Chapter 11 376 free to choose the incentive of their liking. Those willing to pay a deposit were advised an incentive scheme that involved a deposit, given previous evidence that such a scheme was the most effective, yet impopular. Combined with donating the deposit to a good cause in the case of relapse, this might have made deposit contracts more popular in our study. Interviews Interviews with non-participants showed that almost all respondents were unaware of the possibility of earning incentives, but they were aware that the smoking cessation program was offered. Most respondents did not feel ready to quit smoking (yet) and did not sign up for information about the smoking cessation program; hence, they did not receive information about the possibility of earning incentives. A few respondents would have been interested in the program, and they knew about the incentives. However, quitting by themselves and intrinsic motivation were deemed to be more important by most participants. There was a strong belief that if you really wanted to quit, you could, and you could, do it on your own. While a tremendous body of literature has shown strongly increasing quit rates for guided quit attempts,3, 11, 25 people who smoke seem to underestimate the effectiveness of these programmes. It is also important to mention that some employees felt guilty or ashamed of smoking in a hospital setting, or did not want colleagues to know that they smoke. This could be a topic in the smoking cessation program but also something to discuss with non-smoking employees. Interview participants expressed feelings of being undervalued and experiencing work-related stress. The COVID-19 pandemic might have amplified and intensified existing workplace issues such as heavy workload and job-related stress.28 The COVID-19 pandemic started within the first half year of recruitment. Hospitals were saturated, staff was overworked and especially during those first month’s smoking cessation was not seen as a priority at all. This of course impacted our recruitment. However, we experienced low recruitment prior to the COVID-19 pandemic, and when COVID-19 became a less pressing issue. Hence, we decided that our recruitment issues were larger than COVID-19 alone and conducted the interview study. Another surprising insight of the interview study was the mismatch between what the researchers expected to be efficient and how participants viewed those elements. The interview participants were critical of the use of incentives and the role of the employer in health promotion. A priori, these were seen as strengths
RkJQdWJsaXNoZXIy MTk4NDMw