ASESSENIG THE ROLE OF HEALTH

COACHING IN TOBACOO COMBAT

Capstone for fulfil health coaching program

By

MOHAMMED SAID MOHAMMED GHONEMY

Health coaching trainer

BISHA HEALTH SECTOR

Aim

Improve the tobacco combat

Objectives

1. implanting the heath coaching approach within smoking cessation clinics in Bisha heath

affairs.

2. Improve smoke cessation rate in Bisha health affairs.

3. Improve client satisfaction in smoke cessation clinic

Rational

The tobacco use epidemic, one of the world’s major public health challenges, WHO states that,

“tobacco is the only legal drug that kills many of its users when used exactly as intended by

manufacturers”. With an estimated 1.2 million non-smokers dying from the effects of second-

hand smoke, the overall annual death toll is over 8 million (1).

During the 2019–20 coronavirus pandemic, it was prescient that WHO reported that

“although often associated with ill-health, disability and death from noncommunicable chronic

diseases, tobacco smoking is also associated with an increased risk of death from communicable

diseases” . There is some evidence from early studies that smoking is a relevant factor in the

likelihood of an individual contracting Covid-19, of being hospitalized as a result of Covid-19,

and the severity with which Covid-19 is experienced(2) (3).

Smoking cessation is one of the most powerful preventive interventions available to

primary care providers. Rates of tobacco treatment delivery in primary care settings, however,

remain sub-optimal (4).

 Saudi Arabia has been striving to control the use of tobacco. In the Gulf Cooperation

Council (GCC), tobacco control activities started in January 1979, when Saudi Arabia presented

an initial scientific proposal at the 6th GCC Health Ministers’ Council Conference on combating

smoking in the Region. The WHO Framework Convention on Tobacco Control (FCTC) has

subsequently been signed by the majority of the GCC member states, including Kuwait, Qatar,

Saudi Arabia and United Arab Emirates, with every single member state endorsing it (5),the

government of Saudi Arabia has become a signatory of the WHO FCTC launched in May 2003,

as well as initiating its own anti-smoking campaign for the first time in the same year.(6)

The country’s national anti-smoking committee is working towards stricter tobacco

control in Saudi Arabia, and passed an anti-smoking law in 2015 to combat tobacco use (The

Executive Regulations of Anti-Smoking Law issued by Royal Decree No. (M/56),

dated28/07/1436H.(https://www.moh.gov.sa/en/Ministry/Rules/Documents/Anti-Tobacco-

Executive-Regulations.pdf, accessed 27 February 2019). As a result, anti-tobacco regulations

were implemented during 2016 and smoking is now prohibited in a variety of areas and public

spaces dedicated to allow smoking, then such facilities must be set apart and access denied to

persons under 18 years of age (7) (8).

In 2016 study survey found that frequency of smoking was around 14.9% among Saudi

Arabians aged 15 and above Smoking cessation clinics were established in Saudi Arabia in 2014

to control smoking among the Saudi population and aid in the realization of Saudi Vision 2030's

goal of having a healthy nation(7)

 Anther study was conduct in 2020 across the Kingdom revealed that, The frequency of

quitting smoking was 26.0%, while that of smoking relapse was 52.3%, and 21.7% remained

smokers. The main causes for success in quitting or smoking relapse among studied participants

are explained in Figures 3 and 4. The reported reasons for success in quitting are: individuals’

contentment with quitting (89.4%), receiving counseling services (82.7%), nicotine replacement

therapy (NRT) (81.7%), self-efficacy (77.9%), and social and family support (77.4%). On the

other hand, the main reported causes of smoking relapse were stress and social problems

(44.5%), being surrounded by smokers (42.6%), and severe withdrawal symptoms (15.1%).(8)

In 2018, Saudi Arabia became one of 23 ‘best practice’ countries highlighted by WHO

for offering tobacco dependence treatment (1). Having implemented Executive Regulations on

Anti-smoking Law issued by Royal Decree with the stated aim “to combat smoking by taking all

necessary measures and steps at the state, community and individual levels, to reduce all types of

smoking habit among individuals of all ages” [. Ministry of Health in Saudi Arabia Government.

The Executive Regulations of Anti-Smoking Law; Ministry of Health in Saudi Arabia

Government: Makkah, Saudi Arabia, 2015. Available online:

https://www.moh.gov.sa/en/Ministry/Rules/Documents/Anti-Tobacco-Executive-Regulations.pdf

(accessed on 14 April 2020).]. The Law in Saudi Arabia defines smoking as “the use of tobacco

and its products, such as, cigarettes, cigars, tobacco leaves, tobacco molasses or any other

product containing tobacco, either through cigarettes, cigars, pipe, snus, hookah, or chewing

tobacco, or any other form”.(6)

Although tobacco use provides utility to its consumers, it causes many chronic and non-

communicable diseases, such as cancers, chronic obstructive pulmonary disease (COPD), and

cardiovascular diseases. In 2018 about 10000 people died of cancer and 25000 new cases were
detected in the KSA. It is estimated that about 70,000 people die annually in the KSA due to

smoking-related diseases(9)

Tobacco use imposes a huge economic cost on societies. At the global level, about 1.8%

of gross domestic product (GDP) is lost to tobacco use . In the KSA, the cost of tobacco use was

approximately USD 20.5 billion between 2001 and 2010 and, in 2012, 0.2% of GDP was lost

due to smoking(10). These costs, emanating from morbidity and mortality, increased to 0.98% of

GDP in 2016 The above, therefore, makes tobacco use a major global health concern (11).

A study examines the socioeconomic and demographic determinants of smoking and

smoking intensity in the KSA. They found that smoking rates are significantly influenced by

income, gender, age, marital status and region of residence. Men have higher odds of smoking

than women and, if men decide to smoke, their intensity is 52.95% higher than that of women.

They found that unmarried people have higher odds of smoking. (12)

Study published in 2020 revealed that people seeking help from clinics increased by 213

percent from July to September 2017. According to the head of the ministry’s smoking cessation

clinics, the taxes were the most effective way to help people, especially youths, who wanted to

quit smoking . Tobacco tax in Saudi Arabia: 213% increase in smokers seeking help to quit(9).

In spite of decades of effort, tobacco use continues to be a leading health challenge in the

workplace(13). One option for encouraging smoking cessation is to offer Health Coaching

services to tobacco users, usually by hiring an outside vendor of Well-being and Health

Promotion (WHP) services.

Health coaching has been shown to be an effective means of encouraging cessation and the

associated per-capita reduction in health care costs associated with quitting may be as high as
$6,000.00 annual. With an estimated per-capita cost of approximately $450 per person these data

suggest an amazing return on investment of ~ 13/1 when participants successfully quit tobacco in

the context of a health coaching program(13) (14).

Tobacco use is a frequent issue in general practitioners' (GPs') offices, with doctors

playing a key role in promoting smoking cessation to their smoking patients (14). For this

purpose, standardized brief interventions involving both counselling and supporting drug therapy

have been established and evaluated for the primary care setting over the last years health

coaching is one of the beast options(16).

broad-based acceptance of a working definition of health coaching (HC) to allow a

common understanding of the process. They described HC as a patient-centered process based on

behavior change theory delivered by health professionals and including patient-determined goals,

self-discovery, and mechanisms for behavioral accountability. With this definition, the process of

HC can be properly examined as an intervention process. Investigations that clearly define and

examine HC as a smoking cessation intervention are needed(17)

a study accessed smoking cessation via health coaching in 2014 reports a very high quit

rate (72.7%) and excellent smoke free rates at 6 months (76.9%) and 12 months (63.2%). Most

smoking cessation programs report quit rates that rarely exceed 30% at 6 months and unassisted

quitting efforts have success rates well below 10%. health coaching (when defined by strict

patient-centered standards) appears to be an effective tobacco cessation intervention. Other

clinical and public healthcare settings should consider adapting and implementing this cost

efficient model to assist their patients with tobacco abstention (17).

 Another study comparing effect of directive and nondirective health caching done in 2016

found that, Telephone based coaching for smoking cessation within the context of several

workplace-based incentives for quitting was effective, with 28 % overall reporting abstinence at

6 to 12-month follow-up and with no reductions in benefit for low income or ethnic minority

employees. Further, both conditions were equally effective in engaging low income and African-

American employees. Both were also effective in helping African Americans to quit. Within this

broadly successful program, the use of a nondirective coaching style amongst employees with

above-median income was most effective. And there was findings contribute to the growing

body of evidence that engagement can be achieved using person-centered communication and

that specific steps can be taken to increase satisfaction. (18).(17)

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