Acceptability of screening for substance use among children at Ugandan health facilities

Substance use among children and adolescents is an emerging public health concern, with studies from some settings reporting substantial levels of alcohol and other substance use among young people. However, in many low- and middle-income countries, including Uganda, the role, feasibility, and implications of routine substance use screening in primary healthcare settings remain poorly understood. Validated tools such as the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument have been used in other contexts, but evidence on their acceptability among children, caregivers, and health workers in African primary care settings is limited. This study assessed the acceptability of the CRAFFT tool among children aged 6–17 years, their caregivers, and health workers in primary healthcare settings in Uganda. A cross-sectional study was conducted with 824 children, their caregivers, and 47 health workers across selected health facilities. Acceptability was measured using Likert-scale questionnaires tailored to each participant group; children, caregivers, and health workers alongside open-ended questions. Quantitative data were analyzed using STATA 18, and qualitative feedback was analyzed thematically. The CRAFFT screening tool was generally acceptable across all participant groups. Children found the tool easy to understand and informative, caregivers appreciated its potential for early identification of risky behaviors, and health workers viewed it as useful in identification of substance use. However, several concerns were raised, including long screening durations, lack of privacy, cultural and religious sensitivities, and doubts about the relevance of screening younger children. CRAFFT screening was found to be acceptable among children, caregivers, and health workers in Ugandan health facilities. However, successful implementation requires addressing key barriers such as confidentiality, time burden, and cultural appropriateness. Integrating screening into routine care, especially in community and school settings, may enhance uptake and early intervention for substance use among children and adolescents.