General discussion 395 12 financial issues. Before and after the coaching trajectory, modest increases in the intentions for healthier behaviour, such as eating more fruit and vegetables or quitting smoking, were observed among our small sample. While Chapter 8 focussed on external factors such as multi-problem situations influencing (health) behaviour, internal factors also largely influence health behaviour. People do not consistently behave rational, moreover; the homo economicus does not exist.12 Acknowledging such irrationalities and incorporating strategies to overcome them can have the potential to improve health interventions. A common irrationality is the tendency to devalue long term rewards, which health effects eminently are. An often proposed strategy to overcome this, and make the current behaviour more desired, is the provision of (financial) incentives. In Chapter 9, 10 and 11 we investigated the effectiveness of incentives to support efforts to reach certain goals, most importantly smoking cessation. More specifically, we investigated personalised incentives to further improve the effectiveness of incentives. Financial incentives often are implemented for behaviour change, but almost always are designed as one-size fits all. However, populations are seldom homogeneous and irrationalities such as devaluing later rewards, or the degree to which one does this, differ. Hence, we should not assume homogeneity but instead perhaps better tailor interventions to accommodate individual differences. In Chapter 9 we investigated strategies to provide different incentive schemes to participants performing a boring task. Effort was expected to increase when participants would receive incentives, either in the form of a flat pay out rate or as a deposit contract. We investigated whether a random assignment or free choice with an advice (i.e. nudge) would result in more effort. Our findings suggested that a nudged assignment may increase incentives’ effect on effort, and that those who actively choose deposit contracts allocated most effort. The effectiveness of deposits, when freely chosen by participants, was also observed in the PERSIST trial, as described in Chapter 10 and 11. We hypothesised that a combination of advice on what type of incentive scheme to choose and a free choice to accept or deviate from the advice could act as a potential facilitator for successful implementation. We tested this in a setting where health care workers followed a group-based smoking cessation intervention. However, because only few individuals were found to be willing to participate in the study, the PERSIST trial was prematurely concluded. The results of the trial should thus be interpreted in light of this, and other, limitations as described in the next section.
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