach Quantitative data included operational service metrics (e.g. quit-date setting pre-, during and post-incentive), socio-demographic context and infant health indicators. Qualitative data included semi-structured interviews with pregnant people who achieved smoke-free births, in-depth reflections from tobacco dependency practitioners and academic reflexive accounts. Data were analysed using descriptive statistical comparison for quantitative data and thematic analysis for qualitative data. Findings The incentives increased the quit date setting at a service level. Infant health indicators among quitters resembled those of non-smokers and differed from those who continued smoking. Interviews reveal that stigma, including internalised, anticipated and enacted stigma, became a significant behavioural barrier to engagement. Non-judgemental, relational support from practitioners was vital in overcoming these stigma types, enhancing agency and sustaining cessation. While incentives supported engagement with the service and maintenance of smoking cessation, concern for the baby’s health and trusting relationships were the primary drivers of motivation. Practical implications Smoking cessation interventions in pregnancy should move beyond instrumental approaches. Financial incentives are most effective when embedded within stigma-free, relationship-centred service models. Social marketing interventions should prioritise non-judgemental communication, practitioner training to minimise stigma and to cope with emotional labour and system-level alignment to support sustained behaviour change. Originality/value This study advances social marketing scholarship by integrating behavioural, emotional and relational insights in interventions. It demonstrates how stigma reduction and relational value creation mediate the effectiveness of behavioural incentives, offering empirically grounded guidance for designing socially responsive interventions.