(see Poster Gallery) Understanding Khat Use and Its Impacts on Quality of Life: A Theory-Generating Qualitative Meta-Synthesis

Background and Purpose: Khat is an evergreen shrub that is used by individuals in East Africa and countries in the southern Arabian Peninsula. Recent reports have shown that chewing Khat is spreading to other regions of the globe including the United States, Europe, Australia, and Asian countries. However, we pay little to no attention to Khat as a growing addictive substance as compared to other substances from a global perspective. Although there are studies that quantitatively documented the prevalence of Khat consumption in some communities, there is limited research on an in-depth understanding of how the use of Khat impacts the quality of life from users’ lived experiences and perspectives. This qualitative meta-synthesis study aims to develop a comprehensive model that may be useful in better understanding Khat users’ quality of life by inductively synthesizing existing qualitative research.

Methods: This study used a theory-generating qualitative meta-synthesis method. Using databases including PubMed, ProQuest, Scopus, and Google Scholar, 131 studies were retrieved using keywords (i.e., Khat, Khat use, quality of life, impacts of khat, qualitative study). A two-staged review, a title and abstract review followed by a full-text review, was done to select a sample of 12 studies for meta-synthesis. Each of the 12 selected studies was evaluated for quality appraisal using the 10 questions of the Critical Appraisal Skills Programme (CASP) checklist. The findings sections from each study were extracted and coded using Nvivo12 software. The software-generated codes were thematically analyzed and a comprehensive diagram was developed to visualize the synthesized findings and guide the discussion.

Results: Our findings showed that Khat use was associated with the deterioration of quality of life among users in multiple domains of life. These included a decline in the mental health domain due to addiction-related restlessness, insomnia, psychosis, depression, anxiety, aggression, suicidality, mood disturbances, and feeling of hopelessness. In addition, Khat users reported negative consequences in the physical health domain such as sexual and reproductive health problems (sexual life and risk of STDs), gastrointestinal issues (constipation and bowel problems), appetite and weight loss, dental and oral problems, and eye issues. In the economic/financial domain, users suffered from wasted time and resources while chewing, debt, low work performance, absenteeism, deteriorating domestic and material wellbeing, and decreasing income. In the familial domain, users reported experiencing poor family life because of spousal conflict and abuse, relationship strain, decreased happiness, and divorce. In the social life domain, Khat users experienced isolation, stigma, loss of respect, engaging in crime, and conflict. Despite these negative impacts on multiple domains of users’ life, there were paradoxical narratives held by some users describing that Khat improved their work performance, memory, and social integration.

Conclusion and Implications: Despite its growing negative impact on peoples’ lives, it is often considered a social substance. Using a theory generating qualitative meta-synthesis a comprehensive model was developed to help understand the impacts of Khat on users’ quality of life. The comprehensive model portrays that Khat results in an all-rounded and interconnected impact on users’ quality of life.