Psychosocial Health Promotion-Related Needs in Adolescent Girls With Substance Abuse: A Qualitative Study
Abstract
Introduction: Adolescent girls involved in drug use are highly vulnerable to health and social welfare-related threats. Providing effective interventions and formulating specific health and social welfare policies require a comprehensive examination of the needs and problems of this group in different dimensions.
Objective: The present study aimed to identify psychosocial health promotion-related needs of adolescent Iranian girls with substance abuse.
Methodology: The present study was conducted with a qualitative approach and with conventional content analysis methodology. The participants consisted of 26 adolescents with history of substance use, health professionals (i.e., psychologists and psychiatrists), and officials affiliated with social welfare organizations, and NGO organizations support socially vulnerable children and adolescents, as well as the families of teenage girls. Data were collected using semistructured qualitative interviews and then coded after transcribing using MAX QDA software.
Results: The identified psychosocial health promotion needs were placed in 12 subcategories and three main categories, including detection and repair of the boundaries of adolescent vulnerability, psychosocial development of the family, and promoting social accountability in the delivery of social services.
Conclusion: Programs and services to promote psychosocial health in girls involved in drug use should include the dimensions of the individual and the family, as well as the departments that provide the services; so that while identifying and repairing people’s injuries and facilitating the optimal functioning of families, it can provide them with the necessary and appropriate services at the right time.
1. Background
According to the World Health Organization (WHO), more than a quarter of all people aged 15–19 years consume alcohol worldwide, amounting to 155 million adolescents [1]. According to the CDC, 15% of high school students reported having ever used select illicit or injection drugs, such as cocaine, inhalants, heroin, methamphetamines, hallucinogens, or ecstasy [2].
Early onset of substance use is associated with higher risks of developing dependence and other problems during adult life, and people of younger ages are disproportionately affected by substance use compared with people of older ages. Alcohol and drug use in children and adolescents are associated with neurocognitive alterations which can lead to social and academic problems in their future life [1]. The results of a study conducted on 1829 German children and adolescents showed that drug use was associated with a lower quality of life in the areas of physical and psychological well-being, parent relation and autonomy, and school environment [3].
According to the UNOCD report, women are more affected than men by barriers to access to health services. On the other hand, women who use drugs tend to develop drug use disorders faster than men. This gap is particularly high for women who use amphetamine-type stimulants, with women forming almost 1 in 2 users of amphetamine-type stimulants [4]. On the other hand, the results of a qualitative study conducted on women who used drugs in Iran revealed that negative attitudes towards women who experienced addiction and stigmatization provided the grounds for the emergence of other risky behaviors in this group [5].
The results of a study conducted in Sweden revealed that girls with substance use report higher levels of mental health issues and experience a greater burden of psychosocial risk factors compared to boys, indicating they may require more comprehensive treatment interventions [6]. Besides, alcohol dependence in adolescent girls increases the chance of engaging in risky sexual behaviors [7]. Also, the abuse of drugs and alcohol significantly heightens the risk of suicide attempts among adolescent girls [8].
The Social Welfare Organization in Iran is responsible for providing support and rehabilitation to socially vulnerable women and girls. Their goal is to help these individuals recover and reintegrate into a healthy personal and social life legally. Although the organizations related to the Ministry of Health and schools also deal with issues related to adolescents, vulnerable girls may still experience numerous psychological and social injuries that require specialized attention. In this regard, the results of a study conducted in Iran showed that several factors put vulnerable teenage girls at high risk of sexual issues [9]. Thus, the vulnerability of adolescent girls engaged in drug use to various psychosocial effects of drug abuse highlights the importance of providing effective interventions such as primary prevention, treatment, and harm reduction. Neglecting their health needs could lead to serious and irreversible consequences for future generations [10]. However, before any action is taken, it is vital to accurately and comprehensively identify the needs of this group. Unfortunately, gender-related cultural sensitivities have limited the available evidence on adolescent girls’ psychosocial health promotion, making it difficult to adopt healthcare programs. Therefore, identifying their needs is critical to promoting their psychosocial health. In general, qualitative research using the perspectives of adolescents involved in drug use, families, and professionals can provide more accurate and comprehensive insights. Hence, this study evaluated the needs related to psychosocial health promotion in adolescent girls with substance abuse through a qualitative approach.
2. Materials and Methods
2.1. Design
This study was conducted using a qualitative approach and the conventional content analysis, justified by the fact that risk-taking behaviors, particularly drug use, are driven by various factors. Therefore, it is necessary to conduct a comprehensive analysis of the psychological and social needs of vulnerable groups to understand these behaviors better and that is why using a qualitative approach and content analysis method can be significant in gaining a deeper insight into this issue.
2.2. Participants
In the current study, there were 26 participants divided into three groups. The first group included adolescent girls with history of substance use (AP), comprising 12 adolescent girls hospitalized in addiction treatment centers, as well as those covered by the welfare organization, living in care and residential centers, and residing in the outskirts of the city. The second group included four people from the families of adolescent girls with substance use (FP), and the third group was made up of 10 experts and officials working in organizations and centers related to the target group including two addiction psychologists, a psychiatrist with an addiction fellowship, a sociologist, a midwife, a social worker who worked in a drop-in center and four officials affiliated with social welfare organizations, and NGO organizations supporting socially vulnerable children and adolescents (EP) (Tables 1, 2, and 3).
| ID | Age | Educational status | Residential status | Type of drug used | Duration of substance use (years) | Smoking and alcohol consumption | Drug-using parents |
|---|---|---|---|---|---|---|---|
| AP1 | 19 | Diploma | Marginalized areas of the city | Heroin–methadone | 5 | Yes | Yes |
| AP2 | 16 | Middle school (dropout) | City | Cannabis–magical mushroom–amphetamine | 2 | Yes | No |
| AP3 | 19 | Diploma | Marginalized areas of the city | Heroin–amphetamine | 6 | Yes | Yes |
| AP4 | 17 | Middle school (dropout) | City | Amphetamine–tramadol–LSD–cannabis | 3 | Yes | Yes |
| AP5 | 18 | Middle school (dropout) | Marginalized areas of the city | Heroin–amphetamine | 4 | Yes | No |
| AP6 | 17 | Middle school (dropout) | Homeless | Heroin–amphetamine | 5 | Yes | Yes |
| AP7 | 19 | Diploma | City | Cannabis–amphetamine | 6 | Yes | No |
| AP8 | 16 | High school | City | Cannabis–magic mushroom | 2 | Yes | No |
| AP9 | 19 | Middle school (dropout) | City | Cannabis–grass-pico | 5 | Yes | No |
| AP10 | 17 | High school (dropout) | Shelter | Amphetamine–cannabis–heroin | 4 | Yes | No |
| AP11 | 14 | Middle school | City | Cannabis, magic mushroom | 2 | Yes | Yes |
| AP12 | 14 | Middle school | City | Cannabis–LSD | 1 | Yes | No |
| ID | Age | Gender | Education | Job experience (year) | Affiliated organization |
|---|---|---|---|---|---|
| EP1 | 45 | Female | PhD in sociology | 20 | Municipality women’s affairs department |
| EP2 | 56 | Male | Psychiatrist | 25 | Technical officer of the addiction treatment center |
| EP3 | 37 | Male | Master of public health | 12 | Managing director of NGO |
| EP4 | 40 | Male | PhD in psychology | 14 | Nongovernmental mental health center |
| EP5 | 55 | Male | PhD in psychology | 25 | Technical officer of a drop-in center (DIC) |
| EP6 | 48 | Male | PhD in management and planning | 23 | The law enforcement officers |
| EP7 | 32 | Female | Master of science in social work | 8 | Social worker at a drop-in center (DIC) |
| EP8 | 42 | Female | Master of midwifery | 14 | Family health center |
| EP9 | 51 | Male | PhD in health psychology | 24 | Drug control organization |
| EP10 | 49 | Male | PhD in sociology | 21 | Municipality |
| ID | Age | Gender | Education | Job | Marital status |
|---|---|---|---|---|---|
| FP1 | 37 | Female | High school | — | Married |
| FP2 | 40 | Female | Bachelor’s degree | Teacher | Divorced |
| FP3 | 46 | Female | Diploma | — | Divorced |
| FP4 | 45 | Male | Diploma | Shopkeeper | Divorced |
2.3. Sampling and Data Saturation
The purposive sampling method was employed to access the participants [11]. In addition, since the selected group was among the vulnerable people of the society, more comprehensive data were obtained using the snowball method and asking the participants to introduce other people if they were willing. Considering the nature of the qualitative research, the data collection process continued until reaching the saturation level. Data saturation was considered after data were repeated in the last three interviews and no new codes were extracted.
2.4. Procedure
First, the research team prepared a list of public and private centers, organizations, and institutions that were active in the field of socially vulnerable adolescent girls. Then, the researchers referred to the desired units, introduced themselves, and clearly stated the general objectives of the study. Participants who met the inclusion criteria were selected, and all completed informed consent forms before starting the research process. Following the principle of confidentiality, all participants were assured that the data obtained would be completely confidential and used without mentioning their names or other information. The age range of 10–18 years, history of drug use for more than 6 months, and willingness to participate in the study were the inclusion criteria for adolescent girls. People active in four related fields, including welfare, medical and health sciences, law enforcement and antinarcotics police, and management organizations, such as the governorate and municipality, were invited to participate in the study as experts and officials. Data were collected through semistructured individual interviews, which lasted 30–78 min. According to the conditions of the participants, the location of the interview was different, from residence, home, or drug addiction camps to the workplace of specialists. Before the research implementation, a guide to the key interview questions was prepared by the research team based on the guidelines for the international assessment of high-risk behaviors (CDC& UNICEF), which was then reviewed by two psychiatrists. Some of the questions in the interview with teenagers include: If you are comfortable, please share your personal experience with drug use. What led you to try drugs and how did you continue to use them? What challenges do you think teenage girls in similar situations face, and what are your hopes for the future?
In expert section: How do you perceive the conditions of teenage girls who use drugs in Iranian society? What services and facilities are available to support them, and what are the strengths and limitations of these resources?
In parent section: If you are comfortable, please share a story about your teenage daughter (feel free to use her name) and her struggles with drug use. How do you believe families can play a positive role in reducing risky behaviors and supporting loved ones who are dealing with drug addiction?
Interviews were conducted face-to-face by the first researcher, who was a female PhD student in Psychiatric Nursing and had completed specialized courses in clinical interviewing and mental health assessment.
2.5. Data Analysis
All the data were recorded by a voice recorder with the participants’ permission, and the files were rewritten and coded after each interview. A second researcher specializing in qualitative health sciences research analyzed the transcripts and interviews to verify the reliability of the findings. During the data analysis phase, the initial codes, themes, and subthemes were reviewed by the research team before evaluation by an external researcher.
For analyzing the qualitative data, inductive qualitative content analysis method was performed based on Graneheim and Lundman approach via conventional approach [12]. Data management was performed using MAXQDA (Version 20) software.
In the first stage, the content of the analysis was prepared, and all the interviews were converted into textual content. In the second stage, the unit of analysis was determined and initial coding was conducted, before which the texts were reread to make the correct inference. After that, line-by-line checking was performed to extract the primary codes, which were then classified into subclasses in the third stage. In general, inductive coding was conducted from raw data, grouping the extracted codes with common concepts and themes. In the fourth stage, subcategories were formed by comparing subclasses and considering their similarities. Finally, more general concepts or the main categories were achieved by comparing subcategories and placing similar ones together.
2.6. Trustworthiness
We enhanced the accuracy and trustworthiness of findings based on four criteria of credibility, dependability, confirmability, and transferability [13, 14]. Thus, through long engagement and spending sufficient time on data collection and analysis, conducting deep interviews, the researcher did his best to enhance the credibility and dependability of study. Additionally, the researcher contributed to the confirmability of the research by maintaining the supporting documentation throughout all phases of the investigation. In order to increase the transferability of data, some interviews were provided to the participants and relevant feedback was applied with the opinion of experts.
3. Results
According to data analysis from 810 primary codes, the identified needs were placed in 12 subcategories and three main categories, including detection and repair of the boundaries of adolescent vulnerability, psychosocial development of the family, and promoting social accountability in the delivery of social services (Table 4).
| Categories | Subcategories |
|---|---|
| Detection and repair of the boundaries of adolescent vulnerability | Screening and management of comorbid psychiatric disorders |
| Equipping adolescent girls with effective social skills | |
| Facilitating the adolescent’s entry into the challenging period of puberty | |
| Healing adolescent psychological trauma | |
| Psychosocial development of the family | Targeted management of vulnerable families |
| Rebuilding parenting skills | |
| Strengthening intimacy and family bonds | |
| Developing comprehensive insights among parents about the challenges faced by adolescents | |
| Promoting social accountability in the delivery of social services | Fostering interprofessional collaboration and a sense of unity among social organizations |
| Facilitating access to health-care services | |
| Strong social support | |
| Dealing with gender discrimination | |
3.1. Detection and Repair of the Boundaries of Adolescent Vulnerability
This category includes the needs related to individual factors in adolescent girls, strengthening the occurrence and development of drug use. The four subcategories under this category include screening and management of comorbid psychiatric disorders, equipping adolescent girls with effective social skills, facilitating the adolescent’s entry into the challenging period of puberty, and healing adolescent psychological trauma.
3.1.1. Screening and Management of Comorbid Psychiatric Disorders
She was always pessimistic, saying that they were looking at our house from the outside. She said that some people were constantly talking in her head, asking us whether we heard the same voices (FP2).
A few years ago, the doctor told me that I had the borderline disease. I hurt myself. I scratched myself with a razor. I liked blood. I calmed down when I saw blood (AP7).
3.1.2. Equipping Adolescent Girls With Effective Social Skills
Our education system is defective. Life skills should be offered as a core curriculum rather than being provided by the principal (EP2).
We went to a party at one of the guys’ houses. They were passing the drugs around. Everyone was consuming. I couldn’t say no and took them (AP6).
3.1.3. Facilitating the Adolescent’s Entry Into the Challenging Period of Puberty
Once, I was all by myself or fighting with others. No one at home understood what I said. The drugs I used made me feel better. I was no longer nervous (AP8).
Due to the increase in sexual desire, they definitely go towards unsafe behaviors, subsequently leading to serious injuries and potentially affecting drug-consuming and even healthy adolescents if not trained adequately. Some substances have a significant effect on increasing sexual power (EP5).
3.1.4. Healing Adolescent Psychological Trauma
Drugs made me feel relaxed, took away my frustration, and increased my self-confidence. I forgot all my sorrows when I used drugs (AP10).
I myself used methamphetamine because I wanted not to be sad and forget my misfortunes (AP2).
3.2. Psychosocial Development of the Family
Improper conditions in the family environment are among the factors that can make adolescents vulnerable to mental health issues, including substance abuse. The four subcategories under this category include targeted management of vulnerable families, rebuilding parenting skills, strengthening intimacy and family bonds, and developing comprehensive insights among parents about the challenges faced by adolescents.
3.2.1. Targeted Management of Vulnerable Families
My mother and father were addicted. All their thoughts were on drug use. I was no longer important to them (AP4).
In many cases, the parent asks the child to consume. In my opinion, children go to addiction sooner in a family that has suffered itself (EP6).
3.2.2. Rebuilding Parenting Skills
Sometimes, too much family pressure may have caused some adolescents to be drawn to drug use and harm.
We have seen many times that parents do not have any reasonable control over the activities and relationships of adolescents. Everyone is looking after and thinking of their own affairs. Unfortunately, drug use starts from somewhere. When drug consumption starts with cigarettes but is neglected by parents, it ends up with amphetamines (EP10).
3.2.3. Strengthening Intimacy and Family Bonds
I have not received love from my parents. I wish my mother would hug me once (AP4).
If adolescent do not get attention from their families, they will compensate for their lack of affection from others. They go to strangers. If they are lucky, the stranger will not be an unworthy person (AP3).
Well, if they (my parents) paid attention to me, I wouldn’t end up in this mess (psychiatric hospital) or run away from home (AP6).
3.2.4. Developing Comprehensive Insights Among Parents About the Challenges Faced by Adolescents
I wish I had the information I have a few years ago not to harm this child so much and to such an extent (FP3).
3.3. Promoting Social Accountability in the Delivery of Social Services
The four subcategories under this category include fostering interprofessional collaboration and a sense of unity among social organizations, facilitating access to health-care services, strong social support, and dealing with gender discrimination.
3.3.1. Fostering Interprofessional Collaboration and a Sense of Unity Among Social Organizations
The main problem of our society is that every organization works individually. For example, the education organization says that no one has the right to enter schools and only its elite can do the job. Well, our biggest mistake is to say that only we know and no one else can take actions. The welfare organization claims that only it knows what to do and other organizations can do nothing (EP5).
3.3.2. Facilitating Access to Healthcare Services
I was involved in addiction for several years, but I found out recently that there are places that give methadone syrup to help me quit. Many children who use drugs want to quit, but there is no one to help or guide them (AP3).
We did not know what to do for treatment. We only knew the camp and took her directly to the camp, but I wish this would not happen. The camp environment was not suitable at all (FP4).
3.3.3. Strong Social Support
An addicted adolescent girl who was not accepted by the society became involved in complex traumas that addiction was a simple issue in comparison. All this happened because she received no support from society or responsible organizations (EP7).
My father kicked me out of the house. I am homeless now. I sleep anywhere and collect waste (AP6).
3.3.4. Dealing With Gender Discrimination
Unfortunately, we do not have a center for adolescent girls involved in addiction because we never want to admit that such a problem exists (EP2).
The mainstream society and family do not want to accept that consumer girls exist. This issue is considered a stigma for girls in our community and culture. No one understands that they have a problem and no actions are taken until the girls experience the worst conditions and harm (EP7).
4. Discussion
Drug use is one of the health problems among adolescents nowadays, especially leading to more psychosocial consequences in adolescent girls. Therefore, the present study aimed to identify and discover psychosocial health promotion-related needs of adolescent girls with substance use disorder to gain deeper insights. According to the results, adolescent girls involvement in drug use often reported a history of an underlying psychiatric disorder, such as depression, attention-deficit/hyperactivity disorder (ADHD), and personality disorders. In addition, weakness in adaptive and social skills, lack of effective education regarding the challenges of adolescence, experiences of traumas, and exposure to multiple stressors during childhood and adolescence were among the main issues that increased the vulnerability of adolescent girls to drug use. Thus, the need to repair the boundaries of vulnerability in adolescent girls seems necessary for their health improvement.
Screening and management of comorbid psychiatric disorders are also among the needs of these adolescents. The results of a systematic review conducted in Australia indicated that depression, anxiety, and hyperactivity were major underlying disorders among substance users [15]. On the other hand, some drugs such as hallucinogens and marijuana may provoke and aggravate the symptoms of psychotic symptoms and schizophrenia [16], indicating the importance of careful monitoring and evaluation, along with the provision of specific treatment measures in adolescent users, especially those reporting a previous history of psychiatric disorders. It seems that more attention from schools and basic monitoring of screening tools can contribute to the early identification and provision of treatment measures in this field.
The need to provide effective coping and social skills was another identified challenge. A study conducted by Dariotis et al. on adolescents revealed significant indirect effects between coping mechanisms and illicit drug use, according to which a lack of effective coping skills contributed as a predictive factor for drug use [17]. The results of a cross-sectional study conducted by Amini et al. on 600 students in Iran showed a significant inverse relationship between social skills, especially assertiveness and effective communication, with the tendency to use drugs in adolescents. As shown, teenagers with low assertiveness skills had a higher tendency to drugs [18], which was in line with the results of the present study. Equipping adolescents with life skills such as assertiveness, self-expression, and critical thinking will lead to more problem-oriented defense responses in high-risk situations. Thus, providing standard education on life skills for adolescents is a basic requirement, which should be carefully reviewed.
Puberty is a sensitive and critical period for adolescent girls, requiring preparation for psychological acceptance. On the other hand, there is an increase in risk-taking during this period, which can lead to risky behaviors if not managed. Pfeifer et al. proposed a theoretical model in which social processes (both social cognition and peer relations) were critical to understanding the way in which pubertal development drove neural and psychological changes that produced potential mental health vulnerabilities, particularly in adolescent girls [19]. Also, Addelyan et al. showed that puberty training among adolescent girls could have a significant effect on reducing risky behaviors [20]. These results agree with the findings of the present study, indicating the need to provide comprehensive education on the challenges of adolescence and the maturation process for adolescent girls.
Relief from unpleasant experiences and psychological discomfort was an influential issue leading adolescent girls to start and continue drug use. The results of a study conducted on women and men using drugs showed that women were more exposed to childhood trauma and experienced more emotional neglect than men [21]. On the other hand, some adolescents develop maladaptive patterns of emotional, physiological, and neural reactivity to stressful situations, and their patterns of reactivity interact with increased stressful life events during adolescence leading to the potential for substance and alcohol use [22]. The results of a study conducted on a group of adolescents in Sweden showed that girls with substance use disorders generally grew up in a more unhealthy childhood environment than boys [23]. These results highlight the need to alleviate the psychological pain and address the underlying problems of adolescent girls involved in drug use to increase the effectiveness of treatment measures.
Other results of the study indicated that emphasis on the family element was one of the major psychosocial needs in this group. Troubled families in which one or both parents are drug users, domestic violence prevails, or parents are in unsuitable economic conditions to meet the needs of adolescents were among the problems of adolescent girls with drug addiction. The need to provide effective educational models, create an intimate atmosphere with empathy among family members, and improve the awareness and knowledge of parents regarding the challenges of adolescence are among the significant issues in drug-addict adolescent girls.
The results of a study conducted by Ghelbash et al. confirmed the greater prevalence of high-risk behaviors such as drug use in adolescents experiencing domestic violence [24]. Also, Guest et al. showed that adolescents are usually affected by family relationships, interpersonal conflicts, and drug and alcohol use until reaching a point where they can no longer manage emotional distress and pain related to those experiences. This study determined the contribution of interpersonal and family conflicts to the risk of suicide and drug use [25].
The results revealed that most adolescent girls involved in drug use were exposed to ineffective training methods and patterns, indicating mainly strict or careless parenting behaviors. In this regard, Liu et al. showed that poor parenting styles were a risk factor for drug abuse in adolescents [26]. Emotional poverty of parents and lack of intimacy between family members were among other issues identified as problems of adolescent girls with substance use disorder. Rusby et al. showed that youth report of a poor relationship with parents was a stronger predictor for girls than boys on their alcohol use onset [27]. The results of another study indicated that the feeling of belonging to the family and the intimacy between parents and adolescents are predictors of the well-being of this age group [28].
Concerning the psychosocial development of the family, the need to create effective insights in parents on how to deal with adolescents and the challenges associated with this period was also considered an important concern. Hansen et al. concluded that parents’ lack of information and knowledge about how to use medical services was a major challenge for adolescents with mental health problems [29]. Therefore, acquiring awareness and knowledge of different psychosocial dimensions and the needs of adolescents can be one of the issues that parents require education about. Raising the awareness of parents can help in the personal development of adolescents since informed parents can perform better in crisis management, subsequently improving the family’s ability to demand their rights from social service systems.
According to other results of the study, social accountability enhancement in the context of vulnerable groups was the third identified category. The need to enhance solidarity and partnership among social organizations, facilitate access to treatment-care services and effective social support, and deal with gender inequality were among the main needs in this category.
The lack of interorganizational solidarity can adversely affect the targeted management in reducing adolescent girls’ vulnerability. The results of a qualitative study showed that the ineffectiveness of key organizations in providing sexual and reproductive health services, along with the lack of legal, political, and social support, was influential factors in the spread of high-risk behaviors among adolescent girls [9].
The need to facilitate access to medical and social services was one of the issues raised by the participants. A review study highlighted access to treatment as a major challenge for young women with drug addiction. Lack of proper access to health services, especially for adolescent girls who are in their early substance abuse stage, unaware of their entry into dangerous activities, and most importantly denied access to adequate support, can have countless irreversible consequences. Thus, the lack of adequate response from social, health, and welfare organizations is a critical factor in the vulnerability category [30].
The need for effective social support due to the lack of social platforms to reduce harm for the adolescent age group was another challenge related to the category of social accountability. The results of the study conducted by Birtel showed that perceived social support was associated with higher self-esteem, lower depression and anxiety, and better sleep among drug users. The researcher also emphasized that social support could be an effective factor in dealing with social stigma [31].
The need to deal with gender inequalities was another issue identified in the category of social accountability. The results of research carried out by Fonseca et al. revealed that specific research on women who use drugs is very scarce and treatments are not gender-sensitive oriented. Hence, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders [32]. McCrady also argues that outcomes for women are best when treatment is provided in women-only programs that include female-specific content [33]. In general, although girls are at greater risk of the consequences of drug use, most drug policies and programs focus on men. Thus, policymakers may need to adopt a gender-transformative approach across services and specifically focus on gender justice as much as gender equality [34].
In the setting of vulnerable groups, social accountability is a broad challenge that affects health and treatment, schools, and organizations related to social welfare, necessitating changes in policies and increased monitoring by policymakers and social organizations. According to the Drug Enforcement Administration declaration, public health, prevention, and access to healthcare must be prioritized worldwide, or drug challenges will leave more people behind.
4.1. Limitations
The main limitation of our study was the challenge of accessing the target group and their families. Despite our efforts to include participants from various social levels and regions, it took us 13 months to reach them. Families with higher socioeconomic status were less likely to participate in the study, which may have limited the diversity of our data set. Additionally, we relied solely on face-to-face individual interviews for data collection. To enhance the richness and diversity of the data, we recommend that future researchers also incorporate focus group methods.
5. Conclusion
This study sought to identify and discover psychosocial health promotion-related needs of adolescent girls who use substances. Based on the findings, programs and services to promote psychosocial health in girls using substance should include the dimensions of the individual and the family, as well as the organizations that provide the services; so that while identifying and repairing people’s injuries and facilitating the optimal functioning of families, it can provide them with the necessary and appropriate services at the right time. Thus, the occurrence of social harm such as addiction can be formed under several individual and social factors. Therefore, policy-making or presenting a strategic plan in this field requires wider and more detailed attention to the needs of the intended target group.
This study underscores the urgent need to address the unique challenges faced by vulnerable adolescents, which is a crucial gap in our existing policies. It is imperative that we critically assess and enhance cross-sectoral interventions aimed at the psychosocial health of at-risk girls. Relevant organizations such as schools, health authorities, and social welfare agencies must take decisive action to implement fundamental and comprehensive improvements to support these groups effectively.
Ethics Statement
All participants completed the written informed consent form for participation. In adolescent participants who had not reached the legal age, besides their own consent, informed consent was acquired from their legal guardian as well. Furthermore, all methods were performed in accordance with the relevant guidelines and regulations by including a statement in the “ethical approval and consent to participate” (Declaration of Helsinki). The present study has been approved with the code of IR.MUI.NURAMA.REC.1401.094 at ethics committee of the Is fahan University of medical sciences, Iran.
Consent
Please see the Ethics Statement.
Conflicts of Interest
The authors declare no conflicts of interest.
Author Contributions
Z.G., M.A., M.N., and M.M.F.: conceptualization, methodology, writing – original draft, visualization, supervision, and writing – reviewing and editing.
Funding
Isfahan University of Medical Sciences.
Acknowledgments
The authors would like to thank all participants for their cooperation.
Supporting Information
This study was evaluated based on the consolidated criteria for reporting qualitative research (COREQ) checklist, which is included in the Supporting file. The criteria included in COREQ, a 32-item checklist, can help researchers report important aspects of the research team, study methods, context of the study, findings, analysis, and interpretations.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
