Experiences of Outreach Workers in Promoting Smoking Cessation to Bangladeshi and Pakistani Men: Longitudinal Qualitative Evaluation.

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.