Lose the Fags

Preliminary focus groups

Following a comprehensive phase of desk research, five mixed gender focus groups were held in Brinnington in spring/summer 2007 to gain an initial understanding of the barriers and motivations towards smoking cessation in Brinnington. The groups included:

• Hardened smokers with no intention of quitting
• Smokers who had tried but failed to quit
• Smokers who were contemplating quitting
• Successful quitters
• Those currently in the process of quitting

The objectives of this research were to explore attitudes to services, experiences of successful quitters and those who had dropped out, and why current cessation services had achieved limited success.

A series of interviews were also held with key health professionals in Brinnington to explore possible improvements to smoking cessation services to make them more consumer-centric.

Barriers and motivators

Key barriers and motivations for quitting were largely in line with national research into smoking amongst R&M workers:

• Smoking is very much a part of Brinnington life and is highly visible – over half of the residents smoke and much social interaction between families, neighbours and friends revolve around smoking. To quit smoking would be to go against the social norm and risk social ostracism
• Life on the Brinnington estate tends to be stressful. People often have to cope with financial strain, social unrest from noisy neighbours, unruly family members or caring for several children without the support of a partner. With little money, time or ‘personal space’, smoking becomes an emotional crutch on which people rely for stress management and a form of escapism
• Brinnington smokers are tired of being ‘nagged’ into quitting and are unlikely to succeed or make an attempt because their support networks consist of smokers
• Low confidence is a considerable barrier to community participation, so services in a trusted, safe and familiar environment with familiar faces is essential
• Given the complexity of their lives, ease of access to nicotine replacement therapy (NRT) is vitally important
• There is a real drive to quit, primarily because of financial worry but also because of the fear of ill-health and desire to be a positive role model for children. For women particularly, family is the most important part of their lives and protecting and encouraging them is paramount

Segmentation

After this first phase of primary research, the target audience was segmented by behaviour, geography, gender and lifestage.

Behaviour

The audience most likely to respond to intervention are ‘contemplators’ and ‘preparers’. Contemplators are those planning to quit smoking and have perhaps been unsuccessful in previous attempts. Preparers are those who have made a definite plan to quit, perhaps including making an appointment with a specialist advisor. Given the project’s budget and the ingrained nature of smoking in the local culture, it was not considered appropriate to target ‘pre-contemplators’, who have yet to seriously consider quitting and may be hardened smokers.

Geography

The intervention was restricted to those living on the Brinnington estate, to capitalise on the strong community networks amongst the residents and the current facilities and services in the hub of the estate. Local people consider the estate area to be a close network of houses at the top of Brinnington hill, cordoned by the M60 bridge from the rest of Stockport and enclosed on all other sides by the green fields of Reddish Vale.

The stop smoking service in Stockport town centre is well respected, but is a 20-minute, £2.40 bus ride from Brinnington and is therefore not considered by many Brinnington residents. While local residents regularly visit the centre of Stockport, they do so to do their shopping, not to attend a drop-in smoking service.

Gender

The project targeted both men (of working age) and women (with preschool age children). However, the scoping research identified that men and women look for different qualities in a smoking cessation service. Women with children of preschool age would benefit from a smoking cessation service in familiar surroundings with trusted advisors and a crèche facility. Men of working age would benefit from an out-of-hours service in a ‘male’ environment, such as a gym with male fitness instructors trained as smoking cessation advisors.

Lifestage

The primary research suggested that while there were some excellent support services for smokers wanting to quit, those underserved were working age men and women with preschool age children.

The GP surgery is popular for advice and is served by a number of GPs, nurses and one smoking cessation adviser available three days a week, who is well-respected and liked. However, men and women did not want to visit the GP practice for smoking advice, as they considered the GP for ‘sick’ people rather than for ill-health prevention. In addition, the irregular shift patterns of working men often made visiting the GP difficult. The pharmacy was not considered a source of advice, although it was well known that NRT was available there.

Quit for Life is the popular Monday morning stop smoking drop-in. Delivered as an informal ‘coffee morning’ group, Quit for Life (now co-branded with Lose the Fags) tends to attract women with children of school age or above. There is no crèche facility and young children can be disruptive and bored. Men commented that they felt outnumbered by the women who went to the group and unaccustomed to the way members discussed their lives and daily issues.

Follow-up focus groups with target segments

Once men and women with preschool age children were chosen as the target audiences for the project, two further focus groups were conducted with representatives of these segments in summer 2007. The purpose of this research was to gain additional insight into their lifestyles, what moves and motivates them, and what their interests, fears and pleasures are.

 Key insights

• For women with preschool age children, childcare facilities provide time to focus on themselves away from their demanding children and is therefore essential to any intervention
• Men are more likely to work, often in shift patterns, so out-of-hours access to support is essential. However, there is a huge stigma for men to admit they need help and support and most men refuse to do so, despite statistics linking NHS support with success. Therefore, a service that distracts from the smoking cessation element is needed

Competition

As the area of highest deprivation in Stockport, Brinnington receives a multitude of health and improvement messages and interventions. There are highly visible back-to-work schemes, health services, social groups and community clubs, and while many people do not participate in these, there is a sense of saturation in Brinnington from external influence.

Community consultation

After the focus groups and interviews were completed, a consultation workshop was held in March 2008 with key members of Brinnington’s community, including health service providers and managers, ex-smokers, current smoking cessation service users, community group leaders and organisers, and smoking cessation service providers. Key findings from the primary research were presented to the group, then participants were split into smaller working parties to discuss ideas for developing appropriate services within the infrastructure in Brinnington for each of the two target segments. The discussions were recorded, transcribed and translated into a report for circulation after the event. The report contained ideas for the development of new services targeting each of the key segments.