Effect of a digital intervention on sexual and reproductive health knowledge, behaviour, and service uptake among university youths in Lagos, Nigeria: a quasi-experimental study.

Résumé

BACKGROUND: Youths in sub-Saharan Africa, particularly Nigeria, face significant barriers to accessing sexual and reproductive health (SRH) information and services because of limited awareness, confidentiality concerns, restrictive policies, and provider attitudes. These barriers contribute to poor SRH knowledge and high rates of HIV infection, unintended pregnancies, and unsafe sexual practices. Digital interventions offer a promising approach to improve SRH outcomes, but evidence of their effectiveness in Nigerian university settings remains limited. This study assessed the impact of a mobile health (mHealth), internet-based, comprehensive sexuality education (CSE) intervention on SRH knowledge, sexual behavior, and service utilization among university students in Lagos, Nigeria.METHODS: A quasi-experimental study was conducted among 600 undergraduate students (300 in intervention group and 300 in control group) who were selected from two public universities in Lagos, Nigeria, via multistage sampling. The intervention consisted of weekly live CSE webinars via Google Meets, peer-led WhatsApp discussions, and digital linkages to youth-friendly SRH services. Quantitative data were collected through self-administered digital questionnaires before and after the intervention. Data analysis included baseline and end-line comparisons via Pearson chi-square tests and difference-in-differences (DID) analysis to estimate intervention effects.RESULTS: At baseline, 57.7% of the participants in the intervention group and 49.7% of the participants in the control group had good knowledge of SRH (p = 0.05). A total of 41.0% of the respondents in the intervention group and 37.0% in the control group had ever had sex, and consistent condom use was low (23.6% in the intervention group and 28.8% in the control group). Only 26.0% of the intervention group and 23.3% of the control group respondents had access to SRH services. Post-intervention, SRH knowledge improved by 10.2% in the intervention group compared with 2.6% in the control group. Condom use during the last sexual encounter increased significantly by 11.7% (from 32.5% to 44.2%, p