The research team, led by Mary Aku Ogum and including Thomas Hormenu and Edward Wilson Ansah, set out to quantify both the prevalence of risky sexual behaviours and the social and demographic factors that predict them among unmarried, regular undergraduate students. Their motivation was straightforward: university students in Ghana, as in many countries, represent a large, mobile, and socially transitional population. They are typically living away from parental oversight for the first time, navigating new peer environments, and encountering the freedoms and pressures of early adulthood. Studies from universities in multiple countries have shown that this group is more likely to be sexually active and to engage in behaviours with negative consequences for health and academic achievement, making them a priority population for prevention efforts.

Methodologically, the study was ambitious in scale. The researchers conducted a quantitative cross-sectional survey using a multistage sampling procedure to recruit 10,896 undergraduate students, split evenly between 5,448 males and 5,448 females. Data were collected with an adapted questionnaire drawn from the Core Expanded Questions of the Global School-based Student Health Survey, a standardized instrument designed to allow comparison across settings and countries. The team then analyzed responses using frequencies, percentages, and binary logistic regression, a statistical technique that estimates how strongly each candidate factor predicts a binary outcome, in this case whether a student engaged in risky sexual behaviour. The study received ethical approval from the Institutional Review Board of the University of Cape Coast, and every participating student signed an informed consent form before taking part.

The headline numbers are sobering. Of the 10,896 students surveyed, 38.3 percent, or 4,176 individuals, reported being sexually active. Within that sexually active group, the researchers documented a cluster of behaviours that epidemiologists consider high-risk. The most common was condom non-use: 63.7 percent of sexually active students, amounting to 2,661 individuals, reported not using condoms. Nearly half, 45.7 percent or 1,654 students, reported having multiple sexual partners, a pattern that multiplies the number of potential transmission pathways for HIV and other sexually transmitted infections. A substantial 37.2 percent, or 1,552 students, reported using alcohol or drugs in connection with sex, a behaviour known to impair judgment, reduce condom negotiation, and increase the likelihood of unprotected encounters.

Two further findings rounded out the risk profile. Some 16.3 percent of sexually active students, or 682 individuals, reported engaging in anal sex, a practice associated with a heightened biological risk of HIV transmission compared with vaginal intercourse because of the fragility of rectal mucosal tissue. Meanwhile, 12.4 percent, or 520 students, reported an early onset of sexual activity, defined in the study context as first intercourse at a young age. Taken together, these behaviours produced an overall magnitude of risky sexual behaviour of 78.8 percent among sexually active students, meaning 3,291 of the 4,176 sexually experienced respondents reported at least one behaviour placing them at elevated risk. The authors frame this figure as a clear signal that the burden of sexual risk in this population is not confined to a small minority but is a mainstream campus health issue.

Beyond the raw prevalence figures, the study’s regression analysis identified which characteristics predicted risky behaviour. Chronological age emerged as a significant factor, with risk profiles shifting as students moved through their undergraduate years. Religious affiliation also played a measurable role, consistent with a body of literature suggesting that religious identity can shape sexual norms, expectations, and disclosure behaviour among young adults in Ghana. Perhaps most tellingly, the age at first sexual intercourse and the circumstances influencing that first experience predicted later risk-taking, suggesting that early sexual trajectories cast a long shadow over subsequent behaviour during university years.

Living arrangements and family communication completed the predictive picture. The researchers found that who students lived with during their studies influenced their likelihood of engaging in risky behaviour, an intuitive but important result given that residence type shapes supervision, privacy, and peer exposure. Equally significant was the difficulty students reported in discussing sexual issues with their parents. Where parent-child communication about sexuality was strained or absent, students were more likely to engage in risky practices. This finding resonates with a broader public health consensus that open, accurate family communication about sexuality acts as a protective factor, delaying sexual debut and increasing protective behaviours such as condom use when sexual activity does begin.

The implications for intervention are spelled out clearly in the study’s conclusion. The authors argue that public health programmes should incorporate campus-based counselling and peer education, with a particular focus on students who are already sexually experienced. Peer education, in which trained students deliver health information and norm-change messages within their own social networks, has a long track record in HIV prevention because it leverages trust and shared language in ways that top-down messaging often cannot. Counselling services, meanwhile, can address the individual-level drivers of risk, including alcohol use, relationship pressures, and gaps in knowledge about transmission and contraception. The finding that parental communication difficulties predict risk suggests that interventions may also need to reach beyond the campus gates, supporting families in sustaining conversations about sexual health into late adolescence and early adulthood.

The study also situates itself within global health frameworks. The rising prevalence of HIV/AIDS and unintended pregnancies is widely attributed to exactly the behaviours this survey measured: non-use of condoms, alcohol intake before sex, multiple sexual partnerships, early sexual debut, and survival sex. Because university students represent an educated cohort whose health behaviours today shape the health of families and communities tomorrow, the authors argue that securing their well-being is crucial for the overall health and development of society, in line with the United Nations Sustainable Development Goals. In Ghana, where young people constitute a large share of the population, the stakes of translating these findings into policy are considerable.

Caveats are worth noting, as with any cross-sectional survey. The design captures behaviour at a single point in time and cannot establish cause and effect; it shows that age, religious affiliation, early sexual debut, living situation, and parental communication are associated with risky behaviour, not that one directly produces the other. Self-reported data on sexual behaviour are also vulnerable to social desirability bias, particularly on sensitive topics, although the large sample size and use of a validated international instrument strengthen confidence in the overall patterns. The study was conducted at a single public university, so generalization to other institutions or countries should be made cautiously. The authors received no specific funding for the research and declare no competing interests. Even with these limitations, the sheer scale of the survey, nearly eleven thousand respondents balanced by sex, makes it one of the most detailed portraits to date of sexual risk among Ghanaian undergraduates, and its central message is hard to ignore: condom use, partner reduction, and substance-related risk remain stubbornly high on campus, and the levers of change run through families, faith communities, and student peer networks as much as through clinics and lecture halls.

Subject of Research: Prevalence and predictors of risky sexual behaviours among undergraduate university students in Ghana

Article Title: Prevalence and factors influencing risky sexual behaviours among university students in Ghana

Article References: Ogum, M. A., Mintah, J. K., Ogum, P. N., Hormenu, T., & Ansah, E. W. (2026). Prevalence and factors influencing risky sexual behaviours among university students in Ghana. BMC Public Health. https://doi.org/10.1186/s12889-026-29715-w

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29715-w

Keywords: risky sexual behaviour, university students, Ghana, HIV/AIDS, condom non-use, multiple sexual partners, sexually transmitted infections, unintended pregnancy, cross-sectional survey, peer education, parental communication, public health

The intervention, known by its Dutch wordplay name that translates roughly as “They Are Not Mental?!” (TANM), was designed to strengthen the resilience of informal caregivers with a migration background whose loved ones live with a suspected mental illness. It pursued three short-term goals: encouraging open conversations about mental health taboos, improving understanding of mental illnesses and available support, and fostering trust between migrant families and the healthcare sector. The program unfolded in three phases. First, four coordinating organizations recruited and trained voluntary “ambassadors”—peer educators who shared participants’ migration backgrounds and, in some cases, their caregiving experiences. Second, ambassadors facilitated three peer education sessions, delivered in the dominant language of each group, covering mental health and the role of culture, specific conditions such as schizophrenia and depression, and the role of family alongside formal support options. Third, caregivers identified during the sessions could be referred for tailored follow-up support, either in group training or one-on-one consultations with a Family-Experience-Expert, a professional who draws on personal lived experience of caring for someone with mental illness.

What makes the new study methodologically interesting is its realist evaluation design. Rather than simply asking whether TANM succeeded, the researchers, led by Malin H. L. Hollaar of Erasmus University Rotterdam, asked how, for whom, and under what circumstances it worked. Realist evaluation, developed by Pawson and Tilley, models outcomes as the product of Context-Mechanism-Outcome (CMO) configurations: specific contextual conditions activate specific mechanisms, which in turn generate outcomes. The team began with an Initial Program Theory built from twelve interviews and a focus group, then tested and refined it during the 2024–2025 implementation period using 27 semi-structured interviews with ambassadors, participants, and program staff, 10 observations of peer education sessions, and 76 anonymous post-session questionnaires. During this cycle, 11 ambassadors facilitated 11 groups attended by 138 participants, most of them women, with considerable variation in age, cultural background, and caregiving experience. Abductive and retroductive reasoning moved the analysis back and forth between the data, the initial theory, and concepts such as social learning, ultimately producing ten refined CMO-configurations validated in a focus group with the coordinating organizations.

The first cluster of findings concerns the taboo on mental illness itself. Nearly half of the participants—47.3 percent—reported experiencing a taboo around mental illness, with no significant differences between cultural groups, suggesting that shame and silence are not the property of any single community. Yet the degree to which groups became more open varied substantially, and the explanation lay in context. Groups whose ambassadors were already acquainted with participants, shared their language and cultural background, and remained available beyond the formal sessions were noticeably more open and engaged. In unfamiliar groups, conversations stayed reserved. Questionnaire analyses confirmed significant associations between prior acquaintance and the sharing of personal experiences, reinforcing that familiarity is not a soft nicety but a structural condition of disclosure.

The mechanisms behind this openness were fundamentally relational. Ambassadors worked as trusted peers, sharing reliable information while acknowledging alternative explanations for mental illness—including attributions to black magic, divine punishment, or the evil eye—rather than dismissing them. Trust emerged as the prerequisite for everything else, a point program staff emphasized by noting that shame and taboo exist in all cultures, and that the only way around them is building enough comfort for people to speak. Ambassadors deliberately engineered safety: setting explicit confidentiality rules, or encouraging indirect sharing. One ambassador described a participant who asked questions “on behalf of a friend” for two full sessions before revealing in the third that the friend was herself. Another described modeling vulnerability—sharing her own experiences or relatable anecdotes—which could trigger a domino effect of disclosures across the group, provided a basic level of trust was already in place.

The second cluster of findings addressed the bridge between informal family care networks and formal healthcare services. Ambassadors recruited participants through their peer role, enabled by their social capital and connections in both formal and informal networks. Recruitment strategies mattered enormously: ambassadors who drew on their own existing community groups or used one-to-one invitations generated many more referrals to the follow-up support phase than ambassadors who appeared as guest speakers in unfamiliar groups. Cultural alignment even shaped how the intervention was introduced. Some ambassadors framed the sessions as discussions about “taboos” rather than naming mental illness upfront, given the cautiousness such topics provoke. The researchers also found that TANM’s Dutch title lost its stigmatizing-ironic wordplay among non-native speakers—its primary target audience—an unexpected barrier to communication.

Clusters three and four traced the path to actual help-seeking and the unexpected role of social support. Before participants could seek help, many first had to recognize themselves as informal caregivers at all, since in many cultures caregiving is framed as a natural family duty rather than a distinct role, and seeking outside help can feel like failing that duty. Overcoming fear and distrust toward formal institutions—including fear that a child might be removed from the home, or wariness rooted in earlier negative encounters with providers—required trusted, independent-seeming guides such as ambassadors and the Family-Experience-Expert. Knowledge of the Dutch care system was transmitted through shared frames of reference, allowing ambassadors to contextualize advice in culturally recognizable terms; one ambassador explained how she could understand a participant consulting an imam or receiving ruqya, a form of spiritual healing involving Quranic recitation, and build on it rather than dismissing it. Strikingly, the researchers discovered that some participants joined primarily for social connection and emotional support rather than information, revealing a psychosocial spillover effect the intervention’s designers had not anticipated. In some cases, peer contact continued long after the formal sessions ended.

The study’s implications cut two ways. On one hand, the findings demonstrate that “being a peer” is not a fixed identity but a relational position constructed through shared culture, language, religion, or lived experience—which explains why the Family-Experience-Expert, whose similarity to participants was experiential rather than cultural, could build trust just as effectively. The ambassadors’ role modeling aligns closely with Bandura’s social learning theory: participants adopt behaviors when demonstrated by someone perceived as similar to themselves, and continued availability reinforces that change over time. On the other hand, this centrality exposed a structural vulnerability. Ambassadors described their roles as demanding, emotionally taxing, and extending well beyond the intervention period without supervision, structural support, or adequate compensation—a pattern documented previously among peer educators in HIV/AIDS prevention and workplace mental health. The researchers recommend structured support and fair compensation for ambassadors, mechanisms for transferring the Family-Experience-Expert’s experiential knowledge rather than concentrating it in a single person, and recruitment through ambassadors’ own groups or individual invitations rather than guest-speaking arrangements.

Perhaps the most sobering conclusion is that even a well-designed, culturally sensitive intervention cannot close the gap alone. Persistent structural barriers—language difficulties, jargon-heavy communication, culturally insensitive practices, and negative past experiences with care professionals—continued to shape participants’ trust and help-seeking, and these lie largely beyond the scope of any peer education program. The authors are explicit that interventions like TANM are a necessary but partial response, effective only when accompanied by system-level investment in culturally sensitive communication and care practices. Future evaluations, they argue, should track longer-term outcomes such as resilience and sustained help-seeking, and researchers working with underserved groups should ask whether the barriers lie within communities or within the research approaches themselves. For migrant caregivers navigating stigma, fear, and family expectations, the study suggests that the most powerful lever remains deceptively simple: someone like them, available over time, who understands both languages—the literal one and the cultural one.

Subject of Research: Realist evaluation of a peer education intervention supporting migrant informal caregivers of people with mental illness in Rotterdam.

Article Title: Navigating Stigma and Support: Realist Evaluation of Support for Migrant Informal Caregivers of Loved Ones with Mental Illness

Article References: Hollaar, M. H. L., Buis, P., Smedts, M., Uysal-Bozkir, Ö., Kocken, P. L., & Denktaş, S. (2026). Navigating Stigma and Support: Realist Evaluation of Support for Migrant Informal Caregivers of Loved Ones with Mental Illness. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01728-0

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01728-0

Keywords: informal caregivers, migration background, mental illness, peer education, realist evaluation, stigma, trust, resilience, help-seeking, culturally sensitive care, social support, Rotterdam