Co-developing a framework to guide school-based substance use prevention (SSUP) interventions in Ghana

Substance use among young people is a global public health challenge with a high burden in African countries, including Ghana. Behavioural interventions implemented in schools can be effective in preventing substance use among young people in Ghana; however, these interventions are currently lacking. Evidence-based frameworks can contribute to the design and implementation of behavioural school-based substance use prevention interventions; however, to be useful, it is important that they reflect the culture and context in which the interventions will be implemented. The goal of the study was to co-develop a framework to guide the design and adaptation of school-based substance use prevention interventions in Ghana. A multi-method approach to develop the framework was implemented in five steps: 1) definition of scope and objectives of the proposed framework, 2) evidence review and synthesis of existing school-based substance use prevention interventions, 3) a mixed methods study of young people's social networks in schools and its association with their substance use behaviour, 4) interest holder consultation (deliberative dialogue with 12 interest holders in Berekum, Ghana) to garner their recommendations for a school-based substance use prevention intervention in Ghana, and 5) framework iteration and its final visualization. The framework specifies what an ideal school-based substance use prevention should entail, components of the intervention, agents that can deliver the intervention, key interest holders to engage in intervention, and the application of theories, models, and frameworks in intervention design and adaptation. The SSUP framework provides a practical and flexible tool to guide the design and adaptation of school-based substance use prevention interventions in Ghana and similar contexts. It supports context-specific planning, interest holder engagement, and integration into existing school health promotion structure. Future research should explore its feasibility and effectiveness across diverse school settings. The framework offers a foundation for advancing locally grounded, prevention efforts across Africa.