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This study assessed the mediating role of teachers’ performance-based assessment (PBA) beliefs in the relationship between their PBA knowledge and practices and challenges in PBA practices. Using a descriptive survey design, 426 public senior high teachers in the Cape Coast Metropolis of Ghana were proportionately sampled. Questionnaires were adapted and showed good reliability (knowledge α = .733, beliefs α = .727, practices α = .747 and challenges α = .839). Mediation analysis revealed that teachers’ knowledge predicted PBA practices, with beliefs significantly mediating this relationship. Structural, school-related, and teacher-related challenges, such as inadequate resources, large class sizes, heavy workloads, limited training, and difficulty creating scoring rubrics, were identified as challenges.