TITLE:
Development and Validation of an Educational Framework to Prevent the Aesthetic Misuse of Cyproheptadine and Dexamethasone among Adolescents Enrolled in Medical Technical Institutes in Kinshasa, Democratic Republic of the Congo: A Three-Round Mixed-Methods Delphi Study
AUTHORS:
Christian Matondo Dianzenza, Guillaume Bofio Bina, Ebuel Mukau, Marie-Claire Omanyondo Ohambe, Emery Kafinga Luzolo
KEYWORDS:
Delphi, Aesthetic Medication Misuse, Cyproheptadine, Dexamethasone, Nursing Education, Competency-Based Education, Adolescents, Kinshasa, Educational Framework
JOURNAL NAME:
Open Journal of Applied Sciences,
Vol.16 No.9,
September
7,
2026
ABSTRACT: Background: The intentional use of medicines to modify physical appearance may expose adolescents to avoidable health risks. In this study, aesthetic medication misuse refers to the intentional use of a medicine primarily to modify body weight, body shape, or another aspect of physical appearance rather than to treat a diagnosed medical condition according to an appropriate therapeutic indication. This concept is distinguished from self-medication, non-prescription medicine use, and off-label use, which are broader or conceptually different medication-use practices. Cyproheptadine and dexamethasone were selected as priority medicines for curricular attention through the expert-consensus process. Their inclusion in the framework should not be interpreted as evidence of population-level prevalence, as the present study did not estimate the prevalence of their use among adolescents in Kinshasa. The objective of this study was to develop and validate a context-specific educational framework aimed at strengthening the competencies of A2 nursing students in preventing the misuse of aesthetic medications among adolescents in Kinshasa. Methods: A three-round mixed-methods Delphi study was conducted between January and April 2026. An initial purposive panel of 15 multidisciplinary experts was recruited; 12 experts completed all three rounds, corresponding to an 80% retention rate. Round 1 used an open-ended semi-structured questionnaire and inductive thematic content analysis to identify the essential components of the educational framework. Rounds 2 and 3 used structured five-point Likert scales. Agreement was defined as the proportion of experts assigning a score of 4 or 5. Consensus was defined a priori as ≥75% agreement. Results: Round 1 identified six major dimensions: the overall purpose of the framework, terminal competency, learning content, teaching strategies, assessment methods, and curricular organization. Round 2 supported pharmacological, psychosocial, behavioral, professional, pedagogical, and theoretical components. In Round 3, all 12 participating experts completed the final validation. The five final validation items generated 58 agreement ratings out of 60 possible ratings, corresponding to an overall agreement of 96.7%. All five items exceeded the predefined 75% consensus threshold. Conclusion: The Delphi process validated the Health, Medicines and Body Image educational framework, organized as a four-year spiral curricular progression for A2 nursing education. The framework integrates pharmacological, psychosocial, behavioral, and professional competencies and emphasizes active teaching and authentic competency-based assessment. The findings represent expert agreement concerning curricular content and structure and should not be interpreted as evidence of the prevalence of aesthetic medication misuse or as evidence that the framework has already changed adolescent medication-use behavior. Further implementation and effectiveness studies are required.