title: Experiences of outreach workers in promoting smoking cessation to Bangladeshi and Pakistani men: longitudinal qualitative evaluation.
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.
authors.affiliation: Allergy & Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK.
authors.forename: Rachna A
authors.initials: RA
authors.lastname: Begh
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
authors.forename: Penney
authors.initials: P
authors.lastname: Upton
authors.forename: Raj S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: Martin
authors.initials: M
authors.lastname: White
authors.forename: Amanda
authors.initials: A
authors.lastname: Amos
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Prescott
authors.forename: Raman
authors.initials: R
authors.lastname: Bedi
authors.forename: Pelham M
authors.initials: PM
authors.lastname: Barton
authors.forename: Monica
authors.initials: M
authors.lastname: Fletcher
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.forename: Qaim
authors.initials: Q
authors.lastname: Zaidi
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000208:ethnology; D003159:Community-Institutional Relations; D005069:Evaluation Studies as Topic; D017144:Focus Groups; D006293:Health Promotion; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D016032:Randomized Controlled Trials as Topic; D016540:Smoking Cessation / Q000208:ethnology*; D006113:United Kingdom; D055815:Young Adult