Financial incentives for successful smoking cessation: an
implementation study to increase reach and adoption among
companies and their employees with a low socioeconomic
status

Background
In a cluster randomized controlled trial (RCT) that we performed in 61 companies, we found that financial incentives
for successful smoking cessation are highly effective in increasing smoking abstinence among employees who follow a
smoking cessation group training. The results of our study are in line with international studies showing the
potential of incentives to increase smoking cessation rates. Very promising is that our intervention was more effective among
employees with a low income and education, which is a group with a high smoking rate that has shown to be difficult to reach
with existing smoking cessation interventions. Because of its promising results and its potential to engage smokers with a lower
socioeconomic status (SES), it is important to investigate how the smoking cessation group training programme combined with
incentives can be diffused and implemented in companies throughout the Netherlands. However, previous research has shown
that successful research trials do not automatically lead to implementation in the field. Although the trial was designed to
closely resemble a real-world situation, the researchers actively recruited interested companies, which is a task that should be
conveyed to other parties and information platforms to be sustainable. Because of the innovative nature of the intervention, it is
possible that mostly companies open to new ideas were the first responders to the call for the recruitment of the trial. There is
need for an implementation strategy that could convince different types of companies to offer the smoking cessation
programme with incentives. Furthermore, the incentives were paid for by the funder of the trial and more research is required
on how companies could implement these incentives. Also, a practical guide should be developed for companies, including a
step-by-step action plan on how to implement the smoking cessation intervention on the worksite and how to break through
potential barriers. This would help companies with the organization of the programme. Finally, in the trial only a small group of
employees within each company participated. It was not investigated how the majority of the employees who smoke could be
reached and made enthusiastic to participate in the smoking cessation training programme, but this knowledge is crucial to
maximize the reach and impact of the intervention, especially for lower SES employees.

Objective
This study aims to increase the dissemination and adoption of a successful smoking cessation intervention among Dutch
companies by developing an implementation strategy which will be constructed and tested after (1) investigating how
companies can be convinced to organize a smoking cessation group training programme with financial incentives for their
employees, (2) assessing how tobacco smoking employees with a low SES can be stimulated to participate in the smoking
cessation group training, (3) identifying which barriers at the employer and employee level could influence adoption of the
programme and how these barriers can be overcome, (4) investigating how the implementation of the programme can be
maintained.

Methods
We want to focus our efforts on companies with relatively many low SES employees. The proposed study will develop an
implementation strategy at the company level and at the employee level to promote a workplace smoking cessation group
training with incentives, and will evaluate the implementation process within the companies who will actually carry out the
smoking cessation programme. The proposed implementation study will start with monitoring the effect of the currently used
implementation strategies as a baseline measure. Employers and employees will be interviewed about which motivators and
barriers influence their decision to organize or enroll in a smoking cessation programme. This information, together with the
input from the consortium partners consisting of end users, health consultancy organizations, smoking cessation counsellors,
health promotion platforms and communication specialists will be used to develop an implementation strategy aimed at the
employer and the employee, which will be tested, evaluated and adapted multiple times. We will develop the implementation
strategy by applying Intervention Mapping, and we will use the RE-AIM Framework to form our implementation study and
evaluate the reach, effectiveness, adoption, implementation, and maintenance of the intervention.

This study aims to increase the implementation of smoking cessation group trainings with financial incentives among Dutch
companies by developing an implementation strategy that will be tested, evaluated and adapted multiple times. We hypothesize that the implementation of the smoking cessation intervention will be more successful with the implementation strategy.

First twelve months: Monitoring of standard strategy (100 companies)
Month 1 – 6: Needs assessment
Month 7 – 8: Analysis and reporting of needs assessment
Month 9 – 12: Development of implementation strategy
Month 13 – 24: Testing of first implementation strategy (100 companies)
Month 25 – 27: Analysis of first effect- and process evaluation
Month 28 – 29: Adjusting implementation strategy
Month 30 – 41: Testing of adjusted implementation strategy (100 companies)
Month 42 – 44: Analysis of second effect- and process evaluation
Month 45 – 48: Reporting, dissemination and implementation

An implementation strategy aimed at employers and at employees who smoke