Associative between mHealth CBT-informed psychoeducational text messaging and substance use among university students: a quasi-experimental study in a low-resource setting

Substance use among university students is a growing public health concern, often contributing to adverse health outcomes and reduced academic performance. This study aimed to examine the association between mHealth CBT-informed psychoeducational text messaging interventions and substance use frequency among undergraduate students at Jimma University, Ethiopia. A quasi-experimental study design was employed, involving 140 students with substance use allocated equally into intervention (n = 70) and control (n = 70) groups by campus. Substances assessed included tobacco, alcohol, cannabis, and khat. Substance use frequency (low/moderate/high) was measured using the validated WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The intervention group received three months of mHealth CBT-informed psychoeducational text messages addressing knowledge and skill-building, while the control group received no study-related text messages, follow-up calls, or mobile credit incentives during the study period. Endline assessment was conducted immediately following the intervention. Ordinal logistic regression was used to assess associations, adjusting for baseline substance use frequency. After adjusting for baseline imbalance (intervention: 82.9% high use vs. control: 45.7%; p < 0.001), the intervention was associated with significantly lower odds of higher substance use frequency (OR = 0.10, 95% CI [0.03-0.31], p < 0.001). Higher self-esteem and low monthly income were also associated with reduced odds (OR = 0.10, p = 0.010), (OR = 0.06, p = 0.013) respectively. The findings suggest that mHealth CBT-informed psychoeducational text messaging intervention was associated with reduced substance use among university students. However, due to the non-randomized design and baseline imbalance, causal inference is limited.