Abstract
Early alcohol consumption has become a growing problem in South Africa, where 67% of adolescents from the ages of 11 to 18 have reported drinking alcohol at least once in their lifetime. Underage drinking is associated with numerous consequences for the physical and social development of adolescents. Schools are the ideal setting to educate adolescents about alcohol prevention; however, school-based alcohol prevention interventions implemented by the South African government and non-governmental organisations are evidently ineffective in curbing underage drinking. Yet, evidence-based research from the global North has shown that an inclusive and collaborative approach to school-based interventions can effectively delay underage drinking. Based on this premise, this study aims to explore the attributes of an effective school-based alcohol prevention intervention in South Africa that focuses on early adolescents. Theoretically, stakeholder theory, the value of co-creation theory, and the theory of planned behaviour are applicable to the study. A concurrent mixed-methods research design was used to evaluate the knowledge, attitudes, and practices related to alcohol of 215 early adolescents enrolled in three primary schools in Johannesburg, South Africa. In addition, 13 interviews were conducted with various stakeholders about school-based alcohol prevention interventions. The key findings indicate that early adolescents have considerable knowledge of the risks of underage drinking, yet those aged 12 to 15 displayed positive attitudes towards alcohol and consumed it. The adolescents also disclosed that they prefer school-based interventions that incorporate their lived experiences, ideas, and collaborate with other stakeholders. The various stakeholders agree that meaningful dialogue and collaboration can prevent underage drinking. Therefore, an adapted, hybrid stakeholder-inclusive and co-change-orientated communication framework is proposed, one which delineates the attributes that should comprise an inclusive and collaborative communicative approach to school-based alcohol prevention interventions. Such a study can provide crucial insights into effective school-based alcohol prevention interventions to health promotion organisations and professionals.