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An Investigation Into the Perceptions of Male Smokers and Health Care

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An Investigation Into the Perceptions of Male Smokers and Health Care University of Huddersfield Repository Al-Turki, Khaled An investigation into the perceptions of male smokers and health care professionals in the smoking cessation clinics in Riyadh on the Tobacco Control Program in Saudi Arabia Original Citation Al-Turki, Khaled (2014) An investigation into the perceptions of male smokers and health care professionals in the smoking cessation clinics in Riyadh on the Tobacco Control Program in Saudi Arabia. Doctoral thesis, University of Huddersfield. This version is available at http://eprints.hud.ac.uk/id/eprint/23794/ The University Repository is a digital collection of the research output of the University, available on Open Access. Copyright and Moral Rights for the items on this site are retained by the individual author and/or other copyright owners. 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For more information, including our policy and submission procedure, please contact the Repository Team at: [email protected]. http://eprints.hud.ac.uk/ An investigation into the perceptions of male smokers and health care professionals in the smoking cessation clinics in Riyadh on the Tobacco Control Program in Saudi Arabia by Khaled Al-Turki A dissertation submitted to the University of Huddersfield in fulfilment of the requirements for the degree of Master of Philosophy University of Huddersfield June 2014 1 Abstract Aim: The aim of this dissertation is to produce an original piece of investigative research into perceptions of smoking cessation services provided by the TCP in the Riyadh region. Objectives: In order to realise this aim, the dissertation has the following objectives: 1. To investigate perceptions of the extent of the health care (smoking cessation) services provided under the TCP for smokers in the Riyadh region. 2. To investigate the perceptions of male clients and health care services professionals in the smoking cessation clinics in this region, on the effectiveness of the clinics in raising awareness of the dangers of smoking, in order to encourage smokers to quit. 3. To identify the perceived strengths and limitations of health care (smoking cessation) services provided for smokers in the Riyadh region specifically as a platform for developing those strengths in the future. Design: Primary data was collected through questionnaires administered to male clients attending the smoking cessation clinics in Riyadh, Saudi Arabia, and professional staff working in those same clinics. The views of respondents represent their individual subjective experience of one specific aspect of an objective social experience, in this case the functioning of the Tobacco Control Program. Methods: A questionnaire was devised based on the policies and activities of the Tobacco Control Programme in Saudi Arabia. Convenience sampling was used, conducting the survey among 500 male clients attending the smoking cessation clinics in Riyadh and 30 staff in the clinics. The sampling was purposive, seeking to obtain the views of service-users and service-providers in the clinics, as those who would be expected to be more informed about the Tobacco Control Programme rather than a random sample drawn from the general population, such as a household survey. The Pilot Study was conducted in a smoking cessation clinic run by an anti-smoking charity in Riyadh. Results: The results obtained from both sets of questionnaires indicated in Sections A and B that respondents considered that the Tobacco Control Program was actively engaged in a series of activities relating to tobacco control, in raising awareness of the hazards of smoking and providing treatment. Responses in Sections C and D suggested that clients and staff 2 perceived that the Tobacco Control Program was operating effectively, despite some difficulties occasioned by a lack of resources. Conclusions: The level of satisfaction with the performance of the Tobacco Control Program indicated in the responses was high. The uniformity of the responses may be responsible due to two factors – a relative lack of cultural diversity among respondents, and limitations of the study itself in overcoming potential problems of reporting bias. Given the setting of the study and the methods chosen, this may have resulted in a measure of unwillingness to criticise aspects of the Program. Nevertheless, as the first study of satisfaction with the TCP since its inception in 2002, valuable lessons will be learned for future surveys to obtain data, perhaps based more closely on surveys such as those conducted in the UK to measure satisfaction with the NHS. A more standardised international approach should, therefore, be the way forward in terms of research design and methods. 3 CONTENTS Abstract..................................................................................................................... 2 Contents.................................................................................................................... 4 List of Tables............................................................................................................ 7 Acknowledgements.................................................................................................. 10 CHAPTER 1 Introduction 1.1. Worldwide prevalence of smoking and mortality.................................. 12 1.2. Prevalence of smoking and mortality in Saudi Arabia.......................... 14 1.3. Patterns of smoking................................................................................... 16 1.4. Smoking and morbidity............................................................................. 19 1.5. The benefits of smoking cessation............................................................ 20 1.6. The methods of aiding cessation............................................................... 22 1.7. The role of smoking cessation clinics in treating tobacco dependence................................................................................................. 23 1.8. Smoking in Saudi Arabia: a historical perspective................................. 24 1.9. Saudi legislation and action on smoking.................................................. 25 1.10. Saudi health service provision.................................................................. 31 1.11. The development of services..................................................................... 32 1.12. The international context of tobacco control........................................... 35 1.13. The research problem and aims and objectives of the study................. 36 CHAPTER 2 Literature Review 2.1. The literature search strategy................................................................... 42 2.2. The Saudi Tobacco Control Program...................................................... 47 2.3. The Eastern Mediterranean context......................................................... 50 2.4. The influence of religion............................................................................ 55 2.5. Promoting smoking cessation.................................................................... 60 2.6. The influence of tobacco warning labels.................................................. 62 2.7. The role of the smoking cessation clinics.................................................. 63 2.8. The operation of smoking cessation clinics.............................................. 66 2.9. The evaluation of smoking cessation clinics............................................. 68 2.10. Motivation and behaviours related to smoking cessation....................... 70 4 2.11. Motivation and dependence...................................................................... 72 2.12. Behavioural and counselling interventions.............................................. 74 2.13. Interventions in treatment: Pharmacotherapy....................................... 78 2.14. Monitoring of patients............................................................................... 80 2.15. Conclusion.................................................................................................. 81 CHAPTER 3 Research Design and Methodology 3.1. Choice of methodology and the aim and objectives of the thesis........... 84 3.2. The design of the questionnaires............................................................... 90 3.3. The pilot study............................................................................................ 92 3.4. The main study........................................................................................... 101 3.4.1. Conduct of the survey................................................................................ 103 3.4.2. The data collection process evaluated...................................................... 105 3.4.3. Ethical issues and respondent privacy..................................................... 106 CHAPTER 4 Results: Survey of Clients 4.1. The study sample and selected demographic characteristics.................. 109 4.2. The questionnaire responses: clients.......................................................... 112 4.3. Trends
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