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

Abstract

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. 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. 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 < 0.05), in the intervention group but decreased by 7.5% in the control group. Uptake of SRH services in the intervention group rose by 9% (from 26.0% to 35.0%, p < 0.05), alongside increased use of teaching hospitals and primary health care centres (PHCs). Sexual behaviour outcomes were mixed, with some indicators (e.g., multiple sexual partners) worsening post-intervention. The mHealth CSE intervention improved SRH knowledge, increased condom use, and enhanced the utilisation of SRH services among university students. However, its effect on risky sexual behaviours was mixed. For greater effectiveness, digital CSE should be integrated with broader SRH services. Young people in Nigeria often struggle to obtain accurate, youth-friendly sexual and reproductive health (SRH) information and services. This leads to poor knowledge of sexual reproductive health and risky sexual behaviour, which contributes to negative health states such as unwanted pregnancies and sexually transmitted diseases. This study tested whether digital tools such as webinars and WhatsApp chats could help. It involved 600 university students divided into two groups, with one group receiving online education and support and another group not receiving it. After the intervention, the students who received the digital program had better knowledge about SRH, used condoms more often during sex, and visited health facilities for SRH services more frequently. However, some risky behaviours—such as having multiple sexual partners—did not improve and, in some cases, increased. This shows that digital programs help, but they work best when combined with access to real-world health services.