The experiences of people who quit khat and the health care professionals who support them

Document Type : Original Article

Authors

School of Health Sciences, Division of Health Services Research and Management, University of London, London, England

Abstract

Background: This study aimed to explore the barriers and enablers to quitting khat from the perspective of
users and the barriers and enablers to supporting users to quit from the perspective of healthcare
professionals (HCPs).
Methods: The present qualitative study was conducted using semi-structured interviews and the Theoretical
Domains Framework (TDF) to collect and analyse data.
Findings: Overall, 10 khat users and 3 professionals were interviewed. Beliefs about the consequences of
continued use facilitated user’s decisions to quit. Social influences were both a barrier and an enabler. For
professionals, the social influence of other colleagues and working together was key in enabling them to
support clients. Social/professional role and identity was also an important enabler, as professionals saw
supporting users to quit as an integral part of their role. A range of behaviour change techniques was
identified as potential ways in which quitting attempts could be more successful, from the perspective of
users and professionals.
Conclusion: The study reveals the complexity of khat chewing and quitting from the perspective of khat users,
such as the varied influence of family and friends. It also identifies the many barriers and enablers that
professionals experience when supporting individuals to quit, such as working with other professionals.
There is little evidence for the effectiveness of current services provided for quitting khat or little information
outlining how they were developed. Current services would benefit from evaluating the effectiveness of the
interventions using established methodology. Recommendations have been provided for practice in the field
of substance misuse.


Keywords


Advisory Council on the Misuse of Drugs (ACMD).
Khat: A review of its potential harms to the
individual and communities in the UK [Online].
[cited 2013 Jan 23]; Available from: URL:
https://www.gov.uk/government/publications/khatreport-2013
2. Honest information about drugs| FRANK. Speed:
Also called: Whizz, Sulph, Paste, Billy, Base,
Amphetamine Sulphate, Amphetamine [Online].
[cited 2017 Dec 24]; Available from: URL:
https://www.talktofrank.com/drug/speed
3. Honest information about drugs| FRANK. Khat:
Also called: Quat, Qat, Qaadka, Chat [Online]. [cited
2014 Feb 4]; Available from:
https://www.talktofrank.com/drug/khat
4. Corkery JM, Schifano F, Oyefeso A, Ghodse AH,
Tonia T, Naidoo V, et al. Overview of literature and
information on "khat-related" mortality: A call for
recognition of the issue and further research. Ann Ist
Super Sanita 2011; 47(4): 445-64.
5. Estifanos M, Azale T, Slassie M, Aynalem G, Kefale
B. Intention to stop khat chewing and associated
factors among khat chewers in Dessie city, North
Eastern Ethiopia. Epidemiology 2016; 6: 11.
6. Advisory Council on the Misuse of Drugs (ACMD).
Khat (Qat): Assessment of Risk to the Individual and
Communities in the UK, 2005 [Online]. [cited 2017
Dec 15]; Available from: URL:
https://www.gov.uk/government/publications/khatreport-2005--6
7. Hassan NA, Gunaid AA, Murray-Lyon IM. Khat
(Catha edulis): Health aspects of khat chewing. East
Mediterr Health J 2007; 13(3): 706-18.
8. Cox G, Rampes H. Adverse effects of khat: A
review. 2003; 9(6): 456-63.
9. Colzato LS, Ruiz MJ, van den Wildenberg WPM,
Hommel B. Khat use is associated with increased
response conflict in humans. Hum Psychopharmacol
Clin Exp 2012; 27(3): 315-21.
10. Pennings EJM, Opperhuizen A, van Amsterdam
JGC. Risk assessment of khat use in the Netherlands:
A review based on adverse health effects,
prevalence, criminal involvement and public order.
Regul Toxicol Pharmacol 2008; 52(3): 199-207.
11. Feyissa AM, Kelly JP. A review of the
neuropharmacological properties of khat. Prog
Neuropsychopharmacol Biol Psychiatry 2008; 32(5):
1147-66.
12. Warfa N, Klein A, Bhui K, Leavey G, Craig T,
Alfred SS. Khat use and mental illness: A critical
review. Soc Sci Med 2007; 65(2): 309-18.
13. Kassim S, Croucher R, Al'Absi M. Khat dependence
syndrome: A cross sectional preliminary evaluation
amongst UK-resident Yemeni khat chewers. J
Ethnopharmacol 2013; 146(3): 835-41.
14. Cane J, O'Connor D, Michie S. Validation of the
theoretical domains framework for use in behaviour
change and implementation research. Implement Sci
2012; 7: 37.
15. Francis JJ, Johnston M, Robertson C, Glidewell L,
Entwistle V, Eccles MP, et al. What is an adequate
sample size? Operationalising data saturation for
theory-based interview studies. Psychol Health 2010;
25(10): 1229-45.
16. Islam R, Tinmouth AT, Francis JJ, Brehaut JC, Born
J, Stockton C, et al. A cross-country comparison of
intensive care physicians' beliefs about their
transfusion behaviour: a qualitative study using the
Experiences of khat users & support staff Begum et al.
254 Addict Health, Autumn 2019; Vol 11, No 4
http://ahj.kmu.ac.ir, 07 October
Theoretical Domains Framework. Implement Sci
2012; 7: 93.
17. Patey AM, Islam R, Francis JJ, Bryson GL,
Grimshaw JM. Anesthesiologists' and surgeons'
perceptions about routine pre-operative testing in
low-risk patients: Application of the Theoretical
Domains Framework (TDF) to identify factors that
influence physicians' decisions to order pre-operative
tests. Implement Sci 2012; 7: 52.
18. McBain H, Begum S, Rahman S, Mulligan K.
Barriers to and enablers of insulin self-titration in
adults with Type 2 diabetes: A qualitative study.
Diabet Med 2017; 34(2): 253-61.
19. Pope C, Ziebland S, Mays N. Qualitative research in
health care. Analysing qualitative data. BMJ 2000;
320(7227): 114-6.
20. Ritchie J, Lewis J. Qualitative research practice: A
Guide for Social science students and researchers.
London, UK: SAGE Publications; 2003.
21. Thomas S, Williams T. Khat (Catha edulis): A
systematic review of evidence and literature
pertaining to its harms to UK users and society. Drug
Science, Policy and Law 2013; 1: 1-25.
22. Deyessa N, Berhane Y, Alem A, Hogberg U, Kullgren
G. Depression among women in rural Ethiopia as
related to socioeconomic factors: a community-based
study on women in reproductive age groups. Scand J
Public Health 2008; 36(6): 589-97.
23. Patel SL, Wright S, Gammampila A. Khat use
among Somalis in four English cities. Home Office
Online Report 47/05 [Online]. [cited 2013];
Available from: URL: http://karin-ha.org.uk/wpcontent/uploads/2013/01/rdsolr4705.pdf
24. Kassim S, Jawad M, Croucher R, Akl EA. The
epidemiology of tobacco use among khat users: A
systematic review. Biomed Res Int 2015; 2015:
313692.
25. Manghi RA, Broers B, Khan R, Benguettat D,
Khazaal Y, Zullino DF. Khat use: Lifestyle or
addiction? J Psychoactive Drugs 2009; 41(1): 1-10.
26. Kassim S, Islam S, Croucher RE. Correlates of
nicotine dependence in U.K. resident Yemeni khat
chewers: A cross-sectional study. Nicotine Tob Res
2011; 13(12): 1240-9.
27. Ghouri N, Atcha M, Sheikh A. Influence of Islam on
smoking among Muslims. BMJ 2006; 332(7536):
291-4.
28. McMurran M. What works in substance misuse
treatments for offenders? Crim Behav Ment Health
2007; 17(4): 225-33.
29. NICE | The National Institute for Health and Care
Excellence. Multimorbidity: clinical assessment and
management. NICE guideline [NG56] [Online].
[cited 20160Sep]; Available from: URL:
https://www.nice.org.uk/guidance/ng56/chapter/reco
mmendations
30. Wedegaertner F, al-Warith H, Hillemacher T, te
Wildt B, Schneider U, Bleich S, et al. Motives for
khat use and abstinence in Yemen - a gender
perspective. BMC Public Health 2010; 10(1): 735.
31. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth
I, Petticrew M. Developing and evaluating complex
interventions: The new Medical Research Council
guidance. BMJ 2008; 337: a1655.
32. Michie S, Richardson M, Johnston M, Abraham C,
Francis J, Hardeman W, et al. The behavior change
technique taxonomy (v1) of 93 hierarchically
clustered techniques: Building an international
consensus for the reporting of behavior change
interventions. Ann Behav Med 2013; 46(1): 81-95.
33. Michie S, Atkins L, West R. The behaviour change
wheel: A Guide to designing interventions. London,
UK: Silverback Publishing; 2014.
34. Nabuzoka D, Badhadhe FA. Use and perceptions of
khat among young Somalis in a UK city. Addiction
Research 2000; 8(1): 5-26.