Using Qualitative Research Methods to Assess Change: Tobacco control in the Dominican Republic

The Dominican Republic, a tobacco growing country, has significant tobacco use and exposure. Published research on DR tobacco use, attitudes/beliefs is limited as are tobacco control and intervention programs.

Six economically disadvantaged DR communities (2 urban, 2 peri-urban, 2 rural) were randomized to community-based tobacco intervention vs. control conditions. Serial Rapid Assessment Procedures provided a baseline (formative data) and post-implementation qualitative snapshot of community attitudes and perspectives on tobacco use. Interdisciplinary mixed gendered teams conducted observations and interviews over a 2-week period in 2003 and 2006 in each community. Each period included over 150 individuals including tobacco users, former users and non-users and key leaders and community members. Changes occurred across all communities: greater awareness of risks of passive smoking, increasing view of tobacco use as a “vice”and more private smoking. The few social smokers considered themselves non-smokers. Additionally new ways of using tobacco were discovered. Chewing tobacco appeared to be increasing among young adults. Intervention communities had more individuals engaged in quitting, greater awareness of anti-tobacco messages, and heightened sense of costs and health risks associated with tobacco use. Health care providers (intervention communities) were more likely to refer smokers to local and community resources.

Overall, attitudes and awareness regarding tobacco changed over time in both intervention and control communities, with greater change in former. The absence of a culture of quitting, noted in 2003, was obvious only in the control communities in 2006. These qualitative findings guided ongoing development of interventions and to increase the viability of sustainability.