Risk and Protective Factors for Alcohol and Other Drug Use (AOD) Among Adolescents in Rubavu District, Rwanda

Background: Despite ongoing prevention efforts, alcohol and other drug (AOD) abuse among adolescents remain public health concerns. Rural adolescents, many of whom are underserved, are disproportionately affected. AOD bring a major challenge for affected families and communities and places an enormous burden on mental health and other health service providers in Rwanda as well as the country’s economy. To our knowledge no study has been done to address AOD in Rwanda. Objectives: The purpose of this study was to explore perspectives on risk and protective factors influencing AOD of parents and their adolescents attending parent-adolescent communication (PAC) program in Rubavu district, Rwanda. Methods: This study employed qualitative methods and community-based participatory research (CBPR) guided in large part by community members, in partnership with research and health practitioners from Imbuto Foundation and Rubavu Youth Friendly Center (RYFC). CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health issues and involve communities in every aspects of the research process. Through a systematic process, community participants and researchers work to achieve a shared understanding of the important influences on AOD in the community and suggestions for how to take action in addressing AOD. Purposive sampling procedure was used to select participants for the study. A total of 20 families (17 fathers, 20 mothers and 20 adolescents aged 14 to 24 years) were participants in PAC program from Rubavu Youth Friendly Center (RYFC) in rural sector of Rubavu district. Focus groups and in-depth interviews in Kinyarwanda language were conducted with all study participants. The interview guide was semi structured, nondirective and informal process to elicit rich information regarding risk and protective factors of AOD abuse among adolescents. Each interview and focus group session were written in narrative format and were analysed using grounded theory approach. Results: This Individual risk and protective factors for AOD, environmental risk and protective factors for AOD and suggestion to AOD among the adolescents were the main themes that emerged from this study. Parents and their children adolescents’ participants in PAC program perceived poor communication as a leading risk factor of alcohol and drugs abuse; other risks included poor family support, stressful life events and availability of drugs. Family support, communication about drugs, employment and religion were viewed as protective factors. Participants suggested strengthening parent-adolescent communication about drugs through parenting and drugs education sessions and community home visit and integration the program in village. Other suggestions included strengthening the parent-adolescent relationship in prevention or reduce AOD. Conclusions: Participants believe that parents and families have the ultimate responsibilities to protect and educate their own children about alcohol and drugs. This study calls for the governments to equip families in performing this task. Establishing a family-based drug prevention intervention that aims to produce competent parents would improve parenting practice in prevention of adolescent risk health behavior including alcohol and other drugs.