Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: a qualitative study

Abstract

Although recent medical studies have found a significant correlation between betel quid chewing and oral cancer, some Taiwanese aboriginal people continue the traditional betel quid culture. Using the transtheoretical model framework, we conducted a qualitative study to examine the stages of behavioral change in betel quid chewing in the Paiwan sociocultural context. We conducted in-depth interviews with 20 aboriginal chewers of betel quid. Results of a content analysis showed significant patterns in the precontemplation, contemplation, action, and maintenance stages, but none in the preparation stage. Relapse was most likely to occur between the contemplation and action stages. In the precontemplation stage, interviewees showed no motivation to change their chewing behavior due to shared positive attitudes of psychosocial benefits and cultural identity. In the contemplation stage, dependent-type chewers were aware of oral damage and pain caused by chewing betel quid but could not resist their cravings; social-type chewers showed approach–avoidance conflicts between social needs and cessation. Chewers entered the action stage once they decided to quit; “to stop immediately” or “reduce quantity” were the most frequent strategies reported. In this stage, chewers endured withdrawal symptoms and refused betel quid from others but tended to relapse easily. Participants entering the maintenance stage were not affected by withdrawal symptoms and did not have ulcers or pain. Future research should identify ways to preserve traditional aboriginal culture while encouraging aboriginal people to quit betel quid chewing to promote the prevention and treatment of oral cancer.