Effectiveness of a theory-based health intervention on knowledge, attitude, perception and self-efficacy towards Khat chewing among adolescents in Mogadishu, Somalia

Background: For thousands of years, khat chewing has been common in the Horn of Africa and the Arabian Peninsula. It is estimated that over 20 million people in Africa and the Arabian Peninsula are habitual khat chewers. Khat releases chemicals like amphetamines, causing various health issues such as mood swings, hyperactivity, anxiety, depression, hypertension, insomnia, and psychosis. Objective: This study aims to develop, validate, implement, and evaluate the effect of an IMB-based health intervention program to improve attitude, knowledge, perception, and self-efficacy on khat chewing among secondary students in Mogadishu, Somalia. Methods: This study conducted in Mogadishu, Somalia, from September 2017 to October 2022, employed a single-blinded cluster RCT with 284 secondary school students. A pretested questionnaire assessed knowledge, attitude, perception, and self￾efficacy at baseline, two months, and four months. Data analysis was performed using SPSS Version 27, which included descriptive statistics, chi-square tests, and General Estimation Equations. The significance level was p < 0.05 with a 95% confidence interval. Results: Baseline data revealed that most students 64.8% had knowledge about khat chewing, a positive attitude 54.2%, a negative perception 50.7%, and low self-efficacy 56.7%. Post-intervention analysis showed significant improvements in the intervention group compared to the control group at two and four months, with better knowledge (B=2.456, p<0.001), attitude (B=2.11, p=0.002), and perception (B=9.209, p<0.001). Within the intervention group, knowledge significantly increased from baseline to both the two-month and four-month follow-ups (B=4.643, p<0.001 and B=4.179, p<0.001, respectively). Attitude and perception also showed significant improvements over the same periods (attitude: B=5.842, p<0.001 and B=4.396, p<0.001; perception: B=16.589, p<0.001 and B=16.749, p<0.001). Conclusion: This study revealed the effectiveness of IMB-based health intervention on knowledge, attitude, self-efficacy, and perception among school students. Adolescents should be provided with sufficient information on the harmful effects of khat chewing to improve their perceived norms towards it through improving attitude, perception, and Self-efficacy.

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