The enormities and consequences of tobacco use among youths in resource limited settings in Kenya

Abstract

Objective
Tobacco usage continues to be pronounced prominently as a public health concern distressing a broad-spectrum of health and well-being of populations around the world. Despite the harm caused by its consumption, the extent and its consequences to youths in resource limited settings is not known. To determine the enormity and consequences of tobacco usage among youths while specific objectives were to determine the level of usage, contributing factors and the consequences of its usage among youths in resource limited settings.

Methods
A cross-sectional study design with simple random sampling was used. An interviewer-administered questionnaire was used. Quantitative data was analyzed using SPSS. Chi- Square and Odds Ratio were used to test for significance of association.

Results
Tobacco usage and gender of the respondents was statistically significant at 95% confidence level with χ²=107.0; df =1; p=0.0001. Odds Ratio showed that males were 7.5 times more likely to use tobacco compared to female respondents. Main source of tobacco products was in markets (78%) and friends (22%). Peer pressure was reported by 48% as the main factor that drives youths to tobacco usage. A total of 56.6% of the respondents did not know any health consequences of tobacco usage.

Conclusions
The recommended intervention included awareness creation, reduction of accessibility to tobacco, health education and functional youth friendly centres.

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Journal of Addictive Diseases
ISSN: 1055-0887 (Print) 1545-0848 (Online) Journal homepage: https://www.tandfonline.com/loi/wjad20
Assessing the usability of a Willingness to Quit
smoking questionnaire in a sample of active
tobacco smokers: A qualitative study
David Onchonga, Haitham Khatatbeh, Martin Thuranira, Kabuga Lennox &
Mithil Barath Rajendran Venkatesh
To cite this article: David Onchonga, Haitham Khatatbeh, Martin Thuranira, Kabuga Lennox &
Mithil Barath Rajendran Venkatesh (2020) Assessing the usability of a Willingness�to�Quit smoking
questionnaire in a sample of active tobacco smokers: A qualitative study, Journal of Addictive
Diseases, 39:1, 3-10, DOI: 10.1080/10550887.2020.1800891
To link to this article: https://doi.org/10.1080/10550887.2020.1800891
Published online: 24 Aug 2020.
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Assessing the usability of a Willingness to Quit smoking questionnaire
in a sample of active tobacco smokers: A qualitative study
David Onchonga, MPH
a,b
, Haitham Khatatbeh, MSN
a
, Martin Thuranira, MD
b
, Kabuga Lennox, BSc,
Pharm
b
and Mithil Barath Rajendran Venkatesh, BSc (Biology)
c
a
Doctoral School of Health Sciences, University of P
ecs, Hungary;
b
County Department of Health Services Samburu-Kenya;
c
Faculty of
Sciences, University of P
ecs, Hungary
ABSTRACT
Background and objectives: Tobacco products are conceivably the most accessible
addictive substances. Its use contributes to numerous negative health outcomes both in the
developed and developing world. The objective of the study was to assess the usability of
aWillingness to Quit smoking questionnaire; a concise questionnaire used to assess the
readiness of active tobacco smokers to stop smoking, and also guiding in constructive
conversations between healthcare workers and clients regarding stopping smoking.
Methods: In this study, 25 active tobacco smokers and four healthcare workers of different
cadres were interviewed. Participants were given the Willingness to Quit smoking question-
naire and asked to fill and comment on its usability, ease of comprehension and plausibility
in the healthcare system settings.
Results: All the 25 active tobacco smokers demonstrated their readiness to stop smoking. It
was reported that the Willingness to Quit smoking questionnaire triggered the intention
to stop smoking and effectively guided the interviews between the healthcare workers and
clients who had expressed the intention of stopping smoking.
Conclusion: The Willingness to Quit smoking questionnaire is a valuable tool in clinical prac-
tice as it can be used to prompt tobacco cessation dialogues between healthcare workers
and clients attempting to stop smoking.
KEYWORDS
Readiness to stop smoking;
tobacco cessation; active
tobacco smokers; qualitative
study; Kenya
Introduction
Globally, tobacco smoking is an issue of public
health interest
1
and as a result, it has continuously
become a threat to both consumers and passive-
smokers. Some of these threats include illnesses
that sometimes turn fatal.
2
In developing countries
and especially in sub-Saharan Africa, it impacts
negatively not only the adults but also school going
children and youth.
3
According to World Health
Organization (WHO), about a third of men use
tobacco products.
4
In the United States alone,
deaths are three times higher among active cigarette
smokers compared to nonsmokers
5,6
Tobacco consumption has greatly increased in
the sub-Saharan African countries. At the
moment, numerous non-communicable diseases
have emerged.
7
Considering that most of these
countries are already struggling economically,
tobacco-related health problems continue to
overwhelm them further.
8
Among youths who
start smoking at a young age there is an
increased risk of death in their adulthood due to
tobacco-related health complications.
9
In the sub-Saharan Africa, the prevalence of
tobacco smoking is highest in Kenya. Annually,
there are 8,100 deaths from tobacco related
health complications. In the country, an esti-
mated 18,000 young people between the ages of
10–14 and 2,116,000 adults are regular users of
tobacco products.
10
In comparison based on gen-
der, about 1,982,100 adult men and 14,300 young
boys smoke tobacco. On the other hand, female
smokers consist of about 134,400 adult women
and 4,200 young girls.
10
Economically, the cost of
smoking in Kenya amounts to 2.9 billion Kenya
shillings annually. It includes direct costs associ-
ated with healthcare overheads, and indirect costs
due to decreasing productivity at the workplace
as a result of health related complications.
11
CONTACT David Onchonga onchonga7@gmail.com Doctoral School of Health Sciences, University of P
ecs, Hungary.
ß2020 Taylor & Francis Group, LLC
JOURNAL OF ADDICTIVE DISEASES
2021, VOL. 39, NO. 1, 3–10
https://doi.org/10.1080/10550887.2020.1800891

Reviewed literature reported that barriers to
tobacco cessation included the limited number
of healthcare professionals involved in tobacco
cessation activities, due to limited knowledge and
skills about such tobacco interventions.
12
Also,
clinician’s attitudes toward tobacco cessation,
staff smoking, inadequate clinician training in
tobacco cessation, concern among clinicians and
administrators regarding potential loss of clients,
difficulty enforcing tobacco policies, and limited
resources to address tobacco use have been cited
as potential barriers. Smoking cessation interven-
tions have been noted to be given a lower prior-
ity as compared with other clinical interventions
and there is a lack of consistent expectations by
health care institutions regarding the delivery
of tobacco cessation in general.
13
Similarly,
environmental factors have been cited as key
barriers to tobacco cessation, including opinions
that everyone smokes, easy access to purchasing
cigarettes in one’s vicinity, and exposure to cigar-
ette advertising. Emphasizing the influence of
social context and norms in high-prevalence areas
greatly deters the implementation of tobacco
cessation programs especially among youths.
14
Cessation of smoking in Kenya has been slow
despite the country being a signatory to numer-
ous regional and international treaties and
conventions. For instance, the country signed and
ratified World Health Organization’s Framework
Convention on Tobacco Control (WHO-FCTC)
in 2004, followed by an enactment of the Tobacco
Control Act (TCA) in 2007 by the Kenyan parlia-
ment. This intervention aimed to domesticate the
FCTC. The TCA gave provisions for: smoking-free
public places, graphic health warnings on cigarettes
packages, ban on tobacco promotion and sponsor-
ships, tax and price measures, public awareness
initiatives, and limiting sales to only the persons
above 18 years of age.
15
Smoking cessation efforts
are constrained by economic hardships, lack of
awareness on the health consequences of tobacco,
and poor healthcare systems.
16
The United States Public Health Service
(USPHS) in 1996 sponsored Clinical Practice
Guidelines on the treatment of tobacco depend-
ence through partnerships between Tobacco Use
and Dependence Guideline Panel, Public Health
Consortium Representatives, consultants and
staff. The guidelines noted that tobacco depend-
ence is a chronic disease that often requires con-
tinuous interventions. Also, suggestively, tobacco
misuse could be treated through the implementa-
tion of the 5 As approach: A- Ask about tobacco,
Advise users to stop smoking, Assess the interest
of users to stop smoking, Assist in the stopping
tobacco smoking attempt, and Arrange for fol-
low-up.
17
From literature, more than 70% of
tobacco product users visit healthcare facilities at
least once annually.
A brief Willingness to Quit smoking question-
naire (WTQ) for use in clinical practice was
developed. This is a short questionnaire which is
comprised of four short open-ended statements
that smokers attempting to stop smoking are
given to fill. The statements are: (1). If I could
quit smoking I would …. (2). I want to quit smok-
ing because I worry about how smoking affects my
health …. (3). I would be willing to decide to quit
smoking …. (4). and I would be willing to cut
down my number of cigarettes before quitting ….
The WTQ smoking questionnaire assess smoker’s
present readiness to stop smoking. The question-
naire is equally used to expedite open communi-
cation between smokers and clinicians. The
questionnaire was developed based on an inten-
sive literature review of patient-reported informa-
tion to involve active tobacco users in smoking
cessation conversations and the tool has been
used in developed countries especially in the
United States of America where its contents have
been validated.
18
Although the questionnaire has been used
in developed countries,
19
there are inadequate
findings from developing countries. Our intensive
literature review did not find any published
studies on its usage in the African continent, and
therefore assessing its usability will ensure that
the items in the questionnaire are appropriate for
the intended use and the target population. In
that regard, the goal of the study was to assess
the usability of the WTQ smoking questionnaire
in a sample of active tobacco smokers in Kenya,
while the specific objectives were to assess the
experience and motivation of active smokers
to quit smoking, the readability of the WTQ
smoking questionnaire by active smokers, and
the perspectives of healthcare providers on the
4 D. ONCHONGA ET AL.

plausibility of the WTQ smoking questionnaire
in routine clinical practice.
Methods
Based on the objectives, an exploratory descriptive
research design was used in this study. This method-
ology has been used for the purposes of understand-
ing the study participant’sperspectiveand
experiences in the context of the phenomenon being
investigated. In our case, we wanted to investigate the
active smoker’s experience and motivation to stop
smoking and explore their experiences of tobacco
smoking cessation methods. Equally, healthcare pro-
viders were interviewed to get their comments about
the usability and applicability of the instrument
in clinical practice. This method has been used by
researchers to grasp the phenomenon of interest as
they are articulated by the study correspondents.
In this study, 28 active tobacco users and four
healthcare workers (medical specialist, medical
officer, nursing officer, and a clinical officer)
were recruited in the study. Purposive sampling
methodology was used.
20
This involved identifica-
tion and selection of individuals or groups of
individuals that were competent and knowledge-
able with a phenomenon of interest in addition
to knowledge and experience and the importance
of availability and willingness to participate, and
the ability to converse experiences and opinions
in a coherent, meaningful and thoughtful man-
ner.
21
This was done through prescreening of
potential study participants by the recruiting
research assistant (outpatient nursing officer).
The prescreening questions were basically about
the knowledge on tobacco cessation, previous his-
tory of attempting to quit smoking, and their
willingness to participate in the current study.
The office of the director of nursing services
managing the Outpatient Department (OPD) in a
County referral hospital in Kenya was tasked
with recruiting the study participants. This office
was involved because about 70% of the smokers
visit health facilities and the process of triage
starts at the OPD. Therefore, the first point of
contact is the nurses manning the triage. The
recruitment process involved a brief interaction
with patients who came for health services and
were willing to quit smoking.
Interviews were discontinued after 25 individ-
ual interviews when no new information was
being obtained both from the interviews and the
analysis of the submission from the last study
participant.
22,23
The inclusion criteria for current
smokers was: active adult smokers, above 18 years
of age, smoking at least 10 cigarettes per day,
had been smoking continuously for at least
24 months, currently not on tobacco cessation
treatment, and must have tried to stop smoking
at least twice in the last 90 months.
For healthcare workers, inclusion criteria were:
being in practice as a clinician and directly han-
dling patients (a Medical Specialist, a Medical
Officer, a Clinical Officer and a Nursing Officer)
for at least three years, having experience in
assisting active tobacco users to stop smoking,
and having at least used the questionnaire with
three active tobacco users during their routine
practice. All the four healthcare workers were
from the public health sector.
Study participants were informed of the con-
tents, purpose, and objectives of study before
recruitment. Also, they were given a chance to
seek clarification or withdraw from the study in
case they were not comfortable. Three partici-
pants withdrew during recruitment and a final
sample of 25 active tobacco smokers consented.
Interview guides were used for both participants,
audio recorded with their permission, and tran-
scribed verbatim. The individual interviews took
between 12 and 21 minutes for both participants.
The study received ethical approval from
Jaramogi Oginga Odinga Teaching and Referral
Ethical Review Committee (ERC.IB/VOL.1/69).
Interviews with active smokers and
healthcare providers
The first and third author undertook qualitative
interviews with the two sets of respondents using
the same approach. First, active smokers were
interviewed and the interview was divided into
two phases. We used interview guides that were
developed from intensive literature review. These
were open ended questions that were asked
to avoid getting direct responses from the study
participants. Questions like; Tell me about your
smoking journey …were asked. These were
JOURNAL OF ADDICTIVE DISEASES 5

followed by further specific but not direct ques-
tions such as the duration of smoking in years,
frequency of smoking in a day, quantity of ciga-
rettes smoked in a day, any attempts to quit
smoking, reasons for any attempt, and the motiv-
ation for current attempt to quit smoking. The
first phase was undertaking concept elicitation
where open-ended questions were asked about
the participant’s smoking history, their willing-
ness to quit smoking journey, and factors that
could influence their willingness to stop smoking.
The second phase was the administration of the
WTQ instrument. They were asked to complete
the four questions on the instrument and also
several discussions on the meaning, relevance,
and adequate understanding of each question was
investigated. They were equally required to com-
ment on the wording of the instrument, if they
understood it well and if not, they were asked to
give suggestions on different words to be used to
better the tool.
The healthcare providers were equally required
to give their observations on the usability of the
instrument, especially how best the patients com-
prehended the instrument. They were also asked
to recommend any modifications to the phrasings
and identify any content that was not relevant.
In concept elicitation, they were asked broad,
open-ended questions that were geared to give
more insights on their patient’s smoking history
and their willingness to be assisted to stop
smoking. The interview with active smokers took
between 38 and 52 minutes and with healthcare
providers it took between 18 and 32 minutes.
Data analysis
Miles and Huberman’s proposed steps for
qualitative data analysis methodology was used.
24
This method involves three steps: data reduction,
data display, and conclusion drawing/verification.
Data were reduced through making summaries,
focusing on important aspects, related to usability
of WTQ smoking questionnaire. Data which had
no direct relation with the theme of the study
were discarded. Next, the retained data was
organized and used to formulate the research
questions for this study. The questions included:
the readability of the WTQ smoking
questionnaire by both the healthcare workers and
the active smoker, the applicability of the WTQ
smoking questionnaire, and the duration taken to
use the tool in actual clinical practice. The third
step was conclusions drawing and verification of
the themes that emerged from the discussions.
The collected data from active smokers and
healthcare providers were transcribed and ana-
lyzed separately. The analysis was done using the
thematic content analysis method to ascertain
how concepts and sub-concepts would be coded.
The concepts were coded as ‘spontaneous elicit-
ation’if the concept was mentioned by the study
participant with ease and instantly during the
open-ended discussions/interviews. We coded
concepts as ‘probed’if the investigator asked the
study participants about a particular concept that
was important but was not mentioned in the
open-ended interviews and if they agreed that the
concept was appropriate and significant. Finally,
we coded ‘no impact’if it was not mentioned
either in the open- ended discussions/interviews
and further probing. Conceptual saturation was
evaluated to confirm that the concepts elicited
from participants had been fully investigated
through the interviews and provided evidence
of an adequate sample size. Saturation was
contemplated to be attained if no new concepts
arose in the final group of interviews.
The audiotaped interviews were initially tran-
scribed by three transcriptionists and appraised
by the first author. The second author reviewed
30% of the transcripts of the audiotaped inter-
view for consistency and reliability. Credibility
and trustworthiness were further verified by an
independent reviewer, who also examined the
codes, themes and any disagreements from the
three transcriptionists (this was ascertained
through crosschecking with the field notes)
Results
Demographic characteristics of study participants
A total of 25 active smokers participated in this
study 92% being males (n ¼23). Also, among the
healthcare workers, 75% of participants were
male (n ¼3) as shown in Table 1.
6 D. ONCHONGA ET AL.

Concept elicitation from research participants
The first extensive thought dwelled on health
influence of tobacco use with the corresponding
specific concept settling on inflammation and
decreased immune function of the smokers
(n ¼19), poor muscle strength making the body
of tobacco smokers weak (n ¼23), delayed heal-
ing on wounds in case tobacco smokers had inju-
ries (n ¼20), and lack of appetite among the
heavy tobacco smokers (n ¼24).
Respondents adequately acknowledged the risk
factors of tobacco use during pregnancy. They men-
tioned the following: expectant women who smoke
are likely to have preterm births (n ¼23), give birth
to children with low birthweight (n ¼21), they are
likely to experience ectopic pregnancies (n ¼17),
they are prone to miscarriages (n ¼25),andtheyare
susceptible to still births (n ¼23).
The third extensive concept mentioned was
immediate adverse health effects, specifically;
compromised immune system of the tobacco
smokers (n ¼19), nicotine addiction (n ¼24),
and respiratory problems (n ¼18). The other
thought was long-term adverse effects on health
outcomes, particularly; development of malignant
cancers (n ¼25), cardiovascular diseases (n ¼24),
respiratory diseases, (n ¼18), rheumatoid arthritis
(n ¼20), increased health cost (n ¼18), and
deaths attributed to tobacco use (n ¼17). “Well-
being”was another extensive thought. They
reported that tobacco smoking reduces stress for
smokers (n ¼23), improves their mental state
(n ¼23), prevents boredom (n ¼21), and brings
relaxation and pleasure to active tobacco smokers
(n ¼22) as shown in Table 2.
Healthcare workers
The health workers unanimously gave an overview
of the health conditions associated with tobacco use
such as lung cancer, cancers of the mouth, pharynx,
larynx, esophagus, stomach, pancreas, cervix,
kidney, bladder, and myeloid leukemia. Other
conditions included bronchitis, chronic obstructive
pulmonary diseases, and pneumonia.
Responses on the usability of the WTQ smoking
questionnaire in public health facilities
The usability of the WTQ smoking questionnaire
was tested in this study. The participants
Table 1. Social demographic characteristics of respondents.
CODE Gender Location Age Marital status Employment Level of education Number of attempts
R1 Male Rural 20 Single Not working College Diploma 3
R2 Male Rural 23 Single Working College Diploma 3
R3 Male Rural 31 Single Working Bachelor Degree 3
R4 Male Urban 42 Married Not working Bachelor Degree 3
R5 Male Urban 32 Single Working Bachelor Degree 3
R6 Male Urban 38 Single Not working Bachelor Degree 3
R7 Male Urban 45 Married Working College Diploma 4
R8 Male Urban 28 Single Working Bachelor Degree 3
R9 Female Urban 33 Single Working Master Degree 3
R10 Male Rural 21 Single Not working College diploma 3
R11 Male Rural 19 Single Working Master degree 3
R12 Male Rural 45 Married Working Master degree 4
R13 Male Rural 41 Single Working College diploma 3
R14 Male Rural 31 Single Not working College diploma 3
R15 Male Rural 30 Married Not working Bachelor degree 3
R16 Male Urban 39 Married Not working Bachelor degree 4
R17 Male Urban 32 Married Not working Bachelor degree 3
R18 Male Urban 46 Married Working Bachelor degree 3
R19 Male Urban 48 Single Not working College diploma 4
R20 Female Urban 21 Single Working College Diploma 5
R21 Male Urban 23 Single Working Master degree 3
R22 Male Urban 25 Married Not working College diploma 3
R23 Male Urban 28 Single Working Master degree 3
R24 Male Urban 29 Single Working College diploma 3
R25 Male Rural 35 Married Not working Bachelor degree 3
Healthcare
provider
Gender Location Age Marital status Years of experience Cadre Patients assisted to
quit smoking
HCP1 Male Urban 37 Married 15 Nursing officer 4
HCP2 Female Urban 34 Married 10 Clinical Officer 6
HCP3 Male Urban 46 Married 16 Medical Officer 5
HCP4 Male Urban 48 Married 12 Medical Consultant 7
JOURNAL OF ADDICTIVE DISEASES 7

exhibited an excellent grasp of all the questions
in the questionnaire. They had the ability to
answering all the questions without difficulties.
All the participants (n ¼25) provided encourag-
ing views about the questionnaire. Also, they sug-
gested that the instrument should be introduced
in all healthcare facilities during clinical consulta-
tions to assist those attempting to stop smoking.
Healthcare workers (n ¼4) noted that the
questionnaire was plausible with each item being
appropriate. They mentioned that the instrument
was brief, easy to complete and the users always
gave responses that would be used to measure
their intention to quit smoking. They also noted
that the tool facilitated open communication with
clients during clinical appointments and consulta-
tions as it does not take much time to fill. There
were no changes suggested to the questionnaire
either by the healthcare providers or the active
tobacco users who participated in this study.
A summary of participants quotes obtained
from the questionnaires on WTQ tobacco
smoking is given in Table 3.
Discussion
In both the developed and developing world,
tobacco smoking remains a public health issue
that require strategic interventions. In that regard,
any efforts that promote the discussions on
tobacco cessation should be supported. The
Willingness to Quit smoking questionnaire is
among the instruments that have been developed
to expedite constructive dialogues between tobacco
smokers willing to stop smoking and the health-
care workers during routine clinical practice.
From the thoughts of the respondents, they
were knowledgeable of the health conditions
Table 2. Concept/thoughts saturation analysis.
Concepts/thoughts Sub-concepts
Participant responses
12345678910111213141516171819202122232425
Impact of smoking on
general health
Low immunity 冑––冑冑 ––冑 –冑
Weakens the body 冑 – 冑 –
Delay healing –冑   –冑冑––
Teeth problems –冑冑– –冑冑– –
Loss of weight                
Loss of appetite – –
Health risk to expectant
mothers
Pre-term births 冑   冑冑
Low birth weight 冑冑冑 冑冑冑冑
Miscarriage      –
Risks with neonate 冑冑冑冑
Immediate health risks Nicotine addiction 冑 冑
Respiratory problems 冑冑冑冑冑冑冑冑冑冑冑–
Long term health risks
and Diseases
Cancer                
Cardiovascular      –冑
rheumatoid arthritis 冑冑冑冑冑冑冑冑 –
Cost of medication –冑冑冑–冑冑冑冑––
Well-being Stress reliever  – 冑
Improved mental state 冑   冑 
Reduction of boredom –冑冑 –冑冑冑
Mind relaxation 冑冑 ––
Key: - instinctive elicitation.
冑- Explored.
- No effect.
Table 3. Responses from participants supporting WTQ smoking questionnaire.
Instructions: if you are a smoker, please answer these simple questions to help understand your readiness to stop smoking
s/no Item Responses
1. If I would stop smoking I would “I want better health”. (male, 28 years)
“Smoking is not good and therefore if I am able to quit, I will”(female, 30 years)
2. I want to stop smoking because I worry about
how smoking affects my health
“The item is very significant because my health is deteriorating fast with this smoking”
(male, 32 years)
“As a mother, my health is affected and it is a concern”. (female, 39 years)
“My health is deteriorating and I need to stop this thing”(male, 51 years)
3. I would be willing to decide to stop smoking “Planning is very important because you can’t quit immediately”. (male, 42 years).
“I have made two attempts of quitting smoking but I think I lacked an appropriate plan.”
(female, 45 years)
4. I would be willing to cut down my number of
cigarettes before stopping
“I will start by reducing the number of cigarettes I smoke per day”(male, 33 years)
“I think it’s possible to reduce the number of cigarettes”(female, 43 years)
8 D. ONCHONGA ET AL.

attributed to smoking and this agrees with
various studies that have indicated that tobacco
smokers are cognizant of the dangers attributed
to prolonged smoking although they find it
challenging to stop.
25,26
This qualitative study endorses the usability of
the WTQ smoking questionnaire as a practical
tool during routine clinical practice. The study
participants agreed that the items in the question-
naire are practical, suitable, concise, easy to com-
prehend, and strategic in tobacco smoking
cessation discussions. This study agrees with
other findings done in other parts of the world
on the content validity of the WTQ smoking
questionnaire.
18,27
The plausibility of the questionnaire allows
healthcare providers to discuss with active smokers
on possible ways of stopping smoking through
constructive dialogues. Studies have indicated that
where healthcare workers serve many patients due
to limited number of staff, there is a need to adopt
tools that will reduce the amount of time taken so
as to improve client satisfaction in public health
facilities.
28
The study findings agree with other studies
that there are many tobacco users who are willing
to be assisted to stop smoking and therefore the
available healthcare systems should be cognizant
of those needs so as to develop measures that can
help in tobacco smoking cessation
29,30
To the best of our knowledge, the tool has not
been widely used and therefore the existing litera-
ture did not find any evidence that disagrees with
the findings of this study or the already existing
studies. There is therefore need for more research
on the applicability of this tool in diverse settings.
Study limitations
It has been commented that in qualitative research,
data collected generally lacks randomization and
there is a leeway of bias during elucidation. Due to
the small sample size, the research may lack the
ability to establish causal associations.
Conclusion
The WTQ smoking questionnaire was noted to
be a usable tool and its adoption in routine
clinical practice should be encouraged. Most
active tobacco smokers are eager to stop smoking
but are unable due to misuse. The healthcare sys-
tems should be cognizant of the people who are
willing to stop smoking and put adequate meas-
ures such as adopting the WTQ smoking ques-
tionnaire in routine clinical practice. Equally,
strategic approaches such as counseling, medica-
tion, and rehabilitation measures should be made
available, accessible, and affordable. This will pro-
vide an enabling environment for tobacco users
who are willing to quit smoking. The question-
naire should be made available in all strata of the
healthcare system.
ORCID
David Onchonga http://orcid.org/0000-0003-4461-797X
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