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“I am not aware of a research company that can match ETHNOS' expertise in the field of ethnic minority health. Their knowledge and experience are unrivalled.”

Gaynor Legall
Chair of Health Committee
All Wales Ethnic Minority Association

“We are delighted with the quality of work ETHNOS produced. Not only have they enabled us to better understand the issues surrounding meningitis and cultural diversity, they have provided a clear direction for us to take our work forward.”

Philip Kirby
Chief Executive
Meningitis Trust

“We commissioned ETHNOS to pre-test promotional materials and to evaluate a complex public health campaign targeted at the Muslim population in London. Because of their in-depth knowledge of the Muslim community and extensive networks, they were able to access a range of community members in their own languages and in culturally sensitive ways. They used innovative research methods and strategies to deliver a thoughtful evaluation with clear recommendations.”

Judith Watt
Head of Programme
NHS Executive – London

“ETHNOS uses sound and rigorous research methods to provide meaningful and authoritative recommendations that make a real difference.”

Qaim Zaidi
Ethnic Strategy Co-ordinator
British Heart Foundation

The Department of Health launched a national tobacco education campaign targeting the three main South Asian communities in England. This was the very first national campaign to explicitly focus on these communities in order to raise awareness and knowledge of the health risks associated with tobacco use and to assist tobacco users in their attempt to give up. The campaign involved TV and radio adverts on South Asian channels, press advertisement, as well as posters and information booklets.

The Central Office of Information commissioned ETHNOS to evaluate the campaign. We designed a comprehensive evaluation which involved interviews and focus groups with health professionals, community workers, as well as South Asian tobacco users, in order to assess their knowledge and views about the campaign. The research took place in three areas: Bradford (Pakistanis), Birmingham/Leicester (Indians), and Tower Hamlets in London (Bangladeshis).

The research provided the Department of Health with detailed information on:

• the extent to which the campaign had raised awareness of the health risks associated with
tobacco use (smoking and chewing)
• the extent to which the campaign had motivated tobacco users to change their habits
• the impact of the campaign on awareness, usage and attitudes towards the NHS Asian
tobacco helpline
• the extent to which the campaign had raised awareness and usage of local support services
• recommendations to improve future campaigns

BREAST CANCER CARE

Raising awareness of breast cancer

Breast cancer is the UK's most common cancer and its incidence is increasing. Rates of breast cancer increase with age. The rates of breast cancer are rising particularly quickly among South Asian women. Against this background, Breast Cancer Care asked ETHNOS:

• to research South Asian women's knowledge, attitudes and beliefs about breast health,
breast cancer, breast screening and breast cancer treatment
• to assess the effectiveness of current resources in communicating information on breast
health to South Asian women
• to identify breast health education messages that are culturally relevant and appropriate
• to determine the most appropriate means of communicating information about breast health
to South Asian women

Through a series of focus groups which embedded methods to test resources, ETHNOS identified that while general health knowledge and practices were relatively good among most South Asian women, awareness and knowledge of the risk factors, symptoms and treatment of breast cancer were extremely limited, especially among older Pakistani and Bangladeshi women. Similarly, breast self-checks and the uptake of breast cancer screening were generally very low and decreased with age. The study identified a number of reasons for this, including: lack of knowledge of breast cancer, limited cultural focus on prevention, a view that doctors won't see patients for prevention, negative experiences of GPs, concerns over being examined by a male doctor, language barriers (and difficulty understanding NHS letters that encourage screening) and a fatalistic outlook. The study also found that many health promotion messages were not effective. They needed to be simplified and made more concrete and inclusive to reach their intended audience. The recommendations based on the research have been included in a wider corporate strategy to improve all Breast Cancer Care services for ethnic minority people.

BIRMINGHAM HEALTH AND WELLBEING PARTNERSHIP

Evaluation of "Increasing Male Life Expectancy Programme"

Men living in the most deprived areas of Birmingham have an average life expectancy some four years below the national average. Furthermore, the gap between the city and national average is not closing. GHK and ETHNOS were asked to undertake a formative evaluation of the Neighbourhood Renewal Fund programme established to address this problem. The evaluation used an action research approach and examined effects at strategic, programme and individual levels. A wide range of methods were employed by the evaluation, including: community consultations, logic models, a quantitative baseline, in-depth project evaluations, and workshops to feedback and learn from the results of the research. The results of the evaluation were used to support the mainstreaming of some of the approaches used by the NRF programme.

BIRMINGHAM HEALTH AND WELLBEING PARTNERSHIP

Evaluation of "Reducing Infant Mortality Programme"

The infant mortality rate in Birmingham has increased in recent years, against a background of falling rates nationally and regionally. GHK and ETHNOS were jointly commissioned to carry out an evaluation of the Neighbourhood Renewal Fund Programme established to address the issue of rising infant mortality in Birmingham. The evaluation was based on an action research approach and examined effects at strategic, programme and individual levels. A wide range of methods were employed, including: community consultations, logic models, a quantitative baseline, in-depth project evaluations, and workshops to feedback and learn from the results of the research.

BIRMINGHAM HEALTH AND WELLBEING PARTNERSHIP

Understanding inter-generational attitudes and beliefs towards consanguineous marriages in Birmingham

As part of a wider programme of work to understand how social and cultural practices contribute to high levels of infant mortality among Birmingham's ethnic minority population, ETHNOS was commissioned by the Birmingham Health and Wellbeing Partnership to research the attitudes, beliefs and practices of the local Pakistani community in relation to consanguineous (cousin) marriages. The study was used to support the planning and delivery of maternity provisions and communications that are sensitive to the cultural beliefs and practices of the Pakistani community in Birmingham.

NHS EXECUTIVE LONDON

Evaluation of a London-wide smoking cessation campaign for the Muslim community

Smoking rates amongst Muslim men are very high. The National Health Service Executive for London conducted a London-wide campaign to curb smoking amongst Muslims. ETHNOS was commissioned to evaluate the overall campaign. We employed a range of techniques to understand
how well the messages of the campaign were received by the target populations:

• a postal survey of all London mosques to assess their awareness and opinions of the campaign
• an audit of promotional and educational activities carried out by campaign personnel
• a call audit analysis of Pakistani, Bangladeshi and Turkish smokers helplines during Ramadan
• in-depth interviews with Imams and Directors of Mosques
• in-depth interviews with campaign organisers
• focus groups with Muslim smokers from different minority ethnic communities

The survey of mosques indicated the level of support for the campaign, people’s views of the materials and their willingness to support and participate in activities. The audit of promotional and educational activities detailed exactly the work performed by campaign personnel and the audience they reached, and the relative success of specific activities. The call audit assessed the effectiveness of the media campaign in generating awareness of the campaign and in stimulating calls to Asian telephone helplines. It also yielded a socio-demographic profile of the callers and an account of the key issues raised during their communication with helpline personnel. The evaluation showed the effectiveness of the promotional material in generating awareness of the campaign and in stimulating calls to the different helplines, and the relative impact made by the different media in encouraging smoking cessation. The evaluation led to recommendations on a range of organisational matters.

NHS SICKLE CELL AND THALASSAEMIA SCREENING PROGRAMME

Evaluation of the Family Origin Questionnaire

The NHS Sickle Cell & Thalassaemia (SC&T) Screening Programme aims to offer effective and appropriate antenatal and neonatal screening programmes for haemoglobinopathy and sickle cell disease. These conditions are disproportionately found amongst people from black and minority ethnic backgrounds.

The NHS SC&T Screening Programme commissioned ETHNOS to a “Family Origin Questionnaire" used to identify parents who are in high risk groups for being a carrier for SC&T. The evaluation involved a range of health professionals (midwives, antenatal care coordinators, consultant haematologists and biomedical scientists) to find out how to improve both the questionnaire itself and its administration ahead of the implementation of the Screening Programme nationally. The research identified issues with the layout, presentation, content and administration of
the FOQ. It also identified organisational factors likely to impact on the success of the Programme. The research report was published and distributed nationally.

BRITISH HEART FOUNDATION

Promoting physical activity amongst older people from minority ethnic backgrounds

The British Heart Foundation wished to produce an “Active for Life” resource pack to promote physical activity amongst people aged 50 and above. ETHNOS was commissioned to conduct research that would provide guidance on the practical aspects of promoting physical activity amongst older people from minority ethnic backgrounds.

ETHNOS carried out in-depth interviews with people working with elderly members of the ethnic minority populations and with ethnic minority older people themselves. All interviews were conducted in the participants’ preferred language. We also carried out observations at day care facilities for elderly ethnic minority people.

Our research provided the British Heart Foundation with a good understanding of older ethnic minority people’s knowledge of the health benefits of physical activity, as well as the main barriers to participating in physical activity. We devised a number of strategies to promote culturally appropriate physical activities in different communities through a variety of approaches. Case studies of “good practice” were also provided.

LAMBETH PRIMARY CARE TRUST

Overweight and obesity among Lambeth residents

The obesity epidemic is a major public health concern in the UK. Almost a quarter of all adults are obese, with this figure predicted to rise to 90% of adults by 2050, if left unchecked. Obesity has a serious impact on the physical health and welfare of individuals. Obese people are at greater risk of diabetes, heart disease and certain forms of cancer. Obesity causes some 9,000 deaths every year in England. Its cost to the NHS is estimated to be over £4 billion every year. Rates of obesity are especially high in some communities. Lambeth PCT sought understand Somali, West African, Black Caribbean, Portuguese and deprived White British residents':

• knowledge and awareness of overweight and obesity
• attitudes towards overweight and obesity
• knowledge and awareness of healthy eating and physical activity
• behavioural choices related to overweight and obesity
• barriers to healthy behaviour change

Using interviews with health professionals and community workers, as well as focus groups with residents (including various projective techniques), the research identified a range of cultural, economic, lifestyles and personal factors related to overweight and obesity. It led to policy
recommendations to deliver public health information programmes that are relevant and effective in these populations.