Perceptions of young people in the Democratic Republic of Congo on the factors influencing their intention to use mobile health applications for comprehensive sex education: A descriptive qualitative study

BackgroundYoung peoples access to quality comprehensive sex education (CSE) is crucial to promoting their health and well-being. This access remains limited in the Democratic Republic of Congo, despite increasing use by young people of smartphones and social media, which does not lead to structured access to digital CSE. In this context, mobile health applications represent a promising solution, as they complement interpersonal CSE by providing confidential, accessible and culturally appropriate learning. However, few studies have explored young peoples perceptions of the factors influencing their intention to use such an application. The purpose of this study is to fill this gap with young people interviewed in the city of Bukavu. MethodsA descriptive qualitative study was conducted with 21 students recruited by purposive sampling from eight public secondary schools in Bukavu. Development of the interview guide was informed by the Unified Theory of Acceptance and Use of Technology. Semi-structured, face-to-face individual interviews were conducted until thematic saturation was reached, with audio recordings analyzed using Braun and Clarkes inductive thematic approach, supported by MAXQDA Pro 24.8.0 software. ResultsSix themes and twenty interrelated subthemes emerged: (i) intention to use based on personal need; (ii) structural, economic and psychosocial barriers; (iii) adaptive financial strategies for accessing digital CSE; (iv) the positive influences of families and peers; (v) perceived educational usefulness of the applications; and (vi) perceived conditions for digital engagement. The young people expressed a need for reliable information. They develop ingenious access strategies to offset the cost of mobile data, smartphones and repeated power outages. Their intention is also based on financial and technical support from friends and family. They perceive such applications as useful, especially in the context of a humanitarian crisis. Their perceived engagement depends on ease of use, familiarity with digital technologies, information reliability and offline access. ConclusionsThis study enriches the field of digital health by showing that the intention to use CSE applications is based on both favourable perceptions and facilitating and adaptive conditions, including perceived educational benefits, innovative access strategies and a mobilizing social environment. It highlights the need to co-design, with young people, solutions tailored to their needs to guide the development of realistic digital interventions that are sensitive to the local context. Author SummaryIn this study, we sought to understand what motivates--or discourages--young people in Bukavu, in the Democratic Republic of Congo, from using mobile health applications to learn about the body, relationships, and infection prevention, adolescent pregnancy, and violence. We met with 21 students from eight public secondary schools and asked them, in individual interviews, what they expected from such tools. First and foremost, the young people expressed a strong need for reliable information on sexual health, provided discretely, especially since these topics are rarely discussed at school or in the home. They also described very real obstacles: the cost of an Internet connection, smartphone availability, repeated power outages, fear of coming across inappropriate content, and concerns about confidentiality. They reported some ingenious strategies for overcoming these obstacles, such as saving money, taking small paid jobs, using their neighbours Wi-Fi and connecting to an external battery. Our findings demonstrate that a truly useful mobile health application must be simple, accessible offline, inexpensive, and tailored to local conditions. They also suggest that the best way to achieve this is to design such solutions in collaboration with young people, so that the solutions meet their needs and reflect the reality of their daily lives.