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Open Access Research article

Experiences of outreach workers in promoting smoking cessation to Bangladeshi and Pakistani men: longitudinal qualitative evaluation

Rachna A Begh1, Paul Aveyard1, Penney Upton2, Raj S Bhopal3, Martin White4, Amanda Amos5, Robin J Prescott3, Raman Bedi6, Pelham M Barton7, Monica Fletcher8, Paramjit Gill1, Qaim Zaidi9 and Aziz Sheikh1011*

Author Affiliations

1 UK Centre for Tobacco Control Studies, Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK

2 Psychological Sciences, Institute of Health and Society, University of Worcester, Worcester, WR2 6AJ, UK

3 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK

4 Fuse, UKCRC, Centre for Translational Research in Public Health, Institute of Health & Society, Newcastle University, NE2 4HH, UK

5 UK Centre for Tobacco Control Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK

6 International Centre for Child Oral Health, King's College London, London, WC2B 5RL, UK

7 Health Economics, University of Birmingham, Birmingham, B15 2TT, UK

8 Education for Health, Warwick, CV34 4AB, UK

9 British Heart Foundation, London, W1H 6DH, UK

10 Allergy & Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK

11 CAPHRI, University of Maastricht, The Netherlands

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BMC Public Health 2011, 11:452  doi:10.1186/1471-2458-11-452

Published: 9 June 2011

Abstract

Background

Despite having high smoking rates, there have been few tailored cessation programmes for male Bangladeshi and Pakistani smokers in the UK. We report on a qualitative evaluation of a community-based, outreach worker delivered, intervention that aimed to increase uptake of NHS smoking cessation services and tailor services to meet the needs of Bangladeshi and Pakistani men.

Methods

This was a longitudinal, qualitative study, nested within a phase II cluster randomised controlled trial of a complex intervention. We explored the perspectives and experiences of five outreach workers, two stop smoking service managers and a specialist stop smoking advisor. Data were collected through focus group discussions, weekly diaries, observations of management meetings, shadowing of outreach workers, and one-to-one interviews with outreach workers and their managers. Analysis was undertaken using a modified Framework approach.

Results

Outreach workers promoted cessation services by word of mouth on the streets, in health service premises, in local businesses and at a wide range of community events. They emphasised the reasons for cessation, especially health effects, financial implications, and the impact of smoking on the family. Many smokers agreed to be referred to cessation services, but few attended, this in part being explained by concerns about the relative inflexibility of existing service provision. Although outreach workers successfully expanded service reach, they faced the challenges of perceived lack of awareness of the health risks associated with smoking in older smokers and apathy in younger smokers. These were compounded by perceptions of "lip service" being given to their role by community organisations and tensions both amongst the outreach workers and with the wider management team.

Conclusions

Outreach workers expanded reach of the service through taking it to diverse locations of relevance to Pakistani and Bangladeshi communities. The optimum method of outreach to retain and treat Bangladeshi and Pakistani smokers effectively in cessation programmes needs further development.