Chapter 11 360 for health care workers smoking cessation is particularly relevant as they may be expected to have an exemplary role. Financial incentives can make smoking cessation programs more attractive, thereby increasing enrolment rates, stimulating compliance, and enhancing cessation rates.3 Despite these positive aspects, participation rates of workplacebased smoking cessation programs involving incentives are generally low.11 Unfortunately, this was also the case in the PERSIST trial, and we prematurely concluded the trial after recruiting 31 participants (i.e., 14% of the required sample size of 220) after two years. Given the limited understanding of why eligible participants do not participate in cessation programs with financial incentives, we extended our initial aim to explore the considerations of potentially eligible non-participants (employees who smoke) regarding their decision to not participate in smoking cessation programs in the workplace. We aim to identify and analyse barriers and facilitators that could help improve future programs. Here, we describe the findings of our prematurely concluded trial, as well as those of the subsequent interview study among non-participants. Methods Trial We conducted a randomized controlled trial comparing the effectiveness of personalized incentives in combination with group-based training sessions to promote sustained smoking cessation among healthcare employees to groupbased training sessions alone, following our peer-reviewed published protocol.9, 12 Eligible participants were persons who smoked daily and were employed by one of four participating hospitals in the South-Holland region of the Netherlands (Erasmus MC, ⁓15,000 employees; Fransiscus Gasthuis & Vlietland, ⁓5,000 employees; Ikazia, ⁓2,500 employees; Leiden University Medical Center, ⁓8,800 employees). Individuals who used only e-cigarettes were excluded from the study. Recruitment took place between October 1, 2019, and April 1, 2021, when it was decided to terminate the study. Follow-up ended on July 1, 2022, and 15 months after the last inclusion. Based on previous research and an anticipated extra motivation among health care employees,13 we estimated increase in CO-validated continuous abstinence from 30% in the control group to 50% in the intervention group, a sample size of at least 185 participants was needed, which was set to 220 to account for
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