EFFECTIVENESS OF A THEORY-BASED HEALTH INTERVENTION ON KNOWLEDGE, ATTITUDE, PERCEPTION AND SELF-EFFICACY TOWARDS KHAT CHEWING AMONG ADOLESCENTS IN MOGADISHU, SOMALIA

Last registered on May 06, 2026

Pre-Trial

General Information

Title

RCT ID

AEARCTR-0018535

Initial registration date

May 02, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

May 06, 2026, 11:20 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country

Somalia

Region

Benadir

Primary Investigator

Name

Osman Abubakar Fiidow

Affiliation

Universiti Putra Malaysia

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Halimatus Sakdiah Minhat

PI Affiliation

UniverUniversiti Putra Malaysia

PI Name

Lim Poh Ying

PI Affiliation

Universiti Putra Malaysia

Additional Trial Information

Status

Completed

Start date

2020-01-30

End date

2020-10-29

Keywords

Health

Additional Keywords

Khat chewing, knowledge, attitude, perception, self-efficacy, health intervention.

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

Background: For thousands of years, khat chewing has been a common habit throughout the Horn of Africa and the Arabian Peninsula. Chewing fresh khat releases compound structurally related chemicals to amphetamines. It is estimated that more than 20 million people in Africa and the Arabian Peninsula are habitual khat chewers. Khat chewing leads to several health problems, including mood swings, hyperactivity, aggressiveness, anxiety, depression, high blood pressure, manic behavior, paranoia, Insomnia, poor concentration, and psychosis.

Objective: This study aims to develop, validate, implement, and evaluate the effect of health education intervention program to improve attitude, knowledge, perception, and self-efficacy on khat chewing among secondary students in Mogadishu, Somalia.

Methods: This study adopted a single-blinded cluster randomized control trial design from March 2020 to August 2020. A total of 284 Secondary students were recruited in Mogadishu, Somalia. This study used a pretested questionnaire, measuring knowledge, attitude, and perception as the primary outcomes and self-efficacy as the secondary outcome. Data were collected at three-time points: baseline, two months after, and four months after. The collected data were cleaned, entered, and analyzed in SPSS software, Version 27, using descriptive statistics, chi-square, and general estimation equations (GEE) to evaluate the effect of the health intervention. A p-value of <0.05 was used as a significant level, with a 95% confidence interval.

Results: Most included baseline characteristics are comparable between intervention and control groups, except for age, gender, family income, and attitude. At baseline, most students had poor knowledge (64.8%), positive attitude (54.2%), negative perception (50.7%), and poor self-efficacy (56.7%) related to khat chewing. The Generalized Equation Estimation analysis shows a significant difference between the control and intervention groups at the two-month and four-month post-intervention, with improved knowledge (B = 2.456, 95% CI: 1.103, 3.808, p<0.001), attitude (B = 2.111, 95%CI: 0.779-3.443, p=0.002), and perception (B = 9.209, 95% CI 4.170, 14.248, p<0.001).

The GEE showed significant differences within groups at all three time points. The results indicated that the knowledge improved significantly within the intervention group from the baseline to two months post-intervention (B =4.643, 95%CI 3.394, 5.875, p<0.001), as well as from the two months post-intervention to the four-month follow-up (B =4.179, 95% CI: 3.479,5.960, p<0.001). Similarly, attitude improved significantly within the intervention group from the baseline to two months post-intervention (B =5.842, 95%CI: 3.454, 8.230, p<0.001), and from the two months post-intervention to the four-month follow-up (B =4.396, 95%CI: 1.926, 6.865, p<0.001). Perception also improved significantly within the intervention group from the baseline to two months post-intervention (B =16.589, 95% CI: 9.775, 23.403, p<0.001) and from the two months post-intervention to the four-month follow-up (B =16.749, 95%CI: 9.890, 23.607, p<0.001).

Conclusion: This study revealed the effectiveness of health education intervention program on knowledge, attitude, self-efficacy to stop khat chewing, 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 to stop it.

Keywords: Khat chewing, knowledge, attitude, perception, self-efficacy, health intervention.

External Link(s)

Registration Citation

Citation

Fiidow, Osman Abubakar , Halimatus Sakdiah Minhat and Lim Poh Ying . 2026. "EFFECTIVENESS OF A THEORY-BASED HEALTH INTERVENTION ON KNOWLEDGE, ATTITUDE, PERCEPTION AND SELF-EFFICACY TOWARDS KHAT CHEWING AMONG ADOLESCENTS IN MOGADISHU, SOMALIA." AEA RCT Registry. May 06. https://doi.org/10.1257/rct.18535-1.0

Sponsors & Partners

Experimental Details

Interventions

Intervention(s)

The intervention was designed to reduce khat chewing among students by improving knowledge, attitudes, risk perceptions, and self-efficacy related to quitting khat use. Its primary goal was to promote healthier behavioral choices and strengthen students’ confidence in resisting or stopping khat chewing.

The intervention module was developed using evidence-based resources and internationally recognized prevention frameworks, including UNICEF life skills education materials, as well as prior research by Gilbert J. Botvin and Kenneth W. Griffin on substance use prevention programs. Additional guidance was drawn from intervention studies conducted in Italy that demonstrated the effectiveness of school-based behavioral prevention strategies.

The educational materials were first developed in English and then reviewed by four academic experts at Universiti Putra Malaysia to ensure scientific validity and cultural appropriateness. Following expert review, the booklet was translated into Somali to enhance accessibility and relevance for the target population.

The intervention was delivered to the intervention group through structured educational lectures and interactive discussions using the standardized booklet. To improve feasibility and acceptability, input was also obtained from key stakeholders, including school principals and teachers’ associations.

Students assigned to the control group were placed on a waitlist and did not receive the intervention during the study period. However, they received the same educational booklet after study completion. Both intervention and control groups completed identical questionnaires at baseline, two months, and four months to assess changes over time.

Intervention (Hidden)

Intervention Start Date

2020-03-03

Intervention End Date

2020-10-01

Primary Outcomes

Primary Outcomes (end points)

Knowledge, Perception, Attitude

Primary Outcomes (explanation)

The intervention focused on three key psychosocial determinants of khat chewing behavior: improving students’ knowledge of the negative health, social, academic, and economic consequences of khat use; reshaping perceptions toward khat chewing by addressing beliefs, perceived risks, and social norms while correcting misconceptions that normalize the practice; and promoting negative attitudes toward khat use alongside positive attitudes toward abstinence, cessation, and healthier lifestyle choices.

Secondary Outcomes

Secondary Outcomes (end points)

Self Efficacy

Secondary Outcomes (explanation)

Experimental Design

This study was a single-blind cluster randomized controlled trial conducted among adolescents in Mogadishu. Participants of this study were randomized into either the intervention group that received IMB-based health education intervention on khat chewing or the control group that received no intervention(waitlist). They were assessed at baseline and followed up at three points (baseline, two months, and four months post-intervention). The CONSORT extension for Cluster Trials was used as guidance (Campbell et al., 2012).

Experimental Design Details

Randomization Method

Randomization was performed to achieve random assignment to the selected participants; Each participant was allocated into either a control group or an intervention group. The present study used secondary schools as a randomization unit. The schools were randomised to reduce group contamination (Campbell et al., 2012; Eccles et al., 2003). However, to ensure allocation concealment, the schools selected at the previous stage allocated the allocation sequence to the intervention and control groups (five as the control group and five as the intervention group). This was achieved by employing a randomisation method which is a block randomisation procedure using a computer-generated list of random numbers. The process was exclusive to another researcher who allocated the ten schools to the two groups. In addition, none of the participants knew about his/her allocation to either the intervention or the control (single blinding).

Randomization Unit

The sampling unit was a secondary school student at the ten selected schools in Mogadishu, Somalia.

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

Sample size: planned number of observations

Sample size (or number of clusters) by treatment arms

5 For Intervention and 5 for Control

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

After accounting for sample design and clustering, with an ICC of 0.05, cluster size of 31, 80% power, and 5% significance level, the study can detect a minimum difference of approximately 2.0 score points between intervention and control groups

Supporting Documents and Materials

IRB