A Participatory Rural Action Approach for Developing Strategies to Mitigate Substance Use Among Secondary School Students in Limpopo Province, South Africa

Abstract

Substance use remains a global public health concern with adverse effects on health, education, and community safety. In South Africa, in rural areas like substance use among secondary school students compromises teaching quality and school safety. This study aims to develop and validate community-based strategies to mitigate substance use among secondary school students using a Participatory Action Research approach. A qualitative, participatory design will be implemented in three phases: (1) situational analysis through interviews with parents and focus groups with students; (2) co-development of strategies guided by the strengths, weaknesses, opportunities, threats, building, overcoming, exploring, and minimizing framework and Dickoff’s practice-oriented theory; and (3) validation using Chinn and Kramer’s evaluation criteria. Twenty students (aged 13–18 years) and twenty parents will be purposively and conveniently sampled. Data will be analyzed thematically using Tesch’s eight-step method, with trustworthiness ensured using Guba’s criteria. This study is expected to strengthen collaboration among schools, parents, and community stakeholders. The co-developed strategies will inform future interventions, guide school health policy, and promote sustainable, community-driven approaches to adolescent health promotion, ultimately enhancing secondary school students’ well-being and academic performance in rural educational settings.

1. Introduction

Substance use among secondary school students poses a significant challenge worldwide, impacting educational performance, health, and community well-being. In South Africa, substance use among secondary school students is reported to be twice the global average, contributing to rising rates of violence, school dropout, and mental health problems. Rural municipalities face additional challenges due to limited access to health promotion services. A participatory rural action approach (PRAA) provides an inclusive framework that empowers communities to identify problems, co-develop strategies, and sustain solutions within their local context.

Substance use worldwide, particularly among high school students, has consistently attracted attention from researchers, policymakers, and the public due to the potential negative impacts, both immediate and long-term, that substance use can have on an individual’s overall health and well-being [1]. Globally, approximately 5.5% of rural secondary-school students engage in substance use, with those in low-income countries being particularly vulnerable [2,3]. Substance use among adolescents has been extensively studied, with consistent findings pointing to its detrimental effects on education, health, and social stability [4]. Ref. [5] describes it as a significant public health challenge, particularly in developing regions. Ref. [2] emphasizes that secondary school students in rural areas are disproportionately affected due to socio-economic vulnerability.

International comparisons reveal stark differences in prevalence rates. For instance, Brazil reports a 16% rate of substance use among secondary school students, while Australia’s rate is significantly higher at 39.9% [6]. Sweden and Zambia also report concerning figures of 25.4% and 35.5%, respectively [7,8]. In Sub-Saharan Africa, Ref. [9] also noted a prevalence of 11.3%, highlighting the regional burden. In South Africa, substance use among secondary school students is compounded by limited access to health services in rural areas [10]. Ref. [11] reported that substance use among secondary school students is twice the global average, with over 15% of the population affected.

Substance use among secondary school students in South Africa remains a significant concern for both public health and education. National data from the Youth Risk Behavior Survey (YRBS) indicate that 25.1% of students in Grades 8–11 reported binge drinking in the previous month, with alcohol and cannabis being the most commonly used substances [12,13]. A study in a rural province found that nearly 47% of high-school students had experimented with substances, primarily alcohol, cigarettes, and cannabis—highlighting widespread accessibility even in under-resourced settings [14]. Similarly, research in the Western Cape revealed early initiation and frequent binge drinking among Grade 8–10 students, with male students reporting higher usage rates [15]. Recent analyses have further shown that adolescent substance use is correlated with risk behaviors, such as school absenteeism and other health-risk practices [15]. Collectively, these findings underscore the urgent need for targeted, context-sensitive interventions to mitigate substance use among South African secondary school students.

School management at selected secondary schools has expressed growing concern about the increasing prevalence of substance use among secondary school students, which has become a significant threat to effective teaching and learning. Reports indicate that students frequently bring various substances to school and consume them within the premises, resulting in disruptive and violent behaviors. Teachers report that intoxicated students often disrupt classroom activities, leave lessons without permission, and interfere with the learning process. In several instances, secondary school students under the influence have engaged in physical fights, verbally abused teachers and peers, and vandalized school property. Alarmingly, one school principal revealed that some students, particularly two female students, were found mixing and selling harmful substances within the school grounds. Such substance-related behaviors not only compromise learner safety and academic performance but have also led to the Department of Education rating several schools as dysfunctional. This escalating situation highlights an urgent need for context-specific, community-driven strategies to mitigate substance use and its detrimental effects on the learning environment.

To address the challenge of substance use among secondary-school students, innovative and inclusive strategies are essential. The Participatory Rural Action Approach (PRAA), rooted in Participatory Action Research (PAR), provides a practical framework that empowers communities to identify problems, co-develop solutions, and sustain interventions. By emphasizing collaboration and shared responsibility, this approach promotes local ownership and enhances the relevance, acceptability, and long-term effectiveness of substance-use prevention initiatives.

1.1. Definition of Terms

The table below summarizes the key operational definitions used in this study protocol (

Table 1. Definitions of terms.

Terms	Definition
Community	A group of individuals with diverse backgrounds connected by social relationships, shared values, and collective actions within a specific geographic area [16]. In this study, the term refers to parents of affected students, school management, students involved in substance use, the School Governing Body (SGB), and local leaders in selected villages of Vhembe District in Limpopo Province.
Strategy Development	A systematic process of formulating, implementing, and evaluating coordinated actions designed to achieve specific goals within the community [17,18]. In this study, strategy development will involve planning and coordinating actions among stakeholders to address specific challenges, such as reducing substance use among secondary school students.
Students	Students are individuals enrolled in formal educational institutions who are actively engaged in structured learning processes to acquire the knowledge, skills, attitudes, and values necessary for their personal and social development [19]. In this study, the students specifically refer to adolescents aged 13–18 years attending rural secondary schools in Limpopo Province.
Participatory Rural Action Approach (PRAA) Research	A community-driven research methodology that empowers local populations to identify issues, develop solutions, and monitor progress [20]. In this study, PRAA will emphasize inclusive participation and local ownership in addressing substance use among school students.
Substance Use	Substance use refers to the consumption or administration of psychoactive substances, including alcohol, tobacco, cannabis, opioids, stimulants, and inhalants, which alter mental states, mood, perception, and behavior [21,22]. In this study, substance use denotes explicitly the use of any psychoactive substances by secondary school students in rural schools of Limpopo Province, South Africa.

).

1.2. Theoretical Framework

The theoretical framework defines the basic considerations of the study [23]. This study is grounded in a constructivist paradigm, which acknowledges multiple realities shaped by social and cultural contexts (Figure 1). The first phase of the study is guided by Roy’s Adaptation Model (RAM), which conceptualizes individuals as adaptive systems who respond to internal and external environmental stimuli [24]. According to Roy, individuals continuously interact with their environment and adapt through physiological, self-concept, role-function, and interdependence modes. Adaptation occurs when individuals use coping mechanisms to achieve a state of balance and integration. In this study, secondary students and parents are viewed as adaptive beings responding to environmental stressors related to substance use, such as peer pressure, socio-economic challenges, and family dynamics. The model supports exploration of how these stressors influence maladaptive behaviors (e.g., substance use) and how positive adaptation can be facilitated through supportive interventions. Previous studies have applied RAM in addressing adolescent health and behavioral challenges, emphasizing its relevance in promoting adaptive coping and preventive health behaviors [25,26].

Phase 2 (co-development of strategies) integrates Dickoff’s Practice-Oriented Theory, which provides a six-element framework (agent, recipient, context, procedure, dynamics, and purpose to guide strategy formulation. This framework enables the co-creation of contextually relevant strategies by identifying who acts (agents), for whom the action is intended (recipients), in what context, and toward what purpose [27]. In the present study, the Participatory Rural Action Approach (PRAA) will facilitate collaboration among students, parents, educators, and community stakeholders to design feasible interventions. The strategy formulation is further enhanced through a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis, which promotes situational awareness, and the BOEM (Building, Overcoming, Exploring, Minimizing) action plan, which operationalizes the strategies [28,29]. These tools collectively ensure that the developed strategies are practical, culturally responsive, and grounded in real community experiences, supported by strengths, weaknesses, opportunities, and threats (SWOT) analysis, as well as the Building, Overcoming, Exploring, and Minimizing (BOEM) Action Plan [27,28,29].

The third phase applies the theory evaluation framework [30], which assesses theoretical and practice-based models according to five key criteria: clarity, simplicity, generality, accessibility, and importance. These criteria will guide the validation of the co-developed substance-use-mitigation strategies to ensure conceptual soundness and practical applicability. Clarity ensures that strategies are well-defined and understandable; simplicity promotes ease of implementation; generality evaluates the scope of applicability across various contexts; accessibility addresses usability in real-world settings; and importance determines the relevance and contribution to health-promotion practice [31].

1.3. Purpose and Objectives

The purpose of this study is to develop and validate strategies to mitigate substance use among secondary school students in rural schools within Limpopo Province, South Africa.

1.3.1. Phase One Objectives

• To explore the experiences of parents of secondary school students using substances at rural secondary schools in Limpopo province, South Africa.
• To explore and describe the experiences of secondary school students using substances at rural secondary schools in Limpopo Province, South Africa.
• To identify social, cultural, and environmental factors contributing to the use of substances by the secondary school students at rural secondary schools in Limpopo Province, South Africa.

1.3.2. Phase Two Objective

• To collaboratively develop community-based strategies for mitigating substance use amongst the secondary school students at rural secondary schools in Limpopo province, South Africa, using PRAA.

1.3.3. Phase Three Objective

• To validate the co-developed strategies for mitigating substance, use among rural secondary school students in Limpopo Province, South Africa through stakeholder participation.

1.4. Research Questions

1.4.1. Phase 1: Situational Analysis (Guided by Roy’s Adaptation Model)

• What are the patterns, types, and contributing factors to substance use among secondary school students in Limpopo province, South Africa?
• How do secondary school students and parents perceive and experience the effects of substance use on school performance and behavior?
• How do affected secondary school students and parents adapt to the social and environmental stressors related to substance use?

1.4.2. Phase 2: Co-Development of Strategies (Guided by Dickoff’s Practice-Oriented Theory and PRAA Principles)

• What community-driven strategies can be collaboratively developed to prevent and manage substance use among secondary school students?
• How can the PRAA process foster stakeholder collaboration in addressing substance use?

1.4.3. Phase 3: Validation of Strategies (Guided by Chinn and Kramer’s Evaluation Criteria)

• How do experts and stakeholders evaluate the developed strategies in terms of clarity, simplicity, generality, accessibility, and importance?
• What recommendations can be made to enhance the sustainability and effectiveness of the proposed strategies within the school and community context?

1.5. Protocol Presentation

This study protocol is structured to provide a clear, detailed, and comprehensive overview of the research aims, design, and methodology. The presentation of this protocol adheres to the key reporting principles outlined in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement and the broader EQUATOR Network guidelines, ensuring maximum transparency and rigor. While this study will employ a qualitative Participatory Action Research (PAR) approach and is not a clinical trial, the protocol has been organized to reflect the essential components required for effective reporting of a research plan. The protocol is organized sequentially, with the key sections announcing the following main components of the research plan:

• Introduction: Provides the rationale, local context, and specific objectives of the study.
• Experimental Design: Details the qualitative, participatory rural action research and phases approach, outlining the specific activities for the situational analysis, strategy co-development, and validation.
• Study Setting and Population: Describes the study site in Limpopo Province and the procedures for participant recruitment.
• Materials and Equipment: Explains the range of materials and equipment that will be utilized to support data collection and ensure the integrity of the research process. It also addresses the measures taken to protect the rights, dignity, and safety of participants, including informed consent, assent, and confidentiality.
• Detailed Procedure: Explains the procedures for data collection, quality assurance, and the planned analytical methods (e.g., thematic analysis).
• Ethical consideration: It addresses the measures taken to protect the rights, dignity, and safety of participants, including informed consent, assent, and confidentiality.
• Anticipated Implications and Conclusion: Discusses the expected contributions of the research to local practice and potential policy development.

2. Experimental Design

This study will employ a qualitative design grounded in the Participatory Rural Appraisal (PRA) approach. The research will be conducted in three distinct phases:

2.1. Study Phases and Process

The project will be implemented in three sequential phases, designed to understand, co-develop, and validate strategies to mitigate substance use among secondary school students in the Limpopo Province, South Africa. These phases include: (1) Situational Analysis, (2) Co-Development of Strategies, and (3) Strategy Validation.

2.1.1. Phase One: Situational Analysis

This phase will utilize exploratory, descriptive, and contextual approaches to understand the lived experiences of secondary school students and their parents regarding substance use. Data will be collected through individual interviews with parents and focus group discussions with students. This phase aims to provide in-depth insight into the social, environmental, and familial factors contributing to substance use within the community. The findings from this phase will inform the development of contextually relevant strategies in the subsequent phases.

2.1.2. Phase Two: Co-Development of Strategies

In this phase, community stakeholders, including students, parents, educators, and local leaders, will collaboratively develop strategies to mitigate substance use among secondary school students. The process will be guided by PRAR Principles, within the context of the community setting, enabling the community to determine the project’s direction by defining roles, priorities, and responsibilities. The theoretical framework for this study is the PRAR, supported by the Royal adaptation of the Biopsychosocial Model and the six elements of Practice Theory, as outlined by [27]. Dickoff’s Practice Theory will be used to integrate the findings from Phase One and provide the conceptual framework for strategy formulation. This phase will lead to the co-development of practical, community-driven strategies aimed at reducing substance use and promoting healthier behavioral practices among secondary school students. Together with community stakeholders, the researchers will conduct a SWOT analysis to assess the existing strengths, weaknesses, opportunities, and threats within the community [28]. The BOEM action plan will then be applied to build on the community’s strengths and address identified gaps [29]. The motivation and commitment of both researchers and community members to reduce substance use and promote healthier behavioral practices among secondary school students will drive the development of practical, community-driven strategies.

2.1.3. Phase Three: Strategy Validation

The final phase will involve validating the co-developed strategies using [30] evaluation criteria, which assess clarity, simplicity, generality, accessibility, and importance. Stakeholder feedback will be central in refining and finalizing the strategies to ensure they are contextually relevant and sustainable. Researchers and community members will collaboratively review and refine each strategy based on the agreed criteria until consensus is reached. This participatory validation process will ensure that the final strategies are theoretically sound, practical, and acceptable to the target community.

2.1.4. Project Timeline

The Gantt chart in Figure 2 illustrates the project timeline for the Participatory Rural Action Study. The study spans from May 2025 to April 2026 and consists of three key phases:

• Phase 1 (May–September 2025): Situational Analysis (Exploratory, Descriptive, Contextual Approaches).
• Phase 2 (October–December 2025): Co-creation of Strategies.
• Phase 3 (January–April 2026): Validation and Reporting of Strategies.

This figure provides a clear visual representation of the project schedule, emphasizing the sequential and overlapping phases essential for developing and validating community-based strategies.

2.2. Study Setting and Population

The study setting is a specific location where data are gathered, and in a qualitative study, this is typically a naturalistic setting in the field, as researchers are interested in people’s experiences [23]. The study will be conducted in two rural secondary schools located within the Vhembe District of Limpopo Province, South Africa. Limpopo Province is located in the northernmost region of South Africa. It serves as a strategic gateway to neighboring countries, sharing international borders with Zimbabwe to the north, Botswana to the west, and Mozambique to the east. Domestically, it is bound by the provinces of Mpumalanga, Gauteng, and North West. The provincial capital, Polokwane, functions as the administrative and economic hub. Limpopo Province is characterized by its diverse cultural heritage, significant agricultural output, and proximity to major conservation areas, including sections of the Kruger National Park, which collectively underscore its socio-economic and ecological importance within the Southern African context [32,33]. This setting is characterized by limited access to health promotion services, high levels of poverty, and social challenges that contribute to substance use among adolescents.

The target population includes:

• Secondary school students, aged 13–18 years, who have been identified by teachers or school management as engaging in substance use.
• Parents or guardians of these students, who are directly involved in their upbringing, may provide valuable insights into the social and familial factors influencing substance use.

A total of 40 participants will be recruited, comprising 20 students and 20 parents or guardians. These individuals will be selected using purposive and convenience sampling methods. Purposive sampling will ensure the inclusion of participants with direct experience and knowledge of substance use among secondary school students. In contrast, convenience sampling will facilitate access to participants who are readily available and willing to participate during scheduled visits to schools and communities. This population is expected to provide rich, contextually relevant data that will inform the development of effective, community-based strategies for mitigating substance use in rural secondary schools.

2.3. Sampling Method and Eligible Criteria

Sampling is a systematic process used to select a specific number of individuals from a defined population to participate in a research study [34]. In qualitative and participatory research, the emphasis is placed on the depth, richness, and relevance of the information gathered, rather than statistical generalizability [35]. This study will employ a combination of purposive and convenience sampling techniques. Purposive sampling will be used to deliberately select participants who possess direct experience and knowledge of substance use among secondary school students. This method is particularly suitable for exploratory and participatory studies, where the goal is to generate context-specific insights and strategies [36,37]. Convenience sampling will complement purposive selection by including participants who are readily available and willing to participate during scheduled school and community visits. While convenience sampling enhances accessibility and efficiency, especially in rural contexts with limited resources, efforts will be made to minimize bias by ensuring that all participants meet the defined inclusion criteria [38,39].

Inclusion Criteria:

• Secondary school students aged 13–18 years, currently enrolled in rural secondary schools within Limpopo Province, South Africa.
• Students identified by school staff as engaging in substance use (e.g., alcohol, tobacco, cannabis).
• Parents or guardians of secondary school students engaging in substance use.
• Both male and female participants will be included.

The anticipated sample size is 40 participants, comprising 20 secondary school students and 20 parents or guardians. However, the final sample size will be determined by data saturation, which occurs when no new information, themes, or patterns emerge from subsequent interviews [40]. This flexible approach ensures the adequacy and depth of data collection. Data collection is scheduled to take place between September 2025 and April 2026, allowing sufficient time for participant recruitment, informed consent, and iterative analysis. This timeline aligns with the principles of the Participatory Rural Action Approach, which emphasizes community engagement, reflection, and the development of collaborative strategies.

3. Materials and Equipment

The study will utilize a range of materials and equipment to support data collection and ensure the integrity of the research process. These include:

• Semi-structured interview guides tailored for both secondary school students and their parents. These guides will facilitate open-ended discussions, allowing participants to share their experiences and perspectives on substance use in a flexible and conversational manner.
• Audio recorders will be used to accurately capture interviews and focus group discussions, ensuring that all verbal data is preserved for thorough analysis and helping maintain the authenticity of participants’ narratives.
• Secure digital storage devices will be employed to store audio recordings and transcriptions. These devices will be password-protected to maintain confidentiality and data security.
• Consent and assent forms will be provided for all participants. These documents will outline the purpose of the study, procedures, potential risks and benefits, and participants’ rights, including the option to participate and withdraw at any time voluntarily.

All materials will be prepared in both English and Xitsonga to accommodate participants’ language preferences and enhance understanding and comfort during the data collection process.

4. Detailed Procedure

Participants will be recruited through collaboration with secondary school principals and the School Governing Body (SGB). Prior to participation, informed consent will be obtained from parents, and assent will be obtained from secondary school students. Data collection will involve:

• Individual interviews with parents to explore their experiences and perceptions regarding substance use among their children.
• Focus group discussions with secondary school students to understand their lived experiences, contributing factors, and coping mechanisms related to substance use.

All interviews and discussions will be conducted in English and Xitsonga, depending on participants’ language preferences, to ensure comfort and comprehension. Data will be analyzed using Tesch’s eight-step thematic analysis method [35], which involves:

• Reading all transcripts carefully.
• Identifying key topics and themes.
• Clustering similar topics.
• Coding the data.
• Organizing codes into categories.
• Refining themes.
• Interpreting findings.
• Validating results through peer review and member checking.

An independent coder will review the transcripts to ensure consistency and enhance the credibility of the findings. This collaborative and iterative approach aligns with the principles of the Participatory Rural Action Approach, emphasizing community engagement and reflective learning throughout the research process.

5. Measures to Ensure Trustworthiness

To ensure the credibility and rigor of the study, Guba’s four criteria for trustworthiness—credibility, transferability, dependability, and confirmability—will be applied [23].

• Credibility will be enhanced through prolonged engagement with participants, triangulation of data sources (e.g., interviews and focus groups), and member checking, where participants will be invited to verify the accuracy of the transcribed data and interpretations.
• Transferability will be supported by providing a rich, detailed description of the study context, including the setting, participant characteristics, and data collection procedures, which will enable readers to determine the applicability of the findings to similar contexts.
• Dependability will be ensured through the use of Audit trails, which document all research decisions, processes, and changes throughout the study, allowing for replication and assessment of the consistency of the findings.
• Confirmability will be achieved by maintaining reflective journals and involving an independent coder to analyze the data, which will help minimize researcher bias and ensure that the findings are grounded in participants’ perspectives rather than the researchers’ assumptions.

These measures collectively strengthen the integrity of the research and support the development of reliable, community-based strategies for mitigating substance use among secondary school students.

6. Ethical Consideration

Ethical approval for this study has been obtained from the University of Venda Human and Clinical Trial Research Ethics Committee (Reference: FHS/24/PDC30/2910). Additional permission will be obtained from the Limpopo Department of Education and the selected secondary schools within Limpopo Province, South Africa. All participants will be fully informed about the purpose of the study, the procedures involved, potential risks and benefits, and their rights, including the right to voluntary participation and the option to withdraw at any time without penalty. Informed consent will be obtained from parents or guardians, and assent will be sought from students prior to participation. To ensure confidentiality, participants’ identities will be protected through the use of pseudonyms and secure data storage. Permission to use audio recording devices during interviews and focus group discussions will be requested from participants. In cases where students experience emotional distress during their studies, referrals will be made to school counselors or appropriate local health services for support. The study will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, ensuring respect, beneficence, and justice throughout the research process.

7. Expected Results

It is anticipated that the study will identify key social, cultural, and Environmental factors contributing to substance use among secondary school students in rural areas. Through thematic analysis of qualitative data, the research will generate evidence-based insights into the lived experiences of secondary school students and parents affected by substance use. The findings are expected to inform the co-development of community-based strategies that are contextually relevant, culturally sensitive, and practically applicable. These strategies will be designed to promote community ownership, collaboration, and sustainability, aligning with the principles of the PRAA. Ultimately, the study aims to contribute to the development of effective interventions that can be implemented within rural school settings to reduce substance use and improve the overall learning environment. The results may also serve as a foundation for future research and policy formulation targeting adolescent substance use in resource-constrained communities.

8. Limitations

This study protocol acknowledges several limitations, including reliance on self-reported data, potential social desirability bias, and limited generalizability due to the use of purposive sampling in a rural context.

9. Anticipated Implications and Conclusions

The outcomes of this study are expected to strengthen collaboration among schools, parents, and community stakeholders in addressing substance use among secondary school students. The co-developed strategies will serve as a foundation for future intervention studies and inform policy decisions aimed at reducing substance use in rural secondary schools across Limpopo Province. These strategies may also contribute to the development of district-level school health policies and provide a replicable framework for other rural municipalities facing similar challenges. By promoting community ownership and sustainability, PRAA has the potential to transform how substance use is addressed in resource-constrained educational settings. Furthermore, the study’s findings may support the integration of participatory methodologies into public health and education programs, encouraging inclusive and culturally responsive approaches to adolescent health promotion. The evidence generated will be valuable for policymakers, educators, and health professionals seeking to implement effective, locally grounded interventions that enhance students’ well-being and academic success.