A smoking cessation project for South Asian men in Yau Tsim Mong

Health literacy Cantonese leaflets assume Chinese literacy and familiarity with written health information. Many target smokers have limited Chinese literacy, so the message was not accessible. A TV advert in Cantonese may not reach people who watch other channels or work during broadcast times. Recall of 6% is consistent with a channel mismatch, not necessarily a lack of interest in quitting.

Cultural competence The campaign did not use the languages, social networks or settings of the target group. It did not involve South Asian community organisations, religious leaders or workplace peers. It may also have ignored cultural norms around hospitality, masculinity and smoking among co-workers. A message that frames smoking only as individual weakness can feel judgemental and reduce engagement.

Ottawa Charter

• Healthy public policy: Smoke-free legislation exists, but enforcement and awareness in small restaurants may be weak.
• Supportive environments: Workplaces where co-workers smoke make quitting harder; the campaign did not create smoke-free social norms.
• Community action: The target community was not involved in designing or delivering the campaign.
• Personal skills: Information was not provided in an accessible format or with practical quitting support.
• Reorientation of services: The nearest clinic is 40 minutes away and open only on weekdays, which excludes shift workers.

Conclusion The campaign was a message-delivery exercise, not a health-promotion programme. It did not address access, language, social norms or community participation, so a low recall rate is not surprising.

Settings and channels

• Workplaces: recruit 10-15 restaurants and small shops as smoke-free champions; train managers to offer brief advice and refer staff to cessation support.
• Community venues: outreach at South Asian associations, mosques, community centres and grocery shops; hold evening drop-in sessions and use the part-time interpreter.
• Peer champions: train 8-10 former smokers from the target group to give brief advice and share their own quitting stories.
• Digital and phone: bilingual WhatsApp groups, short videos in Urdu/Hindi/Nepali, and a phone follow-up service for shift workers.
• Access: negotiate evening appointments or a visiting cessation counsellor at a community venue; provide travel support if clients must attend a clinic.

Partnerships Local South Asian associations, restaurant owners, the District Health Centre, the Tobacco Control Office, and the Hospital Authority smoking cessation service.

Indicative budget

• Peer champion training and stipends: HK$70,000
• Translation, bilingual materials and media: HK$60,000
• Interpreter hours and outreach sessions: HK$60,000
• Brief-advice training for managers and community workers: HK$40,000
• Evaluation and follow-up: HK$50,000
• Contingency: HK$20,000

Trade-offs The budget cannot fund a clinic or nicotine replacement therapy for everyone. I would prioritise outreach and referral, and negotiate free or subsidised NRT through existing services. Two staff cannot cover all venues, so peer champions and partners are essential.

Critique of prevalence as a 12-month indicator

• Prevalence is an outcome measure. It changes slowly and is influenced by population turnover, immigration, national tobacco policy and economic conditions, not only by this project.
• A district-level prevalence survey with a small sample of South Asian men may lack statistical power. A fall or rise could be random variation.
• The project may reach motivated quitters first; prevalence may not change even if many people make quit attempts.
• Attributing change to the NGO would be unsafe without a comparison group.
• The indicator can create pressure to report success rather than to support people who are not ready to quit.

Realistic evaluation plan

• Process: number of venues engaged; number of outreach sessions; number of people receiving brief advice; percentage of materials in appropriate languages; number of peer champions trained.
• Impact: number of quit attempts; 7-day point-prevalence abstinence at 4 weeks and 6 months; referrals to cessation services; changes in knowledge and confidence; satisfaction.
• Outcome: smoking prevalence in the target group at 24 months, using a validated survey and, if feasible, a comparison district.
• Design: baseline survey before the programme; follow-up of participants; anecdotal and qualitative interviews to understand barriers.

Ethical points Avoid victim blaming and stigmatising smokers. Report limitations honestly. Protect confidentiality in small community networks. A realistic funder should accept that 12 months is enough to measure reach and quit attempts, but not necessarily prevalence reduction.