Rural voices: A social-ecological perspective on factors influencing youth substance use in rural South africa.

Background: Youth can be a positive force for development when provided with the knowledge and opportunities they need to thrive, yet they continue to experience insurmountable challenges, such as poverty and absentee fathers, that prompt them to resort to risk behaviours such as substance use. In rural South Africa, women tend to be the breadwinners and more involved with parenting than men.

Objective: The primary objective of the study was to explore perspectives of rural youth on factors influencing youth participation in substance use. The secondary objective was to obtain the perspectives of adult women on factors influencing substance use among young people.

Methods: The qualitative study, informed by a social-ecological framework, utilised a semi-structured interview protocol in focus group discussions in rural South Africa. Seven focus group discussions, each with between 8 and 15 individuals were conducted with 79 youth. The eighth discussion was with nine adult women. Data were audio recorded and transcribed verbatim, manually coded and further analysed into themes using NVivo 12.

Findings: Four themes emerged: hopelessness and lack of motivation, lack of adult role models such as father, lack of built environment for recreational activities and lack of educational opportunities. The social-ecological model provided a useful framework to understand the findings. In line with this model, rural youth in South Africa described a variety of factors that influenced youth substance use and other risk behaviours. These related to the individual, relationships with others, community and societal norms and values factors of the social-ecological model.

Conclusions: The broadening spectrum of substances available to an increasing youth population bulge in Africa suggests a strong threat of social and disease burden due to substance use disorders. Given this threat, this study provides awareness to a multi-systems approach needed to support the rural South African youth.