BACKGROUND: Despite the overall decline in smoking prevalence, socioeconomic disparities in smoking quit rates are widening in Ireland. Financial incentives (FI) are effective tools to enhance smoking cessation. However, they are complex, context-dependent and often criticised for unclear rationale on approach and structure. Co-creation methods ensure local community views are integrated into intervention design, enhancing feasibility, but no such approach has been applied to FI for smoking cessation. Hence, we aimed to co-design a FI programme together with community stakeholders to answer the question: what is an acceptable and effective FI programme for local Stop Smoking Services?
METHODS: A mixed-methods approach was utilised to codesign the FI programme. A modified Nominal Group Technique, underpinned by Adams et al. (2014) 8-domain incentive framework, was employed over three one-day workshops in Limerick, Dublin and Longford, with 59 community stakeholders, to elicit ideas and reach consensus on FI. We summarised quantitative data and the most highly rated ideas and qualitatively analysed participants’ perceptions on individual domains and perceived barriers and facilitators of implementation.
RESULTS: Results according to the eight domains were: 1) Total amount: €400 (Median, IQR: 200-500); 2) Form: Digital/Physical Voucher; 3) Certainty: Definite reward; 4) Target population: Eligible smokers in deprived areas; 5) Target behaviour: Validated quit; 6) Schedule/Frequency: Incremental increases aligned with current services; 7) Immediacy: On the day or as soon as possible; 8) Provider: Stop Smoking Advisors. Implementation issues included increased workload and time constraints of service providers and possibility of 'gaming' the system. Establishing a standardised intervention protocol, adequate staff training and regular one-to-one consultations with clients presented as facilitators.
CONCLUSIONS: This is the first study to codesign a stakeholder-mediated, tailored and theoretically-sound incentive-based programme to support smoking cessation. These results will inform programme implementation and evaluation in local clinics.