Development of a Culturally Adapted Pharmacist-Led Smoking Cessation Model for Urban Nigerian Adults: A Theory-Driven Multi-Phase Study

Background: Pharmacist-led smoking cessation interventions have demonstrated effectiveness in high-income countries, but no validated model exists for the Nigerian cultural context, where tobacco use is intertwined with social norms, economic stress, and varying access to pharmacotherapy. This research develops and pilot-tests a theory-driven, culturally adapted pharmacist-led smoking cessation model for urban Nigeria. Methods: Three sequential phases constitute the study design. Phase one employs qualitative research (in-depth interviews and focus groups, n = 60) with tobacco users and pharmacists across Lagos (South West), Kano (North West), and Enugu (South East) to derive cultural adaptation domains. Phase two uses the Behaviour Change Wheel framework to construct the model, integrating nicotine replacement therapy, brief intervention counselling, and peer-support components. Phase three pilots the model in 120 smokers across three cities over six months, assessing seven-day point prevalence abstinence, carbon monoxide-verified cessation, and model fidelity. Results: Qualitative phase identified unique cultural adaptation needs including gender-differentiated cessation approaches, family involvement modules, and faith-aligned motivational messaging. Pilot data at three months show 28 percent point prevalence abstinence in the intervention arm versus 11 percent in standard care. Conclusion: A culturally adapted Nigerian pharmacist-led cessation model is feasible and shows promising preliminary efficacy. Full-scale randomised trial is warranted to establish evidence for national adoption. Keywords: smoking cessation, pharmacist-led intervention, behaviour change, Nigeria, cultural adaptation