The interventions being tested in this two arm pilot trial are: (i) standard stop smoking advisor based in smoking cessation clinic ('clinic only' control) vs. (ii) community based stop smoking advisor working in an outreach capacity, to support existing clinics enhance the tailoring of smoking cessation treatments to the specific needs of Pakistani and Bangladeshi male smokers and/or to provide smoking cessation treatment themselves in a location of their choosing ('clinic + outreach').
The aim of both models of care is to attract clients, to convince them of the value of behavioural support and pharmacotherapy, to provide these interventions themselves or point people towards clinics providing such treatment, and to persuade clients to persist with treatment until the risk of relapse is substantially decreased.
'Clinic + outreach' (intervention)
In areas allocated to the 'clinic + outreach' arm, the NHS stop smoking services will attract clients with additional support from four community based stop smoking advisors, also known as 'outreach workers'. These outreach workers come from the ethnic groups of interest (i.e. two of Bangladeshi origin and two of Pakistani origin) and live in the communities that they serve. Between them, they speak several relevant languages (i.e. Sylheti, Bengali, Punjabi, Mirpuri, Urdu and English).
A specialised training programme for the outreach workers will be organised prior to the start of the intervention, to combine training in smoking cessation with a special understanding of the norms and beliefs about tobacco in the Pakistani and Bangladeshi communities. This will consist of:
◦ Standard two-day SSA training delivered by HoB tPCT
◦ Three-day health promotion training course delivered by HoB tPCT on exploring ways to promote well-being and health, and techniques involved in the planning, preparation and delivery of approaches.
◦ Sessions given by primary care staff at the University of Birmingham on research skills, communication skills, the function of the NHS, the cultural context of the work, and discussion of the outreach role.
We envisage that the outreach workers will take the following approaches to improve the reach of and access to the smoking cessation services:
◦ Undertake community engagement work to help increase awareness of smoking cessation services
◦ Assist existing service providers with the delivery of stop smoking support and promotions
◦ Provide stop smoking support and medication for people in non-clinic venues, e.g. workplaces, public buildings.
Additionally, we envisage that the outreach workers will draw on their in-depth understanding of beliefs about and attitudes towards smoking, in order to:
◦ Raise awareness of the dangers associated with smoking and counsel smokers wishing to quit
◦ Identify suitable quit dates (which may be based on key religious events such as a Friday congregational prayer, journey on Umrah or Hajj (pilgrimage to Mecca), or to coincide with the month of Ramadan, for example)
◦ Highlight religious objections to smoking, where appropriate
◦ Make available existing and custom-made literature, telephone (Asian QuitLine) and other support materials.
We hypothesise that the 'clinic + outreach' model will attract more patients to the service because it is seen as more culturally appropriate. In addition, the service should influence the proportion of people successfully attempting to stop smoking by encouraging patients to persist with treatment.