{"paper_id":"3db10b93-49d2-409f-be75-c432effa4205","body_text":"Co-design of a Community-based Financial Incentive Scheme for Smoking Cessation Services in Ireland: A Modified Nominal Group Technique | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Co-design of a Community-based Financial Incentive Scheme for Smoking Cessation Services in Ireland: A Modified Nominal Group Technique Reham A. Lasheen, Brian Doyle, Cheyenne Downey, Debbi Stanistreet, and 26 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8688569/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Despite the overall decline in smoking prevalence, socioeconomic disparities in smoking quit rates are widening. Financial incentives such as cash or cash-like rewards provided conditional on performance of healthy behaviours, are effective tools to enhance smoking cessation, yet are complex and often designed without community input or theoretical rationale. Hence, we aimed to co-design a theoretically driven and contextually-relevant financial incentive scheme for implementation, with key stakeholder groups including community members and health professionals, in Irish primary care and community services. Methods A mixed-methods approach was utilised with a modified Nominal Group Technique, underpinned by Adams et al.’s (2014) 9-domain incentive framework, over three one-day workshops (n = 59 participants) to elicit ideas and achieve consensus on incentive design. Descriptive statistics were used to identify the highly-ranked ideas, while reflexive thematic analysis was employed to examine the decision-making process focusing on key considerations across various domains of the proposed incentive scheme. Results The incentive design was as follows: 1) Total amount: €400 (Median, IQR: €200–500); 2) Form: voucher; 3) Certainty: definite reward; 4) Target population: adults living in deprived areas who smoke and are in receipt of free primary care services; 5) Target behaviour: validated smoking cessation and clinic attendance; 6,7) Schedule and Frequency: incrementally increasing amount aligned with current services review timepoints; 8) Immediacy: as soon as possible within a week; 9) Provider: smoking cessation advisors. Participants’ key considerations in reaching consensus on each incentive domain were represented by five themes including: acceptability, potential of gaming, operational and administrative demands, fit with existing services workflows, maintaining organisational image, and public scrutiny. Conclusion This is the first study to co-design a stakeholder-informed, and theory-aligned incentive-based scheme to support smoking cessation for people living in deprived areas. A pilot is now underway to test real-life implementation feasibility on smoking cessation outcomes. Financial incentives Smoking cessation Co-design Nominal Group Technique Participatory research methods Health behaviours Intervention design Implementation science Figures Figure 1 Figure 2 Background The tobacco epidemic persists as a serious threat to population health and a major driver of inequalities worldwide [ 1 ] . In Ireland, despite an overall decline in smoking prevalence, smoking remains the leading preventable cause of ill-health and premature death, with recent estimates suggesting it accounts for ~ 4500 deaths annually, an estimated 4.9 million total loss in life years and a healthcare cost burden of €20.2 billion to the Irish healthcare system [ 2 , 3 ] . Smoking prevalence, however, has remained static since 2019 at 17–18%, with a disproportionately lower decline in prevalence and quit rates among lower socioeconomic status (SES) groups [ 2 , 4 ] . Similarly, global patterns repeatedly indicate that the lower SES populations bear the greatest burden [ 5 – 7 ] . Nationally, smoking inequalities are growing, particularly among the least educated and for individuals living in the most deprived areas. [ 8 ] For example, in 2025 current smoking prevalence was 21% among individuals with lower educational attainment, compared to only 11% for those with higher levels of education [ 4 ] . Furthermore, smoking and SES smoking-related inequalities tend to perpetuate a vicious cycle of overall health and socioeconomic inequalities such as financial strain [ 9 , 10 ] , mortality gap between SES groups [ 11 , 12 ] , and poor health outcomes [ 13 , 14 ] . In an effort to reduce inequalities, proposals to support smoking cessation have included a range of innovative approaches, such as the use of financial incentives (FI) [ 2 , 15 – 17 ] . FI, defined as cash or cash-like rewards or penalties provided contingent on performance of healthy behaviours, are increasingly recognised as effective tools in promoting smoking cessation across diverse populations [ 18 – 20 ] . A Cochrane review of 39 trials (18303 participants) has found high-certainty evidence that individuals offered FI were 52% more likely to quit smoking at six months or longer follow-up compared to control groups (pooled risk ratio of 1.52, 95%, CI 1.33 to 1.74) [ 20 ] . In particular, evidence suggests that FI interventions might be more effective and cost-effective when targeted at populations of lower SES [ 21 , 22 ] . Additionally, FI are considered effective for individuals facing financial strain or those who require external motivation to support their quit attempts; either through offering tangible monetary benefits or by serving as a positive reinforcement that helps build confidence and self-esteem [ 21 ] . Nonetheless, FI interventions have been largely subject to criticism, due to issues of acceptability, design heterogeneity and context-sensitivity, with little clarity around what constitutes an appropriate, efficient and effective FI structure [ 19 , 23 – 26 ] . Adams et al. [ 25 ] recommend the use of a comprehensive framework to design effective incentive configurations. This framework provides key domains as follows: direction (positive gain or avoidance of loss), form (Cash, vouchers, etc.), magnitude (total value), certainty (certain or [variable] chance incentives), target (e.g., attendance at programmes and/or quitting), frequency (proportion of occurrences incentivised), immediacy, schedule (e.g. fixed incentives or increasing incentives over time) and recipient [ 25 ] . Participatory research approaches, including co-design, have long been advocated as valuable in addressing potential contextual issues in intervention design and implementation, where the meaningful integration of relevant stakeholders’ views (including health professionals and community members) shape service design and delivery [ 27 , 28 ] . Stakeholders can be defined as “individuals, organizations or communities that have a direct interest in the process and outcomes of a project, research or policy endeavor” [ 29 , 30 ] . Such methods are therefore thought to produce robust knowledge acquired by systematic inquiry and through the mutual understanding of key perspectives, including those affected by the intervention, that is relevant, acceptable and sustainable [ 28 , 31 ] . They also pose as valuable tools to strengthen co-creation approaches by providing the platform to address existing health inequities and promote positive change [ 32 ] . These methods, however, are infrequently informed by relevant theory or frameworks to guide intervention development processes [ 33 – 35 ] with theoretical underpinnings often implicit or inconsistently applied limiting replicability. To overcome these limitations and enhance implementation processes, we aimed to utilise a blended approach, where participatory research principles supported by theory-guided specific questions are applied to inform intervention design. To our knowledge, this is the first study that aimed to co-design a FI intervention for smoking cessation in alignment with theoretical considerations by addressing the overarching question: What would an appropriate and contextually-relevant FI intervention for smoking cessation look like in terms of structure, amount and delivery? Methods This study is reported using the ACCURATE Consensus Reporting Document (ACCORD) guidelines [ 36 ] to ensure methodological transparency, reporting consistency and enhance reproducibility (See Additional file 1). Patient and public involvement: Patients and public representatives contributed during the planning phase of the wider COMPASS project [ 37 ] , shaping the participatory research approach to answer this study’s aim and refining study materials. Context The smoking cessation services provide nationwide evidence-based services in 152 primary care settings including free support for up to one year, consisting of behavioural counselling and access to cessation medications as free nicotine replacement therapy when appropriate [ 38 ] . Sláintecare Healthy Communities Programme Areas [ 39 , 40 ] (SHCPAs) target 24 designated disadvantaged areas based on high deprivation rates across 16 local authorities, where high levels of ill-health and health inequalities are evident. In these areas, intensive, community-based support with dedicated smoking cessation services and integrated health initiatives has significantly expanded [ 41 , 42 ] . Low-income residents can avail of general medical cards (GMCs), which are typically means-tested, meaning they are entitled to free general practice and primary care services [ 43 ] . The qualifying threshold is low and therefore GMCs eligibility generally serves as a proxy indicator of socioeconomic disadvantage. Study Design A modified nominal group technique (mNGT) was used to facilitate three consensus workshops to co-design the FI scheme for implementation from September to October 2024. NGT offers a systematic, yet highly adaptable procedure to generate ideas and rank priorities from groups of individuals who have insights into the topic of inquiry, triangulating both quantitative and qualitative data [ 44 ] . A standard approach is typically undertaken in one session to answer one broad theme or question [ 45 , 46 ] , comprised of four key stages: idea generation, round robin, refining ideas and ranking of idea by voting. [ 44 , 47 ] However, given the complexity of FI design, a modified approach was considered necessary to align with the utilised theoretical framework, encompassing nine sub-questions supporting our overarching study aim. Participants and recruitment Purposive and snowball sampling techniques were used to recruit participants aiming to gain transdisciplinary representation from clinical, research, policymakers and community member groups with relevant insights on the topic. Specifically, community members were recruited through the Local Authority Development Officers of three pilot areas – two urban and one rural, and were reimbursed for their time using gift vouchers. Additionally, the research team, in collaboration with Health Service Executive Tobacco Free Ireland (HSE TFI) office, leveraged existing networks to invite additional stakeholder groups including health professionals and service providers with the majority providing services in pilot areas. Community member participation was not restricted to those who currently or previously smoked. Data collection Participants’ demographic and medical history data were collected in addition to questionnaires. The questionnaire comprised of two main sections: the individual response section and the ideas ranking section. Questions reflected the nine elements of financial incentive structure as per Adams’ et al nine-domain conceptual framework [ 25 ] (See Additional file 2). Participants received their questionnaire on arrival, to allow sufficient familiarisation time prior to workshop commencement, with onsite support for participants with literacy challenges. Each workshop lasted approximately 5–6 hours, and were facilitated by either FD or BD, who have extensive expertise in public health research and/or leading community and stakeholder engagement activities. When BD was in the facilitator’s role, FD participated as a member of the NGT panel, but his responses were not considered as part of the results. Similarly, responses from repeat HSE TFI participants were recorded across the three workshops, but only those from the first workshop were included in the analysis. Discussions held during the group’s decision-making processes, were audio-recorded and field notes/observations were also documented by RL and CD as appropriate. The standard NGT methods have been reported extensively elsewhere [ 44 ] . Table 1 outlines the stepwise process used in the technique, as originally presented by Gallagher et al. [ 44 ] and our deviations and rationale for same. Briefly, we adapted the NGT to enable the examination of nine domain-specific sub-questions at each of the three workshops one question at a time. To accommodate the anticipated rich nature of the data, an on-site method triangulation was also undertaken through diverse data collection methods, including flipcharts, questionnaires, field notes and voice recordings of each group [ 48 ] . Lastly, an online follow-up discussion post-analysis with participants from all sites was sought for sense-checking and final adjustments of the intervention design. Table 1 An outline of the modifications (highlighted in bold) made to the standard NGT procedure. Phase mNGT Step 1: Introduction and explanation of the procedure Introductions, NGT objectives and working together guidelines. Summary of the nine questions presented by the facilitator via a PowerPoint presentation in plain English. Step 2: Silent generation of ideas in writing Each of the nine questions were presented one at a time in succession, accompanied by an explanation, with adequate time allocated for participants to respond. Step 3: Listing of ideas on flip chart Each participant was asked to voice their ideas in round-table manner for each of the nine questions. Step 4: Discussion of ideas on flip chart Participants shared their rationale for each idea they had shared. Additionally, on completion of each list per domain, time was given to the participants to have open discussions on all generated ideas. Step 5: Ranking to select the “top-five “ideas Participants ranked ideas listed on the flipchart on a scale from 1 to 5 on their ranking sheets, the most highly ranked idea receiving 5 points. Step 6–7: Voting on “top-five” idea; Break Participants were asked to voice out their top two ideas. No list was produced. Instead, ideas were tallied on the flipchart and shortlisted. During the break, a prioritised consensus list was produced. Step 8–9 Active discussion of the votes; Re-evaluation of rankings Active and moderated discussion about the nature and content of all listed items were carried out. Participants discussed feelings and insights about items included or excluded and were allowed to reflect/ modify their highly ranked answers. Step 10: Conclusion of the nominal group -Consensus The final list of the highly ranked “top-five per participant” items were presented to the participants, one question at a time. Participants were asked whether they collectively agree on the top-rated idea per domain. Disagreements prompted further in-depth discussions where scoring of each idea was considered until consensus was reached. Data Analysis Data analysis was undertaken following completion of all data collection across the three workshops. Consensus processes during the meetings continued until majority consensus (> 50%) was achieved. By adopting this approach, in-session results validation at the end of each workshop was inherently ensured [ 49 ] . Demographic data were analysed descriptively while quantitative data related to the gathered ideas and their final rankings was analysed using Excel V.2018 according to a recommended procedure, with participants’ idea scores being divided by the sum of all scores given per domain, yielding the relative importance given to each idea per domain [ 44 ] . Discussions were transcribed verbatim initially using aTrain [ 50 ] , a trained transcription software using machine learning for accuracy, then cross-checked by BD and RL to enable idea and results validation. Transcripts were inductively analysed using reflexive thematic analysis (Braun and Clarke, 2022) [ 51 – 53 ] by RL. The analysis was conducted at both semantic and latent levels, aiming to provide a clear display of participants’ explicit and diverse views surrounding the intervention constituents and its implementation processes whilst capturing the rich and more nuanced understanding of the underlying reasonings behind the resultant consensus decisions, collectively shaping the multifaceted nature of decision making. Post initial analysis, coding and themes development processes were discussed with CD and BD to promote a critical dialogue enhancing reflexivity and deepening interpretation [ 53 ] . See Additional file 3 for information on researcher reflexivity and more details on the process. Findings Participants Characteristics A total of 59 participants took part in the study across the three sites; A (n = 26), B (n = 16) and C (n = 17). Most of whom were aged between 35 and 64 years old (n = 43), females (n = 36) and white Irish (n = 50). Of the total sample, 28 were community members, and 25 were healthcare or service providers including three organisational representatives. The majority of participants (n = 41) either currently or previously smoked conventional cigarettes. A total of 22 participants had been diagnosed with a long-term medical condition, with almost half of those having multimorbidity (more than two long term conditions at one time). Table 2 presents participants’ site and detailed characteristics. Table 2 Participants’ characteristics Site (No. of participants) Site A, Urban (n = 26) Site B, Urban (n = 16) Site C, Rural (n = 17) Total (n = 59) Age, n (%) 18–24 1 0 2 3 (5.3%) 25–34 4 2 1 7 (12.3%) 35–44 9 3 4 16 (28.1%) 45–54 6 2 6 14 (24.6%) 55–64 6 5 2 13 (22.8%) 65+ 0 3 1 4 (7.0%) Sex , n (%) Male 11 7 5 23 (39.7%) Female 15 8 12 35 (60.3%) Ethnicity , n (%) Irish White 25 12 13 50 (84.7%) Irish Traveller 0 0 2 2 (3.4%) Other a 1 4 2 7 (11.9%) Role , n (%) Community member 10 11 7 28 (47.5%) Healthcare/Service provider 13 3 9 25 (42.4%) Other 3 2 1 6 (10.2%) Never smoker b , n (%) Yes 5 5 8 18 (30.5%) No 21 11 9 41 (69.5%) Diagnosed long-term condition c , n (%) yes 9 9 4 22 (39.3%) No 13 5 12 30 (53.6%) prefer not to say 2 1 1 4 (7.1%) If yes , n (%) One condition 4 3 3 10 (45.5%) Two or more 5 5 0 10 (45.5%) Prefer not to say 0 1 1 2 (9.1%) a: including other white, East−Asian and South−Asians b: pertains to never being daily, occasional tobacco or e−cigarette smoker c: Conditions include: Diabetes, hypertension or kidney, cardiovascular, respiratory, gastrointestinal, neurological, joint and bone diseases, mental health illness, cancer or long−lasting impairment or difficulty Consensus During initial phases, all three groups were asked to answer the questions on the nine domains of FI design and were subsequently invited to share those with the wider group. Participants were allowed to skip their turn, share more than one idea per question or refrain from answering altogether. More than 69 ideas were generated for all nine domains across the three workshops with 43–58 participants sharing their ideas per domain. Consensus data, measured by frequency of participant’s votes, across the three workshops were analysed to generate the final list of highly ranked ideas. Table 3 presents the collective views of participants (See Additional file 4 for full list of generated ideas and ranking) Table 3 First three top-rated ideas per domain across the three workshops Domain Magnitude (€) Rank Idea Sum of scores Frequency of votes RI (%) Total amount 1 400 60 14 17.9 2 200 36 13 10.7 3 500 34 8 10.1 Form 1 (Physical/digital) voucher 87 18 35.8 2 Limited-use voucher 66 15 27.2 3 Money Transfer 34 13 14.0 Certainty a 1 Certain reward 101 21 54.0 2 Combination of a certain reward and chance 39 9 20.9 3 Certain chance e.g., Prize draw 28 9 15.0 Target Behaviour 1 Validated quit 52 11 27.1 2 Validated quit at certain timepoints 43 9 22.4 3 Validated quit and clinic attendance 38 8 19.8 Frequency and schedule 1 Fixed timepoints in line with services 45 11 27.4 2 Incremental increase at certain timepoints in line with the service 31 8 26.1 3 Lump sum payment in the end 28 7 17.1 Immediacy 1 Immediately (as soon as possible) 109 22 66.1 2 Within a week 24 6 14.5 3 Other 17 4 10.3 Target population 1 Targeted (Socioeconomic Status) 77 16 33.8 2 All smokers 51 13 22.4 3 Means-tested 43 11 18.9 Service Provider 1 Stop Smoking Advisors 83 18 40.3 2 HSE (TFI Programme Office) 73 16 35.4 3 Healthcare professionals 29 9 14.1 Sum of Scores total sum of all scores given for an idea on a scale of five to one across all participants Frequency of votes number of participants voted per idea RI (Relative importance) (Score of each individual idea/ total sum of all scores given for all ideas per domain) * 100 a Terminology used adopted from Adams et al’s framework as follows. Certain : guaranteed FI upon achieving the behaviour. Certain Chance : guaranteed entry into a lottery but winning is not assured. Uncertain Chance : neither entry nor winning is guaranteed; only participation depends on meeting eligibility. Qualitative findings The post-ranking discussions were further used to inform finalisation of the FI design. Themes from these discussions are outlined below. Categories of each theme are presented followed by the number of units relevant to each category in brackets. Participants are identified by role, where CM denotes community members, HP healthcare professionals, and SP service providers. An Equitable system: idealism versus realism. Discussions surrounding each domain of the financial incentive intervention highlighted the complexity of decision-making processes as well as the profound social and ethical weight of the entire endeavour, particularly considering resources at hand, evidence-base and population needs. Overall, under this overarching theme, the tension between a range of idealised scenarios to the realities of the implementation environment are presented. Analysis revealed five key themes 1 across 159 units of analysis 1) Shaping form, assigning value; 2) When standardisation meets (an ever-changing) reality; 3) Commitment to quit: validation and pitfalls; 4) For all or for some? 5) The implementation dilemma: accommodating expectations. Figure 1 shows the thematic map showing the five main themes, subthemes and categories where necessary, with Additional file 5 presenting same with full data excerpts. 1. Shaping form, assigning value This theme depicts the difficulty determining the amount or value as well as the various forms of incentives to be administered considering their relative significance and their feasibility. Some participants argued that non-monetary incentives [5] e.g., a trophy or graduation ceremony “ so that it lasts forever” (CM) as a constant reminder of their achievement are more meaningful, while the majority inclined towards those of monetary value [20]. On the value of the incentive, several participants recognised the importance of offering an incentive that is “enticing enough (HP) and “worth their while” (CM) to drive an individual’s motivation towards a quit attempt [13]. When considering factors such as relative costs borne by the service user during service access, or those foregone savings borne by the healthcare system should people manage to quit, as well as the current evidence-base, it was soon realised that what could be valuable to one would not necessarily be to another, nor feasible given contextual factors. “I think the money could be very tokenistic. If I say 50 or 150 or 200 or 300, it could be like a middle-class approach to a working-class problem… I'm sort of honing in around that 400 mark. But cost impact, you could probably scale it up to 4000, easy enough.” SP, Site C. When it came to the form or the shape of the incentive, it became apparent, perhaps, unsurprisingly, that there were concerns about logistical and the practical aspects of implementation. These included tax implications, administration/utilisation procedural complexity, associated fees and potential impact on a more personalised approach, particularly surrounding the degree of choice that purchasing a certain incentive type, could offer a user [27]. For example, forms like prepaid cards and cash were not favoured due to their cumbersome administration, tax implications or the notion that “ If you get cash, it just gets swallowed!\" (CM). A voucher system was most favoured mainly due to its less complex nature of implementation, administration and tracking, as well as its relative broad applicability for local stores. “(On electronic money transfer as a method of FI delivery) For the reason that it would involve tax implications. Whereas a voucher; you are allowed to have a voucher for a certain amount without changing or declaring it as an income” HP, Site C. 2. When standardisation meets (an ever-changing) reality Two main concepts were discussed in relation to incentive administration: a one-size-fits all model versus a person-centred approach. Although participants highlighted service users’ diverse needs and capabilities to quit and the importance of a flexible system, especially when dealing with groups across different sites and who are most in need of support [6], they also recognised that it would be practically impossible to operate a fluid system without a clear framework in place [11]. “I understand why it's important to stick to structure, but I suppose my concern with that is it will appeal to and it will work more with certain persons and those who, maybe, don't have the supports around them to the same degree; which are the people we're trying to get to support.” SP, Site A. As Ireland’s Stop Smoking clinics already operate a standardised, evidence-based service, participants mainly proposed a structured approach for several reasons, including its ability to leverage well-established systems, permit standardisation across sites, enable clear messaging to service users and efficient communication across implementation parties as well as ensure orderly management of an already complex intervention – thereby helping prevent potential disputes. “We've got one IT system and just like administrating something like this... even from a communications point of view (for example, someone could say) I'm living in Longford, so I'm getting €500 to quit. I'm living in Dublin; I'm only getting 300. Or, I'm getting (incentives at) different time points. It would be a nightmare!” SP, Site C 3. Commitment to quit: validation and pitfalls On the target behaviour to incentivise, this theme presents discussions primarily focusing on how to define or measure commitment to quit, and validation methods and concerns around potential gaming of the system. Participants generally held a strong stance towards incentivising a form of witnessed and maintained effort to quit as to “do the leg work and then you get it!” (CM) with a “no punishment” (SP) approach in case of relapse [18]. “You'd have to get yourself back to where you were and then carry on. Yeah; to catch up on yourself!\" CM, Site A. The format of such effort or commitment, however, was subject of considerable deliberation among participants. For example, while several participants recognised the importance of rewarding service attendance or setting a quit date, potential system misuse and overwhelming of services, as well as limited defensibility to the public, significantly rendered rewarding these behaviours impractical. Hence, a robust and objective measure of a quit attempt would be required [20]. “I feel very strongly on this. I actually feel that people should only get rewarded for a validated quit, so I think that administering this with any kind of subjectivity will be impossible and I think what would happen is one service might provide it in one way or another and that could end up backfiring. I think if people know if they come in with the intention that I'm going to get paid to quit and that's it; the message is very clear, people have the same goal. If you start moving the bar; I think that we could undermine the whole thing.” SP, Site A. Although few participants expressed that “there is a certain amount of trust expected from our clients” (SP), a major driver behind having a method of quit validation, often stemmed from concerns surrounding gaming the intervention, as well as the need to uphold a consistent parameter of behaviour validation promoting a sense of fairness and accountability among service users. “(On importance of a test) I think you might be trusting a person to come along and say they are quit…only for them to come out and then smoke!” CM, Site A. It was recognised however, that caveats surrounding the use of the Carbon Monoxide (CO) breath test (Breathalyzer) used to validate smoking cessation existed, with gaming still a possibility. Also, it may not accurately reflect abstinence in specific groups such as those with specific health conditions or physiological variations [9]. “I had a patient – COPD, came into clinic, I could, know her chest was terrible! So, I did- she hadn't smoked or anything, I did her CO testing, and it was actually 15!” HP, Site C. Although a few participants proposed alternative testing methods mainly Cotinine testing [6], these were quickly dismissed mainly over the concern that it would disrupt the well-established provider-user relationship dynamics and be contrary to the longstanding principles of the services, which have consistently centred around providing an optimum opportunity for users to achieve better health. “It changes the tone of the interaction that's happening... you [service user] can hoodwink many different ways, if somebody's trying to catch you out. But then, so what? If somebody's coming to your clinic, they get free money; but it's not a significant amount of money - unless it starts with four grand! So, if we go down to \"I actually want to do a random test to you\" that brings us into that sort of drug testing space. And it does have connotations about what the actual service is about. Giving people the optimum opportunity to overcome a product that is optimized for human consumption and it's highly addictive. Um, I would not like to see mistrust weaving in!” SP, Site C. 4. For all or for some? This theme concerns a rather heavily contemplated domain; the target population of the incentive, where under this theme some participants were conflicted between the ideal “open to anyone” (CM) service as to promote inclusivity and to avoid creating unnecessary divide between different populations in society versus a more targeted and realistically-feasible approach. In spite of such sentiment, real-world constraints [9], for example, the limited budget and resources at hand, necessitated for an eligibility criterion that is clear, easily applicable and defensible to stakeholders to be set. “The least preference would be all smokers, not because I wouldn't like to give every kind of help to every kind of smoker but just politically (and) financially trying to articulate that would be tricky!” SP, Site B. On inclusion criteria, participants mainly reflected upon priority groups such as individuals of socioeconomic need, those with existing medical conditions, or those in the maternal healthcare continuum [22]. It was soon acknowledged that disadvantaged areas are more likely to bear the most burden and encompass all previously-mentioned groups. “But essentially that's everyone in Sláintecare, because anyone in Sláintecare could be pregnant, could have a mental health condition, could have chronic disease” HP, Site B. Soon after, another dilemma raised by the participants was the applicability of such criteria in day-to-day operations as relying exclusively on geographical boundaries to determine enrolment will likely pose potential challenges. Several participants were torn between potentially stigmatising a group of people or excluding those more in need if implementing an objective threshold or parameter. Eventually, discussions revealed various caveats including the fact that even within deprived areas “ there are hot pockets of stark deprivation and just down the road there are affluent areas.” (SP) thus the need for an objective parameter appeared necessary. “I also put medical card or GP card, because we have some people who are quite advantaged living in those areas. And historically, [when we] had free NRT for just those in Sláintecare areas, it was quite difficult to kind of determine where's the boundary and the border and all of that. And you don't want to leave it up to the advisors to have to make that decision. So, you need something very definite that's easy to administer and that's you're either in or you're out and it's a pilot, you know what I mean?” SP, Site C. 5. The implementation dilemma: accommodating expectations Under this theme, participants discussed operational roles and demands with considerations to existing services capacity as well as parameters of intervention success in light of stakeholders and public perceptions [28]. For example, two main areas of responsibilities were communications surrounding the incentive and its actual administration. As the majority agreed that information dissemination is best conducted through the Health Service Executive as “ it’s seen as a trusted source ” and “with the appropriate branding and the appropriate key message” (SP), several pondered over the most efficient method of incentive issuance. “The incentive piece, I was certain from a staff management perspective, I wouldn’t be happy with the team being responsible for holding on to vouchers and money and the pressures that would put on people at a local level. So, we have to think where we'd even store it - in a secure environment…. So, my thinking would be of it being centralised, you know, in our admin teams.” SP, Site C. Eventually, a collaborative approach between both service providers and the HSE were seen the most suitable. A few providers subsequently voiced their concerns surrounding managing expectations when it comes to immediate incentive delivery, as to align with the intervention demands and evidence-best practice. “Because I suppose we (Stop Smoking Advisors) face too much at hand. But we make an attempt to do it (deliver the incentive) on the day.” SP, Site A. Overall, a major consideration governing almost every decision was defensibility, whether to the public or different stakeholder groups. As participants were concerned that incentivising smoking cessation, which is known to be controversial, could further attract public scrutiny, it was important to tread carefully and produce a “bomb-proof” (SP) intervention whether in terms of amount, target population or behaviour or simply utilising tailored and minimal advertising. At the same time, few underscored the value in balancing perceived risks with the implementation of a theoretically-sound and agreeable intervention. “I think we care; I know we have to sell this to the public because it may be under scrutiny … but I would just tread carefully in terms of always being pigeonholed into that direction because of the consequences” SP, Site A. Shaping the FI Intervention design As a result of the mNGT workshops, an initial structure of the FI scheme entailed providing €400 over a 12‑month programme in the form of a digital or physical voucher, delivered as a definite reward to adult smokers living in deprived areas, contingent on biochemically validated quitting and clinic attendance, with incremental payments aligned to the existing service schedule, issued on the day or as soon as possible, and administered by smoking cessation advisors. The final FI design was further refined during a follow-up online discussion with stakeholders, with minimal deviations from the workshop results, primarily due to logistical considerations identified during the planning and implementation phases. While the original design was set to distribute the total €400 amount in incremental increases, this was changed to €20 being issued at fixed amounts for the first three weeks, with incremental increases thereafter. The final Intervention is as follows: Weeks 1-3: €20, week 4: €40, week 12: €60, week 26: €100, week 52: €140. In terms of the voucher, the choice was on On4all Gift card [54] ; available in both digital and physical formats, redeemable at multiple retail outlets. On immediacy, issuing incentives on the same date proved logistically challenging. Therefore, clients were set to receive their incentive within a maximum of one week following a confirmed quit. On the target population, following discussions, it was agreed to use the GMC as an objective criterion for identifying eligible adult clients based on socioeconomic status within SHCPAs. Finally, in terms of relapse mechanisms, clients on the service who relapse at any stage may re-join and remain eligible for financial incentives. Upon re-joining, however, they resume incentives receipt on a successful quit from the point at which they previously relapsed. Due to budget constraints, clients are permitted one re-entry to the FI scheme though they may continue to access other QUIT support services as usual. Figure 2 shows a leaflet used to promote the scheme post-implementation as the “Stop Smoking Gift Voucher Incentive Scheme”. (See Additional file 6) Discussion We have outlined the first co-designed, theory-based FI scheme for smoking cessation in deprived communities. Our study participants proposed the most appropriate FI design for local implementation as follows: a total amount of €400, over a 12-month period delivered in an incrementally increasing schedule at validated quit milestones, confirmed by CO testing with payments provided immediately or as soon as possible following verification for adults meeting a low-income threshold from deprived areas. Key considerations governed the final structure including: public and stakeholders’ acceptability, principles of equity, appropriate incentive valuation and scope of and mechanisms against gaming as well as best fit with existing systems. This study also outlines a methodology that helps bridge the evidence-to-practice gap ensuring a scheme is most likely to have a good fit within existing services and relevant to those involved [ 55 , 56 ] . Overtly, FI interventions may seem simple to design and/or execute yet they are inherently complex shaped by multifaceted, diverse and contextual factors- making such method a valuable tool to address these challenges. Although, it has been argued that it is unrealistic to expect co-design processes to produce ideal solutions to complex problems within a short timeframe [ 57 ] , our combined approach, utilising theory to frame the discussions, allowed for incorporation of participants’ ideas into FI design. This has successfully informed the implementation of an ongoing multi-site pilot FI scheme “Stop Smoking Gift Voucher Incentive Scheme” [ 58 ] which is currently being evaluated as part of the wider study, COMPASS [ 37 ] . Overall, we believe our design closely aligns with existing evidence-base [ 18 , 20 , 21 , 24 ] and is contextually appropriate model for Ireland’s smoking cessation services and well-established national programmes of similar systems [ 59 ] . Studies have shown that an “appropriate” FI intervention for smoking cessation is often governed by key inter-dependent aspects: acceptability, which is regularly linked to amount issued and target population, effectiveness and cost-effectiveness [ 23 , 26 , 60 , 61 ] . It is also important to note that evidence suggests that the perceived value of a specific incentive amount could vary significantly across settings and target populations [ 18 , 62 – 64 ] . For example, Notley et al.’s systematic review [ 62 ] of 48 RCTs examined incentives ranging from $ 45 to $ 1185 (excluding zero self-deposits), and found that low-to-moderate incentives (under $ 500) often achieved sustained abstinence beyond the reward schedule of six months or more. Interestingly there was no significant difference in long-term quit rates between smaller (< $ 100) and larger (> $ 700) incentives. Although their analysis yielded no significant association between total incentive value and cessation outcomes, this is a crude analysis, and non-significant results may be due to local contexts or cultural significance of FI amounts. This in fact may underscore the importance of co-design methods in formulating FI reward structures to better account for context (e.g., income level, cultural norms, target population) [ 21 , 62 , 64 , 65 ] . In both Irish and UK contexts, similar reward sizes appear to be both impactful and scalable [ 22 , 59 ] . Our participants voiced their acceptance of both the proposed amount as well as the overall structure of the scheme based on several factors aligning with previous literature [ 21 , 23 , 26 , 60 , 61 , 64 ] . Results showed that the amount needed to be sufficiently large to motivate cessation, yet not so substantial as to invite misuse or attract adverse public scrutiny, as well as remain within budget, and integrated with associated administrative operations consistent with existing services workflows. On public attitudes to FI for smoking cessation, Cosgrave et al. [ 66 ] conducted a cross-sectional survey of 1000 participants and found that among the 47% of respondents supporting the use of FI, the majority (60.6%) believed the maximum amount given should be under €250 (median €100), although there was a very wide range (€1-€7000). Therefore, our findings are within the expected range and likely to be publicly acceptable, particularly to those affected by smoking, while remaining cost-effective in the national context [ 22 ] . The timely delivery of FI is critical. For logistical reasons, it was considered that receiving a voucher within a week would be realistic. FI received within days to weeks following a validated quit are proven to reinforce abstinence and sustaining motivation [ 19 , 67 ] . The relative immediacy of FI has been frequently shown to influence outcomes of incentive-based programmes; the more immediate rewards have larger effect sizes, whereas a delay could compromise the influence of even high-magnitude incentives on behaviour [ 19 , 62 , 63 , 67 , 68 ] . The theory of hyperbolic discounting, where individuals tend to disproportionally prefer smaller, immediate rewards over largely delayed ones, with the rate of discounting decreasing over time, may explain these findings [ 19 , 69 ] . Despite this, many FI interventions conducted involve significant delays between target behaviour and incentive delivery. [ 24 , 67 ] Almost all our participants agreed that an incentive should be received immediately or as soon as possible (within a week of validation). The HSE’s Stop Smoking services are structured, with set quit verification timepoints at 4, 12, 26 and 52 weeks [ 38 ] . Participants agreed that the most administratively sound and potentially effective reinforcer was to tie the rewards with such milestones. Additionally, the majority of our participants, generally, preferred a validated quit to be incentivised over other behaviours e.g., attendance only. This is also in line with recommendations of biochemical validation over self-reporting of quit status, noting that the latter tends to overestimate quit rates, particularly when financial rewards are involved [ 62 ] . Moreover, theory suggests that incentives might work according to operant conditioning (rewards tied to desired behaviour) [ 63 ] with evidence emphasising that incentives are more effective not only when tied to specific milestones, but specifically when delivered as part of a contingency-based framework, meaning incentives are conditional upon verified maintenance of some sort [ 19 , 21 , 70 ] . Others argue that engagement-based incentives are easier than those contingent on verified cessation, with positive impact on promoting attendance particularly among individuals who struggle to achieve or maintain abstinence [ 71 ] . Nonetheless, prior literature indicates that incorporating validation methods can enhance behaviour change and is associated with positive outcomes [ 19 , 21 , 72 ] , by supporting self-efficacy, adherence and promoting accountability, reducing relapse risk and reinforcing perceived fairness and incentive value [ 64 , 71 ] . Additionally, these methods help limit gaming behaviours, thereby improving acceptability and consequently facilitating wide-scale adoption. Our participants voted SHCPAs [ 39 ] as most appropriate for scheme implementation where socioeconomically-disadvantaged groups are prevalent, shouldering high burden of smoking, ill-health and inequality [ 2 , 8 , 22 ] . Though universal approaches to implementation are often more acceptable to the general public, using a targeted FI- approach toward lower income groups is argued to promote health equity [ 26 , 73 ] , which further ensured by the condition of possessing a GMC in our study. Cosgrave’s et al.’ [ 66 ] , however, found that the support for universal FI interventions and for targeting to people of lower income was similar with those with the greatest need, i.e., younger individuals with lower education who smoke, were more supportive of a targeted approach, in line with our findings. STRENGHTS AND LIMITATIONS While the NGT is typically applied with a small number of participants to address a single broad question, our mNGT approach demonstrated the method’s flexibility, as we conducted three independent workshops with 59 participants, addressing nine specific and relevant sub-questions underpinned by theory rather than one generic question. This introduced a novel and feasible approach, that successfully informed implementation efforts of the pilot scheme. Additionally, the NGT inherently allows for both methodological and data source triangulation [ 44 , 48 ] . In our study, qualitative data was collected via discussions and field notes per individual workshops while we examined the phenomenon at hand, coalescing the insights of different types of individual groups from multiple sites across all workshops. That enabled us to capture multiple perspectives and formulate a comprehensive understanding of those as well as validate the collected data, both in-session and across all workshops. However, the study was not without limitations. Given our specific context, the results may have limited generalisability to other systems or settings. Yet, we believe the overarching concepts of the key considerations raised by our participants surrounding FI design are largely relevant to various implementation efforts and many elements are adaptable to other delivery systems -e.g., scheduling of incentives to link in with existing structures. While our workshops included a substantial number of community members at the start of each workshop, the lengthy nature of the procedure meant that many left before the final consensus phase. However, this was largely mitigated by the fact that most participants had recorded their consensus results on the physical forms which were incorporated into the analysis. All previously ranked ideas and votes were also considered across the three workshops and in-session, although some perspectives may have been missed. Additionally, due to the poor quality of the recordings from one workshop, certain contributions might not have been fully captured in the transcripts. However, since the majority of the research team were on site, our observations and notes should mitigate this. Conclusion We demonstrated that combining participatory research with theory using mNGT, enabled the design and implementation of a one-year FI scheme, with escalating rewards, tied to verified abstinence milestones and the current smoking cessation scheme timeframes. Our community identified multi-faceted considerations when reaching consensuses on each domain of the FI structure including: acceptability, potential of gaming, operational and administrative demands, maintaining organisational image, fit with existing services workflows, and public scrutiny. Abbreviations SES socioeconomic status FI Financial incentive NGT Nominal group technique mNGT Modified nominal group technique HSE Health Service Executive HSE TFI Health Service Executive Tobacco Free Ireland SHCPAs Sláintecare Healthy Communities Programme Areas GMC General medical card CO Carbon monoxide COPD Chronic Obstructive Pulmonary Disease SP Service provider CM Community member HP Healthcare professional Declarations Ethics approval and consent to participate The study received ethical approval from the Reference Research Ethics Committee (RREC) for HSE Dublin and Midlands and HSE centre (Reference number: RRECB1123FD) and all participants have provided their informed consent to participate. Clinical trial number Not Applicable Consent for publication Not applicable Availability of data and materials All data generated or analysed during this study are included in this published article and its supplementary information files. Additional datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research was funded by the Health Research Board APA-2022-029 and SPHERE/2022/001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors contributions RL drafted the manuscript, carried out formal data analysis and interpretation of findings. BD and CD supported data analysis processes. BD, CD, RL and FD led data collection processes. FD provided methodological input and overall supervision. FD, PK and DS provided substantial and critical revisions to the manuscript. All authors contributed to the conceptualisation of this study, reviewed and approved the final manuscript. Acknowledgements We are sincerely grateful to all our study participants involved for their valuable and integral input in co-creating the FI incentive scheme and all those involved in recruitment facilitation. References World Health O. WHO global report on trends in prevalence of tobacco use 2000–2030 [Internet]. Geneva: World Health Organization; 2024. Available from: https://iris.who.int/handle/10665/375711 Health Service Excutive. Tobacco Free Ireland Programme - The State of Tobacco Control in Ireland: 2nd Report [Internet]. 2022. Available from: https://www.hse.ie/eng/about/who/tobaccocontrol/research/ Valentelyte G, Sheridan A, Kavanagh P, Doyle F, Sorensen J. Health and societal burden of tobacco smoking in Ireland: A life table modelling study. Public Health. 2025;247:105880. Government of Ireland. Healthy Ireland Survey Summary Report 2025 [Internet]. Dublin: [cited 2025 Nov 18]. Available from: https://www.gov.ie/en/healthy-ireland/publications/healthy-ireland-survey-2025 Huang MZ, Liu TY, Zhang ZM, Song F, Chen T. Trends in the distribution of socioeconomic inequalities in smoking and cessation: evidence among adults aged 18 ~ 59 from China Family Panel Studies data. Int J Equity Health. 2023;22(1):86. Garrett BE, Martell BN, Caraballo RS, King BA. Socioeconomic Differences in Cigarette Smoking Among Sociodemographic Groups. Prev Chronic Dis. 2019;16:180553. Teshima A, Laverty A, Filippidis F. Burden of current and past smoking across 28 Europeancountries in 2017: A cross-sectional analysis. Tob Induc Dis. 2022;20(June):1–11. Valentelyte G. Socioeconomic Variation in Tobacco Smoking Among the Adult Population in Ireland. 2024;Available from: https://doi.org/10.1093/ntr/ntae245 Waters A, Kendzor D, Roys M, Stewart S, Copeland A. Financial strain mediates the relationship betweensocioeconomic status and smoking. Tob Prev Cessation [Internet] 2019 [cited 2025 Dec 1];5(January). Available from: http://www.journalssystem.com/tpc/Financial-Strain-Mediates-the-Relationship-between-Socioeconomic-Status-and-Smoking,102258,0,2.html Action on smoking and Health (ASH) UK. Smoking and poverty [Internet]. Internet: 2022 [cited 2025 Jan 12]. Available from: https://ash.org.uk/uploads/Smoking-and-Poverty-Briefing.pdf Gregoraci G, Van Lenthe FJ, Artnik B, Bopp M, Deboosere P, Kovács K, et al. Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990–2004. Tob Control. 2017;26(3):260–8. Jha P, Peto R, Zatonski W, Boreham J, Jarvis MJ, Lopez AD. Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America. Lancet. 2006;368(9533):367–70. Marmot M. Smoking and inequalities. Lancet. 2006;368(9533):341–2. Zuokemefa A, Sharma S. Investigating correlates of chronic multimorbidity prevalence in Ireland: Evidence from Irish health survey 2015 and 2019. Public Health. 2025;249:106009. Department of Health G of I. Stop Smoking: Guideline Number: 28. Updated January 19, 2022. [Internet]. 2024. Available from: https://www.gov.ie/en/publication/4828b-stop-smoking/ Higgins ST, Davis DR, Kurti AN. Financial Incentives for Reducing Smoking and Promoting Other Health-Related Behavior Change in Vulnerable Populations. Policy Insights Behav Brain Sci. 2017;4(1):33–40. Smith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control. 2021;30(e2):e87–95. Giles EL, Robalino S, McColl E, Sniehotta FF, Adams J. The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis. PLoS ONE. 2014;9(3):e90347. Vlaev I, King D, Darzi A, Dolan P. Changing health behaviors using financial incentives: a review from behavioral economics. BMC Public Health. 2019;19(1):1059. Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews [Internet] 2025 [cited 2025 Nov 1];2025(5). Available from: http://doi.wiley.com/ 10.1002/14651858.CD004307.pub7 Rikke Siersbaek PKJ, Ford S, Burke. Sarah Parker. Financial incentives for stopping smoking: how and why do they work? [Internet]. Health Service Excuitve; 2023. Available from: https://www.hse.ie/eng/about/who/tobaccocontrol/ Valentelyte G, Sheridan A, Kavanagh P, Doyle F, Sorensen J. Financial incentives to stop smoking: Potential financial consequences of different reward schedules. Tob Prev Cessat. 2024;10(July):1–10. Giles EL, Robalino S, Sniehotta FF, Adams J, McColl E. Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods. Prev Med. 2015;73:145–58. Miranda JJ, Pesantes MA, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Carrillo-Larco RM, et al. Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review. Wellcome Open Res. 2021;6:163. Adams J, Giles EL, McColl E, Sniehotta FF. Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours. Health Psychol Rev. 2014;8(3):286–95. Hoskins K, Ulrich CM, Shinnick J, Buttenheim AM. Acceptability of financial incentives for health-related behavior change: An updated systematic review. Prev Med. 2019;126:105762. Jagosh J, Bush PL, Salsberg J, Macaulay AC, Greenhalgh T, Wong G, et al. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health. 2015;15(1):725. Seward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, et al. A guide to systems-level, participatory, theory-informed implementation research in global health. BMJ Glob Health. 2021;6(12):e005365. Arnahoutova K, De Geest S, Mielke J, Boaz A, Schoemans H, Valenta S. Exploring Stakeholder Involvement in Intervention Implementation Studies: Systematic Evidence Synthesis With an Evidence Gap Map Approach. Eval Health Prof 2025;01632787251352837. Deverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, et al. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Compar Effect Res. 2012;1(2):181–94. Macaulay AC, Commanda LE, Freeman WL, Gibson N, McCabe ML, Robbins CM, et al. Participatory research maximises community and lay involvement. BMJ. 1999;319(7212):774–8. Morales-Garzón S, Parker LA, Hernández-Aguado I, González-Moro Tolosana M, Pastor-Valero M, Chilet-Rosell E. Addressing Health Disparities through Community Participation: A Scoping Review of Co-Creation in Public Health. Healthc (Basel). 2023;11(7):1034. Harb SI, Tao L, Peláez S, Boruff J, Rice DB, Shrier I. Methodological options of the nominal group technique for survey item elicitation in health research: A scoping review. J Clin Epidemiol. 2021;139:140–8. Messiha K, Chinapaw MJM, Ket HCFF, An Q, Anand-Kumar V, Longworth GR, et al. Systematic Review of Contemporary Theories Used for Co-creation, Co-design and Co-production in Public Health. J Public Health. 2023;45(3):723–37. Grindell C, Coates E, Croot L, O’Cathain A. The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res. 2022;22(1):877. Gattrell WT, Logullo P, Van Zuuren EJ, Price A, Hughes EL, Blazey P, et al. ACCORD (ACcurate COnsensus Reporting Document): A reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med. 2024;21(1):e1004326. COMmunity PArticipation to set direction on design and implementation of financial incentives in. Stop Smoking services in Ireland: COMPASS [Internet]. COMPASS Project [cited 2025 Aug 11];Available from: https://compass-study.eu/ Blake M. HSE Tobacco Free Ireland Programme [Internet]. 2025;Available from: https://iiop.ie/content/stop-smoking-medicines-hse-stop-smoking-services Department of Health. Sláintecare Healthy Communities Progress Report 2022 [Internet]. 2023 [cited 2025 Sep 11];Available from: Health Service Excutive Ireland. HSE Sláintecare Healthy Communities 2023 Overview [Internet]. Internet. 2023. Available from: https://www.hse.ie/eng/services/publications/health-and-wellbeing/hse-slaintecare-healthy-communities-2023-overview.pdf Health Service Excutive Ireland. The HSE Health and Wellbeing Annual Report 2024 [Internet]. Internet: 2024 [cited 2025 Nov 20]. Available from: https://hsehealthandwellbeingnews.com/hse-health-and-wellbeing-annual-report-2024/ Health Service Excutive. Sláintecare Healthy Communities [Internet]. Internet: 2025 [cited 2025 Jan 12]. Available from: https://www.gov.ie/en/healthy-ireland/publications/sl%C3%A1intecare-healthy-communities/ Health Service Excutive. Medical Cards: How much you can earn and still qualify for a medical card [Internet]. [cited 2025 Dec 11];Available from: https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/how-much-you-can-earn/ Gallagher M, Hares T, Spencer J, Bradshaw C, Webb I. The Nominal Group Technique: A Research Tool for General Practice? Fam Pract. 1993;10(1):76–81. Wall G, Pearce C, Gustafsson L, Isbel S. Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design. Aus Occup Therapy J. 2024;71(5):674–85. Kearney N, Connolly D, Bahramian K, Guinan E. Strategies to improve participation in exercise programmes during chemotherapy: a modified nominal group technique. J Cancer Surviv [Internet]. 2025 [cited 2026 Jan 24];Available from: https://link.springer.com/ 10.1007/s11764-025-01771-y Harvey N, Holmes CA. Nominal group technique: An effective method for obtaining group consensus. Int J Nurs Pract. 2012;18(2):188–94. Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The Use of Triangulation in Qualitative Research. Oncol Nurs Forum. 2014;41(5):545–7. Vargas C, Zorbas C, Longworth GR, Ugalde A, Needham C, Sunil A et al. Exploring co-design: a systematic review of concepts, processes, models, and frameworks used in public health research. J Public Health 2025;fdaf084. Haberl A, Fleiß J, Kowald D, Thalmann S. Take the aTrain. Introducing an interface for the Accessible Transcription of Interviews. J Behav Experimental Finance. 2024;41:100891. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. Braun V, Clarke V. A critical review of the reporting of reflexive thematic analysis in Health Promotion International . Health Promot Int. 2024;39(3):daae049. Braun V, Clarke V. Thematic analysis: a practical guide. Los Angeles London New Delhi Singapore Washington DC Melbourne: SAGE; 2022. One4All Gift Card [Internet]. [cited 2025 Dec 11];Available from: https://www.one4all.ie/gift-cards-online.html?gad_source=1&gad_campaignid=22355621180&gclid=CjwKCAiA_dDIBhB6EiwAvzc1cHng_ YIW2QIqSJhNczA9ztVrta7CZ6CaGq5d_SlKk2cNALVH4VuEbxoC9vcQAvD_BwE Kelly Y, O’Rourke N, Hegarty J, Gannon J, Flynn R, Keyes LM. The co-design of a digitally supported intervention for selecting implementation tools and actions for standards (SITAS). BMC Health Serv Res. 2024;24(1):1582. Andrews JO, Newman SD, Heath J, Williams LB, Tingen MS. Community-Based Participatory Research and Smoking Cessation Interventions: A Review of the Evidence. Nurs Clin North Am. 2012;47(1):81–96. Larkin M, Boden ZVR, Newton E. On the Brink of Genuinely Collaborative Care: Experience-Based Co-Design in Mental Health. Qual Health Res. 2015;25(11):1463–76. Health Service Excutive, Tobacco Free Ireland. Stop Smoking Gift Voucher Incentive Scheme Leaflet [Internet]. 2025 [cited 2025 Aug 11];Available from: https://www.hse.ie/eng/about/who/tobaccocontrol/resources/stop-smoking-gift-voucher-incentive-scheme-leaflet.pdf Tappin D, Sinclair L, Kee F, McFadden M, Robinson-Smith L, Mitchell A, et al. Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ. 2022;379:e071522. Giles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study. BMC Public Health. 2016;16(1):989. Giles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups. BMC Public Health. 2015;15(1):58. Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews [Internet] 2025 [cited 2025 Nov 9];2025(5). Available from: http://doi.wiley.com/ 10.1002/14651858.CD004307.pub7 Gneezy U, Meier S, Rey-Biel P. When and Why Incentives (Don’t) Work to Modify Behavior. J Economic Perspect. 2011;25(4):191–210. Reham A, Lasheen B, Doyle C, Downey D, Stanistreet S, Allwright L, Bauld, et al. Facilitators of and Barriers to Implementation of Financial Incentive Interventions for Health Behaviour Change: A Systematic Review. Implementation Science [manuscript submitted for publication]; 2025. Gneezy U, Rustichini A. Pay Enough or Don’t Pay at All*. Quart J Econ. 2000;115(3):791–810. Cosgrave E, Sheridan A, Murphy E, Blake M, Siersbaek R, Parker S, et al. Public attitudes to implementing financial incentives in stopsmoking services in Ireland. Tob Prev Cessat. 2023;9(April):1–5. Meredith S, Jarvis B, Raiff B, Rojewski A, Cassidy R, Erb P et al. The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice. PRBM 2014;103. Higgins ST, Heil SH, Lussier JP. Clinical Implications of Reinforcement as a Determinant of Substance Use Disorders. Annu Rev Psychol. 2004;55(1):431–61. Miglin R, Kable JW, Bowers ME, Ashare RL. Withdrawal-Related Changes in Delay Discounting Predict Short-Term Smoking Abstinence. Nicotine Tob Res. 2017;19(6):694–702. Mantzari E, Vogt F, Shemilt I, Wei Y, Higgins JPT, Marteau TM. Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis. Prev Med. 2015;75:75–85. Van Der Spek L, Breunis LJ, Scheffers-van Schayck T, Bauld L, Ista E, Been JV. Financial incentives for smoking cessation among (expectant) parents: a systematic review of facilitators and barriers to implementation. Tob Control 2025;tc-2024-059198. Iguchi MY, Lamb RJ, Belding MA, Platt JJ, Husband SD, Morral AR. Contingent reinforcement of group participation versus abstinence in a methadone maintenance program. Exp Clin Psychopharmacol. 1996;4(3):315–21. Smith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control. 2021;30(e2):e87–95. Additional Declarations No competing interests reported. Supplementary Files Additionalfiles16.docx Additional file 1: ACCORD Checklist Additional file 2: Individual ranking sheet; survey form used for data collection on highly-ranked ideas Additional file 3: Theoretical assumptions, paradigm, researcher reflectivity and data triangulation process Additional file 4: Detailed results of the mNGT process; expanded list of generated ideas in phase three as well as full list of frequently voted ideas Additional file 5: Themes and supporting participants’ verbatims; detailed description of themes with supporting participants verbatims Additional File 6: Co-design FI scheme pilot materials; financial incentive leaflet distributed at pilot services Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor invited by journal 30 Jan, 2026 Editor assigned by journal 29 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 24 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8688569\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":581960180,\"identity\":\"0f9a6234-73d3-4ef9-a149-74ba7c17d41f\",\"order_by\":0,\"name\":\"Reham A. Lasheen\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFACHiAuYGAwALE//LABkowNRGgxgGhhnNmTRqIWZh62w4SdZd7ee/DTDQM7e3P25mMPeHjO5/P3H25g+FGxDacWmTPnkqVzDJITd/YcSzeQsLhtOeNGYgNjz5nbOLVISOQYALUwJxjcyDGTMOC5bWAgwdjAzNiGR4v8G+PfOQb19gb333+TSGA7Z2DAf5CAFgkeM6Athxk33OBhkzjAdsDAgCGRgBaeHDPrHIPjiRvOpJlJNvYkG0gA/XIQr1/Yzxjfzqmotjc4fviZ9J8fdgb8/ccfPvhRgVsLdnCARPWjYBSMglEwCtAAAExDU50qjNgSAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Reham\",\"middleName\":\"A.\",\"lastName\":\"Lasheen\",\"suffix\":\"\"},{\"id\":581960183,\"identity\":\"86375564-ab14-493d-995b-ce4e1bab8612\",\"order_by\":1,\"name\":\"Brian Doyle\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Brian\",\"middleName\":\"\",\"lastName\":\"Doyle\",\"suffix\":\"\"},{\"id\":581960185,\"identity\":\"86e6f32c-977e-4258-ad61-d8262f74b465\",\"order_by\":2,\"name\":\"Cheyenne Downey\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Cheyenne\",\"middleName\":\"\",\"lastName\":\"Downey\",\"suffix\":\"\"},{\"id\":581960186,\"identity\":\"3c0d4b28-da18-43ed-a55f-57aca9c005a2\",\"order_by\":3,\"name\":\"Debbi Stanistreet\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Debbi\",\"middleName\":\"\",\"lastName\":\"Stanistreet\",\"suffix\":\"\"},{\"id\":581960187,\"identity\":\"36e6293e-63ba-43c3-8bb4-d85d4f870dce\",\"order_by\":4,\"name\":\"Shane Allwright\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Irish Heart Foundation\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shane\",\"middleName\":\"\",\"lastName\":\"Allwright\",\"suffix\":\"\"},{\"id\":581960188,\"identity\":\"5636cc71-221a-4d44-9af1-f92604588949\",\"order_by\":5,\"name\":\"Linda Bauld\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Edinburgh\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Linda\",\"middleName\":\"\",\"lastName\":\"Bauld\",\"suffix\":\"\"},{\"id\":581960190,\"identity\":\"850ea360-29e5-4174-a74f-a8db15cee7c9\",\"order_by\":6,\"name\":\"Martina Blake\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Health Service Executive\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Martina\",\"middleName\":\"\",\"lastName\":\"Blake\",\"suffix\":\"\"},{\"id\":581960192,\"identity\":\"f6fe2d95-cb86-42a5-8bb0-902eb2b94712\",\"order_by\":7,\"name\":\"Sara Burke\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Trinity College Dublin\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sara\",\"middleName\":\"\",\"lastName\":\"Burke\",\"suffix\":\"\"},{\"id\":581960194,\"identity\":\"b0128706-f4d3-4647-8f42-61132efe61b0\",\"order_by\":8,\"name\":\"Molly Byrne\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Galway\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Molly\",\"middleName\":\"\",\"lastName\":\"Byrne\",\"suffix\":\"\"},{\"id\":581960195,\"identity\":\"0fb5ba0b-ef11-4f37-83af-2ff1a42886a0\",\"order_by\":9,\"name\":\"Jane Coyne\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"NHS Greater Manchester\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jane\",\"middleName\":\"\",\"lastName\":\"Coyne\",\"suffix\":\"\"},{\"id\":581960197,\"identity\":\"7ba248d4-80b2-43c3-8613-89597d54708a\",\"order_by\":10,\"name\":\"Fran Frankland\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Plane Sailing Consultancy Ltd\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Fran\",\"middleName\":\"\",\"lastName\":\"Frankland\",\"suffix\":\"\"},{\"id\":581960198,\"identity\":\"916c8726-cfc3-41da-b2a9-040eb85ccd22\",\"order_by\":11,\"name\":\"Claire Gordon\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Health\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Claire\",\"middleName\":\"\",\"lastName\":\"Gordon\",\"suffix\":\"\"},{\"id\":581960199,\"identity\":\"5454654d-191b-42e5-b282-95c1dc2ac331\",\"order_by\":12,\"name\":\"Sarah Halpin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Patient Public Involvement (PPI)\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sarah\",\"middleName\":\"\",\"lastName\":\"Halpin\",\"suffix\":\"\"},{\"id\":581960200,\"identity\":\"011f9fbb-3f0c-4b41-9321-bbd0a0e6e74f\",\"order_by\":13,\"name\":\"Roisin Lowry\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Health Service Executive\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Roisin\",\"middleName\":\"\",\"lastName\":\"Lowry\",\"suffix\":\"\"},{\"id\":581960201,\"identity\":\"2345a9e5-8967-4049-8cf1-5d4a1270c771\",\"order_by\":14,\"name\":\"Helen McAvoy\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Institute of Public Health\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Helen\",\"middleName\":\"\",\"lastName\":\"McAvoy\",\"suffix\":\"\"},{\"id\":581960202,\"identity\":\"1cdfd9df-609c-45e8-9929-f102070ac657\",\"order_by\":15,\"name\":\"Steve Moore\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Patient Public Involvement (PPI)\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Steve\",\"middleName\":\"\",\"lastName\":\"Moore\",\"suffix\":\"\"},{\"id\":581960203,\"identity\":\"6d54cc6a-0ed2-4fdb-8bb5-1d0c4413a520\",\"order_by\":16,\"name\":\"Edward Murphy\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Health Service Executive\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Edward\",\"middleName\":\"\",\"lastName\":\"Murphy\",\"suffix\":\"\"},{\"id\":581960204,\"identity\":\"711858df-9c80-4ab0-bbb7-71039bae9d58\",\"order_by\":17,\"name\":\"Gabrielle O’Keefe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"HSE Cork Kerry Community Healthcare\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Gabrielle\",\"middleName\":\"\",\"lastName\":\"O’Keefe\",\"suffix\":\"\"},{\"id\":581960205,\"identity\":\"c6a4548c-a10c-4afe-910d-82a894baacab\",\"order_by\":18,\"name\":\"Tony O'Reily\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Patient Public Involvement (PPI)\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tony\",\"middleName\":\"\",\"lastName\":\"O'Reily\",\"suffix\":\"\"},{\"id\":581960206,\"identity\":\"a1d72135-dfad-49eb-91f7-b37251c17b80\",\"order_by\":19,\"name\":\"Caitriona Reynolds\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Health Service Executive\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Caitriona\",\"middleName\":\"\",\"lastName\":\"Reynolds\",\"suffix\":\"\"},{\"id\":581960209,\"identity\":\"dfb79f44-b7f9-4204-950c-119d6256cf4e\",\"order_by\":20,\"name\":\"Aishling Sheridan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Health Service Executive\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Aishling\",\"middleName\":\"\",\"lastName\":\"Sheridan\",\"suffix\":\"\"},{\"id\":581960211,\"identity\":\"0af5ba37-826e-433b-bca7-c24a73c8941b\",\"order_by\":21,\"name\":\"Rikke Siersbaek\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Trinity College Dublin\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rikke\",\"middleName\":\"\",\"lastName\":\"Siersbaek\",\"suffix\":\"\"},{\"id\":581960212,\"identity\":\"ac2e87f1-0cae-42a8-bb47-01988d28c80d\",\"order_by\":22,\"name\":\"Susan M Smith\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Trinity College Dublin\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Susan\",\"middleName\":\"M\",\"lastName\":\"Smith\",\"suffix\":\"\"},{\"id\":581960214,\"identity\":\"31ffd887-f598-4c58-bdac-5471a63bc0e7\",\"order_by\":23,\"name\":\"Jan Sorensen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jan\",\"middleName\":\"\",\"lastName\":\"Sorensen\",\"suffix\":\"\"},{\"id\":581960215,\"identity\":\"c2df266a-6fd9-41f5-a4bf-1b381622c225\",\"order_by\":24,\"name\":\"Greg Straton\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Health\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Greg\",\"middleName\":\"\",\"lastName\":\"Straton\",\"suffix\":\"\"},{\"id\":581960217,\"identity\":\"a8aa2ce5-1bc0-4107-ba0b-383d59ba3a9b\",\"order_by\":25,\"name\":\"Sarah Tighe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Irish Cancer Society\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sarah\",\"middleName\":\"\",\"lastName\":\"Tighe\",\"suffix\":\"\"},{\"id\":581960219,\"identity\":\"4fff66b1-4601-4612-beb0-6776924be531\",\"order_by\":26,\"name\":\"Kenneth D. Ward\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of New Mexico\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kenneth\",\"middleName\":\"D.\",\"lastName\":\"Ward\",\"suffix\":\"\"},{\"id\":581960220,\"identity\":\"7030f697-08b1-4a14-8ec0-522eec47e21e\",\"order_by\":27,\"name\":\"Pauline Williams\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Patient Public Involvement (PPI)\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pauline\",\"middleName\":\"\",\"lastName\":\"Williams\",\"suffix\":\"\"},{\"id\":581960221,\"identity\":\"4453dc89-2bd1-41a7-b72d-ac324e99fb51\",\"order_by\":28,\"name\":\"Paul Kavanagh\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Paul\",\"middleName\":\"\",\"lastName\":\"Kavanagh\",\"suffix\":\"\"},{\"id\":581960222,\"identity\":\"9b16facd-3f3d-47a2-b0c8-a5479b9336e9\",\"order_by\":29,\"name\":\"Frank Doyle\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Royal College of Surgeons in Ireland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Frank\",\"middleName\":\"\",\"lastName\":\"Doyle\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-01-24 18:09:02\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8688569/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8688569/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":101406094,\"identity\":\"01dfeb44-7853-429d-b84b-0a0707717290\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:42:38\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":325296,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThematic map showing five main themes: 1) Shaping form, assigning value; 2) When standardisation meets (an ever-changing) reality; 3) Commitment to quit: validation and pitfalls; 4) For all or for some? 5) The implementation dilemma: accommodating expectations\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8688569/v1/939935a11c6704dda1147960.png\"},{\"id\":101406084,\"identity\":\"fab34327-9e65-4bb1-b452-1918e54d776e\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:42:31\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":372690,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe Irish stop smoking gift voucher incentive scheme leaflet provided by the HSE TFI office.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8688569/v1/0367d38a044b12fa671b0f7d.png\"},{\"id\":101406136,\"identity\":\"362a6eda-560e-4d19-adc3-6714de94c90f\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:42:44\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2443068,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8688569/v1/7407f3fb-430d-42ee-a7a3-a7537f2b7190.pdf\"},{\"id\":101406092,\"identity\":\"2fb92ce8-152a-4225-b0ec-0e54a3ea6ec2\",\"added_by\":\"auto\",\"created_at\":\"2026-01-29 10:42:38\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":434088,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAdditional file 1: ACCORD Checklist\\u003c/p\\u003e\\n\\u003cp\\u003eAdditional file 2: Individual ranking sheet; survey form used for data collection on highly-ranked ideas\\u003c/p\\u003e\\n\\u003cp\\u003eAdditional file 3: Theoretical assumptions, paradigm, researcher reflectivity and data triangulation process\\u003c/p\\u003e\\n\\u003cp\\u003eAdditional file 4: Detailed results of the mNGT process; expanded list of generated ideas in phase three as well as full list of frequently voted ideas\\u003c/p\\u003e\\n\\u003cp\\u003eAdditional file 5: Themes and supporting participants’ verbatims; detailed description of themes with supporting participants verbatims\\u003c/p\\u003e\\n\\u003cp\\u003eAdditional File 6: Co-design FI scheme pilot materials; financial incentive leaflet distributed at pilot services\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Additionalfiles16.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8688569/v1/f71d3c9bee328378b3d6c04f.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Co-design of a Community-based Financial Incentive Scheme for Smoking Cessation Services in Ireland: A Modified Nominal Group Technique\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eThe tobacco epidemic persists as a serious threat to population health and a major driver of inequalities worldwide\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. In Ireland, despite an overall decline in smoking prevalence, smoking remains the leading preventable cause of ill-health and premature death, with recent estimates suggesting it accounts for ~\\u0026thinsp;4500 deaths annually, an estimated 4.9\\u0026nbsp;million total loss in life years and a healthcare cost burden of \\u0026euro;20.2\\u0026nbsp;billion to the Irish healthcare system\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. Smoking prevalence, however, has remained static since 2019 at 17\\u0026ndash;18%, with a disproportionately lower decline in prevalence and quit rates among lower socioeconomic status (SES) groups\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. Similarly, global patterns repeatedly indicate that the lower SES populations bear the greatest burden\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR6\\\" citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. Nationally, smoking inequalities are growing, particularly among the least educated and for individuals living in the most deprived areas.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e For example, in 2025 current smoking prevalence was 21% among individuals with lower educational attainment, compared to only 11% for those with higher levels of education\\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. Furthermore, smoking and SES smoking-related inequalities tend to perpetuate a vicious cycle of overall health and socioeconomic inequalities such as financial strain\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e, mortality gap between SES groups\\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e, and poor health outcomes\\u003csup\\u003e[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eIn an effort to reduce inequalities, proposals to support smoking cessation have included a range of innovative approaches, such as the use of financial incentives (FI)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR16\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e. FI, defined as cash or cash-like rewards or penalties provided contingent on performance of healthy behaviours, are increasingly recognised as effective tools in promoting smoking cessation across diverse populations\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR19\\\" citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e. A Cochrane review of 39 trials (18303 participants) has found high-certainty evidence that individuals offered FI were 52% more likely to quit smoking at six months or longer follow-up compared to control groups (pooled risk ratio of 1.52, 95%, CI 1.33 to 1.74)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e. In particular, evidence suggests that FI interventions might be more effective and cost-effective when targeted at populations of lower SES\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e. Additionally, FI are considered effective for individuals facing financial strain or those who require external motivation to support their quit attempts; either through offering tangible monetary benefits or by serving as a positive reinforcement that helps build confidence and self-esteem\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eNonetheless, FI interventions have been largely subject to criticism, due to issues of acceptability, design heterogeneity and context-sensitivity, with little clarity around what constitutes an appropriate, efficient and effective FI structure\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR24 CR25\\\" citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e. Adams et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e recommend the use of a comprehensive framework to design effective incentive configurations. This framework provides key domains as follows: direction (positive gain or avoidance of loss), form (Cash, vouchers, etc.), magnitude (total value), certainty (certain or [variable] chance incentives), target (e.g., attendance at programmes and/or quitting), frequency (proportion of occurrences incentivised), immediacy, schedule (e.g. fixed incentives or increasing incentives over time) and recipient\\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eParticipatory research approaches, including co-design, have long been advocated as valuable in addressing potential contextual issues in intervention design and implementation, where the meaningful integration of relevant stakeholders\\u0026rsquo; views (including health professionals and community members) shape service design and delivery \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e. Stakeholders can be defined as \\u003cem\\u003e\\u0026ldquo;individuals, organizations or communities that have a direct interest in the process and outcomes of a project, research or policy endeavor\\u0026rdquo;\\u003c/em\\u003e\\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e. Such methods are therefore thought to produce robust knowledge acquired by systematic inquiry and through the mutual understanding of key perspectives, including those affected by the intervention, that is relevant, acceptable and sustainable\\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e. They also pose as valuable tools to strengthen co-creation approaches by providing the platform to address existing health inequities and promote positive change\\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e. These methods, however, are infrequently informed by relevant theory or frameworks to guide intervention development processes\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR34\\\" citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e with theoretical underpinnings often implicit or inconsistently applied limiting replicability.\\u003c/p\\u003e \\u003cp\\u003eTo overcome these limitations and enhance implementation processes, we aimed to utilise a blended approach, where participatory research principles supported by theory-guided specific questions are applied to inform intervention design. To our knowledge, this is the first study that aimed to co-design a FI intervention for smoking cessation in alignment with theoretical considerations by addressing the overarching question: What would an appropriate and contextually-relevant FI intervention for smoking cessation look like in terms of structure, amount and delivery?\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThis study is reported using the ACCURATE Consensus Reporting Document (ACCORD) guidelines\\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e to ensure methodological transparency, reporting consistency and enhance reproducibility (See Additional file 1).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient and public involvement:\\u003c/h2\\u003e \\u003cp\\u003ePatients and public representatives contributed during the planning phase of the wider COMPASS project\\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e, shaping the participatory research approach to answer this study\\u0026rsquo;s aim and refining study materials.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eContext\\u003c/h3\\u003e\\n\\u003cp\\u003eThe smoking cessation services provide nationwide evidence-based services in 152 primary care settings including free support for up to one year, consisting of behavioural counselling and access to cessation medications as free nicotine replacement therapy when appropriate\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e. Sl\\u0026aacute;intecare Healthy Communities Programme Areas\\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e (SHCPAs) target 24 designated disadvantaged areas based on high deprivation rates across 16 local authorities, where high levels of ill-health and health inequalities are evident.\\u003c/p\\u003e \\u003cp\\u003eIn these areas, intensive, community-based support with dedicated smoking cessation services and integrated health initiatives has significantly expanded\\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e. Low-income residents can avail of general medical cards (GMCs), which are typically means-tested, meaning they are entitled to free general practice and primary care services\\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e. The qualifying threshold is low and therefore GMCs eligibility generally serves as a proxy indicator of socioeconomic disadvantage.\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Design\\u003c/h3\\u003e\\n\\u003cp\\u003eA modified nominal group technique (mNGT) was used to facilitate three consensus workshops to co-design the FI scheme for implementation from September to October 2024. NGT offers a systematic, yet highly adaptable procedure to generate ideas and rank priorities from groups of individuals who have insights into the topic of inquiry, triangulating both quantitative and qualitative data\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e. A standard approach is typically undertaken in one session to answer one broad theme or question\\u003csup\\u003e[\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e]\\u003c/sup\\u003e, comprised of four key stages: idea generation, round robin, refining ideas and ranking of idea by voting.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]\\u003c/sup\\u003e However, given the complexity of FI design, a modified approach was considered necessary to align with the utilised theoretical framework, encompassing nine sub-questions supporting our overarching study aim.\\u003c/p\\u003e\\n\\u003ch3\\u003eParticipants and recruitment\\u003c/h3\\u003e\\n\\u003cp\\u003e Purposive and snowball sampling techniques were used to recruit participants aiming to gain transdisciplinary representation from clinical, research, policymakers and community member groups with relevant insights on the topic. Specifically, community members were recruited through the Local Authority Development Officers of three pilot areas \\u0026ndash; two urban and one rural, and were reimbursed for their time using gift vouchers. Additionally, the research team, in collaboration with Health Service Executive Tobacco Free Ireland (HSE TFI) office, leveraged existing networks to invite additional stakeholder groups including health professionals and service providers with the majority providing services in pilot areas. Community member participation was not restricted to those who currently or previously smoked.\\u003c/p\\u003e\\n\\u003ch3\\u003eData collection\\u003c/h3\\u003e\\n\\u003cp\\u003eParticipants\\u0026rsquo; demographic and medical history data were collected in addition to questionnaires. The questionnaire comprised of two main sections: the individual response section and the ideas ranking section. Questions reflected the nine elements of financial incentive structure as per Adams\\u0026rsquo; et al nine-domain conceptual framework\\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e (See Additional file 2). Participants received their questionnaire on arrival, to allow sufficient familiarisation time prior to workshop commencement, with onsite support for participants with literacy challenges. Each workshop lasted approximately 5\\u0026ndash;6 hours, and were facilitated by either FD or BD, who have extensive expertise in public health research and/or leading community and stakeholder engagement activities. When BD was in the facilitator\\u0026rsquo;s role, FD participated as a member of the NGT panel, but his responses were not considered as part of the results. Similarly, responses from repeat HSE TFI participants were recorded across the three workshops, but only those from the first workshop were included in the analysis. Discussions held during the group\\u0026rsquo;s decision-making processes, were audio-recorded and field notes/observations were also documented by RL and CD as appropriate.\\u003c/p\\u003e \\u003cp\\u003eThe standard NGT methods have been reported extensively elsewhere\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e outlines the stepwise process used in the technique, as originally presented by Gallagher \\u003cem\\u003eet al.\\u003c/em\\u003e\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e and our deviations and rationale for same. Briefly, we adapted the NGT to enable the examination of nine domain-specific sub-questions at each of the three workshops one question at a time. To accommodate the anticipated rich nature of the data, an on-site method triangulation was also undertaken through diverse data collection methods, including flipcharts, questionnaires, field notes and voice recordings of each group\\u003csup\\u003e[\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]\\u003c/sup\\u003e. Lastly, an online follow-up discussion post-analysis with participants from all sites was sought for sense-checking and final adjustments of the intervention design.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eAn outline of the modifications (highlighted in bold) made to the standard NGT procedure.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhase\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emNGT\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 1: Introduction and explanation of the procedure\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"No\\\" id=\\\"Taba\\\" border=\\\"1\\\"\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cp\\u003eIntroductions, NGT objectives and working together guidelines. Summary of the nine questions presented by the facilitator via a PowerPoint presentation in plain English.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 2: Silent generation of ideas in writing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEach of the nine questions were presented one at a time in succession, accompanied by an explanation, with adequate time allocated for participants to respond.\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 3: Listing of ideas on flip chart\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eEach participant was asked to voice their ideas in round-table manner for each of the nine questions.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 4: Discussion of ideas on flip chart\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eParticipants shared their rationale for each idea they had shared. Additionally, on completion of each list per domain, time was given to the participants to have open discussions on all generated ideas.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 5: Ranking to select the \\u0026ldquo;top-five \\u0026ldquo;ideas\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eParticipants ranked ideas listed on the flipchart on a scale from 1 to 5 on their ranking sheets, the most highly ranked idea receiving 5 points.\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 6\\u0026ndash;7: Voting on \\u0026ldquo;top-five\\u0026rdquo; idea; Break\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eParticipants were asked to voice out their top two ideas. No list was produced. Instead, ideas were tallied on the flipchart and shortlisted. During the break, a prioritised consensus list was produced.\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 8\\u0026ndash;9 Active discussion of the votes; Re-evaluation of rankings\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eActive and moderated discussion about the nature and content of all listed items were carried out. Participants discussed feelings and insights about items included or excluded and were allowed to reflect/ modify their highly ranked answers.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStep 10: Conclusion of the nominal group -Consensus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eThe final list of the highly ranked \\u0026ldquo;top-five per participant\\u0026rdquo; items were presented to the participants, one question at a time. Participants were asked whether they collectively agree on the top-rated idea per domain. Disagreements prompted further in-depth discussions where scoring of each idea was considered until consensus was reached.\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Analysis\\u003c/h2\\u003e \\u003cp\\u003eData analysis was undertaken following completion of all data collection across the three workshops. Consensus processes during the meetings continued until majority consensus (\\u0026gt;\\u0026thinsp;50%) was achieved. By adopting this approach, in-session results validation at the end of each workshop was inherently ensured\\u003csup\\u003e[\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e]\\u003c/sup\\u003e. Demographic data were analysed descriptively while quantitative data related to the gathered ideas and their final rankings was analysed using Excel V.2018 according to a recommended procedure, with participants\\u0026rsquo; idea scores being divided by the sum of all scores given per domain, yielding the relative importance given to each idea per domain\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eDiscussions were transcribed verbatim initially using aTrain\\u003csup\\u003e[\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e]\\u003c/sup\\u003e, a trained transcription software using machine learning for accuracy, then cross-checked by BD and RL to enable idea and results validation. Transcripts were inductively analysed using reflexive thematic analysis (Braun and Clarke, 2022) \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR52\\\" citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]\\u003c/sup\\u003e by RL. The analysis was conducted at both semantic and latent levels, aiming to provide a clear display of participants\\u0026rsquo; explicit and diverse views surrounding the intervention constituents and its implementation processes whilst capturing the rich and more nuanced understanding of the underlying reasonings behind the resultant consensus decisions, collectively shaping the multifaceted nature of decision making. Post initial analysis, coding and themes development processes were discussed with CD and BD to promote a critical dialogue enhancing reflexivity and deepening interpretation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]\\u003c/sup\\u003e. See Additional file 3 for information on researcher reflexivity and more details on the process.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Findings\",\"content\":\"\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eParticipants Characteristics\\u003c/h2\\u003e \\u003cp\\u003eA total of 59 participants took part in the study across the three sites; A (n\\u0026thinsp;=\\u0026thinsp;26), B (n\\u0026thinsp;=\\u0026thinsp;16) and C (n\\u0026thinsp;=\\u0026thinsp;17). Most of whom were aged between 35 and 64 years old (n\\u0026thinsp;=\\u0026thinsp;43), females (n\\u0026thinsp;=\\u0026thinsp;36) and white Irish (n\\u0026thinsp;=\\u0026thinsp;50). Of the total sample, 28 were community members, and 25 were healthcare or service providers including three organisational representatives. The majority of participants (n\\u0026thinsp;=\\u0026thinsp;41) either currently or previously smoked conventional cigarettes. A total of 22 participants had been diagnosed with a long-term medical condition, with almost half of those having multimorbidity (more than two long term conditions at one time). Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e presents participants\\u0026rsquo; site and detailed characteristics.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eParticipants\\u0026rsquo; characteristics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSite (No. of participants)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSite A, Urban\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;26)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSite B, Urban\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;16)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eSite C, Rural\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;17)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;59)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAge, \\u003cem\\u003en (%)\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3 (5.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e25\\u0026ndash;34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7 (12.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e35\\u0026ndash;44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16 (28.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e45\\u0026ndash;54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14 (24.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e55\\u0026ndash;64\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e13 (22.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e65+\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4 (7.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSex\\u003c/b\\u003e, \\u003cb\\u003en\\u003c/b\\u003e \\u003cb\\u003e(%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23 (39.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35 (60.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEthnicity\\u003c/b\\u003e, \\u003cb\\u003en\\u003c/b\\u003e \\u003cb\\u003e(%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIrish White\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e50 (84.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIrish Traveller\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (3.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther \\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7 (11.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRole\\u003c/b\\u003e, \\u003cb\\u003en\\u003c/b\\u003e \\u003cb\\u003e(%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCommunity member\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e28 (47.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHealthcare/Service provider\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25 (42.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6 (10.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eNever smoker\\u003c/b\\u003e \\u003csup\\u003e\\u003cb\\u003eb\\u003c/b\\u003e\\u003c/sup\\u003e, \\u003cb\\u003en\\u003c/b\\u003e \\u003cb\\u003e(%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e18 (30.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41 (69.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDiagnosed long-term condition\\u003c/b\\u003e \\u003csup\\u003e\\u003cb\\u003ec\\u003c/b\\u003e\\u003c/sup\\u003e, \\u003cb\\u003en\\u003c/b\\u003e \\u003cb\\u003e(%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eyes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22 (39.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e30 (53.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eprefer not to say\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eIf yes\\u003c/b\\u003e, \\u003cb\\u003en\\u003c/b\\u003e \\u003cb\\u003e(%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOne condition\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (45.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTwo or more\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (45.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrefer not to say\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (9.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003csup\\u003ea: including other white, East\\u0026minus;Asian and South\\u0026minus;Asians\\u003c/sup\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003csup\\u003eb: pertains to never being daily, occasional tobacco or e\\u0026minus;cigarette smoker\\u003c/sup\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e\\u003csup\\u003ec: Conditions include: Diabetes, hypertension or kidney, cardiovascular, respiratory, gastrointestinal, neurological, joint and bone diseases, mental health illness, cancer or long\\u0026minus;lasting impairment or difficulty\\u003c/sup\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eConsensus\\u003c/h2\\u003e \\u003cp\\u003eDuring initial phases, all three groups were asked to answer the questions on the nine domains of FI design and were subsequently invited to share those with the wider group. Participants were allowed to skip their turn, share more than one idea per question or refrain from answering altogether. More than 69 ideas were generated for all nine domains across the three workshops with 43\\u0026ndash;58 participants sharing their ideas per domain. Consensus data, measured by frequency of participant\\u0026rsquo;s votes, across the three workshops were analysed to generate the final list of highly ranked ideas. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e presents the collective views of participants (See Additional file 4 for full list of generated ideas and ranking)\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eFirst three top-rated ideas per domain across the three workshops\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDomain\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c5\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eMagnitude (\\u0026euro;)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRank\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIdea\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSum of scores\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFrequency of votes\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRI (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal amount\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e400\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e200\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e500\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eForm\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(Physical/digital) voucher\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e87\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLimited-use voucher\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e66\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMoney Transfer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCertainty\\u003c/b\\u003e \\u003csup\\u003e\\u003cb\\u003ea\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCertain reward\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e101\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e54.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCombination of a certain reward and chance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e20.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCertain chance e.g., Prize draw\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTarget Behaviour\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eValidated quit\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e52\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eValidated quit at certain timepoints\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eValidated quit and clinic attendance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFrequency and schedule\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFixed timepoints in line with services\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIncremental increase at certain timepoints in line with the service\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLump sum payment in the end\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eImmediacy\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eImmediately (as soon as possible)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e109\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e66.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWithin a week\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTarget population\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTargeted (Socioeconomic Status)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e77\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e33.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAll smokers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMeans-tested\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e18.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eService Provider\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStop Smoking Advisors\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e83\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e2\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHSE (TFI Programme Office)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHealthcare professionals\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSum of Scores\\u003c/strong\\u003e \\u003cp\\u003etotal sum of all scores given for an idea on a scale of five to one across all participants\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eFrequency of votes\\u003c/strong\\u003e \\u003cp\\u003enumber of participants voted per idea\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eRI (Relative importance)\\u003c/strong\\u003e \\u003cp\\u003e(Score of each individual idea/ total sum of all scores given for all ideas per domain) * 100\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003e \\u003cb\\u003ea\\u003c/b\\u003e \\u003c/sup\\u003e Terminology used adopted from Adams et al\\u0026rsquo;s framework as follows. \\u003cem\\u003eCertain\\u003c/em\\u003e: guaranteed FI upon achieving the behaviour. \\u003cem\\u003eCertain Chance\\u003c/em\\u003e: guaranteed entry into a lottery but winning is not assured. \\u003cem\\u003eUncertain Chance\\u003c/em\\u003e: neither entry nor winning is guaranteed; only participation depends on meeting eligibility.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eQualitative findings\\u003c/h2\\u003e \\u003cp\\u003eThe post-ranking discussions were further used to inform finalisation of the FI design. Themes from these discussions are outlined below. Categories of each theme are presented followed by the number of units relevant to each category in brackets. Participants are identified by role, where CM denotes community members, HP healthcare professionals, and SP service providers.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eAn Equitable system: idealism versus realism.\\u003c/b\\u003e \\u003c/p\\u003e \\u003cp\\u003eDiscussions surrounding each domain of the financial incentive intervention highlighted the complexity of decision-making processes as well as the profound social and ethical weight of the entire endeavour, particularly considering resources at hand, evidence-base and population needs. Overall, under this overarching theme, the tension between a range of idealised scenarios to the realities of the implementation environment are presented. Analysis revealed five key themes\\u003csup\\u003e1\\u003c/sup\\u003e across 159 units of analysis 1) Shaping form, assigning value; 2) When standardisation meets (an ever-changing) reality; 3) Commitment to quit: validation and pitfalls; 4) For all or for some? 5) The implementation dilemma: accommodating expectations. Figure\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e shows the thematic map showing the five main themes, subthemes and categories where necessary, with Additional file 5 presenting same with full data excerpts.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e1.\\u0026nbsp; \\u0026nbsp;Shaping form, assigning value \\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme depicts the difficulty determining the amount or value as well as the various forms of incentives to be administered considering their relative significance and their feasibility. Some participants argued that non-monetary incentives [5] e.g., a trophy or graduation ceremony \\u0026ldquo;\\u003cem\\u003eso that it lasts forever\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(CM) as a constant reminder of their achievement are more meaningful, while the majority inclined towards those of monetary value [20]. On the value of the incentive, several participants recognised the importance of offering an incentive that is \\u003cem\\u003e\\u0026ldquo;enticing enough\\u003c/em\\u003e (HP) and \\u003cem\\u003e\\u0026ldquo;worth their while\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(CM) to drive an individual\\u0026rsquo;s motivation towards a quit attempt [13]. When considering factors such as relative costs borne by the service user during service access, or those foregone savings borne by the healthcare system should people manage to quit, as well as the current evidence-base, it was soon realised that what could be valuable to one would not necessarily be to another, nor feasible given contextual factors.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;I think the money could be very tokenistic. If I say 50 or 150 or 200 or 300, it could be like a middle-class approach to a working-class problem\\u0026hellip; \\u0026nbsp;I\\u0026apos;m sort of honing in around that 400 mark. But cost impact, you could probably scale it up to 4000, easy enough.\\u0026rdquo; SP, Site C.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eWhen it came to the form or the shape of the incentive, it became apparent, perhaps, unsurprisingly, that there were concerns about logistical and the practical aspects of implementation. These included tax implications, administration/utilisation procedural complexity, associated fees and potential impact on a more personalised approach, particularly surrounding the degree of choice that purchasing a certain incentive type, could offer a user [27]. For example, forms like prepaid cards and cash were not favoured due to their cumbersome administration, tax implications or the notion that \\u0026ldquo;\\u003cem\\u003eIf you get cash, it just gets swallowed!\\u0026quot;\\u003c/em\\u003e(CM).\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e A voucher system was most favoured mainly due to its less complex nature of implementation, administration and tracking, as well as its relative broad applicability for local stores. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;(On electronic money transfer as a method of FI delivery) For the reason that it would involve tax implications. Whereas a voucher; you are allowed to have a voucher for a certain amount without changing or declaring it as an income\\u0026rdquo; HP, Site C.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.\\u0026nbsp; \\u0026nbsp;When standardisation meets (an ever-changing) reality\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTwo main concepts were discussed in relation to incentive administration: a one-size-fits all model versus a person-centred approach. Although participants highlighted service users\\u0026rsquo; diverse needs and capabilities to quit and the importance of a flexible system, especially when dealing with groups across different sites and who are most in need of support [6], they also recognised that it would be practically impossible to operate a fluid system without a clear framework in place [11].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;I understand why it\\u0026apos;s important to stick to structure, but I suppose my concern with that is it will appeal to and it will work more with certain persons and those who, maybe, don\\u0026apos;t have the supports around them to the same degree; which are the people we\\u0026apos;re trying to get to support.\\u0026rdquo; SP, Site A.\\u003c/p\\u003e\\n\\u003cp\\u003eAs Ireland\\u0026rsquo;s Stop Smoking clinics already operate a standardised, evidence-based service, participants mainly proposed a structured approach for several reasons, including its ability to leverage well-established systems, permit standardisation across sites, enable clear messaging to service users and efficient communication across implementation parties as well as ensure orderly management of an already complex intervention \\u0026ndash; thereby helping prevent potential disputes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;We\\u0026apos;ve got one IT system and just like administrating something like this... even from a communications point of view (for example, someone could say) I\\u0026apos;m living in Longford, so I\\u0026apos;m getting \\u0026euro;500 to quit. I\\u0026apos;m living in Dublin; I\\u0026apos;m only getting 300. Or, I\\u0026apos;m getting (incentives at) different time points. It would be a nightmare!\\u0026rdquo; SP, Site C\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.\\u0026nbsp; \\u0026nbsp;Commitment to quit: validation and pitfalls\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOn the target behaviour to incentivise, this theme presents discussions primarily focusing on how to define or measure commitment to quit, and validation methods and concerns around potential gaming of the system. Participants generally held a strong stance towards incentivising a form of witnessed and maintained effort to quit as to \\u003cem\\u003e\\u0026ldquo;do the leg work and then you get it!\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(CM) with a \\u003cem\\u003e\\u0026ldquo;no punishment\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(SP) approach in case of relapse [18].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;You\\u0026apos;d have to get yourself back to where you were and then carry on. Yeah; to catch up on yourself!\\u0026quot; CM, Site A.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe format of such effort or commitment, however, was subject of considerable deliberation among participants. For example, while several participants recognised the importance of rewarding service attendance or setting a quit date, potential system misuse and overwhelming of services, as well as limited defensibility to the public, significantly rendered rewarding these behaviours impractical. Hence, a robust and objective measure of a quit attempt would be required [20]. \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;I feel very strongly on this. I actually feel that people should only get rewarded for a validated quit, so I think that administering this with any kind of subjectivity will be impossible and I think what would happen is one service might provide it in one way or another and that could end up backfiring. I think if people know if they come in with the intention that I\\u0026apos;m going to get paid to quit and that\\u0026apos;s it; the message is very clear, people have the same goal. If you start moving the bar; I think that we could undermine the whole thing.\\u0026rdquo;\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003eSP, Site A. \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough few participants expressed that \\u003cem\\u003e\\u0026ldquo;there is a certain amount of trust expected from our clients\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(SP), a major driver behind having a method of quit validation, often stemmed from concerns surrounding gaming the intervention, as well as the need to uphold a consistent parameter of behaviour validation promoting a sense of fairness and accountability among service users. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;(On importance of a test) I think you might be trusting a person to come along and say they are quit\\u0026hellip;only for them to come out and then smoke!\\u0026rdquo; CM, Site A.\\u003c/p\\u003e\\n\\u003cp\\u003eIt was recognised however, that caveats surrounding the use of the Carbon Monoxide (CO) breath test (Breathalyzer) used to validate smoking cessation existed, with gaming still a possibility. Also, it may not accurately reflect abstinence in specific groups such as those with specific health conditions or physiological variations [9].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;I had a patient \\u0026ndash; COPD, came into clinic, I could, know her chest was terrible! So, I did- she hadn\\u0026apos;t smoked or anything, I did her CO testing, and it was actually 15!\\u0026rdquo; HP, Site C.\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough a few participants proposed alternative testing methods mainly Cotinine testing [6], these were quickly dismissed mainly over the concern that it would disrupt the well-established provider-user relationship dynamics and be contrary to the longstanding principles of the services, which have consistently centred around providing an optimum opportunity for users to achieve better health.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;It changes the tone of the interaction that\\u0026apos;s happening... you [service user] can hoodwink many different ways, if somebody\\u0026apos;s trying to catch you out. But then, so what? If somebody\\u0026apos;s coming to your clinic, they get free money; but it\\u0026apos;s not a significant amount of money - unless it starts with four grand! So, if we go down \\u003cem\\u003eto \\u0026quot;I actually want to do a random test to you\\u0026quot;\\u003c/em\\u003e that brings us into that sort of drug testing space. And it does have connotations about what the actual service is about. Giving people the optimum opportunity to overcome a product that is optimized for human consumption and it\\u0026apos;s highly addictive. Um, I would not like to see mistrust weaving in!\\u0026rdquo; SP, Site C.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e4.\\u0026nbsp; \\u0026nbsp;For all or for some?\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme concerns a rather heavily contemplated domain; the target population of the incentive, where under this theme some participants were conflicted between the ideal \\u003cem\\u003e\\u0026ldquo;open to anyone\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(CM)\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003eservice as to promote inclusivity and to avoid creating unnecessary divide between different populations in society versus a more targeted and realistically-feasible approach. In spite of such sentiment, real-world constraints [9], for example, the limited budget and resources at hand, necessitated for an eligibility criterion that is clear, easily applicable and defensible to stakeholders to be set.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;The least preference would be all smokers, not because I wouldn\\u0026apos;t like to give every kind of help to every kind of smoker but just politically (and) financially trying to articulate that would be tricky!\\u0026rdquo; SP, Site B.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOn inclusion criteria, participants mainly reflected upon priority groups such as individuals of socioeconomic need, those with existing medical conditions, or those in the maternal healthcare continuum [22]. \\u0026nbsp;It was soon acknowledged that disadvantaged areas are more likely to bear the most burden and encompass all previously-mentioned groups.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;But essentially that\\u0026apos;s everyone in Sl\\u0026aacute;intecare, because anyone in Sl\\u0026aacute;intecare could be pregnant, could have a mental health condition, could have chronic disease\\u0026rdquo; HP, Site B.\\u003c/p\\u003e\\n\\u003cp\\u003eSoon after, another dilemma raised by the participants was the applicability of such criteria in day-to-day operations as relying exclusively on geographical boundaries to determine enrolment will likely pose potential challenges. Several participants were torn between potentially stigmatising a group of people or excluding those more in need if implementing an objective threshold or parameter. Eventually, discussions revealed various caveats including the fact that even within deprived areas \\u0026ldquo;\\u003cem\\u003ethere are hot pockets of stark deprivation and just down the road there are affluent areas.\\u0026rdquo;\\u003c/em\\u003e (SP) thus\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003ethe need for an objective parameter appeared necessary.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u0026ldquo;I also put medical card or GP card, because we have some people who are quite advantaged living in those areas. \\u0026nbsp;And historically, [when we] had free NRT for just those in Sl\\u0026aacute;intecare areas, it was quite difficult to kind of determine where\\u0026apos;s the boundary and the border and all of that. And you don\\u0026apos;t want to leave it up to the advisors to have to make that decision. So, you need something very definite that\\u0026apos;s easy to administer and that\\u0026apos;s you\\u0026apos;re either in or you\\u0026apos;re out and it\\u0026apos;s a pilot, you know what I mean?\\u0026rdquo; SP, Site C.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e5.\\u0026nbsp; \\u0026nbsp;The implementation dilemma: \\u0026nbsp;accommodating expectations\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eUnder this theme, participants discussed operational roles and demands with considerations to existing services capacity as well as parameters of intervention success in light of stakeholders and public perceptions [28]. For example, two main areas of responsibilities were communications surrounding the incentive and its actual administration. As the majority agreed that information dissemination is best conducted through the Health Service Executive as \\u0026ldquo;\\u003cem\\u003eit\\u0026rsquo;s seen as a trusted source\\u003c/em\\u003e\\u0026rdquo; and \\u003cem\\u003e\\u0026ldquo;with the appropriate branding and the appropriate key message\\u0026rdquo; (SP),\\u0026nbsp;\\u003c/em\\u003eseveral pondered\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003eover the most efficient method of incentive issuance.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;The incentive piece, I was certain from a staff management perspective, I wouldn\\u0026rsquo;t be happy with the team being responsible for holding on to vouchers and money and the pressures that would put on people at a local level. So, we have to think where we\\u0026apos;d even store it - in a secure environment\\u0026hellip;. So, my thinking would be of it being centralised, you know, in our admin teams.\\u0026rdquo; SP, Site C.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eEventually, a collaborative approach between both service providers and the HSE were seen the most suitable. \\u0026nbsp;A few providers subsequently voiced their concerns surrounding managing expectations when it comes to immediate incentive delivery, as to align with the intervention demands and evidence-best practice. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;Because I suppose we (Stop Smoking Advisors) face too much at hand. But we make an attempt to do it (deliver the incentive) on the day.\\u0026rdquo; SP, Site A.\\u003c/p\\u003e\\n\\u003cp\\u003eOverall, a major consideration governing almost every decision was defensibility, whether to the public or different stakeholder groups. As participants were concerned that incentivising smoking cessation, which is known to be controversial, could further attract public scrutiny, it was important to tread carefully and produce a \\u003cem\\u003e\\u0026ldquo;bomb-proof\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(SP) intervention whether in terms of amount, target population or behaviour or simply utilising tailored and minimal advertising. \\u0026nbsp;At the same time, few underscored the value in balancing perceived risks with the implementation of a theoretically-sound and agreeable intervention.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026ldquo;I think we care; I know we have to sell this to the public because it may be under scrutiny \\u0026hellip; but I would just tread carefully in terms of always being pigeonholed into that direction because of the consequences\\u0026rdquo; SP, Site A.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;Shaping the FI Intervention design \\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAs a result of the mNGT workshops, an initial structure of the FI scheme entailed providing \\u0026euro;400 over a 12‑month programme in the form of a digital or physical voucher, delivered as a definite reward to adult smokers living in deprived areas, contingent on biochemically validated quitting and clinic attendance, with incremental payments aligned to the existing service schedule, issued on the day or as soon as possible, and administered by smoking cessation advisors.\\u003c/p\\u003e\\n\\u003cp\\u003eThe final FI design was further refined during a follow-up online discussion with stakeholders, with minimal deviations from the workshop results, primarily due to logistical considerations identified during the planning and implementation phases. While the original design was set to distribute the total \\u0026euro;400 amount in incremental increases, this was changed to \\u0026euro;20 being issued at fixed amounts for the first three weeks, with incremental increases thereafter. The final Intervention is as follows: Weeks 1-3: \\u0026euro;20, week 4: \\u0026euro;40, week 12: \\u0026euro;60, week 26: \\u0026euro;100, week 52: \\u0026euro;140. \\u0026nbsp; In terms of the voucher, the choice was on \\u003cem\\u003eOn4all\\u003c/em\\u003e Gift card\\u003csup\\u003e[54]\\u003c/sup\\u003e; available in both digital and physical formats, redeemable at multiple retail outlets. On immediacy, issuing incentives on the same date proved logistically challenging. Therefore, clients were set to receive their incentive within a maximum of one week following a confirmed quit. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOn the target population, following discussions, it was agreed to use the GMC as an objective criterion for identifying eligible adult clients based on socioeconomic status within SHCPAs. Finally, in terms of relapse mechanisms, clients on the service who relapse at any stage may re-join and remain eligible for financial incentives. Upon re-joining, however, they resume incentives receipt on a successful quit from the point at which they previously relapsed. Due to budget constraints, clients are permitted one re-entry to the FI scheme though they may continue to access other QUIT support services as usual. Figure 2 shows a leaflet used to promote the scheme post-implementation as the \\u0026ldquo;Stop Smoking Gift Voucher Incentive Scheme\\u0026rdquo;. (See Additional file 6)\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eWe have outlined the first co-designed, theory-based FI scheme for smoking cessation in deprived communities. Our study participants proposed the most appropriate FI design for local implementation as follows: a total amount of \\u0026euro;400, over a 12-month period delivered in an incrementally increasing schedule at validated quit milestones, confirmed by CO testing with payments provided immediately or as soon as possible following verification for adults meeting a low-income threshold from deprived areas. Key considerations governed the final structure including: public and stakeholders\\u0026rsquo; acceptability, principles of equity, appropriate incentive valuation and scope of and mechanisms against gaming as well as best fit with existing systems.\\u003c/p\\u003e \\u003cp\\u003eThis study also outlines a methodology that helps bridge the evidence-to-practice gap ensuring a scheme is most likely to have a good fit within existing services and relevant to those involved\\u003csup\\u003e[\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e]\\u003c/sup\\u003e. Overtly, FI interventions may seem simple to design and/or execute yet they are inherently complex shaped by multifaceted, diverse and contextual factors- making such method a valuable tool to address these challenges. Although, it has been argued that it is unrealistic to expect co-design processes to produce ideal solutions to complex problems within a short timeframe\\u003csup\\u003e[\\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e]\\u003c/sup\\u003e, our combined approach, utilising theory to frame the discussions, allowed for incorporation of participants\\u0026rsquo; ideas into FI design. This has successfully informed the implementation of an ongoing multi-site pilot FI scheme \\u0026ldquo;Stop Smoking Gift Voucher Incentive Scheme\\u0026rdquo;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR58\\\" class=\\\"CitationRef\\\"\\u003e58\\u003c/span\\u003e]\\u003c/sup\\u003e which is currently being evaluated as part of the wider study, COMPASS\\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e. Overall, we believe our design closely aligns with existing evidence-base\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e and is contextually appropriate model for Ireland\\u0026rsquo;s smoking cessation services and well-established national programmes of similar systems\\u003csup\\u003e[\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eStudies have shown that an \\u0026ldquo;appropriate\\u0026rdquo; FI intervention for smoking cessation is often governed by key inter-dependent aspects: acceptability, which is regularly linked to amount issued and target population, effectiveness and cost-effectiveness\\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e]\\u003c/sup\\u003e. It is also important to note that evidence suggests that the perceived value of a specific incentive amount could vary significantly across settings and target populations\\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR63\\\" citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR64\\\" class=\\\"CitationRef\\\"\\u003e64\\u003c/span\\u003e]\\u003c/sup\\u003e. For example, Notley et al.\\u0026rsquo;s systematic review\\u003csup\\u003e[\\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e]\\u003c/sup\\u003e of 48 RCTs examined incentives ranging from \\u003cspan\\u003e$\\u003c/span\\u003e45 to \\u003cspan\\u003e$\\u003c/span\\u003e1185 (excluding zero self-deposits), and found that low-to-moderate incentives (under \\u003cspan\\u003e$\\u003c/span\\u003e500) often achieved sustained abstinence beyond the reward schedule of six months or more. Interestingly there was no significant difference in long-term quit rates between smaller (\\u0026lt;\\u003cspan\\u003e$\\u003c/span\\u003e100) and larger (\\u0026gt;\\u003cspan\\u003e$\\u003c/span\\u003e700) incentives. Although their analysis yielded no significant association between total incentive value and cessation outcomes, this is a crude analysis, and non-significant results may be due to local contexts or cultural significance of FI amounts. This in fact may underscore the importance of co-design methods in formulating FI reward structures to better account for context (e.g., income level, cultural norms, target population)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR64\\\" class=\\\"CitationRef\\\"\\u003e64\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR65\\\" class=\\\"CitationRef\\\"\\u003e65\\u003c/span\\u003e]\\u003c/sup\\u003e. In both Irish and UK contexts, similar reward sizes appear to be both impactful and scalable\\u003csup\\u003e[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eOur participants voiced their acceptance of both the proposed amount as well as the overall structure of the scheme based on several factors aligning with previous literature\\u003csup\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR64\\\" class=\\\"CitationRef\\\"\\u003e64\\u003c/span\\u003e]\\u003c/sup\\u003e. Results showed that the amount needed to be sufficiently large to motivate cessation, yet not so substantial as to invite misuse or attract adverse public scrutiny, as well as remain within budget, and integrated with associated administrative operations consistent with existing services workflows. On public attitudes to FI for smoking cessation, Cosgrave et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e]\\u003c/sup\\u003e conducted a cross-sectional survey of 1000 participants and found that among the 47% of respondents supporting the use of FI, the majority (60.6%) believed the maximum amount given should be under \\u0026euro;250 (median \\u0026euro;100), although there was a very wide range (\\u0026euro;1-\\u0026euro;7000). Therefore, our findings are within the expected range and likely to be publicly acceptable, particularly to those affected by smoking, while remaining cost-effective in the national context\\u003csup\\u003e[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe timely delivery of FI is critical. For logistical reasons, it was considered that receiving a voucher within a week would be realistic. FI received within days to weeks following a validated quit are proven to reinforce abstinence and sustaining motivation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e]\\u003c/sup\\u003e. The relative immediacy of FI has been frequently shown to influence outcomes of incentive-based programmes; the more immediate rewards have larger effect sizes, whereas a delay could compromise the influence of even high-magnitude incentives on behaviour\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR68\\\" class=\\\"CitationRef\\\"\\u003e68\\u003c/span\\u003e]\\u003c/sup\\u003e. The theory of hyperbolic discounting, where individuals tend to disproportionally prefer smaller, immediate rewards over largely delayed ones, with the rate of discounting decreasing over time, may explain these findings\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e]\\u003c/sup\\u003e. Despite this, many FI interventions conducted involve significant delays between target behaviour and incentive delivery.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e]\\u003c/sup\\u003e Almost all our participants agreed that an incentive should be received immediately or as soon as possible (within a week of validation).\\u003c/p\\u003e \\u003cp\\u003eThe HSE\\u0026rsquo;s Stop Smoking services are structured, with set quit verification timepoints at 4, 12, 26 and 52 weeks\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e. Participants agreed that the most administratively sound and potentially effective reinforcer was to tie the rewards with such milestones. Additionally, the majority of our participants, generally, preferred a validated quit to be incentivised over other behaviours e.g., attendance only. This is also in line with recommendations of biochemical validation over self-reporting of quit status, noting that the latter tends to overestimate quit rates, particularly when financial rewards are involved\\u003csup\\u003e[\\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e]\\u003c/sup\\u003e. Moreover, theory suggests that incentives might work according to operant conditioning (rewards tied to desired behaviour)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e]\\u003c/sup\\u003e with evidence emphasising that incentives are more effective not only when tied to specific milestones, but specifically when delivered as part of a contingency-based framework, meaning incentives are conditional upon verified maintenance of some sort\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e]\\u003c/sup\\u003e. Others argue that engagement-based incentives are easier than those contingent on verified cessation, with positive impact on promoting attendance particularly among individuals who struggle to achieve or maintain abstinence\\u003csup\\u003e[\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e]\\u003c/sup\\u003e. Nonetheless, prior literature indicates that incorporating validation methods can enhance behaviour change and is associated with positive outcomes\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR72\\\" class=\\\"CitationRef\\\"\\u003e72\\u003c/span\\u003e]\\u003c/sup\\u003e, by supporting self-efficacy, adherence and promoting accountability, reducing relapse risk and reinforcing perceived fairness and incentive value\\u003csup\\u003e[\\u003cspan citationid=\\\"CR64\\\" class=\\\"CitationRef\\\"\\u003e64\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e]\\u003c/sup\\u003e. Additionally, these methods help limit gaming behaviours, thereby improving acceptability and consequently facilitating wide-scale adoption.\\u003c/p\\u003e \\u003cp\\u003eOur participants voted SHCPAs\\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e as most appropriate for scheme implementation where socioeconomically-disadvantaged groups are prevalent, shouldering high burden of smoking, ill-health and inequality\\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e. Though universal approaches to implementation are often more acceptable to the general public, using a targeted FI- approach toward lower income groups is argued to promote health equity\\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR73\\\" class=\\\"CitationRef\\\"\\u003e73\\u003c/span\\u003e]\\u003c/sup\\u003e, which further ensured by the condition of possessing a GMC in our study. Cosgrave\\u0026rsquo;s et al.\\u0026rsquo;\\u003csup\\u003e[\\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e]\\u003c/sup\\u003e, however, found that the support for universal FI interventions and for targeting to people of lower income was similar with those with the greatest need, i.e., younger individuals with lower education who smoke, were more supportive of a targeted approach, in line with our findings.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSTRENGHTS AND LIMITATIONS\\u003c/h2\\u003e \\u003cp\\u003eWhile the NGT is typically applied with a small number of participants to address a single broad question, our mNGT approach demonstrated the method\\u0026rsquo;s flexibility, as we conducted three independent workshops with 59 participants, addressing nine specific and relevant sub-questions underpinned by theory rather than one generic question. This introduced a novel and feasible approach, that successfully informed implementation efforts of the pilot scheme. Additionally, the NGT inherently allows for both methodological and data source triangulation\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]\\u003c/sup\\u003e. In our study, qualitative data was collected via discussions and field notes per individual workshops while we examined the phenomenon at hand, coalescing the insights of different types of individual groups from multiple sites across all workshops. That enabled us to capture multiple perspectives and formulate a comprehensive understanding of those as well as validate the collected data, both in-session and across all workshops.\\u003c/p\\u003e \\u003cp\\u003eHowever, the study was not without limitations. Given our specific context, the results may have limited generalisability to other systems or settings. Yet, we believe the overarching concepts of the key considerations raised by our participants surrounding FI design are largely relevant to various implementation efforts and many elements are adaptable to other delivery systems -e.g., scheduling of incentives to link in with existing structures. While our workshops included a substantial number of community members at the start of each workshop, the lengthy nature of the procedure meant that many left before the final consensus phase. However, this was largely mitigated by the fact that most participants had recorded their consensus results on the physical forms which were incorporated into the analysis. All previously ranked ideas and votes were also considered across the three workshops and in-session, although some perspectives may have been missed. Additionally, due to the poor quality of the recordings from one workshop, certain contributions might not have been fully captured in the transcripts. However, since the majority of the research team were on site, our observations and notes should mitigate this.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eWe demonstrated that combining participatory research with theory using mNGT, enabled the design and implementation of a one-year FI scheme, with escalating rewards, tied to verified abstinence milestones and the current smoking cessation scheme timeframes. Our community identified multi-faceted considerations when reaching consensuses on each domain of the FI structure including: acceptability, potential of gaming, operational and administrative demands, maintaining organisational image, fit with existing services workflows, and public scrutiny.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSES\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003esocioeconomic status\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eFI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eFinancial incentive\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eNGT\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eNominal group technique\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003emNGT\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eModified nominal group technique\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHSE\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHealth Service Executive\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHSE TFI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHealth Service Executive Tobacco Free Ireland\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSHCPAs\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eSl\\u0026aacute;intecare Healthy Communities Programme Areas\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eGMC\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eGeneral medical card\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCO\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eCarbon monoxide\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCOPD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eChronic Obstructive Pulmonary Disease\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSP\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eService provider\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCM\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eCommunity member\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHP\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHealthcare professional\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study received ethical approval from the Reference Research Ethics Committee (RREC) for HSE Dublin and Midlands and HSE centre (Reference number: RRECB1123FD) and all participants have provided their informed consent to participate.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files. Additional datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research was funded by the Health Research Board APA-2022-029 and SPHERE/2022/001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors contributions\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRL drafted the manuscript, carried out formal data analysis and interpretation of findings. BD and CD supported data analysis processes. BD, CD, RL and FD led data collection processes. FD provided methodological input and overall supervision. FD, PK and DS provided substantial and critical revisions to the manuscript. All authors contributed to the conceptualisation of this study, reviewed and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe are sincerely grateful to all our study participants involved for their valuable and integral input in co-creating the FI incentive scheme and all those involved in recruitment facilitation. \\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eWorld Health O. WHO global report on trends in prevalence of tobacco use 2000\\u0026ndash;2030 [Internet]. Geneva: World Health Organization; 2024. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://iris.who.int/handle/10665/375711\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHealth Service Excutive. Tobacco Free Ireland Programme - The State of Tobacco Control in Ireland: 2nd Report [Internet]. 2022. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.hse.ie/eng/about/who/tobaccocontrol/research/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eValentelyte G, Sheridan A, Kavanagh P, Doyle F, Sorensen J. Health and societal burden of tobacco smoking in Ireland: A life table modelling study. Public Health. 2025;247:105880.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGovernment of Ireland. Healthy Ireland Survey Summary Report 2025 [Internet]. Dublin: [cited 2025 Nov 18]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.gov.ie/en/healthy-ireland/publications/healthy-ireland-survey-2025\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHuang MZ, Liu TY, Zhang ZM, Song F, Chen T. Trends in the distribution of socioeconomic inequalities in smoking and cessation: evidence among adults aged 18\\u0026thinsp;~\\u0026thinsp;59 from China Family Panel Studies data. Int J Equity Health. 2023;22(1):86.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGarrett BE, Martell BN, Caraballo RS, King BA. Socioeconomic Differences in Cigarette Smoking Among Sociodemographic Groups. Prev Chronic Dis. 2019;16:180553.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eTeshima A, Laverty A, Filippidis F. Burden of current and past smoking across 28 Europeancountries in 2017: A cross-sectional analysis. Tob Induc Dis. 2022;20(June):1\\u0026ndash;11.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eValentelyte G. Socioeconomic Variation in Tobacco Smoking Among the Adult Population in Ireland. 2024;Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1093/ntr/ntae245\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eWaters A, Kendzor D, Roys M, Stewart S, Copeland A. Financial strain mediates the relationship betweensocioeconomic status and smoking. Tob Prev Cessation [Internet] 2019 [cited 2025 Dec 1];5(January). Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttp://www.journalssystem.com/tpc/Financial-Strain-Mediates-the-Relationship-between-Socioeconomic-Status-and-Smoking,102258,0,2.html\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eAction on smoking and Health (ASH) UK. Smoking and poverty [Internet]. Internet: 2022 [cited 2025 Jan 12]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://ash.org.uk/uploads/Smoking-and-Poverty-Briefing.pdf\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGregoraci G, Van Lenthe FJ, Artnik B, Bopp M, Deboosere P, Kov\\u0026aacute;cs K, et al. Contribution of smoking to socioeconomic inequalities in mortality: a study of 14 European countries, 1990\\u0026ndash;2004. Tob Control. 2017;26(3):260\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eJha P, Peto R, Zatonski W, Boreham J, Jarvis MJ, Lopez AD. Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America. Lancet. 2006;368(9533):367\\u0026ndash;70.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMarmot M. Smoking and inequalities. Lancet. 2006;368(9533):341\\u0026ndash;2.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eZuokemefa A, Sharma S. Investigating correlates of chronic multimorbidity prevalence in Ireland: Evidence from Irish health survey 2015 and 2019. Public Health. 2025;249:106009.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eDepartment of Health G of I. Stop Smoking: Guideline Number: 28. Updated January 19, 2022. [Internet]. 2024. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.gov.ie/en/publication/4828b-stop-smoking/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHiggins ST, Davis DR, Kurti AN. Financial Incentives for Reducing Smoking and Promoting Other Health-Related Behavior Change in Vulnerable Populations. Policy Insights Behav Brain Sci. 2017;4(1):33\\u0026ndash;40.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eSmith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control. 2021;30(e2):e87\\u0026ndash;95.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGiles EL, Robalino S, McColl E, Sniehotta FF, Adams J. The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis. PLoS ONE. 2014;9(3):e90347.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eVlaev I, King D, Darzi A, Dolan P. Changing health behaviors using financial incentives: a review from behavioral economics. BMC Public Health. 2019;19(1):1059.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eNotley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews [Internet] 2025 [cited 2025 Nov 1];2025(5). Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttp://doi.wiley.com/\\u003c/span\\u003e\\u003c/span\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/14651858.CD004307.pub7\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eRikke Siersbaek PKJ, Ford S, Burke. Sarah Parker. Financial incentives for stopping smoking: how and why do they work? [Internet]. Health Service Excuitve; 2023. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.hse.ie/eng/about/who/tobaccocontrol/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eValentelyte G, Sheridan A, Kavanagh P, Doyle F, Sorensen J. Financial incentives to stop smoking: Potential financial consequences of different reward schedules. Tob Prev Cessat. 2024;10(July):1\\u0026ndash;10.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGiles EL, Robalino S, Sniehotta FF, Adams J, McColl E. Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods. Prev Med. 2015;73:145\\u0026ndash;58.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMiranda JJ, Pesantes MA, Lazo-Porras M, Portocarrero J, Diez-Canseco F, Carrillo-Larco RM, et al. Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review. Wellcome Open Res. 2021;6:163.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eAdams J, Giles EL, McColl E, Sniehotta FF. Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours. Health Psychol Rev. 2014;8(3):286\\u0026ndash;95.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHoskins K, Ulrich CM, Shinnick J, Buttenheim AM. Acceptability of financial incentives for health-related behavior change: An updated systematic review. Prev Med. 2019;126:105762.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eJagosh J, Bush PL, Salsberg J, Macaulay AC, Greenhalgh T, Wong G, et al. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health. 2015;15(1):725.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eSeward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, et al. A guide to systems-level, participatory, theory-informed implementation research in global health. BMJ Glob Health. 2021;6(12):e005365.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eArnahoutova K, De Geest S, Mielke J, Boaz A, Schoemans H, Valenta S. Exploring Stakeholder Involvement in Intervention Implementation Studies: Systematic Evidence Synthesis With an Evidence Gap Map Approach. Eval Health Prof 2025;01632787251352837.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eDeverka PA, Lavallee DC, Desai PJ, Esmail LC, Ramsey SD, Veenstra DL, et al. Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. J Compar Effect Res. 2012;1(2):181\\u0026ndash;94.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMacaulay AC, Commanda LE, Freeman WL, Gibson N, McCabe ML, Robbins CM, et al. Participatory research maximises community and lay involvement. BMJ. 1999;319(7212):774\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMorales-Garz\\u0026oacute;n S, Parker LA, Hern\\u0026aacute;ndez-Aguado I, Gonz\\u0026aacute;lez-Moro Tolosana M, Pastor-Valero M, Chilet-Rosell E. Addressing Health Disparities through Community Participation: A Scoping Review of Co-Creation in Public Health. Healthc (Basel). 2023;11(7):1034.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHarb SI, Tao L, Pel\\u0026aacute;ez S, Boruff J, Rice DB, Shrier I. Methodological options of the nominal group technique for survey item elicitation in health research: A scoping review. J Clin Epidemiol. 2021;139:140\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMessiha K, Chinapaw MJM, Ket HCFF, An Q, Anand-Kumar V, Longworth GR, et al. Systematic Review of Contemporary Theories Used for Co-creation, Co-design and Co-production in Public Health. J Public Health. 2023;45(3):723\\u0026ndash;37.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGrindell C, Coates E, Croot L, O\\u0026rsquo;Cathain A. The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res. 2022;22(1):877.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGattrell WT, Logullo P, Van Zuuren EJ, Price A, Hughes EL, Blazey P, et al. ACCORD (ACcurate COnsensus Reporting Document): A reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med. 2024;21(1):e1004326.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eCOMmunity PArticipation to set direction on design and implementation of financial incentives in. Stop Smoking services in Ireland: COMPASS [Internet]. COMPASS Project [cited 2025 Aug 11];Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://compass-study.eu/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eBlake M. HSE Tobacco Free Ireland Programme [Internet]. 2025;Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://iiop.ie/content/stop-smoking-medicines-hse-stop-smoking-services\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eDepartment of Health. Sl\\u0026aacute;intecare Healthy Communities Progress Report 2022 [Internet]. 2023 [cited 2025 Sep 11];Available from:\\u0026nbsp;\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHealth Service Excutive Ireland. HSE Sl\\u0026aacute;intecare Healthy Communities 2023 Overview [Internet]. Internet. 2023. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.hse.ie/eng/services/publications/health-and-wellbeing/hse-slaintecare-healthy-communities-2023-overview.pdf\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHealth Service Excutive Ireland. The HSE Health and Wellbeing Annual Report 2024 [Internet]. Internet: 2024 [cited 2025 Nov 20]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://hsehealthandwellbeingnews.com/hse-health-and-wellbeing-annual-report-2024/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHealth Service Excutive. Sl\\u0026aacute;intecare Healthy Communities [Internet]. Internet: 2025 [cited 2025 Jan 12]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.gov.ie/en/healthy-ireland/publications/sl%C3%A1intecare-healthy-communities/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHealth Service Excutive. Medical Cards: How much you can earn and still qualify for a medical card [Internet]. [cited 2025 Dec 11];Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www2.hse.ie/services/schemes-allowances/medical-cards/applying/how-much-you-can-earn/\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGallagher M, Hares T, Spencer J, Bradshaw C, Webb I. The Nominal Group Technique: A Research Tool for General Practice? Fam Pract. 1993;10(1):76\\u0026ndash;81.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eWall G, Pearce C, Gustafsson L, Isbel S. Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design. Aus Occup Therapy J. 2024;71(5):674\\u0026ndash;85.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eKearney N, Connolly D, Bahramian K, Guinan E. Strategies to improve participation in exercise programmes during chemotherapy: a modified nominal group technique. J Cancer Surviv [Internet]. 2025 [cited 2026 Jan 24];Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://link.springer.com/\\u003c/span\\u003e\\u003c/span\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11764-025-01771-y\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHarvey N, Holmes CA. Nominal group technique: An effective method for obtaining group consensus. Int J Nurs Pract. 2012;18(2):188\\u0026ndash;94.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eCarter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The Use of Triangulation in Qualitative Research. Oncol Nurs Forum. 2014;41(5):545\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eVargas C, Zorbas C, Longworth GR, Ugalde A, Needham C, Sunil A et al. Exploring co-design: a systematic review of concepts, processes, models, and frameworks used in public health research. J Public Health 2025;fdaf084.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHaberl A, Flei\\u0026szlig; J, Kowald D, Thalmann S. Take the aTrain. Introducing an interface for the Accessible Transcription of Interviews. J Behav Experimental Finance. 2024;41:100891.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\\u0026ndash;101.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eBraun V, Clarke V. A critical review of the reporting of reflexive thematic analysis in \\u003cem\\u003eHealth Promotion International\\u003c/em\\u003e. Health Promot Int. 2024;39(3):daae049.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eBraun V, Clarke V. Thematic analysis: a practical guide. Los Angeles London New Delhi Singapore Washington DC Melbourne: SAGE; 2022.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eOne4All Gift Card [Internet]. [cited 2025 Dec 11];Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.one4all.ie/gift-cards-online.html?gad_source=1\\u0026amp;gad_campaignid=22355621180\\u0026amp;gclid=CjwKCAiA_dDIBhB6EiwAvzc1cHng_\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003cbr\\u003e\\u003cspan\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003eYIW2QIqSJhNczA9ztVrta7CZ6CaGq5d_SlKk2cNALVH4VuEbxoC9vcQAvD_BwE\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eKelly Y, O\\u0026rsquo;Rourke N, Hegarty J, Gannon J, Flynn R, Keyes LM. The co-design of a digitally supported intervention for selecting implementation tools and actions for standards (SITAS). BMC Health Serv Res. 2024;24(1):1582.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eAndrews JO, Newman SD, Heath J, Williams LB, Tingen MS. Community-Based Participatory Research and Smoking Cessation Interventions: A Review of the Evidence. Nurs Clin North Am. 2012;47(1):81\\u0026ndash;96.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eLarkin M, Boden ZVR, Newton E. On the Brink of Genuinely Collaborative Care: Experience-Based Co-Design in Mental Health. Qual Health Res. 2015;25(11):1463\\u0026ndash;76.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHealth Service Excutive, Tobacco Free Ireland. Stop Smoking Gift Voucher Incentive Scheme Leaflet [Internet]. 2025 [cited 2025 Aug 11];Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.hse.ie/eng/about/who/tobaccocontrol/resources/stop-smoking-gift-voucher-incentive-scheme-leaflet.pdf\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eTappin D, Sinclair L, Kee F, McFadden M, Robinson-Smith L, Mitchell A, et al. Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ. 2022;379:e071522.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGiles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study. BMC Public Health. 2016;16(1):989.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGiles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups. BMC Public Health. 2015;15(1):58.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eNotley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews [Internet] 2025 [cited 2025 Nov 9];2025(5). Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttp://doi.wiley.com/\\u003c/span\\u003e\\u003c/span\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/14651858.CD004307.pub7\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGneezy U, Meier S, Rey-Biel P. When and Why Incentives (Don\\u0026rsquo;t) Work to Modify Behavior. J Economic Perspect. 2011;25(4):191\\u0026ndash;210.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eReham A, Lasheen B, Doyle C, Downey D, Stanistreet S, Allwright L, Bauld, et al. Facilitators of and Barriers to Implementation of Financial Incentive Interventions for Health Behaviour Change: A Systematic Review. Implementation Science [manuscript submitted for publication]; 2025.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eGneezy U, Rustichini A. Pay Enough or Don\\u0026rsquo;t Pay at All*. Quart J Econ. 2000;115(3):791\\u0026ndash;810.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eCosgrave E, Sheridan A, Murphy E, Blake M, Siersbaek R, Parker S, et al. Public attitudes to implementing financial incentives in stopsmoking services in Ireland. Tob Prev Cessat. 2023;9(April):1\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMeredith S, Jarvis B, Raiff B, Rojewski A, Cassidy R, Erb P et al. The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice. PRBM 2014;103.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eHiggins ST, Heil SH, Lussier JP. Clinical Implications of Reinforcement as a Determinant of Substance Use Disorders. Annu Rev Psychol. 2004;55(1):431\\u0026ndash;61.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMiglin R, Kable JW, Bowers ME, Ashare RL. Withdrawal-Related Changes in Delay Discounting Predict Short-Term Smoking Abstinence. Nicotine Tob Res. 2017;19(6):694\\u0026ndash;702.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eMantzari E, Vogt F, Shemilt I, Wei Y, Higgins JPT, Marteau TM. Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis. Prev Med. 2015;75:75\\u0026ndash;85.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eVan Der Spek L, Breunis LJ, Scheffers-van Schayck T, Bauld L, Ista E, Been JV. Financial incentives for smoking cessation among (expectant) parents: a systematic review of facilitators and barriers to implementation. Tob Control 2025;tc-2024-059198.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eIguchi MY, Lamb RJ, Belding MA, Platt JJ, Husband SD, Morral AR. Contingent reinforcement of group participation versus abstinence in a methadone maintenance program. Exp Clin Psychopharmacol. 1996;4(3):315\\u0026ndash;21.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eSmith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control. 2021;30(e2):e87\\u0026ndash;95.\\u003c/span\\u003e\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Financial incentives, Smoking cessation, Co-design, Nominal Group Technique, Participatory research methods, Health behaviours, Intervention design, Implementation science\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8688569/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8688569/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eDespite the overall decline in smoking prevalence, socioeconomic disparities in smoking quit rates are widening. Financial incentives such as cash or cash-like rewards provided conditional on performance of healthy behaviours, are effective tools to enhance smoking cessation, yet are complex and often designed without community input or theoretical rationale. Hence, we aimed to co-design a theoretically driven and contextually-relevant financial incentive scheme for implementation, with key stakeholder groups including community members and health professionals, in Irish primary care and community services.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003e A mixed-methods approach was utilised with a modified Nominal Group Technique, underpinned by Adams et al.\\u0026rsquo;s (2014) 9-domain incentive framework, over three one-day workshops (n\\u0026thinsp;=\\u0026thinsp;59 participants) to elicit ideas and achieve consensus on incentive design. Descriptive statistics were used to identify the highly-ranked ideas, while reflexive thematic analysis was employed to examine the decision-making process focusing on key considerations across various domains of the proposed incentive scheme.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe incentive design was as follows: 1) Total amount: \\u0026euro;400 (Median, IQR: \\u0026euro;200\\u0026ndash;500); 2) Form: voucher; 3) Certainty: definite reward; 4) Target population: adults living in deprived areas who smoke and are in receipt of free primary care services; 5) Target behaviour: validated smoking cessation and clinic attendance; 6,7) Schedule and Frequency: incrementally increasing amount aligned with current services review timepoints; 8) Immediacy: as soon as possible within a week; 9) Provider: smoking cessation advisors. Participants\\u0026rsquo; key considerations in reaching consensus on each incentive domain were represented by five themes including: acceptability, potential of gaming, operational and administrative demands, fit with existing services workflows, maintaining organisational image, and public scrutiny.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThis is the first study to co-design a stakeholder-informed, and theory-aligned incentive-based scheme to support smoking cessation for people living in deprived areas. A pilot is now underway to test real-life implementation feasibility on smoking cessation outcomes.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Co-design of a Community-based Financial Incentive Scheme for Smoking Cessation Services in Ireland: A Modified Nominal Group Technique\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-01-29 10:41:46\",\"doi\":\"10.21203/rs.3.rs-8688569/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-20T13:22:04+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"110093122111437324340555480653119791024\",\"date\":\"2026-03-06T08:51:23+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-02-24T08:24:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-01-30T07:40:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-01-29T12:14:26+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-01-29T12:13:05+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Public Health\",\"date\":\"2026-01-24T18:00:14+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"0937bd38-e200-43ab-9ce7-b9f3f13c8cea\",\"owner\":[],\"postedDate\":\"January 29th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-24T08:38:22+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-01-29 10:41:46\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8688569\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8688569\",\"identity\":\"rs-8688569\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}