Investigation of Educational Needs of Primary Health Care Professionals in Greece for the Management of Adolescent Addictive Behaviors

Abstract

Purpose: Adolescence is a period of increased vulnerability to addictive behaviors, and Primary Health Care (PHC) plays a crucial role in prevention and intervention (e.g., through Screening, Brief Intervention, and Referral to Treatment), but professionals often face barriers, such as inadequate training and systemic challenges, particularly within the Greek context. Given the lack of data on their needs, this study aimed to investigate the levels of self-perceived knowledge/skills, attitudes regarding communication and readiness, perceived barriers, and educational expectations among PHC professionals in Greece. Method: A cross-sectional descriptive survey was conducted using an anonymous questionnaire with a convenience sample of 331 PHC professionals from 5 Health Regions. Results: Professionals recognized the high importance of effective communication (M = 4.31/5) but reported low preparedness (M = 2.65/5) and moderate confidence in knowledge, especially in screening tools/motivational interviewing (M = 2.25/5). Lack of training was the main barrier (87.6%). A strong positive correlation was found between knowledge and preparedness (rho = 0.68, p < 0.001), but not between age/experience and readiness (p > 0.05). Discussion: The study highlights a significant readiness gap and a substantial need for specialized training for PHC professionals in Greece, regardless of experience. Targeted interventions are required to enhance skills (especially in SBIRT/MI) and self-efficacy, alongside action to address systemic barriers.

1. Introduction

Adolescence is a critical developmental phase characterized by rapid and profound physical, cognitive, and social changes [1,2]. This period is marked by a unique neurobiological specificity, primarily the asynchronous maturation of the limbic system (responsible for emotions and rewards) and the prefrontal cortex (governing executive functions like decision-making and impulse control). This developmental lag means that the brain regions driving emotional responses and reward-seeking are highly active, while the regions responsible for rational thought and self-regulation are still developing, thereby contributing to an increased propensity for risk-taking behaviors and impulsivity [2,3,4]. When these inherent neurobiological vulnerabilities are coupled with significant psychosocial pressures, such as peer influence, academic stress, family dynamics, and the quest for identity and autonomy, the susceptibility to engaging in addictive behaviors significantly increases [1,2,4,5,6,7,8,9]. These behaviors, encompassing substance use (like alcohol and illicit drugs) and non-substance-related addictions (such as problematic internet use or gambling), constitute a global public health problem with serious and far-reaching consequences. These consequences can include detrimental impacts on physical and mental health (risks), impaired academic or occupational performance, strained social relationships, and a notably increased risk of developing more severe and persistent addiction issues in adulthood [1,2,4,5,6,7,8,9].

The 2024 nationwide ESPAD survey reveals a concerning picture for 16-year-old students in Greece, with rates of substance use, alcohol consumption, smoking, and gambling involvement exceeding the European average across many indicators. Longitudinally, a significant increase in illicit substance use is observed, reaching 13% (up from 9.4% in 2019), with cannabis being predominant (11%) and the perception of “easy” access to it strengthening (34%). Also alarming is the rise in heavy episodic drinking (37% from 32% in 2019) and intoxication (13% from 10% in 2019), reversing previous downward trends. Smoking of traditional and electronic/vape cigarettes also increased significantly (overall 54% from 43% in 2019), with the declining trend of traditional cigarette smoking being interrupted and experimentation at a very young age tripling. Finally, there is increased involvement in gambling (36% from 33% in 2019), especially online, as well as problems arising from frequent engagement with electronic games (particularly among girls) and social media (48% from 36% in 2015) [10].

In this context, Primary Health Care (PHC) is positioned to play a strategic and pivotal role in addressing adolescent addictive behaviors. This discrepancy reflects a well-documented international ’readiness gap,’ where professionals acknowledge the importance of intervention but lack confidence in their ability to perform effectively. This concept is best understood through the lens of Bandura’s Social Cognitive Theory, which posits that self-efficacy-an individual’s belief in their own capability to execute tasks and achieve desired outcomes is a primary determinant of behavior. In this context, low self-efficacy in applying specialized techniques like Screening, Brief Intervention, and Referral to Treatment (SBIRT) and Motivational Interviewing (MI) becomes a critical barrier to action, even when knowledge of the problem’s importance is high [4,11,12,13,14,15]. This readiness gap is further compounded by common barriers. These include practical constraints like insufficient time allocated for comprehensive consultations, a lack of formal, specialized training and opportunities for continuing education specifically focused on adolescent addiction, difficulties in navigating and accessing referral pathways to specialized services, ethical concerns surrounding patient confidentiality, particularly when dealing with minors, and broader systemic challenges within the healthcare system, such as inadequate funding, fragmented services, or lack of integrated care models [4,11,12,14,16,17]. Within the specific context of Greece, existing weaknesses in the adolescent mental health system significantly compound these challenges. This includes a pronounced lack of coordination between different levels of care (e.g., primary settings, schools, specialized units), resulting in fragmented service delivery and convoluted referral pathways. Moreover, the system contends with insufficient resources, both in specialized personnel and financial backing for accessible community services. These systemic deficiencies inevitably amplify the pre-existing barriers, potentially leaving PHC professionals feeling acutely ill-equipped, isolated, and unsupported when attempting to manage these complex adolescent cases [18]. Given the notable absence of comprehensive Greek data on these specific challenges, the primary aim of this study is to investigate the self-perceived knowledge and skills, attitudes and perceptions regarding the importance of communication and their readiness for management, perceived barriers, and the educational expectations of PHC professionals. Specifically, the study seeks to answer the following questions: (1) What are the self-perceived levels of knowledge, skills, and preparedness among Greek PHC professionals for managing adolescent addictive behaviors? (2) What are the primary barriers they face in this role? (3) What are their specific expectations from an educational training program on this topic? This investigation is crucial for the subsequent design and implementation of targeted interventions aimed at bolstering their capacity to effectively address adolescent addictive behaviors. To translate this study’s findings into a targeted intervention, Kern’s six-step model was adopted as a foundational framework. The value of this systematic approach is that it provides an evidence-based bridge from problem identification to solution development, ensuring the resulting curriculum directly addresses the specific readiness gaps of Greek PHC professionals. This process grounds the educational design in data-driven principles aimed at fostering professional self-awareness and targeted improvement [19].

2. Materials and Methods

2.1. Study Design and Sample

This study adopted a quantitative, cross-sectional, descriptive research design. The target population for this study comprised all multidisciplinary health professionals (physicians, nurses, health visitors, etc.) working in public PHC structures within Greece. We selected participants using multi-stage convenience sampling from five of the seven Health Regions of Greece (1st, 3rd, 4th, 5th, 6th HRs), encompassing a diverse geographical distribution. An email invitation was sent to the various PHC structures (e.g., Health Centers, Local Health Teams, Regional Clinics, and other public PHC facilities) within these approved regions. While the total number of professionals who received the email is unknown, a total of 331 complete responses were collected. Given the exploratory nature of the study and the non-probability sampling method, a formal sample size calculation was not conducted. However, a post-hoc power analysis was performed using G*Power 3.1 to determine the adequacy of the sample size. The analysis confirmed that the final sample of N = 331 provides excellent statistical power. For instance, it yields a power of >0.99 to detect medium to large correlations (0.30) at an alpha level of 0.05. This confirms that the sample was more than adequate for the descriptive and correlational analyses performed.

2.2. Measurement Tools

We developed a structured, anonymous self-report questionnaire was developed for the specific purposes of this study, which was conducted within the framework of a postgraduate thesis. As no single existing instrument was suitable, items were developed based on a review of relevant literature [4,11,14] and the core competencies of SBIRT. Prior to its use in the main study, the questionnaire underwent a content and face validity assessment. It was reviewed for clarity, relevance, and comprehensiveness by two experts: the supervising professor of the postgraduate thesis and a Senior Researcher from the University Mental Health, Neurosciences and Precision Medicine Research Institute (U.M.H.R.I.) with expertise in Sociology and Social Medicine. We then pilot-tested with a group of 12 PHC professionals who participated in a seminar conducted for the needs of the postgraduate thesis, and minor revisions were made to improve wording and flow. The questionnaire is available from the authors upon request. It included the following sections: Demographics: Gender, age, profession, years of experience, work setting. Self-perceived Knowledge/Skills: Confidence in effective communication skills, management of addictive behaviors, knowledge of risk/protective factors, familiarity with screening tools and motivational interviewing techniques (5-point Likert scale, 1 = Not at all confident to 5 = Very confident). Attitudes/Perceptions: Perceived importance of effective communication in addressing adolescent addictive behaviors and sense of preparedness for managing them (5-point Likert scale). Perceived Barriers to addressing addictive behaviors: Selection from a predefined list of barriers (e.g., lack of training, time, referral problems) (checklist) with an option to add “Other”. Expectations from Educational Program: Evaluation of expectations from participating in training regarding specific skills/knowledge (e.g., recognizing signs, understanding factors, applying MI, communication skills) (5-point Likert scale) with an option to add “Other”. The questionnaire included closed-ended questions (multiple-choice, Likert scales, checklist) and open-ended questions (for some demographics and the “Other” option). The multi-item knowledge scale (Q6-Q11) demonstrated excellent internal consistency (Cronbach’s Alpha = 0.897).

2.3. Data Collection Procedure and Ethics

Following approvals from the Health Regions, the questionnaire was distributed electronically (Google Form) via email to the PHC structures. Completion was voluntary and preceded the educational program. The study ensured participant confidentiality. The online survey was anonymous, collecting no personal identifying information with the responses. In the initial invitation email and information sheet, participants were provided with contact details for the research team should they have any inquiries. This process was designed to maintain the anonymity of the submitted data while upholding ethical standards for participant support, in accordance with the EU General Data Protection Regulation (GDPR), Regulation (EU) 2016/679 [20]. Participants were informed that by submitting the questionnaire, they were providing their consent to participate. The study adhered to the principles of the Declaration of Helsinki. The study was approved by the Bioethics and Deontology Committee of the Medical Department of the Aristotle University of Thessaloniki (decision: 133/21.2.2024) and received the necessary approvals from the Scientific Councils of the participating Health Regions (1st, 3rd, 4th, 5th, 6th HRs).

2.4. Statistical Analysis

We conducted multivariable analyses to account for potential confounding in this cross-sectional study. Preparedness (Q13; 1–5 Likert) was modeled as the dependent variable, with knowledge (mean of Q6–Q11) and perceived importance (Q12) as key predictors. We adjusted for a priori covariates selected on substantive grounds, based on literature suggesting their potential influence on health professionals’ knowledge, attitudes, and practices: age (years, derived from date of birth and response date), gender (female/male/prefer not to say), profession (nurse, physician, midwife, health visitor, other), years of experience, and work setting (Health Center, Local Health Team, other). Reference categories were selected based on their frequency and conceptual relevance: Female (Gender), Nurse (Profession), and Health Center (Work setting). These groups represented the largest and most typical categories in the sample, allowing for more stable estimates and straightforward interpretation of comparisons. The primary model used ordinary least squares with HC3 robust standard errors. As a sensitivity analysis, we fitted a proportional-odds ordinal logistic model with the same covariates. Missing data were handled via complete-case analysis. We report coefficients (or odds ratios), 95% confidence intervals, p-values, and adjusted R²; we also provide predicted values across the range of knowledge holding other covariates at their mean/reference values. Internal consistency for the knowledge scale (Q6–Q11) was assessed using Cronbach’s alpha.

3. Results

The final study sample consisted of N = 331 health professionals. As shown in

Table 1. Demographic Characteristics of Participating Health Professionals (N = 331).

Characteristic/Category	N (%)/Value
Gender
Male	48 (14.5%)
Female	281 (84.9%)
Prefer not to say	2 (0.6%)
Age (Years)
Mean (Standard Deviation)	46.76 (8.45)
Range (Minimum-Maximum)	41 (25–66)
Profession
Nurse	101 (30.5%)
Physician	94 (28.4%)
Health Visitor	71 (21.5%)
Administrative Staff	29 (8.8%)
Midwife	22 (6.6%)
Social Worker	9 (2.7%)
Other	5 (1.5%)
Years of Experience
Mean (Standard Deviation)	19.28 (9.46)
Range (Minimum-Maximum)	41 (1–42)
Work Setting (N = 323)
Health Centers	253 (78.3%)
Local Health Teams	56 (17.3%)
Regional Clinics	7 (2.2%)
Multi-purpose Reg. Clinics	4 (1.2%)
Private EOPYY clinics	2 (0.6%)
Municipal Clinics	1 (0.3%)

, the majority were female (84.9%), with a mean age of 46.76 years (SD = 8.45) and mean years of professional experience of 19.28 (SD = 9.46). The main professional categories were Nurses (30.5%), Physicians (28.4%), and Health Visitors (21.5%), primarily from Health Centers (78.3%) and LHTs (17.3%). Participants rated their knowledge as moderate overall (Mean scores ranged from 2.25 to 3.01 on the 5-point scale), expressing the lowest confidence regarding screening tools (M = 2.25, SD = 0.92) and motivational interviewing techniques (M = 2.25, SD = 1.05) (

Table 2. Descriptive Statistics and Reliability for Key Scales/Questions (N = 331).

Variable/Scale	Mean (M)	SD	Min	Max
Knowledge Scale
Communication strategies	2.95	1.00	1	5
Management of addictive behaviors	2.45	0.97	1	5
Risk factors	3.01	1.00	1	5
Protective factors	2.81	0.94	1	5
Screening tools	2.25	0.92	1	5
Motivational interviewing	2.25	1.05	1	5
Attitudes/Perceptions
Perceived Importance	4.31	1.02	1	5
Sense of Preparedness	2.65	1.01	1	5
Expectations from Training
Recognition of early signs	4.43	0.73	2	5
Understanding risk/protective factors	4.41	0.75	1	5
Application of motivational interviewing	4.44	0.79	1	5
Development of communication methods	4.59	0.62	3	5

The knowledge scale showed excellent internal consistency (Cronbach’s Alpha = 0.897). All variables were measured on a 1–5 Likert scale.

). Concurrently, while the perception of the importance of effective communication was very high (M = 4.31, SD = 1.02), the sense of preparedness for managing related discussions was significantly lower (M = 2.65, SD = 1.01), highlighting a clear gap between belief and readiness (Table 2).

Key Adjusted Findings

The knowledge scale showed excellent internal consistency (Cronbach’s $\alpha$ = 0.897). In the fully adjusted OLS model (N = 296), higher knowledge was strongly associated with greater preparedness ($\beta$ = 0.918, 95% CI 0.829–1.006, p < 0.001; Adj. R² = 0.554). The standardized effect of knowledge was large (${\beta }_{std}$ = 0.734, 95% CI 0.663–0.805). Perceived importance did not remain independently associated with preparedness after adjustment ($\beta$ = 0.063, 95% CI 0.017–0.143, p = 0.120). In a hierarchical model, adding knowledge increased explained variance by ΔR² = 0.481 beyond the covariates alone. Sensitivity analysis using proportional-odds ordinal logistic regression yielded consistent results (OR per 1-point increase in knowledge = 17.36, 95% CI 11.00–27.41, p < 0.001) (

Table 3. Multivariable associations with preparedness (coefficients/95% CIs/p-values).

Variable	Coefficient ($\mathit{\beta }$)	95% CI	p-Value
Knowledge_Mean	0.918	0.829–1.006	<0.001
Importance	0.063	−0.017–0.143	0.120
Age	−0.003	−0.010–0.005	0.516
Experience	0.000	−0.006–0.006	0.960
Gender_Male	−0.178	−0.407–0.051	0.127
WorkSetting_Local Health Team	−0.161	−0.410–0.088	0.205
WorkSetting_Other	0.013	−0.176–0.202	0.891
Profession_Physician	0.004	−0.352–0.360	0.984
Profession_Midwife	−0.014	−0.511–0.483	0.956
Profession_Health Visitor	−0.074	−0.430–0.283	0.686
Profession_Social Worker	0.301	−0.091–0.693	0.131
Profession_Other	−0.103	−0.601–0.396	0.687

OLS model with HC3 robust standard errors. N = 296.

). Figure 1 shows adjusted effects (forest plot) and Figure 2 shows the adjusted prediction curve across the knowledge range. Participants identified the main barriers as ‘Lack of training and knowledge’ (87.6%), the fact that ’Services are not designed with adolescents in mind’ (75.5%), and ‘Ignorance about where cases can be referred’ (55.3%) (

Table 4. Frequency and Percentage of Recognition of Barriers in Addressing Adolescent Addictive Behaviors (N = 331).

Barrier	N Selecting “Yes”	% Selecting “Yes”
a. Lack of training and knowledge	290	87.6%
b. Services are not designed with adolescents in mind	250	75.5%
c. Ignorance about where cases can be referred	183	55.3%
d. Reduced parental support	151	45.6%
e. Low internal motivation of adolescents	145	43.8%
f. Time constraints in interactions	142	42.9%
g. Reduced effectiveness of screening tools	90	27.2%

). Expectations from the training were universally very high (M > 4.4 for all dimensions), with the highest concerning the ‘Development of effective ways to communicate with adolescents’ (M = 4.59, SD = 0.62) (Table 2).

Correlation analysis showed a strong, statistically significant positive relationship between the total knowledge score and the sense of preparedness (Spearman’s $\rho$ = 0.68, p < 0.001), suggesting that more knowledge is associated with greater confidence. Conversely, the relationship between perceived importance and preparedness was statistically significant but weak ($\rho$ = 0.21, p = 0.008). A significant finding was the absence of a statistically significant correlation between age ($\rho$ = 0.09, p > 0.05) or years of experience ($\rho$ = 0.10, p > 0.05) and levels of knowledge or readiness, indicating that general experience does not necessarily translate into competence in this specific field. Finally, statistical comparisons (

Table 5. Summary of Statistical Comparisons on Knowledge, Attitudes, and Expectations Scales based on Demographic Groups.

Dependent Variable	Grouping: Gender Z (p-Value)	Grouping: Profession ${\mathit{\chi }}^2$ (df = 5) (p-Value)	Grouping: Work Setting ${\mathit{\chi }}^2$ (df = 5) (p-Value)
Knowledge
Communication strategies	−2.418 (0.016) *	22.609 (<0.001) **	6.886 (0.229)
Management of addictive behaviors	−1.853 (0.064)	18.309 (0.003) **	5.178 (0.395)
Risk factors	−0.471 (0.638)	12.869 (0.025) *	6.015 (0.305)
Protective factors	−0.895 (0.371)	17.529 (0.004) **	3.868 (0.569)
Screening tools	−0.853 (0.393)	10.467 (0.063)	0.967 (0.965)
Motivational interviewing	−0.089 (0.929)	21.229 (0.001) **	5.335 (0.376)
Attitudes/Perceptions
Perceived Importance	−2.031 (0.042) *	5.360 (0.374)	6.414 (0.268)
Sense of Preparedness	−1.990 (0.047) *	11.314 (0.045) *	5.392 (0.370)
Expectations from Training
Recognition of signs	−2.504 (0.012) *	4.482 (0.482)	5.734 (0.333)
Application of MI	−2.681 (0.007) **	8.517 (0.130)	8.336 (0.139)
Development of communication	−2.302 (0.021) *	10.150 (0.071)	4.898 (0.428)
Understanding factors	−2.069 (0.039) *	3.795 (0.579)	3.587 (0.610)

* p < 0.05, ** p < 0.01.

) showed significant differences based on gender (with women reporting higher levels on several variables) and profession (mainly in knowledge and preparedness), but not based on work setting (a finding requiring caution due to sample imbalance).

As shown in Table 5 and illustrated in Figure 3, inferential analyses revealed several significant differences between demographic groups. The analysis of preparedness by gender shows that females reported a slightly higher mean sense of preparedness (M ≈ 2.86) compared to males (M ≈ 2.68), a difference that was statistically significant (p = 0.047). When examining preparedness by profession (Figure 3), which also showed a significant overall difference (p = 0.045), post-hoc tests with Bonferroni correction revealed that social workers reported a significantly higher mean score (M ≈ 3.59) than nurses (p < 0.05). Other inter-group differences were not statistically significant. No significant differences were found based on the work setting (e.g., Health Center vs. LHT), though this should be interpreted with caution due to the imbalanced sample sizes across settings.

4. Discussion

This study assessed the knowledge, attitudes, barriers, and educational expectations of PHC professionals in Greece regarding the management of adolescent addictive behaviors, providing directions for interventions.

4.1. The Importance-Readiness Discrepancy and Its International Relevance

A key finding of this study is the marked discrepancy between the high value PHC professionals place on effective communication and intervention in adolescent addiction and their relatively low levels of self-reported preparedness and knowledge. Although the importance of addressing addictive behaviors is widely acknowledged, participants reported only moderate confidence—particularly in applying specialized tools such as standardized screening instruments and motivational interviewing (MI)—and expressed a general sense of insufficient training. This discrepancy reflects a well-documented challenge at the international level within PHC systems [4,11,12,13,14,15]. The reported lack of confidence in specific evidence-based techniques highlights an urgent need for targeted training initiatives, including approaches such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) [11,12,13]. The observed positive correlation between knowledge and perceived preparedness suggests that improving knowledge may directly enhance professional confidence and self-efficacy [13,21]. This is critical, as awareness of the issue alone is unlikely to translate into effective action [22]. In the Greek context, systemic barriers such as the fragmentation and poor coordination of adolescent mental health services [18]—may further widen this gap, contributing to feelings of professional isolation and inadequate support among PHC providers.

4.2. The Role of Knowledge, Experience, and Training

The strong positive correlation between knowledge and preparedness highlights the importance of a cognitive base for enhancing confidence. Conversely, the only weak correlation between high perceived importance and preparedness demonstrates it is not sufficient if not accompanied by a sense of competence (knowledge and self-efficacy) [22]. The effectiveness of training in enhancing knowledge and self-efficacy is well-documented [12,21,23], and the universally high expectations of a participant from training indicate fertile ground for relevant interventions. The finding of no correlation between age or years of experience and readiness in this specialized field challenges the assumption that general clinical experience suffices. This suggests that effectively managing the contemporary and evolving challenges of adolescent health (e.g., new synthetic substances, internet addictions, and vaping) requires specialized, dynamic, and ongoing training that general clinical experience alone cannot provide.

4.3. Investigating Demographic and Professional Differences

The statistically significant differences observed between genders, with women reporting higher perceived importance, preparedness, expectations, and communication knowledge, warrant attention. Potential factors include social roles, differences in professional responsibilities, or in seeking training. They suggest that male professionals may require specific encouragement or tailored educational approaches [24,25]. Similarly, differences between professions in knowledge and preparedness levels (but not in perceived importance or expectations) indicate that professional roles partly shape specialization. However, the common high recognition of importance and high expectations across all professions underscore the universal need for learning and the suitability of interdisciplinary training programs. The lack of statistically significant differences based on work setting must be interpreted cautiously due to the extreme sample imbalance. These findings suggest that training programs could be enhanced with targeted modules. For instance, understanding why male professionals report lower readiness may require specific engagement strategies, while interdisciplinary programs should leverage the differing knowledge bases of physicians, nurses, and health visitors to foster collaborative learning.

4.4. Barriers to Effective Care Beyond Individual Readiness

Beyond the lack of training, which emerged as the dominant barrier (87.6%), professionals identified other significant obstacles that transcend their individual readiness. These include systemic issues, such as the non-adolescent-friendly design of services (75.5%) and difficulty/ignorance in connecting for referrals (55.3%), practical constraints like lack of time (42.9%), as well as factors concerning the adolescent’s environment (parental support 45.6%, adolescent motivation 43.8%). These barriers are widely recognized in international literature as well [4,11,12,13,14]. Lack of time and referral difficulties are almost universal problems, appearing particularly acute in the Greek context due to lack of coordination and gaps in public structures [18]. Implementing structured approaches like SBIRT often clashes with systemic barriers (lack of protocols, workflow, reimbursement) [11,12,26]. Concerns about confidentiality and managing the relationship with parents are also critical barriers [11,14]. Recognizing these multiple, interconnected barriers underscores that improving care requires multi-level interventions beyond individual training: improving service organization, creating clear referral pathways, securing time, developing protocols, etc.

4.5. Future Directions: A Multi-Level Approach for the Greek Context

The findings call for a move beyond individual training towards a multi-level strategy that acknowledges the unique Greek context. This context is characterized by a “readiness paradox,” where the healthcare system’s capacity to support change is dramatically diminished due to austerity, precisely when the population’s need for such change is greatest [9]. The low professional readiness identified in our study is not merely subjective but reflects objective, systemic barriers, a reality well-interpreted through theoretical frameworks like the Health Belief Model, which highlights the impact of high perceived barriers on behavior [27]. Therefore, a hybrid, multi-level program is necessary, but its components must be critically evaluated for suitability in Greece. While future initiatives should equip professionals with youth-centered strategies like gamification and conversational media to counter misinformation [28,29], their implementation via blended learning models must address the challenges of the digital divide and negative e-Health attitudes prevalent in Greece [8,30]. Similarly, while Motivational Interviewing (MI) is ideal for addressing the ambivalence seen in our participants [31,32], its effectiveness hinges on practitioner fidelity, which requires intensive, costly supervision—a significant challenge in an underfunded system [9,33]. Finally, community-level interventions like media campaigns and peer mentoring must be crafted with care. Media messaging risks reinforcing existing cultural schemas of stigma [12,34], and peer mentor recruitment can be hindered by the same stigma it seeks to combat [12,35]. These interconnected challenges demonstrate that isolated training is insufficient. A truly effective strategy requires a coordinated, multi-level response that simultaneously builds individual capacity and addresses the systemic and cultural barriers to care.

Building on these findings, future research should move in several key directions. The most pressing need is for interventional research to design and rigorously evaluate the effectiveness of targeted training programs, ideally structured according to Kern’s Six-Step Model [36]. A pre–post study design or a cluster randomized controlled trial could assess the impact of such interventions on professionals’ knowledge, self-efficacy, and, ultimately, their clinical behaviors. Furthermore, longitudinal studies are needed to track professionals over time, clarifying the causal relationship between knowledge and preparedness [12,21]. In parallel, research should investigate systemic factors, such as referral pathways, adolescent-friendly service design, and the broader organizational context of PHC [11,14,18]. International comparative studies would further contextualize the Greek experience within wider European and global frameworks [6,7]. Finally, qualitative research—through in-depth interviews and focus groups—would provide invaluable context, capturing the nuanced experiences of professionals as well as gender- and profession-specific challenges [24,25]. Such a multi-methodological approach is essential for creating sustainable, evidence-based change in adolescent addiction management.

4.6. A Structured Framework for Training: Applying Kern’s Six-Step Model

The imperative for targeted interventions, as highlighted by this study, necessitates a systematic, evidence-based approach. Kern’s six-step model for curriculum development is the ideal framework for this purpose, providing a robust structure to translate empirical research into an effective educational program [36]. The present study serves as a direct and formal execution of the model’s fundamental first steps (Figure 4). Specifically, it functions as a comprehensive Needs Assessment (Steps 1 & 2) by quantitatively identifying the critical gap between the high perceived importance of managing addiction (M = 4.31/5) and the low professional readiness (M = 2.65/5) thus grounding the educational endeavor in objective data [37]. Consequently, these precise findings allow for the formulation of clear Goals and Objectives (Step 3). For instance, a broad goal of enhancing self-efficacy can be translated into measurable objectives, such as participants successfully conducting a brief intervention using MI principles in a simulated scenario. The data also strongly dictates the choice of Educational Strategies (Step 4); the identified need for practical skills demands a shift from passive learning towards active, experiential methods. Techniques like role-playing are essential for building tangible confidence in a safe, controlled environment, directly addressing the reported skill gaps [23]. The final stages, Implementation (Step 5) and Evaluation (Step 6), constitute the logical progression from this foundational work, laying the groundwork for a future interventional study that would deliver the designed curriculum and rigorously assess its impact, ideally using this study’s validated instrument in a pre- and post-test design.

4.7. Limitations

This study has certain limitations that should be considered when interpreting the findings. Firstly, the use of a convenience sample from five specific Health Regions, although geographically diverse, is not based on random selection. This inherently limits the generalizability of our findings. The disproportionately high number of female participants (84.9%) may introduce selection bias. However, it is important to note that this high participation of women also reflects the significant gender disparity within the primary healthcare workforce in Greece, where women constitute the vast majority of professionals. According to recent Eurostat and OECD data, women represent approximately 62% of physicians and over 80% of nurses in Greece, figures that align with the gender distribution observed in our sample [38,39]. Nevertheless, this imbalance may also indicate a higher willingness among women to participate in such surveys. Secondly, the data were self-reported, which might be subject to social desirability bias or recall bias, potentially affecting the accuracy of the reported knowledge, attitudes, and practices. Thirdly, the cross-sectional design of the study allows for the identification of associations but not for causal inferences between variables. While we now control for several a priori covariates, residual and unmeasured confounding from factors such as prior specialized training, personal attitudes towards addiction, or organizational characteristics of the work setting cannot be completely ruled out.

In addition to the above, certain further considerations should be noted. The use of a convenience sample and the overrepresentation of women, although reflective of the PHC workforce in Greece [38,39], limit the external validity of the findings. Moreover, the reliance on self-reported perceptions rather than directly observed clinical practice raises the possibility that actual competencies may differ from reported confidence, an issue noted in previous international research on health professionals’ self-efficacy [21,23]. The cross-sectional design further restricts the ability to establish causal relationships, as knowledge and preparedness may influence each other bidirectionally [22]. Finally, despite adjusting for several key covariates, the potential for residual confounding from unmeasured variables remains. Factors not captured in our survey, such as prior specialized training in adolescent health, personal attitudes towards addiction, or the specific organizational culture and available resources of each PHC setting, could also play a role. However, the strength and consistency of the association between knowledge and preparedness across different statistical models suggest that this finding is robust.

5. Conclusions

This study reveals a pressing need for targeted training programs aimed at enhancing the capacity of PHC professionals in Greece to effectively communicate with and manage adolescents with addictive behaviors. The prominent gap between the acknowledged importance of the issue and the professionals’ perceived readiness mirrors global findings and underscores a critical area for intervention. Notably, this need transcends age and years of experience, emphasizing the importance of continuous, structured professional development tailored to the realities of everyday clinical practice. Encouragingly, the high level of interest and expectation from PHC professionals provides fertile ground for implementing impactful training. However, to achieve lasting change, these efforts must be embedded within a broader, system-wide reform. This study’s findings constitute a clear call to action for health policy makers to design and implement targeted, mandatory continuing professional development (CPD) programs for all PHC professionals. Such an initiative is not merely a recommendation but a necessary step towards fulfilling our collective professional responsibility to the adolescent population. Ultimately, improving the care of adolescents with addictive behaviors demands a coordinated, multi-level response. This involves not only empowering front-line providers through targeted and continuous training-utilizing effective pedagogical methods such as blended learning, peer mentoring, and supervised practice in motivational interviewing-but also strengthening the health system as a whole to support these enhanced clinical skills.