PERSonalised Incentives for Supporting Tobacco cessation (PERSIST) among healthcare employees: evaluation and lessons learned 375 11 Discussion Our randomized controlled trial assessing the effectiveness of personalized incentives for sustained smoking cessation among healthcare employees participating in group-based smoking cessation training was closed prematurely due to low recruitment. Although the overall continuous cessation rates after a year were high among trial participants, there was no clear sign of the added benefit of personalized incentives. Interviews with non-participating employees showed three main reasons why people who smoke would not participate: unawareness that incentives could be earned, not being ready to quit, and not feeling the need for a cessation program to quit. Trial In our study, the quit rates were substantially higher than those in many other studies that evaluated workplace-based smoking cessation interventions. While a systematic review and meta-analysis of smoking cessation programs among healthcare employees found a fairly high success rate of 21% for behavioural and pharmacological smoking cessation interventions in this group,25 we found even higher rates. A likely explanation for this finding is the high degree of selection in our sample. We focused on hospital employees, particularly among staff in medical settings where the importance of good health was felt. Moreover, against the background of the low recruitment rates, those who participated in the program were most likely very motivated to quit. This might also explain why we did not observe higher quit rates in the intervention group than in the control group; we may have reached a ceiling effect in our sample, in which (personalizing) the intervention had no additional effect. However, any comparisons should be made with care, given the sample size limitation of our study. Another striking finding was that the share of participants who chose a depositbased incentive scheme (57%) was remarkably high compared to previous literature.26, 27 For example, in a US workplace-based smoking cessation trial, Halpern et al.8 offered four different incentive schemes to participants, of which two deposit-based schemes had a combined acceptance rate of only 14%. While this in part can be the effect of having a highly motivated sample, another explanation might be the personalized advice offered to participants. A novel element of our trial was that we offered participants informed advice on which incentive scheme would likely be most suitable for them, while they remained
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