Projects & Research Partnerships

Introduction

Smoking remains a leading cause of preventable illness and premature death in the UK, significantly contributing to health inequalities. To address this, last year Sheffield City Council initiated a pilot scheme offering financial incentives to encourage smoking cessation within specific priority groups, including individuals with mental health conditions, those in social housing, and people receiving drug and alcohol support.

Under Sheffield City Council's smoking cessation incentive scheme, participants could earn up to £200 in vouchers for successfully quitting smoking for 12 weeks. This included an initial £20 for setting a quit date, followed by £40, £60 and £80 at four-week intervals, providing they remained smoke-free as confirmed by carbon monoxide readings (6ppm or below). For remote clients, in-person verification appointments were required at each stage.

This project is a comprehensive evaluation of the incentive scheme. Our research aims to understand its effectiveness in supporting individuals to quit smoking and sustain their smoke-free status. By rigorously assessing the scheme's implementation, acceptability and impact, we intend to provide crucial evidence that will inform future policy decisions and enhance smoking cessation services not only in Sheffield but potentially across the UK.

Project aims

The overall aim of this evaluation is to explore the effectiveness of Sheffield City Council's smoking cessation incentive scheme in encouraging individuals to make a quit attempt and maintain smoke-free status. The evaluation will also provide valuable recommendations for future smoking cessation service improvement and public health policy.

Specifically, the evaluation will investigate:

• The strengths and weaknesses of the incentive scheme.
• How the scheme can be adapted and improved for priority groups.

These overarching questions will be addressed through four key research questions:

1. Acceptability to staff: What is the acceptability of the incentives scheme to staff delivering it? This includes exploring facilitators and barriers to delivery, staff experiences, perceived implications for uptake, and how the scheme meets different client needs.
   
2. Equity and acceptability to service users: What is the acceptability of the incentives scheme to service users? This will involve understanding their experiences, and the facilitators and barriers to their participation.
   
3. Engagement and effectiveness: To what extent is the incentives scheme utilised by and effective for different client groups? This will look at uptake, rates of being lost to follow-up, and quitting rates compared to those not receiving incentives.
   
4. Value for money: How does the introduction of an incentives scheme affect the overall service value for money in terms of the cost per quit at 4, 8, and 12 weeks?

Methods

This evaluation employs a mixed-methods approach.

Qualitative data collection will involve interviews and focus groups with service staff and key stakeholders (service providers, managers, commissioners and smoking cessation advisors). Additionally, 12-15 interviews will be conducted with service users from target priority groups who were involved in the incentives scheme, exploring their perspectives and experiences to understand the scheme's feasibility, acceptability and factors that could improve engagement.

Quantitative data will be collected from routinely available Smokefree Sheffield service data. This includes service user engagement, quitting outcomes at 4, 8, and 12 weeks, and scheme implementation costs. Descriptive statistics will show uptake, loss to follow-up, and quit rates across client groups and referral sources. The evaluation will also estimate the additional costs of providing the incentives scheme (vouchers, staff time, administration, and management) to assess its impact on the overall cost per quit.

The qualitative and quantitative findings will be analysed separately before being brought together at a review meeting with Sheffield City Council stakeholders to generate recommendations for future service provision.

Impact

The findings of this evaluation will provide Sheffield City Council with evidence to understand the effectiveness of this public health intervention and how Sheffield City Council's smoking cessation incentive scheme might increase engagement and success in quitting smoking among priority groups.

This will help shape current and future service delivery, and the translational knowledge produced will also benefit smoking cessation services and policy decisions more broadly.

The project also aims to upskill council and Smokefree Sheffield team members by involving them in the methodology, enabling them to conduct and repeat aspects of the evaluation in the future.