Applying Multi-Theory Model (MTM) in Determining Intentions to Smoking Cessation among male Health Worker Smokers in Kabul, Afghanistan

Introduction Globally, smoking causes lung cancer and a wide range of acute and chronic diseases. A fourth-generation behavioral framework, the multi-theory model (MTM) of health behavior change was used to predict the initiation and maintenance of smoking cessation among health worker smokers.

By visiting different Health Centers, a convenience sample of male health worker smokers from west part of Kabul city, was invited to participate in this cross-sectional study. A valid and reliable 37-item MTM-based survey instrument was administered to the male participants who smoked. To explain smoking cessation behavior, stepwise multiple regressions were conducted. The entire value of the Cronbach alpha coefficient (α) of the subscales and the scale for the initiation of MTM variables was 0.80 and for the sustenance of MTM variables was 0.79.

The study was completed by 170 participants. Participants were averaging 29.33 years of age (SD = 6.21). The average number of years smokers reported (SD = 4.7), was 5.6. Smoking cigarettes was the median (SD = 5.21), with 5.64 cigarettes consumed per day. Changes in the physical environment (+0.2225, P = 0.029) and behavioral confidence (+0.441, P = 0.014) were significant predictors of smoking cessation initiation. The intention to sustain smoking cessation behavior was significantly influenced by emotional transformation (β = 0.222, P = 0.017) and practicing for change (β = 0.217, P = 0.015).

There was moderate variance in smoking cessation behavior among health worker smokers in Kabul’s western part explained by two MTM constructs (behavioral confidence, physical environment) for initiation and two MTM constructs (emotional transformation, practicing for change) for maintenance. Smoking cessation behavior can be assessed using MTM both at the initiation and maintenance stages. It is important to develop future interventions using MTM constructs aiming to change smokers’ behavior in regard to quitting smoking. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Research Ethics Committee of Tarbiat Modares University granted ethics approval for this study (IR.MODARES.REC.1399.256). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors