From Taboo to Touchscreen: A Qualitative Study of Digital Sexual and Reproductive Health Intervention for Bangladeshi Adolescents.

Résumé

BACKGROUND: Adolescents in Bangladesh, approximately one-fifth of the total population, face significant challenges accessing relevant sexual and reproductive health (SRH) information, with the added burdens of cultural taboo, limited accessibility, and poor communication channels. Traditional adolescent-friendly approaches have shown limited effectiveness in addressing these challenges. In response, Mukhorito was developed as a peer-led, mobile-based digital platform to facilitate SRH, education, and communication among ninth-grade students.OBJECTIVE: This study explored the feasibility and constraints of piloting the Mukhorito app to enhance adolescent SRH education in Bangladesh. It also sought to determine the self-reported usage, usability, and effect on knowledge and peer communication of the app, as well as to identify implementation and adoption challenges.METHODS: A qualitative design was applied in the context of a broader mixed-methods study. Data were collected through 6 in-depth interviews, 3 key informant interviews, and 1 focus group discussion from 19 participants, including students, peer leaders, teachers, and government representatives, across 3 secondary schools (a boys' school, girls' school, and coeducational school) in the Feni district. Thematic analysis was conducted using NVivo software (QSR International) under Braun and Clarke's guidelines.RESULTS: The Mukhorito app was perceived as a valuable tool to meet the SRH needs of adolescents in Bangladesh owing to its well-structured, easily navigable content with relatable stories. Participants described increased awareness of critical SRH issues, including reproductive health, nutrition, early marriage, violence against adolescents, and drug addiction, and reported sharing this knowledge with their families and communities. The app was seen as creating a safe space to discuss previously taboo SRH topics, reducing cultural reluctance to communicate, and promoting peer-to-peer communication. Interactive sessions were noted to strengthen decision-making skills and leadership qualities. Many users reported feeling more comfortable discussing SRH issues without shyness. However, challenges such as limited smartphone access, unreliable internet connection, and economic factors hindered adoption, especially in rural settings. Participants suggested the integration of the Mukhorito app in school curricula, aligning it with the government adolescent health program, adding visually rich and interactive content (eg, short dramas, videos, and animations), and enabling offline access to address connectivity challenges and maximize the effectiveness of the app.CONCLUSIONS: Mukhorito possesses strong potential as a culturally relevant, digital SRH education tool for Bangladeshi adolescents. The app enabled knowledge and openness in SRH discourse. Alignment with national health programs and enhanced app functionality may promote greater and more sustainable adolescent health.