Scottish stakeholder views on closing the evidence to practice gap in substance use prevention

Background In 2018, Scotland’s national and local government leaders declared reducing the use and harms associated with alcohol, drugs, and tobacco a public health priority. Barriers to widespread implementation of evidence-based prevention measures include confusion about what prevention is and diverging views on what works. We explored the views of Scottish stakeholders about their understanding, expectations, and experience of preventing substance use harm in youth, including during the COVID19 pandemic, to inform prevention policy development.    Methods We used a social research agency to conduct 11 focus groups with 94 participants. We identified participants by snowball approach through existing child wellbeing and youth networks. We included public health officials, educators, youth workers, government officials, voluntary organisations, and young people. We conducted online focus groups during January and February 2023. The research agency recorded and transcribed focus groups and analysed data thematically according to pre-defined codes.    Results Participants described the importance of working in an environment where the health, social and emotional development of children was a long-term political priority. Participants described examples of good practice, but also felt that action on prevention had been inconsistent and difficult to sustain. Most participants agreed that a range of approaches based on risk were necessary and required input from different agencies. Participants demonstrated different interpretations of prevention concepts. Participants said they were drawing on evidence but differed in what they considered to be evidence and how they brought evidence from diverse sources together. Reported barriers to implementation included a lack of high-quality local data to understand the population at risk. Participants highlighted the challenge of working towards long term goals in a structural environment that was short term and uncoordinated. universal and selective interventions were particularly difficult to sustain. They described how the highly competitive nature of short-term funding led to a disproportionate focus on process indicators. The COVID19 pandemic directly affected the delivery of prevention activities and participants described difficulties in responding to emergent changes in substance use patterns.    Conclusions Structural factors, differing interpretations of evidence and preferences towards certain approaches contributed to an evidence into practice gap. A common framework for substance-use harm prevention that uses a shared language would be of value in Scotland. Future work should consider links to promoting children’s rights and addressing social determinants of health to improve coordination, develop shared outcome indicators and promote the participation of young people.