“You’ll never account for every client scenario” Perceived Facilitators and Barriers of a Co-designed Financial Incentive Intervention for Smoking Cessation in Ireland: A Qualitative Investigation

Background: Financial incentive interventions for promoting smoking cessation are effective, yet, as a complex intervention, exploring facilitators and barriers to any potential programme is vital to underpin appropriate implementation. We aimed to examine perceived facilitators and barriers to implementing a co-designed pilot financial incentive intervention for smoking cessation, targeting disadvantaged communities in Ireland. Methods: Three audio-recorded co-design workshops were held in communities that are nationally recognised as disadvantaged. As part of a larger mixed-methods study that used a nominal group technique to co-design a pilot financial incentive intervention for smoking cessation, we used a qualitative approach to specifically examine the potential facilitators and barriers to implementation. Applying the Theoretical Domains Framework, themes were developed, categorising these through both inductive thematic and deductive analysis using NVivo 15. Results: Themes were developed to categorise perceived facilitators and barriers. Perceived facilitators included: establishing clear intervention guidelines, implementation training for staff, fair distribution of tasks, face-to-face consultations for rapport-building, incentives for smoking cessation being more defendable when appropriately targeted, minimal intervention promotion to reduce public backlash. Perceived barriers included: an inability to account for all potential intervention challenges, disruption to work dynamics if training needs are not planned for, increased workload among staff, concerns about introducing biological-testing, concerns that some clients will game the intervention, public disapproval, limited technological resources, incurred travel expenses. Conclusion: Potential facilitators and barriers of the co-designed intervention were identified prior to commencement, informing subsequent strategy for design and implementation.Key words: Financial Incentives, Smoking, Intervention, Barriers, Facilitators