Keywords
Prescription drug misuse, health risks, drug risk awareness, young women and girls, Theory of Planned Behavior
-
Views
-
Downloads
How to cite this article
Chimukuche RS and Seeley J. Community perspectives on the risks of prescription drug misuse and awareness among young women and girls in KwaZulu-Natal, South Africa [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:494 (https://doi.org/10.12688/f1000research.164539.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
Export Citation
Sciwheel
EndNote
Ref. Manager
Bibtex
ProCite
Sente
▬
✚
Brief Report
Community perspectives on the risks of prescription drug misuse and awareness among young women and girls in KwaZulu-Natal, South Africa
[version 1; peer review: awaiting peer review]
PUBLISHED 14 May 2025
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Addiction and Related Behaviors gateway.
This article is included in the University College London collection.
Abstract
Corresponding author:
Rujeko Samanthia Chimukuche
Competing interests:
No competing interests were disclosed.
Grant information:
This research was funded in whole, or in part, by Wellcome [Grant number Wellcome Strategic Core award: 227167/A/23/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2025 Chimukuche RS and Seeley J.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Chimukuche RS and Seeley J. Community perspectives on the risks of prescription drug misuse and awareness among young women and girls in KwaZulu-Natal, South Africa [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:494 (https://doi.org/10.12688/f1000research.164539.1)
First published: 14 May 2025, 14:494 (https://doi.org/10.12688/f1000research.164539.1)
Latest published: 14 May 2025, 14:494 (https://doi.org/10.12688/f1000research.164539.1)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Introduction
Prescription drug misuse is on the increase in sub-Saharan Africa and globally.1–4 The term “misuse” is often used interchangeably with “non-medical” use with prescription drugs used for recreational purposes such as benzodiazepines and opioids.2,5 Commonly misused prescription drugs are stimulants (methamphetamine), opioids (codeine, tramadol), and central nervous system depressants (benzodiazepines, methaqualone, sleeping pills).1 For the purposes of this research, prescription drug misuse is the use of medication in ways other than intended by a clinician, or by someone other than the person for whom the medication is prescribed.5
The South Africa Demographic Health Survey in 2016 revealed that 2% of the surveyed adult population (15 years and older) mentioned prescription misuse.6 Prescription drug misuse has been associated with lack of knowledge regarding the addictive potential, risk dependency and the harm; large doses of prescription drugs may result in respiratory problems, seizures and potentially death.7,8 Some users lack the ability to read and understand the medicine information sheet.9 Carney et al.10 stated that pharmacy staff in South Africa were challenged by lack of training in prescription drug misuse, limiting their ability to effectively contribute to addressing the problem.10
To understand the perceptions, attitudes and opinions of individuals towards inappropriate prescription use in South Africa, we used the Theory of Planned Behaviour (TPB) to guide data collection and analysis. In our setting, various norms and cultural beliefs influence certain behaviours.11 The social environment that individuals are exposed to facilitates, motivates and encourages misuse of prescription drugs beyond those originally specified by the TPB framework. By incorporating these factors, the modified TPB framework becomes context specific. In this analysis we used an adapted TPB framework with the concepts of attitudes, subjective norms, perceived behavioural control, and socio-environmental factors ( Figure 1).
Figure 1. Adaptation of the theory of planned behaviour, Azjen 1985.
Methods
Between 2023-2024 we collected data on the perspectives of young women and girls on prescription drug misuse to inform the design of a planned larger qualitative study. The study was conducted in Hlabisa health sub-district, in the uMkhanyakude District of Northern KwaZulu-Natal and urban, low socio-economic urban areas in eThekwini (Verulam) South Africa.
Sampling
We interviewed six female peer navigators (youth leaders working with the Africa Health Research Institute), aged 17–30 years selected by community leaders of 21 HIV prevention programme implementation areas in uMkhanyakude to provide support to young people to access the programme intervention.12 In urban eThekwini, six female peer representatives who were youth leaders at a local youth centre in Verulam, were chosen to take part. We conducted focus group discussions with the same groups of peers at both sites. The in-depth interviews were conducted with community youth at the research settings.
Data collection
The study design was exploratory, using qualitative data collection methods that included in-depth interviews and focus group discussions. Written informed consent was sought before each interview and participants were briefed on the purpose of the study. Participants signed the written informed consent before all the data were collected. Data were collected using interview guides, by experienced social scientists, both male and female. We first conducted a focus group discussion with female peer groups to discuss the problem of inappropriate prescription drug use among adolescent girls and young women. In-depth interviews were conducted in IsiZulu (local language) in both sites. Interviews lasted for approximately 45-60 minutes. Lastly, we conducted a follow up focus group discussion with the same female peer groups to co-create ideas for possible interventions that could raise awareness of the risks associated with prescription drug misuse. Data were audio recorded, later transcribed and translated into English with notes taken. Data were analysed by RSC, manually using a thematic approach guided by the TPB framework.
Results
A total of 12 in-depth interviews, and 4 peer navigator focus group discussions were conducted with young women and girls aged 17-25 years.
i. Subjective norms
Social pressures and perceived expectations from others, along with how individuals value those expectations, influence their behaviour. Our participants stated that peers and family members encourage misuse of prescription drugs.
“It has a negative impact because some of us do not have intentions to use these, but we are told by our peers that if you use this it can lead to this…” Female 19 years, IDI uMkhanyakude.
Others perceive misusing prescription drugs as normal because they observe their peers engaging in the same behaviour.
“… they used Alinia (clear the throat), others take it and put it in their intimacy areas.” Female 17 years, IDI eThekwini.
Participants emphasised misuse of prescription drugs for their own benefit as peers,
“Ohh we … use the prescribed medication for our own use like using pills like disprin that is used for a headache, but we use it for abortion.” Peer navigators, FGD uMkhanyakude.
Others highlighted that perceived expectations from their parents make certain behaviours normal or appropriate in their families.
“… you would find out that she knows that she drinks incika and she even get it for the child, some parents assist them.” Peer Navigators, FGD eThekwini.
ii. Attitudes
Participants expressed negative attitudes regarding misuse of prescription drugs.
“Yes, I think that is not a good thing, to be prescribed a certain medication and you use it for another thing…” Female 22 years, IDI eThekwini.
Participants further highlighted the elevated health risk of misusing prescription drugs.
“… the treatment already has its side effects so if you use it inappropriately then maybe ehh … you can end up getting more unexplainable illnesses ….” Female 18 years, IDI uMkhanyakude.
iii. Socio-environmental factors
External influences such as social and environmental factors encourage certain behavioural intentions. Participants highlighted that prescription medication can be easily accessed from pharmacies without prescriptions.
“Yes, here at … there are some that does not need it, even if you want allergex you get whatever you want” Female 27 years, IDI uMkhanyakude.
Other social and environmental factors involved gaps in the healthcare system. In urban areas the participants said some prescription drugs are easily accessed.
“Yes, it is something easy for the young girls to have an access …. The Zenex, yes … she [a young girl] is buying them from the lady from the next door who was working at the hospital.” Female 19 years, IDI eThekwini.
iv. Perceived behavioural control
Participants emphasized the need for peer support groups and awareness programs to be integrated into community youth centres and at school to help them gain knowledge and reduce misuse of prescription drugs.
“What could stop is if there are more of such talks with the young girls, more of it to be able to tell them the results and effects of taking this…” Female 20 years, IDI eThekwini.
“… so if you are going to do an awareness campaign the people who participate in it must be from that community…” Peer navigators, uMkhanyakude.
Contextualizing interventions and awareness programmes was essential for them to be effective.
Discussion
From this analysis we learnt that various factors influence prescription drug misuse and, therefore, raising awareness requires a thorough understanding of these factors. Despite our participants expressing knowledge about the harms and risks that arise from prescription drug misuse, there were other external influences that encouraged them to use them, and this was explained by using the concepts of a modified TPB framework, as has been done in studies on intentional use/misuse of licit and illicit drugs as well as alcohol consumption and smoking.13,14
Participants highlighted the influence of family and peers that encourage them to misuse the prescription drugs, a finding corroborated in other studies that show peer influence as the most consistent predictor of the misuse of drugs and substance use over time in adolescents.15,16
Recommendations on interventions that could raise awareness on the risks associated with prescription misuse focused on the need to tailor interventions to context. Another study in South Africa which had noted the increase in misuse of prescription drugs by females, also highlighted the need to provide interventions specifically for women and girls.17 A systematic review conducted by Saba et al.18 highlighted that behaviour change interventions to prevent substance misuse do need to be context specific.
Raising awareness interventions that are aligned to behavioural frameworks and tailored to the community’s needs are beneficial shaping interventions.19 By engaging local stakeholders and using targeted communication strategies, these interventions inform individuals about the dangers of prescription drug misuse and motivate communities to adopt safer behaviours and seek appropriate support when needed.
Author contributions
All authors directly participated in this study. RSC handled conceptualization, formal analysis, writing—original draft. JS contributed to conceptualization, supervision, writing-review and editing.
Ethics and consent
Ethical approval for this project was obtained from the University of KwaZulu-Natal Biomedical Research Committee in South Africa (BREC Ref No:00006237/2023) on the 16th of March 2024. Ethical approval stated that in no way do the requirements for data availability override the right to confidentiality and privacy of individuals or organisations who are the subjects of research. All methods were performed in accordance with the relevant guidelines and regulations.
Download
Export To
metrics
| Views | Downloads | |
|---|---|---|
| F1000Research | - | - |
|
PubMed Central
Data from PMC are received and updated monthly.
|
- | - |
Citations
CITE
how to cite this article
Chimukuche RS and Seeley J. Community perspectives on the risks of prescription drug misuse and awareness among young women and girls in KwaZulu-Natal, South Africa [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:494 (https://doi.org/10.12688/f1000research.164539.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.
Open Peer Review
Current Reviewer Status:
AWAITING PEER REVIEW
AWAITING PEER REVIEW
Key to Reviewer Statuses
VIEW
HIDE
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Comments on this article Comments (0)