Perceived factors influencing health-seeking for substance use among secondary school learners in the Western Cape, South Africa

Adolescent alcohol and other drug use represents a growing public health challenge in South Africa, particularly in the Western Cape, with early onset and high prevalence rates. Despite the urgent need for prevention and treatment programmes (aligned with SDG 3.5), a substantial treatment gap exists, with many young people failing to seek or receive adequate prevention and treatment services. Understanding perceived factors influencing help-seeking among a heterogenous group of adolescents is essential for developing youth-friendly prevention and treatment. This research aimed to explore secondary school learners’ perspectives on factors that facilitate or hinder health-seeking behaviours in the Western Cape. A qualitative methodology was adopted, semi-structured interviews were conducted with 84 learners from 11 purposively sampled schools across 7 community clusters in Cape Town. Inductive thematic data analysis was conducted. The findings highlighted perceived facilitators and barriers at individual and service levels. Facilitators and barriers reflected both the perspective of adolescents with lived experience of substance use, and general perceptions of services and adolescent help-seeking. User-level facilitators included self-determination and a desire for change, insight to seek professional help, strong preference for informal help-seeking (especially from parents), and peer encouragement and support. User-level barriers comprised self-stigma, reluctance to stop using substances, lack of knowledge of available services (among adolescents and parents), and fear of parental rejection or punishment. Service-level barriers included access constraints (geographic, financial, programme availability), unappealing and ineffective services, stigma and perceived judgement from educators and fear of confidentiality breaches within schools. To address the treatment gap, interventions should leverage existing trust relationships (parents, peers) and develop clear pathways to professional services, be it preventative or targeted treatment. Schools must shift from punitive to supportive environments that address confidentiality and stigma concerns. Future research should examine help-seeking behaviours among adolescents with documented substance use.