Facilitators and barriers to smoking cessation among minority men using the behavioral-ecological model and Behavior Change Wheel: A concept mapping study

Nihaya Daoud, Ye Eun Jung, Ahmad Sheikh Muhammad, Ruth Weinstein, Amir Qaadny, Faten Ghattas, Mohammad Khatib, Itamar Grotto, Nihaya Daoud, Ye Eun Jung, Ahmad Sheikh Muhammad, Ruth Weinstein, Amir Qaadny, Faten Ghattas, Mohammad Khatib, Itamar Grotto

Abstract

Background and aim: Universal smoking cessation strategies are not always successful for minorities, among whom smoking is highly prevalent despite high intention to quit. This study identifies facilitators for smoking cessation, as perceived by minority male smokers, that can inform a culturally appropriate national plan for smoking prevention and cessation.

Methods: We conducted in 2013 a three-stage study among Arab minority male current and former smokers (ages 18-64) in Israel, among whom smoking is very high: first, a Concept Mapping (CM) study with 102 and 202 participants in the brainstorming, and sorting and rating phases respectively. Second, we assigned clusters identified in the CM study to contingency levels using the Behavioral Ecological Model (BEM). Third, we classified clusters into intervention functions and policies using the Behavior Change Wheel (BCW).

Findings: The CM study revealed 58 barriers and facilitators for smoking prevention and cessation that were sorted into 11 clusters by the participants. These clusters were analogous to four BEM level contingency of smoking (social, institutional, community and individual). We classified it into two main policy categories, based on the BCW: 1- restructuring the socio-political environment of smoking through affirmative government's policies towards Arab minority in Israel, and 2-developing a culturally appropriate plan for smoking cessation in Arab local authorities including: raising awareness about tobacco hazards; enforcing anti-smoking laws; strengthening community institutional action; providing smoking cessation services; considering raising prices for tobacco products, addressing psychological sources of smoking in Arab men.

Conclusions: Our study revealed barriers, facilitators and contingencies of smoking prevention and cessation with two main policy action items among the Arab minority in Israel: changing the socio-political environment of smoking, and developing a culturally appropriate smoking prevention and cessation national plan. Our study framework can inform policies and culturally appropriate interventions for smoking prevention and cessation in other minorities.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. A three-stage study framework to…
Fig 1. A three-stage study framework to explore facilitators to smoking cessation in minority Arab male smokers.
Fig 2. Concept mapping study phases among…
Fig 2. Concept mapping study phases among Arab men current and former smokers.
Fig 3. Cluster rating map of participants’…
Fig 3. Cluster rating map of participants’ ideas on contingencies (facilitators, barriers and social determinants) of smoking prevention and cessation.
Fig 4. Smoking cessation cluster ratings (mean…
Fig 4. Smoking cessation cluster ratings (mean rating scores of the clusters).
Fig 5. Pattern match for smoking cessation…
Fig 5. Pattern match for smoking cessation clusters among Arab men by chronic disease status.

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