The challenge of combining ‘lay’ knowledge with ‘evidence-based’ practice in health promotion: Fag Ends Smoking Cessation Service

‘Lay’ knowledge is important for developing socially appropriate health-promotion practices. However, the current emphasis on evidence-based practice privileges expert and experimental knowledge over experiential and local. In practice, the integration of the two forms of knowledge is a negotiated process. A process evaluation of ‘Fag Ends’, a smoking cessation service, provides a case study of how lay advisers tried to integrate National Health Service requirements with both clients and their own knowledge about what works while remaining true to the values of the self-help group from which it originated. Its flexible, customer-orientated approach used a wide range of strategies to support quitters and a particular kind of adviser–client interaction, the essence of which is similar to motivational interviewing. The Fag Ends experience demonstrates how at the heart of UK public health lies a tension between the conflicting ideologies of medical science discourse and community/consumer driven health promotion implicit in the introduction of health advisers in the new public health strategy.