The state of Kuwait is a country in the
Middle East, whose affluence began following the discovery of crude petroleum
in 1938, which led to a boom in the country as a whole. Kuwait currently has a
population of 3.9 million and a per capita GDP of $63,863
(Health Data, 2018). As of 2016, the WHO Framework
Convention on Tobacco Control (FCTC) report estimates that the total prevalence
of smokers in Kuwait is approximately twenty percent
(WHO FCTC, 2006). Only three years after the Environmental
Protection Agency in the United States issued a report identifying second hand
smoking as a carcinogen in 1992, the Kuwaiti government initiated progressive
steps in the control of tobacco consumption by placing a smoking ban in public
(WHO FCTC, 2016).  However due to the lack of appropriate law
enforcement of the stated policies, the tobacco industry in Kuwait was not
(WHO FCTC, 2016).


The problem is further illustrated when physicians inside the
hospital grounds perpetuate the social norm of indoor tobacco use, despite the
knowledge of the harmful effects of smoking. A
literature review revealed that 18.4% of physicians in Kuwait are current
(Behbehani, Hamadeh, & Macklai, 2004), with more
historical questionnaires revealing that up to 45% of male physicians were
(Bener, Gomes, & Anderson, 1993).  The #HealthyKuwait Campaign is
focused on addressing the elimination of tobacco product consumption on
hospital grounds among physicians working in Mubarak Al-Kabir Hospital (MKH), one
of the five Kuwait University affiliated government hospitals. A literature
review for this campaign reveals the target audience is comprised of male physicians,
with the mean age of 44.6 ±
9.1 years
(Behbehani et al., 2004), of Middle Eastern ethnicity, and
middle to high socioeconomic status.


The intention of the campaign is to
utilize social norms and the diffusion of innovation theories to target the audience
through persuasive measures and alter current social norms. The utilization of opinion
leaders to alter the prevailing social norms will be the desired outcome of the
campaign. Key informants will be interviewed from the medical community to gain
in-depth qualitative insight to characterize the habits of the tobacco using
physician prototype and identify opinion leaders within this subculture.
Formative research will be utilized to further identify the shared beliefs
amongst the group. The research reveals that 18% of physicians currently smoke,
and 31% are Kuwaiti nationals (Behbehani
et al., 2004). Questions regarding Knowledge and
attitude towards tobacco control showed that smokers were less knowledgeable
about the harmful effects of smoking and have less favorable attitudes towards tobacco
(Behbehani et al., 2004). Thus, those who identify with this
prototype are more inclined to engage in behaviors associated with this group
(Hogg & Reid, 2006), further reinforcing the social norms
theory which posits that the individual will seek external factors from the
reference group, which the individual identifies with, in order to ascertain
how to behave in an ambiguous situation.


Kuwait as a collectivist
culture (Hofstede Insights, 2018) is
susceptible to trends and the heightened interest in social media can be
adopted to target the subculture of smoking physicians. One study demonstrated
via survey that approximately 94% of medical
students, 79% of medical residents, and 42% of practicing physicians use social
media (Bosslet, Torke, Hickman, Terry, & Helft, 2011). Targeting
materials to a specific audience segment increases likelihood of exposure,
liking, and behavior change (McGuire, 2001; Slater, 1996). McGuire
et al. emphasize that the audience must tune in to the message, attend to the
message and like and maintain interest in the message in order for behavioral
change to occur (McGuire, 2001). 

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