Khat (Catha edulis) is an evergreen plant that grows at high altitudes between 1500–2000 meters above sea level. It commonly grows throughout the year in the Horn of African or Middle East countries. Khat leaves has been used as a stimulant for recreational purposes for centuries in the Horn of Africa and the Arabian Peninsula [1–6]. It also used for social and religious purposes [7]. Khat contains psychoactive ingredients which effect individual’s consciousness, behavior, mood and thinking processes [8]. These active ingredients have a potential to lead physical and psychological dependence [1, 7–9]. However, chewers believe that it would keep them alert, attain greater concentration, boosts pleasure, and enhances motivation [9].
In Ethiopia, chewing of khat is becoming habitual and increasing at an alarming rate, especially in the younger segment of the population. A meta-analysis on the prevalence of khat chewing among university students in Ethiopian indicated that above one in five students have been engaged in chewing khat [10]. According to the 2016 Ethiopia Demographic and Health Survey (EDHS) report 12% of women and 27% of men respondents reported ever chewed khat and of which two in three chewed chat for 6 or more days in the last 30 days preceding the survey. Khat consumption varies widely across by regions (highest in Harari and lowest in Tigray), education and wealth status [11].
However, khat use has multiple serious medical, sexual, economic and psychosocial problems. Long-term khat chewing resulted in mental and neurological aberrations such as cognitive impairment, learning problems and behavioral abnormalities. It also accounts for gastrointestinal tract problems like esophagitis, gastritis, and a delay in intestinal absorption. Moreover, it is associated with dental, cardiovascular, genitourinary problems and myocardial infarction [12–16]. Khat chewing may harm the economy by the loss in production as a result of laziness and absenteeism. Workers go to lunch and engage in Khat sessions, and do not return to work [17].
A qualitative study among khat quitter in Saudi revealed the deciding to quit khat chewing is often due to multiple reasons. The most common reasons were feeling of guilty for giving up prayers, feeling lost and neglecting family, accumulation of debts, work neglect and frequent absenteeism, and impaired health [17]. Similarly, Transtheoretical Model (TTM) assume that people do not change behaviors quickly and decisively and an individual will remain stuck in the early stages of behavioral change. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process [18].
Empirical evidences support the transtheoretical model as the dominant model of health behavior change. The TTM is aimed at understanding an individual's readiness to act on a new healthier-behavior and describing how people move through five different stages of behavioral changes. The four core constructs of TTM are stages of change, self-efficacy, decisional balance, and processes of change. The model indicates that individuals who were attempting to change their health behavior might experience a series of stages of readiness for change, namely: precontemplation, contemplation, preparation, action, and maintenance. Movement through these stages often occurs in cyclic rather than linear patterns. In moving through these stages of change, people apply cognitive, affective, and evaluative processes [19].
The current study focuses on assessing the intention to stop khat chewing among chewers using TTM. Intentions to stop khat chewing can be conceptualized as a readiness to engage in the quitting process [20]. Although, the use of intentions to predict behavior was controversial [21], evidences recognize that behaviors can be predicted by assessing intentions to engage in the behaviors under consideration [20]. Intentions have less impact on behavior when participants lack control over the behavior, when there is potential for social reaction, and when circumstances of the performance are conducive to habit formation [22]. It is assumed that the intention–behavior gap mediated by planning, maintenance self-efficacy and control of action. We expect that the higher the intention, the more likely it is that the behavior will in fact be performed [21, 23]. Theory based measurement of behavior changes is important to organize our thinking about the health problem as well as development and refinement of interventions. Despite numerous studies on the prevalence of khat were conducted in Ethiopia, quitting and intention to quit khat chewing area were not well-investigated in Ethiopia. So, this study aimed at assessing the intention to stop khat chewing and associated factors among chat chewers in Gondar city, northwest Ethiopia.