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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 25, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020. Downloaded from Exploring the concept of Problematic khat use in the Gurage community, South-central Ethiopia: A qualitative study Journal: BMJ Open ManuscriptFor ID peerbmjopen-2020-037907 review only Article Type: Original research Date Submitted by the 27-Feb-2020 Author: Complete List of Authors: Awoke, Mihretu; Addis Ababa University College of Health Sciences, Psychiatry; college of natural and social sciences, Addis Ababa science and Technology University , Department of social sciences Fekadu, Abebaw; Centre for Innovative Drug Development and Therapeutic Trials in Africa (CDT-Africa); Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Habtamu, Kassahun; School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia NHUNZVI, CLEMENT; University of Zimbabwe, Rehabilitation Norton, Sam; King's College London, Psychology Department, Insitute of Psychiatry Teferra, Solomon; Addis Ababa University College of Health Sciences, School of Medicine, Department of Psychiatry; Harvard T.H. Chan School http://bmjopen.bmj.com/ of Public Health, Boston, USA MENTAL HEALTH, Substance misuse < PSYCHIATRY, QUALITATIVE Keywords: RESEARCH on September 25, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 39 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020. 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Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 39 BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020. Downloaded from 1 2 3 Exploring the concept of Problematic khat use in the Gurage community, South-central 4 5 6 Ethiopia: A qualitative study 7 8 Awoke Mihretu*1,2, Abebaw Fekadu1, 3, Kassahun Habtamu4, Clement Nhunzvi5, Sam Norton6, Solomon Teferra 1, 7 9 10 11 Email address of authors: 12 13 Correspondence author :Awoke Mihretu= [email protected] 14 15 16 Postal address:16417 For peer review only 17 18 telephone number: +251921331306 19 20 21 Abebaw Fekadu= [email protected] 22 23 24 Kassahun Habtamu= [email protected] 25 26 27 Clement Nhunzvi= [email protected] 28 29 30 Sam Norton= [email protected] 31 32 Solomon Teferra = [email protected] http://bmjopen.bmj.com/ 33 34 35 1 Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia 36 37 2 Department of social sciences, college of natural and social sciences, Addis Ababa science and Technology University 38 39 3Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, 40 41 Addis Ababa, Ethiopia on September 25, 2021 by guest. Protected copyright. 42 43 4School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia 44 45 5Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe 46 47 6Psychology Department, Institute of Psychiatry, King’s College London, London, UK 48 49 7Harvard T.H. Chan School of Public Health, Boston, USA 50 51 52 53 54 55 56 Abstract 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020. Downloaded from 1 2 3 Objective: This study aimed at exploring how problematic khat use is characterized in the 4 5 6 Gurage community, South-central Ethiopia. 7 8 Design: qualitative study. 9 10 Setting: Gurage community, South-central Ethiopia 11 12 Participants: We conducted in-depth interviews with 14 khat users and 5 non-khat users, and 3 13 14 15 focus-group discussions with khat users. 16 For peer review only 17 Methods: All participants were selected purposively based on their exposure to khat or khat use. 18 19 We used interview guide to explore perception of participants about khat use and problematic 20 21 22 khat use. We analyzed the data thematically using Open Code software version 4.03. We used 23 24 iterative data collection and analysis, triangulation of methods and respondent validation to 25 26 ensure scientific rigour. 27 28 29 Findings: We identified three major themes: sociocultural khat use, khat suse (khat addiction), 30 31 and negative consequences of khat use. Sociocultural khat use included a broad range of contexts 32 33 and patterns including use of khat for functional, social, cultural and religious reasons. Khat http://bmjopen.bmj.com/ 34 35 addiction was mainly explained in terms of associated khat withdrawal experiences, including 36 37 38 harara/craving, and inability to quit. We identified mental health, sexual life, physical health, 39 40 social and financial related negative consequences of khat use. The local idiom Jezba was used 41 on September 25, 2021 by guest. Protected copyright. 42 to label subgroup of individuals with khat suse (khat addiction). 43 44 45 Conclusion: The study has identified what constitutes normative and problematic khat use in the 46 47 Gurage community in South-central Ethiopia. Problematic khat use is broad concepts which 48 49 include frequency, reasons, contexts, negative consequences and addiction of khat use. Insights 50 51 52 generated can be used to inform future studies on development of tools to measure problematic 53 54 khat use. 55 56 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 39 BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020. Downloaded from 1 2 3 Keywords: khat use; normative khat use; problematic khat use; qualitative study; Ethiopia 4 5 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40 41 on September 25, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 39 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-037907 on 12 October 2020.
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