Stakeholder perspectives on community tobacco use and the implementation of tobacco use treatment in Eastern Ethiopia: a qualitative study

Abstract

BACKGROUND: Smoking tobacco causes over 8 million deaths annually and is the leading cause of non-communicable diseases globally. In Eastern Ethiopia, tobacco use is culturally ingrained, often combined with alcohol and khat use. This study explores stakeholders' experiences addressing tobacco use in the region, aiming to identify obstacles and opportunities for implementing telephone counseling as an evidence-based strategy to support tobacco cessation. METHODS: This is a qualitative descriptive study using semi-structured, face-to-face qualitative interviews to gather data from March - April 2025. The study involved 20 healthcare professionals and administrators purposely sampled; the participants were physicians, nurses, non-communicable disease focal points, and health bureau representatives from six health centres and one general hospital located in the East Hararghe region. Open-ended questions elicited information regarding their perceptions and experience with community tobacco use, existing tobacco cessation programs, and the possibility of telephone-based interventions for tobacco cessation. The interviews were conducted in the participants' primary language (either Afan Oromo or Amharic), transcribed into English, and thematically analyzed through a multidisciplinary team of researchers using an inductive approach. Multiple researchers used a combination of open coding and axial coding to manually code the data; regular peer debriefing sessions provided a way to assure both reliability and validity of the data. RESULTS: Community members presented four overarching themes surrounding tobacco use: (i) Motivations and Misconceptions regarding tobacco use as it pertains to perceived functional benefits, use as a coping mechanism, and tobacco as a status symbol; (ii) Screening and Assessment Challenges which providers experience including informal practices and concealment of smoking from providers; (iii) Intervention and Counseling Methods that providers use including gradual reduction, health education, and recommendations for more structured cessation programs; (iv) Challenges and Opportunities Related to Telephone Counseling, including system-level gaps such as a lack of training and protocols, yet an opportunity to utilize mobile technology to access hard-to-reach populations. Functional, Emotional and Social Determinants of Tobacco Use in East Hararghe; Barriers to Treatment (i.e., early initiation and khat co-use), and Lack of Consistent Screening, Structured Cessation Programs, Provider Training, and Community Engagement are also barriers to treatment. CONCLUSIONS: Tobacco use in East Hararghe is sustained by social norms and misconceptions, while inconsistent screening and a lack of structured programs impede cessation. Effective control requires a dual approach: strengthening healthcare systems through training and protocols, alongside culturally sensitive community interventions, with telephone counseling offering a scalable bridge between these settings.