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Digital interventions for adolescent and young adult sexual and reproductive health knowledge and behaviour: A systematic review (2017–2023)
ABSTRACT
Background:
Digital platforms provide accessible innovative solutions to bridge gaps in sexual and reproductive health (SRH) for adolescents and young adults. Given barriers to high-quality, evidence-based SRH education, digital interventions offer promising strategies to enhance knowledge and influence behaviour, supporting universal SRH access goals.
Objective:
This systematic review synthesizes evidence on the impact of digital SRH innovations on behaviour and knowledge.
Methods:
Five reviewers independently searched PubMed and Embase (June 1st, 2017–April 15th, 2023) for studies on digital SRH innovations for adolescents and young adults (10-30 years). Of 11,156 citations screened, 112 studies were included. Given heterogeneity in methods and outcomes, findings were narratively synthesized. Study quality was assessed using the Newcastle-Ottawa Scale, Cochrane Risk of Bias Tool 2, and Cochrane Risk of Bias in Non-randomized Studies – of Interventions Tool.
Results:
112 studies reported data from 50,658 individuals across 24 countries with most studies conducted in the United States (US; 66.1%, 74/112). Studies evaluated mobile applications (n=24), web-based interventions (n=22), text messaging (n=18), multimodal interventions (n=14), websites (n=11), games (n=9), videos (n=7), telehealth (n=3), and other digital interventions (n=4). Randomized controlled trials (RCTs) and pilot RCTs comprised 65.2% (73/112) of studies, while 34.8% (39/112) were quasi-experimental, cross-sectional, or cohort studies. Behavioural outcomes were reported in 78 studies (69.6%) and knowledge in 70 studies (62.5%). Multimodal interventions, combining at least two digital components to deliver SRH content, proved most effective. A trial demonstrated increased pre-exposure prophylaxis adherence (Mean 0.02 to 0.05, possible range: 0-1, P<.001) and reduced condom use errors (Mean 4.04 to 3.70, possible range: 0-9, P<.05). General SRH knowledge improved in all studies where assessed (38.6%, 27/70), with increases ranging from 8.1%-76.0% reported in Nicaragua, Thailand, and the United States. Behavioural changes varied, with notable United States-based trials reporting increased STI testing (P=.016), improved contraception and condom use (IRR=1.39 [95% CI 1.09–2.11]), higher clinic attendance and follow-up (aOR=1.6 [1.1–2.3], P=.01), and reduced sexual risk-taking (PR=0.83 [0.70–0.99], P=.04). Quality varied across studies.
Conclusions:
Digital interventions improve SRH knowledge, while promoting safer behaviours among adolescents and young adults. Future research should prioritize large-scale trials with culturally tailored approaches for broader impact. While these tools demonstrated significant promise, wide variability in outcomes underscores the need for a standardized evaluation framework that will ensure reliable reporting and comparisons across studies to steer normative guidance. Clinical Trial: PROSPERO CRD42021258889
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