Focus Group questions for LGBT, HIV, sexual health and stop-smoking services

25th February 2011

Section A:

Is smoking raised as an issue by your client group/service users?

FGA1: I don’t have direct contact with service users.

FGA2: No. HIV would be an issue. Smoking is not a priority – other issues take priority plus I don’t think I would be confident about raising the issue.

FGA3: I’ve had over 30 years experience in the statutory, NHS and voluntary sectors. People, clients will talk about alcohol issues but no more than a handful over that time have mentioned smoking.

FGA4: I volunteer with Macmillan Care. As a volunteer I don’t feel confident, I tend to stick to one topic and let the clients guide the sessions. People will talk about alcohol. Smoking is seen as less problematic.

FGA5: There’s a stigma around smoking and it seems that people expect the NHS to deal with it, not the voluntary sector. NHS GGC has asked a voluntary organisation to take this forward [smoking cessation awareness]. A lot depends on the organisational mindset and whether they are engaging with other health issues.

FGA3: Within the NHS there are clear pathways for NHS staff to refer in to depending on the issue. Within the community sector the links are not always as good as they could be. The community sector are maybe not always clear about who or where, to refer in to.

FGA5: Community organisations have specific aims and targets, often tied to funding so they are maybe cautious about approaching different or wider issues: For example, does it breach funding conditions. I’m cautious about the motivations of some community organisations regarding health issues. Are they being pushed into a certain direction or are they adopting a cause to attract funding?

Do you think that there should be specialist stop-smoking services aimed at the LGBT community in your area?

FGA4: I think you get mixed reactions, well among the people I know. If you went to a service in the east end of Glasgow you could get slashed (laughter) but then other people I know wouldn’t want services to be LGBT specific.

FGA1: Mainstream services sometimes are not as welcoming but the evidence isn’t clear. Need to make mainstream services accessible to all, particularly in the current funding climate. It is unlikely there would be funding for specific LGBT services. Need to raise issues of equality and diversity within the statutory services. Need awareness sessions for practitioners.

FGA5: There’s nothing within GGC services that would breach equalities. We don’t ask about personal settings within a group and LGBT clients wouldn’t stand out unless they mentioned it. Also we don’t record sexual orientation. There are opportunities to raise or discuss this in 1-1 consultations. Many practitioners would not be comfortable or know how to deal with disclosure so possibly need awareness or training sessions around this.

FGA3: There shouldn’t be a one size fits all approach. We need a multi-layered approach [mentioned a SAMH LGBT report]. There is an option to include stop smoking into current group work sessions but having said that, in discussions of what to include in group work, smoking isn’t usually included when planning group sessions.

FGA2: It would be great if they existed but there wouldn’t be the numbers in rural areas to justify a separate service. Mainstream services need to ensure they treat all clients the same. They need to be LGBT friendly.

FGA3: Facilitators within our own organisation have the necessary skills to challenge attitudes from straight/anti-gay clients.

FGA4: There are no LGBT services outside of the city centre [Glasgow] in the different GGC sectors. They did groups specific for addictions however.

FGA3: There’s no HIV support group in Highland. They can get 1 -1 support but there are [informal]LGBT groups that meet and you could have NHS services come into those. They are usually in community settings and there are lots of opportunities to provide stop smoking services (SSS). The capacity is already there.

FGA5: A lot comes down to partners within other services. Partnership is important and everyone should be clear about expectations. Partners need to be clear which clients are ready to make changes.

Section B:

Do you think you (and/or your organisation) would benefit from training on smoking-related issues?

FGA3: Training would be beneficial for all staff including volunteers. Smoking has to be part of the holistic approach.

FGA2: Yes, but a lot of staff smoke so many feel uncomfortable raising it.

What would be the key elements needed in awareness-raising sessions around tobacco for your staff/volunteers?

FGA1: Smoking’s effects on HIV and health; that would be beneficial. However, currently there is little hard evidence on the effects.

FGA4: Need information on basic NRT [Nicotine Replacement Therapy] and possible contraindications so that people can make an informed decision.

FGA5: There was a survey in east Glasgow based on social marketing research that showed people were aware of the health benefits of quitting but cost is a key factor, not health, for people trying to change behaviours.

FGA3: From the social care model, clients should take the lead. The decision is not with the practitioners. We should empower the clients but they can’t be empowered if they don’t have all the information. Training should be inclusivenot solely focused on a medical model. It shouldn’t be tokenistic and needs proper buy-in form all sectors.

FGA1: Service User Involvement [SUI] would be useful. Have testimony from a successful quitter. SUI could provide a peer educated support role.

note: participants used post-it notes to identify key elements that would be desirable for training staff; those mentioned were:

  • a discussion about why the topic of tobacco use/smoking is important (awareness-raising)
  • how to raise the issue sensitively and in a non-judgmental way (could include role-playing)
  • information on the health effects of smoking (possibly including a bit of anatomy and physiology)
  • information on the specific health effects of smoking in relation to HIV (for HIV/SH services)
  • information about possible contraindications for those on HIV meds who may enquire about using NRT or other pharmacological items (e.g. Champix, Zyban)
  • information on the benefits of quitting
  • information about where to refer clients to locally (i.e. stop-smoking services)
  • that any training be inclusive, non-threatening, participatory, fun/active learning

Do you think your managers would support (either in principle or in provision) more work around tobacco issues?

FGA2: I think there is management buy-in already.

FGA3: I agree. In my experience the NHS never approaches (organisation) but neither do we do that with the NHS.

FGA1There would be support I think.

FGA5: I have HEAT targets to meet but I would need to look at specific LGBT services and that’s when negotiations would happen. But I’m hesitant as we are in a moment of flux with the changes happening [restructuring of GGC CHCP areas].

FGA1: We shouldn’t underestimate MI [motivational interviewing] techniques. Need to look at clients’ individual circumstances.

FGA3: There is a role for the voluntary sector in terms of MI training. For example, they could help with referrals; identifying clients that are ready to make changes. Also training around advocacy work for statutory workers would be useful.

Section C:

[for LGBT/SH/HIV services]: what kind of links – if any – do you have with local stop-smoking services?

FGA2: It’s difficult. I only know someone in Dunoon. I could always find out though.

FGA3: No I don’t know who any of the leads are in the NHS. Also I’m not aware of the referral pathways. I could make better links. You’ve just highlighted a gap.

FGA1: I have a national role. I would like to think I would be able to respond but I don’t have any direct contacts.

[for NHS services]: do you have existing links with local LGBT groups and HIV/SH services?

FGA4: I have personal links but no professional links [with voluntary workers].

FGA5: I don’t know any LGBT groups.

[all]: where links do exist, how were they forged? What was helpful in setting them up?

(No links identified between voluntary and statutory sectors within this group)

[all]: what do you think are/might be the benefits of linking services?

FGA5: It would improve performance. Help meet HEAT targets. It would be interesting to look at inequalities from another point of view rather than, for example in the area we work, just based on being poor and deprived. My experience in the east end of Glasgow is that inequalities is largely based on socio-economic circumstances.

FGA4: More inclusive, information gets spread around.

FGA1: Anything that addresses health inequalities is beneficial.

FGA5: There’s an opportunity to do a bit of campaigning around the tobacco strategy both nationally and locally.

FGA3: Huge benefits. I would like to see more collaborative work. Tensions exist between the voluntary and statutory sectors and these need to be challenged. The voluntary sector could get better at MI [Motivational Interviewing] and getting clients ready to move forward and take the next step.

FGA2: It would begreat to have better links and be able to offer information that helps the clients.

Section D:

Most of today’s focus group attendees stated that they’d like “a clear evidence base on the links between smoking and HIV/BBV” – what would that evidence base look like?

FGA4: Posters and leaflets. And the impact needs to be quick. (Some discussion around information that’s concise and easy to read. Not too much writing on posters – message is simple and quick to read/understand)

FGA5: We need evidence on smoking prevalence within the LGBT community. Knowledge about HIV/BBVs and effect of smoking on HIV/BBV. Also need contacts for further guidance and more information.

FGA3: Smoking cessation is not reflected in our funding. Need evidence on a lot of levels from managers down to peer educators/volunteers.

FGA2: I’m not aware of what information is available.

FGA1: The evidence is very patchy. Need to ensure people raise the subject in a sensitive manner and gear up professionals to ask about smoking.

Who should produce it?

FGA5: The NHS has to be very careful about any guidance they put out. They would need reassurance that a national organisation has rubber-stamped it. They are extremely tight on protocols regarding guidance. Much is taken from NICE [National Institute for Health and Clinical Excellence].

FGA4: HIV Scotland would have more clout than the NHS as they produce many leaflets/guidance.

FGA1: Within HIV there are a number of sub-sets: e.g. LGBT, IDUs [intravenous drug users] and Africans.

FGA3: I have an issue with resource development and duplication. Therefore lots of organisations need to be involved in research development. Perhaps key umbrella groups should be involved for meaningful buy-in.

FGA1: We need better recording systems but LGBT not recorded within services.

How could/would such evidence be disseminated?

FGA5: Wouldn’t know how to disseminate any promotional material.

FGA2: Could look at other campaigns. But it’s also dependant on what other services are available locally.

Winding up the focus group

Any final questions or comments on the issues discussed?

FGA5: Valued the opportunity to come along. I didn’t realise there were such gaps in this area.

FGA3: Valued the opportunity. It’s re-energised/re-focused me regarding MI and the subject.

FGA2: It’s been a good opportunity to re-focus my thoughts on potential links.

Linda Bates

Development Officer (PATH)

March 2011

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PATH LGBT/SH/HIV focus group 25th February 2011