Background Maternal substance use is a public health concern in South Africa (SA), where pregnant women using substances face unique contextual challenges impacting their quality of life; including poverty, violence, and illness. Low-income rural living presents additional challenges for pregnant women using substances. Yet, their lived experiences and quality of life (QoL) remain underexplored, particularly in rural SA contexts.Methods This secondary qualitative analysis explored semi-structured interviews with 13 women from low-income rural communities in the Western Cape participating in a substance use support program. Interpretive phenomenological analysis was conducted, and data interpretation was guided by Recovery Capital and QoL Frameworks.Results Financial and psychological stress intersected with relational conflict, community violence, and insufficient psychosocial support. Social support was vital for the QoL of the women but was not consistently available. Participants relied on personal, social and cultural recovery capital through spiritual, religious and community resources. While the women faced multiple layers of adversity, they demonstrated resilience and hope for the future.Conclusion Recovery capital and the relational assets that support women navigating substance use during pregnancy in low-income, rural SA contexts are important. Findings support the development of interventions integrating psychosocial support that are culturally grounded and community driven.
Background Lived-living experience (LLE) involvement is central to ethical and effective alcohol and other drug (AOD) service delivery. Most outcome measures used in AOD treatment were developed with limited LLE co-production. This may compromise ecological validity in real-world treatment contexts. This paper describes the collaborative adaptation of the Short UPPS-P Impulsivity Scale (S-UPPS-P).Methods This project employed a participatory research design. Peer researchers, academics, clinicians, and Peer Workers reviewed the S-UPPS-P to assess contextual relevance, linguistic accessibility, and cultural fit. Lived-living experience participants contributed to item revision. Two peer-facilitated workshops (n = 12) sought structured feedback and alternative item phrasing. Revisions were developed iteratively and refined through member checking via digital feedback loops.Results Participants identified issues with item wording, cultural relevance, and contextual mismatch to lived AOD experiences. Iterative modification produced the Australian Short UPPS-P (AUS-SUPPS), a collaboratively revised version of the scale for outcome monitoring in AOD services. This was a qualitative, service-based adaptation, not a psychometric validation.Conclusion This paper offers a service-based model for bringing lived-living experience into outcome measure review. Collaborative revision of this kind may improve the acceptability and ecological validity of routine monitoring, but these are anticipated benefits that remain to be tested.
