[A Symbol of Connectedness Between the Self and the Tribal Home: Betel Quid in the Lives of Indigenous Taiwanese].

BACKGROUND: Betel quid chewing plays a significant role in the development of oral cancer, yet the high prevalence of betel quid use remains a serious health problem in Taiwan, especially among indigenous Taiwanese.

PURPOSE: The present study aimed to understand the reasons behind betel-quid chewing among indigenous Taiwanese people by examining the larger context of their culture and traditions.

METHODS: This descriptive, qualitative study recruited ten regular betel quid indigenous chewers using purposive and snowball sampling. Four of the participants were interviewed individually and the remaining six comprised a focus group. Data were collected using in-depth interviews with semi-structured guidelines and analyzed using qualitative content analysis following the process of open coding, identifying codes, giving meaningful names to codes, putting similar codes in categories, and grouping categories into themes.

RESULTS: Most of the participants associated betel quid with significant aspects of life, with betel quid symbolizing social belonging. In indigenous cultures, betel nut embodies the enduring companionship of lifelong friends. For the study participants, chewing betel quid was associated with symbolic meanings associated with the following five themes: betel quid chewing helps reinforce self-identity and sense of belonging; betel quid is considered a traditional symbol of love and marriage; betel quid reflects the celebration of simple abundance in indigenous life; betel quid represents an attitude toward life that accentuates the importance of learning to live in everlasting harmony with the environment and nature; and betel quid chewing is used to cure physical ailments and mitigate dental problems.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Beliefs related to chewing betel quid deeply impact the attitudes of indigenous people toward this behavior. Because chewing betel quid is an essential part of Taiwanese indigenous community life, the cultural and symbolic meanings of this practice must be taken into consideration when drafting related policies and developing cessation programs in order to help indigenous betel-quid chewers effectively reduce the risk of developing oral cancers.