Improving the capacity of teachers to teach Family Life and HIV Education (FLHE) in Nigeria through mobile technology: a randomized controlled trial

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To help address these problems, the government introduced a school program called Family Life and HIV Education (FLHE). This program is meant to provide adolescents with important information and skills to protect their health. However, many teachers do not receive enough training to deliver the curriculum effectively, mostly due to limited resources and the high cost of in-person training. This study tested whether using mobile phone apps could help train teachers more efficiently. We worked with secondary schools in Ibadan-North, Oyo State, and divided them into three groups. One group received in-person training, another used a mobile app for training, and the third group received no training. The study looked at how much teachers learned and how confident they felt about teaching the curriculum. The results showed that both the in-person and mobile app trainings helped teachers improve their knowledge and teaching confidence. However, teachers who used the mobile app were better at retaining what they learned over time compared to the other groups. This suggests that mobile technology can be just as effective as traditional training and possibly even better for long-term learning. It also has the advantage of being easier to scale up, especially in areas with fewer resources. This study supports the use of mobile learning tools to improve how teachers are trained to deliver sexuality education in Nigeria and similar contexts. Adolescent Health mHealth Comprehensive Sexuality Education Teacher training Mobile application Background Adolescents represent a significant proportion of the global population, particularly in low- and middle- income countries, where they often face substantial health and developmental challenges (1,2). Sexual and reproductive health issues, including HIV/AIDS and other sexually transmitted infections (STIs), remain prominent concerns for this age group(3,4). Educational interventions, particularly through schools, are a critical avenue for addressing these challenges. Comprehensive Sexuality Education (CSE), which integrates information on human development, relationships, life skills, and health, has been identified as a key strategy for equipping adolescents with the knowledge and skills they need to make informed decisions about their sexual and reproductive health(5,6). In Nigeria, the Family Life and HIV Education (FLHE) curriculum was introduced in 2003 by the Federal Ministry of Education as a school-based HIV prevention intervention. It was designed to provide adolescents with critical health education through trained teachers(7). Despite the proven effectiveness of the FLHE curriculum (8,9), significant challenges have hindered its full implementation (10). A major barrier is the inadequate training and capacity of teachers to deliver the curriculum effectively (11). Traditional face-to-face training approaches, though widely used and effective, are resource-intensive, time-consuming, and difficult to scale, particularly in resource-constrained settings(12–14). Furthermore, the sustainability of knowledge and skills gained through these methods is often limited. Recent advancement in digital technology offers promising alternatives for addressing these challenges. Digital tools, including mobile applications and online platforms, provide opportunities for scalable, flexible, and potentially more sustainable teacher training solutions (15–18). Mobile-based interventions have gained traction as an innovative approach to addressing systemic barriers in education and healthcare delivery(19–21). Studies have shown that technology, such as virtual reality, online platforms, and AI, can significantly enhance teacher training by providing innovative and interactive learning experiences (17). Digital tools offer several advantages, including scalability, flexibility, and interactivity, which can bridge the gaps in teacher training and resource accessibility. Studies have also shown that use of digital tools in teacher training can improve teaching effectiveness of teachers (ref). A systematic review concluded that interactive technologies hold substantial potential in transforming teacher education in Africa (22). These findings collectively underscore the potential of technology, including mobile-based technology, to transform teacher education generally, including for CSE. Building on this growing body of evidence and considering the challenges in teacher capacity in the delivery of CSE, this study sought to assess the efficacy of digital tools in improving teachers’ knowledge and capacity to deliver the FLHE curriculum in school. Using a randomized controlled trial (RCT) design, teachers were randomized into one of three groups: a traditional face-to-face group (standard group), a digital tools-based training group (experimental group), or a control group. By comparing the outcomes across the three arms, the research aimed to provide robust evidence on the comparative effectiveness of mobile-based and traditional face-to-face training approaches. This study is particularly timely given the growing reliance on digital solutions in education and public health. By addressing critical gaps in teacher training, the findings are expected to inform the design of future intervention that harness mobile technology to strengthen FLHE delivery in Nigeria and beyond. Methodology This study was designed to compare the effectiveness of the traditional didactic face-to-face approach and the use of a mobile application on the knowledge, and self-reported capacity to teach Family Life and HIV Education among teachers. Study design This study employed a multi-phase, cluster-randomised controlled trial (RCT) design to evaluate the efficacy of a mobile application in enhancing the capacity of teachers to deliver Family Life and HIV Education (FLHE) in secondary schools in Ibadan-North Local Government Area (LGA), Oyo state, Nigeria. The trial was registered at the Pan-Africa Clinical Trial registry (PACTR202206840350306). Details of the methodology of this study have been published in another paper(23). This study was conducted in three phases: phase one surveyed eligible schools and collected information from stakeholders on the feasibility of a mobile app in building the knowledge and capacity of teachers. Phase two involved the development of the mobile application and the adaptation of the FLHE teachers’ training curriculum for the mobile application. The evaluation questions for this study were also pretested during phase two. Phase three involved the implementation of the intervention. Evaluation of the study was designed to be conducted pre-intervention, immediately after the last training session (assessment 1), one-month after (assessment 2), and three-months after intervention (assessment 3). Participants Participants for this study were teachers in public/government funded junior secondary schools in Ibadan North Local Government Area. A total of 46 teachers per arm was calculated as minimum sample size for this study. Using a proportion of teachers who felt students were too young to be taught about sexuality and HIV in a previous study(24), assuming a minimum difference of 30% between pre and post intervention proportions, and adding 10% for loss to follow up, an approximate number of participants per group was derived. Eligibility criteria for schools: The school must be a public/government funded schools Have knowledge of the FLHE program, with the head of school able to confirm that the teachers are aware of FLHE being part of the curriculum. The schools must have at least 10 eligible teachers that can participate in the study The head of school must consent to the study and willing to allow teachers participate in the study Eligibility criteria for teachers: Teachers currently employed in government – owned (public) secondary schools within the selected LGA. Teachers teaching at least one subject designated as part of the FLHE curriculum. Certified, experienced (at least one year teaching the course/subject), and full -time teachers. Intervention procedures The details of the intervention procedures are published in a previous methodology paper. This trial had three arms: control, standard, and mobile app groups. The control group received a one-time in-person training on how to communicate with adolescents. The standard group received a four weeks (four hours a week) in-person training sessions on FLHE. The mobile app group received an initial one-time in-person training on how to use the mobile app, followed by a four-week online training on FLHE through the mFLHE app designed. The Mobile application The mFLHE mobile app was developed to facilitate structured educational engagement among the teachers (participants) and between teachers and moderators by providing a platform for accessing curriculums, taking assessments, and enabling communication. The app was specifically designed for Android devices and requires limited internet connectivity to function effectively. It allows participants to access weekly curriculum content, engage in discussions, download lesson documents (for offline access), and communicate in real-time with both peers and moderators. Moderators, on the other hand, could create and manage weekly topics, upload relevant curriculum documents, broadcast information, and monitor participant engagement. Moderators have additional administrative capabilities such as creating and managing participant accounts. Functional features included user account creation, authentication, week and subject configuration, document upload and viewing, real-time chat, and push notifications. The development stack consisted of Flutter and Dart, with Android Studio serving as the primary IDE. An Agile development approach was used, focusing on iterative sprints and feature-driven implementation. For state management, the Bloc pattern was employed to maintain predictable and scalable handling of user interactions and application state. The development workflow involved converting UI/UX prototypes into functional Flutter interfaces, implementing navigation logic, creating API service layers, and integrating these components to ensure seamless user experience. As part of the quality assurance process, standard testing procedures were carried out to ensure the app met both functional expectations and industry best practices. Each feature underwent unit and integration testing to validate performance and stability. Firebase Crashlytics was used to detect and log crashes, enabling thorough debugging and verification before features were marked as complete. During this process, an early challenge was encountered when the 1GB daily download limit on Firebase’s free-tier cloud storage was exceeded, resulting in failed document downloads. This was resolved by enabling Firebase billing and introducing a bandwidth control strategy, which involved disabling access to future weekly content until it became relevant. To maintain compliance with standard mobile development practices, efforts were made to secure user data, handle errors gracefully, and ensure responsive UI performance across supported devices. Additionally, since the app was not published on the Google Play Store (to restrict access during the research period), updates were not distributed automatically. Instead, updated APKs were stored on a secure file server, and download links were shared with users to manually install new versions. This manual update process ensured that post-deployment bugs could be addressed promptly, while also allowing for controlled rollout and continuous improvement of the app. Data collection Measurement of variables Knowledge of FLHE: This variable was assessed using a 20-item true/false scale. Each correct answer was awarded one point, while incorrect answers received zero points. The highest possible score was 20 points. A cut-off score of 50% (10points) was used to categorize knowledge levels. Scores of 10 and above indicated good knowledge, whereas scores below 10 were designated as poor knowledge. Self-reported capacity: This variable was measured using a 9-item scale, with responses graded from “Always” to “Not Sure” (Always, Sometimes, Never, Not Sure). The highest obtainable score was 18 points. A cut-off score of 9 points was used to differentiate between good capacity and poor capacity. Data analysis In this study, a comprehensive statistical analysis was conducted to examine the data. Descriptive statistics, including frequencies, percentages, and means, were calculated to summarize the characteristics of the participants. For inferential analysis, both bivariate and multivariate techniques were employed. Bivariate analysis was performed using chi-square tests, T-tests, and ANOVA to explore associations and differences between variables. Additionally, logistic regression analysis was conducted to identify predictors and assess for significant differences while controlling for confounders. These methods provided a robust framework for understanding the relationships within the data and drawing meaningful conclusions from the study findings. Ethical considerations The study received approval from the Oyo State Ministry of Education. Additionally, permission was obtained from the Association of School Principals in the state. Ethical approval was granted by the Oyo State Research Ethics Review Committee (approval number: AD/13/479/4276 B ) and the University of Ibadan/University College Hospital Ethics Review Committee (approval number: UI/EC/21/0521). Following these approvals, eligible schools were approached. The head teacher (principal) of each school was briefed on the study’s purpose and given the opportunity to consent to their school’s participation. The principals for each of the selected/consenting schools were blinded to the group assignments. Participants provided informed consent after the trial details were explained to them. Teachers were also blinded to the involvement of other groups. Results Participant characteristics Table one presents the socio-demographic characteristics of participants across the groups across the data collection period. Participants across the groups were mostly similar throughout the course of the study. At inception, there were 47, 48, and 50 participants recruited to participate as control, standard and mobile groups participants. This remained largely the same across the period of the study, except for one participant that was lost to follow up after the intervention period. Further, 3 participants in control group also missed data collection at different points after the initial data collection. The data from these three participants were not included in the data analysis. Table 1 Participants’ socio-demographic Characteristics Groups Subgroup Pre-intervention Immediate post-intervention One-month post-intervention Three-months post intervention Control* 47 47 46 46 Standard* 48 48 48 48 Mobile 50 50 50 50 Gender Control Male 19 19 19 19 Female 25 25 25 25 Standard Male 15 15 15 15 Female 33 33 33 33 Mobile app Male 17 17 17 17 Female 33 33 33 33 Have Teenage child Control Yes 31 31 31 31 Standard Yes 28 30 30 31 Mobile app Yes 32 32 32 32 Mean (SD) Mean (SD) Mean (SD) Mean (SD) Age Control 44.8 (8.3) 44.8 (8.5) 44.8 (8.5) 44.8 (8.5) Standard 42.0 (7.9) 42.2 (7.8) 42.2 (9.6) 42.7 (7.8) Mobile app 43.2 (9.9) 43.2 (10.1) 43.2 (10.2) 43.5 (10.0) Average number of classes per week Control 17.38 (7.9) 18.25 (8.6) 18.25 (7.2) 17.7 (7.3) Standard 16.7 (7.1) 17.0 (7.1) 16.9 (7.4) 16.8 (7.4) Mobile app 17.6 (6.3) 18.0 (6.1) 18.2 (6.2) 18.0 (6.9) Number of years in service Control 14.2 (9.9) 14.2 (9.9) 14.3 (10.2) 14.3 (10.2) Standard 10.9 (9.2) 10.9 (9.2) 11.8 (9.6) 11.8 (9.6) Mobile app 13.4 (10.9) 13.4 (10.9) 13.8 (10.7) 13.8 (10.9) * Three teachers in control and two teachers selected to participate in standard groups did not show up on the day of the intervention . Knowledge of FLHE Table two shows the proportion of participants with good knowledge of FLHE. Knowledge was categorized as good or poor using the mean score within the group as the cut-off point. Highest obtainable score was 20. Within each group there was significant increase in knowledge among standard and mobile group participants in the immediate post intervention period. However, mobile group participants had significant increase in knowledge one month and three months after intervention. Across the groups, in comparison to control groups, mobile participants reported significantly higher knowledge scores one month and three months after intervention (Table 3 ). Table 2 Knowledge of FLHE within groups across time Group/ Intervention period Pre-Intervention N(%) Immediate post intervention N(%) One month after N(%) Three months after N(%) Control Good knowledge 17 (38.6) 26 (59.1) 22 (50.0) 21 (47.7) Standard Good knowledge 27 (56.3) 37 (77.1) * 31 (64.6) 30 (62.5) Mobile App Good knowledge 25 (50.0) 36 (72.0) * 35 (70.0) * 35 (70.0) * *Significant at p < 0.05 Table 3 Knowledge Comparison between groups across time Group Pre-interventions Immediate post intervention One month post intervention Three months post intervention Control 1 1 1 1 Standard 2.04 (0.89–4.70) 2.3 (0.95–5.74) 1.8 (0.79–4.21) 1.8 (0.80–4.19) Mobile group 1.6 (0.70–3.61) 1.8 (0.75–4.21) 2.3 (1.00–5.44) * 2.6 (1.10–5.96) * *Significant at p < 0.05 Self-reported capacity to teach FLHE As compared to baseline scores, the capacity of all participants increased significantly at one-month post intervention. However, while this capacity of participants in control group decreased at three-months post intervention, the capacity of standard and mobile group participants increased was still significantly higher at three-months as compared to the post intervention (Table 4 ). Across the groups, as compared to the control group, the self-reported capacity of participants in the standard and mobile app group were significantly higher at three-months post intervention (Table 5 ). There was no significant difference in the self-reported capacity of standard and mobile group participants across the period of the study. Table 4 Self-reported Capacity Group Pre-Intervention Immediate post intervention One month after Three months after Control Good capacity 11 (25.0) 19 (43.2) 20 (45.5) * 18 (40.9) Standard Good capacity 20 (41.7) 27 (56.3) 30 (62.5) * 32 (66.7) * Mobile app Good capacity 23 (46.0) 30 (60.0) 33 (66.0) * 33 (66.0) * Table 5 Self-reported capacity Comparison between groups across time Group Pre-interventions Immediate post intervention One month post intervention Three months post intervention Control 1 1 1 1 Standard 2.1 (0.88–5.23) 1.69 (0.74–3.86) 2.0 (0.87–4.60) 2.9 (1.24–6.75) * Mobile group 2.6 (1.06–6.16) * 1.97 (0.87–4.49) 2.33 (1.01–5.36) * 2.8 (1.21–6.49) * Discussion This study assessed the effectiveness of using mobile technology to improve teachers’ knowledge and capacity to deliver FLHE compared to the traditional face-to-face training method. The findings provide valuable insights into the potential of digital tools as an alternative to traditional teaching methods, especially in resource-low settings. Knowledge of FLHE across groups There was significant increase in knowledge among participants in both the standard and mobile app groups as compared to the control immediately after the intervention. However, knowledge was significantly higher among standard group as compared to mobile app group. Notably, while knowledge declined slightly over time in both intervention groups, the mobile app group maintained significantly better knowledge retention at one-and-three-month post intervention compared to the control. This suggests that mobile technology has the potential to sustain knowledge over a longer period, due to its flexibility and the fact that participants can revisit materials at their own time and pace. The sustained knowledge in the mobile app group can be attributed to the accessibility of the app, which allowed participants to review content repeatedly at their convenience. According to the constructivist learning theory (CLT), learners can build their understanding through active engagement with content(25,26). The continuous engagement with content may have helped participants build their knowledge. The mobile app encouraged teachers to actively engage with the FLHE curriculum at their own pace. The interactive elements of the app (discussion forums, quizzes) supported experiential learning, aligning with the CLT. This study provides evidence that digital tools can enhance learning by fostering interaction and active participation. In contrast, the decline in knowledge among the standard group participants over time may highlight the limitations of the traditional didactic approach, where once the training ends, opportunities for reinforcement are minimal. Published reviews have highlighted the fact that one of training does not work in improving the capacity of teachers to teach FLHE (27). These findings underscore the need for ongoing engagement and the potential value of digital tools in addressing this gap. The significant difference between the intervention groups at immediately after intervention and the sustained knowledge among participants in mobile app group, show a complimentary opportunity. While the face-to-face approach may be better at providing participants with significantly better knowledge, the mobile apps have the unique ability to sustain knowledge among participants. Studies have shown that a blended approach could yield a more significant results than either online or face-to-face approach alone (18,28). Self-reported teaching capacity Self-reported capacity to deliver FLHE improved significantly in both the standard and mobile app intervention groups, with no significant differences between the two. This suggests that mobile applications are equally as effective as traditional face-to-face training in building teachers’ confidence and perceived capability to deliver FLHE. A similar finding has been reported in studies that utilised digital platforms or online means to build capacity of teachers (15,29–32). A 2023 systematic review comparing the effectiveness of face-to-face versus online delivery of continuing professional development for science teachers reported that there is a comparable effectiveness between use of online media and face-to- face. The review reported that the effectiveness of both modes was largely influenced by similar external factors(31). Despite the similarities in capacity outcomes, the mobile app group’s consistent performance overtime suggests that mobile tools may provide more consistent reinforcement of training concepts. The sustained increase in capacity, despite slight knowledge declines, suggests that hands-on practice and interaction with the training materials could have played a crucial role in reinforcing participants’ confidence. Teachers in both intervention groups may have had opportunities to apply what they learned in their teaching environments, leading to the consolidation of skills and capacity over time. This finding highlights the importance of practical application in translating knowledge into confidence and capability. Studies have shown that while face-to-face training events may be more valued and perceived as having better quality and engagement(16,33), online communities provide valuable resources and support for curriculum issues and can be more effective in conceptual understanding and overall teacher satisfaction(29,33). Implications of the findings The result of this study adds to the body of literature that confirms that mobile app-based training method is not only effective but also offers unique advantages over the traditional training approach. The accessibility and self-paced nature of the mobile app allowed participants to learn at their own convenience, which may have contributed to the better knowledge retention observed in the mobile group. Further, the digital platform’s multimedia capabilities (the audio-visual content) was a unique feature in the app tested and may have likely enhanced engagement and comprehension. The inclusion of a discussion forum also allowed for peer-to-peer learning, allowing for further discussions and engagement with the materials. The mobile app’s comparable effectiveness to face-to-face training has significant implications for scalability and sustainability. Mobile technology can overcome logistical challenges such as limited infrastructure, travel costs, and scheduling conflicts, which often hinder traditional training methods(13,14). This is particularly relevant in resource-constrained settings like Nigeria, where access to consistent training opportunities is limited. The findings have several broader implications. Mobile applications offer a scalable and cost-effective solution to teacher training, particularly in regions where traditional workshops are logistically challenging. The adaptability of mobile platforms allows for the inclusion of culturally relevant materials and supports learning at the teachers’ convenience. These tools also enable ongoing professional development by providing refresher modules and updates, addressing the issue of knowledge decline observed in this and other studies. Limitations and Future Directions While the study highlights the effectiveness of mobile technology, it is important to consider potential challenges. Participants in the mobile app group may have benefited for the novelty of the digital platform, which could have influenced their engagement and motivation. Long-term studies are needed to assess whether the observed benefits are sustained over extended periods. Additionally, while this study focused on knowledge and self-reported capacity, future research could explore the impact of these training methods on actual teaching practices and student outcomes. Understanding how these approaches influence classroom delivery and adolescent learning will provide a more comprehensive evaluation of their effectiveness. In this study, participants were provided with mobile phones and internet services, highlighting the need for future research to assess the real-world application of these methods for scaling purposes. Conducting implementation research to evaluate the scalability of these approaches is essential. Conclusion Conclusively, this study provides strong evidence that mobile technology is a viable and effective alternative to traditional face-to-face training for improving teachers’ knowledge and capacity to deliver FLHE. The sustained knowledge retention observed in the mobile group highlights the unique advantages of digital tools in promoting long-term learning. As education systems increasingly seek scalable and innovative solutions, mobile technology offers a promising pathway for enhancing teacher training, particularly in resource-constrained settings. Future interventions should focus on integrating periodic refresher training and exploring the broader impacts of these methods on educational outcomes. Abbreviations FLHE Family Life and HIV Education mFLHE Mobile Family Life and HIV Education RCT Randomized Controlled Trial LGA Local Government Authority ANOVA Analysis of Variance Declarations Ethics approval and consent to participate: Ethical approval was granted by the Oyo State Research Ethics Review Committee (approval number: AD/13/479/4276 B ) and the University of Ibadan/University College Hospital Ethics Review Committee (approval number: UI/EC/21/0521). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Funding: Funding for this project was provided by the Fogarty International Center and the National Institute of Child Health & Human Development (NICHD) of the National Institutes of Health under Award Number D43TW010543. Author Contribution EA conceptualized the study with significant input from AO, AO, and WF. EA and AA were involved in data management and analysis. All authors were involved in data interpretation. EA wrote the first draft of the paper with inputs from all authors. All authors read the final draft of the paper. Acknowledgement The authors would like to acknowledge Halimat Olaniyan and Babatunde Oluwagbayela who supported the data collection process. Data Availability The datasets used and analysed during the current study are available from the corresponding author on reasonable request. References Jakobsson C, Sanghavi R, Nyamiobo J, Maloy C, Mwanzu A, Venturo-Conerly K, et al. Adolescent and youth-friendly health interventions in low-income and middle-income countries: a scoping review. BMJ Glob Health [Internet]. 2024 Sep 5 [cited 2025 Jan 30];9(9):e013393. Available from: https://gh.bmj.com/content/9/9/e013393 Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. The Lancet [Internet]. 2016 Jun [cited 2017 Mar 30];387(10036):2423–78. 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Available from: https://www.mdpi.com/2227-7102/14/11/1188 Adebayo E, Olaniyan HO, Olumide AO, Ogunniyi A, Fawzi W. Use of mobile technology to enhance the capacity of teachers to teach family life and HIV education in Nigeria: Overview of methods for a randomized controlled trial. Dialogues Health. 2023 Dec 1;2:100110. Dlamini N, Okoro F, Ekhosuehi UO, Esiet A, Lowik AJ, Metcalfe K. Vol. 16, African journal of reproductive health. 2012 [cited 2020 Oct 12]. p. 87–102 Empowering teachers to change youth practices: evaluating teacher delivery and responses to the FLHE programme in Edo State, Nigeria. Available from: https://pubmed.ncbi.nlm.nih.gov/22916546/ Mugambi M. Linking Constructivism Theory to Classroom Practice. Int J Humanit Soc Sci Educ [Internet]. 2018 [cited 2025 Jun 2];5(9):96–104. Available from: https://www.arcjournals.org/pdfs/ijhsse/v5-i9/14.pdf Wadsworth BarryJ. Piagets Theory of Cognitive and Effective Devolopment: The foundations of Constructivism. Vol. 9, Trends in Cognitive Sciences. 1995. 69–74 p. Chandra-Mouli V, Lane C, Wong S, Bankole A, Blum RW, Brady M, et al. What does not work in adolescent sexual and reproductive health: A review of evidence on interventions commonly accepted as best practices. Glob Health Sci Pract. 2015;3(3):333–40. Delfino M, Persico D. Online or face-to-face? Experimenting with different techniques in teacher training. J Comput Assist Learn [Internet]. 2007 [cited 2025 Jun 10];23(5):351–65. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2729.2007.00220.x Binmhsen S, Abrahams I. Science teachers’ continuing professional development: online vs face-to-face. Res Sci Technol Educ [Internet]. 2022 [cited 2025 Jun 10];40(4). Available from: https://www.tandfonline.com/doi/full/10.1080/02635143.2020.1785857 Fishman B, Konstantopoulos S, Kubitskey BW, Vath R, Park G, Johnson H, et al. Comparing the Impact of Online and Face-to-Face Professional Development in the Context of Curriculum Implementation. J Teach Educ [Internet]. 2013 Nov 1 [cited 2025 Jun 10];64(5):426–38. Available from: https://doi.org/10.1177/0022487113494413 Li Z, Hassan NC, Jalil HA. The Effectiveness of Face-to-Face versus Online Delivery of Continuing Professional Development for Science Teachers: A Systematic Review. Educ Sci [Internet]. 2023 Dec [cited 2025 Jun 10];13(12):1251. Available from: https://www.mdpi.com/2227-7102/13/12/1251 Russell M, Carey R, Kleiman G, Venable JD. FACE-TO-FACE AND ONLINE PROFESSIONAL DEVELOPMENT FOR MATHEMATICS TEACHERS: A COMPARATIVE STUDY. Online Learn [Internet]. 2009 [cited 2025 Jun 10];13(2). Available from: https://olj.onlinelearningconsortium.org/index.php/olj/article/view/1669 Sentance S, Humphreys S. Online vs Face-To-Face Engagement of Computing Teachers for their Professional Development Needs. In: Brodnik A, Vahrenhold J, editors. Informatics in Schools Curricula, Competences, and Competitions [Internet]. Cham: Springer International Publishing; 2015 [cited 2025 Jun 10]. p. 69–81. (Lecture Notes in Computer Science; vol. 9378). Available from: http://link.springer.com/10.1007/978-3-319-25396-1_7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7012994","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498788916,"identity":"59f20faf-c546-4141-a326-9f73dfaede02","order_by":0,"name":"Emmanuel Adebayo","email":"data:image/png;base64,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","orcid":"","institution":"University of Ibadan","correspondingAuthor":true,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Adebayo","suffix":""},{"id":498788917,"identity":"d41edb9e-f2d1-4173-9375-4b8a7fa45bbd","order_by":1,"name":"Adedamola Adebayo","email":"","orcid":"","institution":"Independent Consultant","correspondingAuthor":false,"prefix":"","firstName":"Adedamola","middleName":"","lastName":"Adebayo","suffix":""},{"id":498788919,"identity":"81d48974-f046-44b0-86b5-da5d8768a67b","order_by":2,"name":"Adesola Olumide","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Adesola","middleName":"","lastName":"Olumide","suffix":""},{"id":498788920,"identity":"3e37c6af-dbbb-4ac6-862e-7812a4341d8b","order_by":3,"name":"Adesola Ogunniyi","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Adesola","middleName":"","lastName":"Ogunniyi","suffix":""},{"id":498788921,"identity":"21ede30c-163b-4cdc-a904-eb40927f4f1d","order_by":4,"name":"Wafaie Fawzi","email":"","orcid":"","institution":"Harvard T.H. Chan School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Wafaie","middleName":"","lastName":"Fawzi","suffix":""}],"badges":[],"createdAt":"2025-06-30 17:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7012994/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7012994/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99233357,"identity":"a9bdbfca-607d-44b0-8ea7-9fce97942089","added_by":"auto","created_at":"2025-12-30 12:41:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":941870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7012994/v1/caceef45-b5fb-4821-aa73-1c70fc0573e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving the capacity of teachers to teach Family Life and HIV Education (FLHE) in Nigeria through mobile technology: a randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eAdolescents represent a significant proportion of the global population, particularly in low- and middle- income countries, where they often face substantial health and developmental challenges (1,2). Sexual and reproductive health issues, including HIV/AIDS and other sexually transmitted infections (STIs), remain prominent concerns for this age group(3,4). Educational interventions, particularly through schools, are a critical avenue for addressing these challenges. Comprehensive Sexuality Education (CSE), which integrates information on human development, relationships, life skills, and health, has been identified as a key strategy for equipping adolescents with the knowledge and skills they need to make informed decisions about their sexual and reproductive health(5,6).\u003c/p\u003e\u003cp\u003eIn Nigeria, the Family Life and HIV Education (FLHE) curriculum was introduced in 2003 by the Federal Ministry of Education as a school-based HIV prevention intervention. It was designed to provide adolescents with critical health education through trained teachers(7). Despite the proven effectiveness of the FLHE curriculum (8,9), significant challenges have hindered its full implementation (10). A major barrier is the inadequate training and capacity of teachers to deliver the curriculum effectively (11). Traditional face-to-face training approaches, though widely used and effective, are resource-intensive, time-consuming, and difficult to scale, particularly in resource-constrained settings(12–14). Furthermore, the sustainability of knowledge and skills gained through these methods is often limited. Recent advancement in digital technology offers promising alternatives for addressing these challenges. Digital tools, including mobile applications and online platforms, provide opportunities for scalable, flexible, and potentially more sustainable teacher training solutions (15–18).\u003c/p\u003e\u003cp\u003eMobile-based interventions have gained traction as an innovative approach to addressing systemic barriers in education and healthcare delivery(19–21). Studies have shown that technology, such as virtual reality, online platforms, and AI, can significantly enhance teacher training by providing innovative and interactive learning experiences (17). Digital tools offer several advantages, including scalability, flexibility, and interactivity, which can bridge the gaps in teacher training and resource accessibility. Studies have also shown that use of digital tools in teacher training can improve teaching effectiveness of teachers (ref). A systematic review concluded that interactive technologies hold substantial potential in transforming teacher education in Africa (22). These findings collectively underscore the potential of technology, including mobile-based technology, to transform teacher education generally, including for CSE.\u003c/p\u003e\u003cp\u003eBuilding on this growing body of evidence and considering the challenges in teacher capacity in the delivery of CSE, this study sought to assess the efficacy of digital tools in improving teachers’ knowledge and capacity to deliver the FLHE curriculum in school. Using a randomized controlled trial (RCT) design, teachers were randomized into one of three groups: a traditional face-to-face group (standard group), a digital tools-based training group (experimental group), or a control group. By comparing the outcomes across the three arms, the research aimed to provide robust evidence on the comparative effectiveness of mobile-based and traditional face-to-face training approaches.\u003c/p\u003e\u003cp\u003eThis study is particularly timely given the growing reliance on digital solutions in education and public health. By addressing critical gaps in teacher training, the findings are expected to inform the design of future intervention that harness mobile technology to strengthen FLHE delivery in Nigeria and beyond.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study was designed to compare the effectiveness of the traditional didactic face-to-face approach and the use of a mobile application on the knowledge, and self-reported capacity to teach Family Life and HIV Education among teachers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This study employed a multi-phase, cluster-randomised controlled trial (RCT) design to evaluate the efficacy of a mobile application in enhancing the capacity of teachers to deliver Family Life and HIV Education (FLHE) in secondary schools in Ibadan-North Local Government Area (LGA), Oyo state, Nigeria. The trial was registered at the Pan-Africa Clinical Trial registry (PACTR202206840350306). Details of the methodology of this study have been published in another paper(23).\u003c/p\u003e\u003cp\u003eThis study was conducted in three phases: phase one surveyed eligible schools and collected information from stakeholders on the feasibility of a mobile app in building the knowledge and capacity of teachers. Phase two involved the development of the mobile application and the adaptation of the FLHE teachers’ training curriculum for the mobile application. The evaluation questions for this study were also pretested during phase two. Phase three involved the implementation of the intervention. Evaluation of the study was designed to be conducted pre-intervention, immediately after the last training session (assessment 1), one-month after (assessment 2), and three-months after intervention (assessment 3).\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants for this study were teachers in public/government funded junior secondary schools in Ibadan North Local Government Area. A total of 46 teachers per arm was calculated as minimum sample size for this study. Using a proportion of teachers who felt students were too young to be taught about sexuality and HIV in a previous study(24), assuming a minimum difference of 30% between pre and post intervention proportions, and adding 10% for loss to follow up, an approximate number of participants per group was derived.\u003c/p\u003e\u003cp\u003eEligibility criteria for schools:\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe school must be a public/government funded schools\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHave knowledge of the FLHE program, with the head of school able to confirm that the teachers are aware of FLHE being part of the curriculum.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe schools must have at least 10 eligible teachers that can participate in the study\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe head of school must consent to the study and willing to allow teachers participate in the study\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eEligibility criteria for teachers:\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTeachers currently employed in government – owned (public) secondary schools within the selected LGA.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTeachers teaching at least one subject designated as part of the FLHE curriculum.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCertified, experienced (at least one year teaching the course/subject), and full -time teachers.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003cb\u003eIntervention procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe details of the intervention procedures are published in a previous methodology paper. This trial had three arms: control, standard, and mobile app groups. The control group received a one-time in-person training on how to communicate with adolescents. The standard group received a four weeks (four hours a week) in-person training sessions on FLHE. The mobile app group received an initial one-time in-person training on how to use the mobile app, followed by a four-week online training on FLHE through the mFLHE app designed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Mobile application\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mFLHE mobile app was developed to facilitate structured educational engagement among the teachers (participants) and between teachers and moderators by providing a platform for accessing curriculums, taking assessments, and enabling communication. The app was specifically designed for Android devices and requires limited internet connectivity to function effectively. It allows participants to access weekly curriculum content, engage in discussions, download lesson documents (for offline access), and communicate in real-time with both peers and moderators. Moderators, on the other hand, could create and manage weekly topics, upload relevant curriculum documents, broadcast information, and monitor participant engagement. Moderators have additional administrative capabilities such as creating and managing participant accounts.\u003c/p\u003e\u003cp\u003eFunctional features included user account creation, authentication, week and subject configuration, document upload and viewing, real-time chat, and push notifications. The development stack consisted of Flutter and Dart, with Android Studio serving as the primary IDE. An Agile development approach was used, focusing on iterative sprints and feature-driven implementation. For state management, the Bloc pattern was employed to maintain predictable and scalable handling of user interactions and application state. The development workflow involved converting UI/UX prototypes into functional Flutter interfaces, implementing navigation logic, creating API service layers, and integrating these components to ensure seamless user experience.\u003c/p\u003e\u003cp\u003eAs part of the quality assurance process, standard testing procedures were carried out to ensure the app met both functional expectations and industry best practices. Each feature underwent unit and integration testing to validate performance and stability. Firebase Crashlytics was used to detect and log crashes, enabling thorough debugging and verification before features were marked as complete. During this process, an early challenge was encountered when the 1GB daily download limit on Firebase’s free-tier cloud storage was exceeded, resulting in failed document downloads. This was resolved by enabling Firebase billing and introducing a bandwidth control strategy, which involved disabling access to future weekly content until it became relevant.\u003c/p\u003e\u003cp\u003eTo maintain compliance with standard mobile development practices, efforts were made to secure user data, handle errors gracefully, and ensure responsive UI performance across supported devices. Additionally, since the app was not published on the Google Play Store (to restrict access during the research period), updates were not distributed automatically. Instead, updated APKs were stored on a secure file server, and download links were shared with users to manually install new versions. This manual update process ensured that post-deployment bugs could be addressed promptly, while also allowing for controlled rollout and continuous improvement of the app.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurement of variables\u003c/b\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKnowledge of FLHE: This variable was assessed using a 20-item true/false scale. Each correct answer was awarded one point, while incorrect answers received zero points. The highest possible score was 20 points. A cut-off score of 50% (10points) was used to categorize knowledge levels. Scores of 10 and above indicated good knowledge, whereas scores below 10 were designated as poor knowledge.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSelf-reported capacity: This variable was measured using a 9-item scale, with responses graded from “Always” to “Not Sure” (Always, Sometimes, Never, Not Sure). The highest obtainable score was 18 points. A cut-off score of 9 points was used to differentiate between good capacity and poor capacity.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eIn this study, a comprehensive statistical analysis was conducted to examine the data. Descriptive statistics, including frequencies, percentages, and means, were calculated to summarize the characteristics of the participants. For inferential analysis, both bivariate and multivariate techniques were employed. Bivariate analysis was performed using chi-square tests, T-tests, and ANOVA to explore associations and differences between variables. Additionally, logistic regression analysis was conducted to identify predictors and assess for significant differences while controlling for confounders. These methods provided a robust framework for understanding the relationships within the data and drawing meaningful conclusions from the study findings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study received approval from the Oyo State Ministry of Education. Additionally, permission was obtained from the Association of School Principals in the state. Ethical approval was granted by the Oyo State Research Ethics Review Committee (approval number: AD/13/479/4276\u003csup\u003eB\u003c/sup\u003e) and the University of Ibadan/University College Hospital Ethics Review Committee (approval number: UI/EC/21/0521). Following these approvals, eligible schools were approached. The head teacher (principal) of each school was briefed on the study’s purpose and given the opportunity to consent to their school’s participation. The principals for each of the selected/consenting schools were blinded to the group assignments. Participants provided informed consent after the trial details were explained to them. Teachers were also blinded to the involvement of other groups.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eParticipant characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable one presents the socio-demographic characteristics of participants across the groups across the data collection period. Participants across the groups were mostly similar throughout the course of the study. At inception, there were 47, 48, and 50 participants recruited to participate as control, standard and mobile groups participants. This remained largely the same across the period of the study, except for one participant that was lost to follow up after the intervention period. Further, 3 participants in control group also missed data collection at different points after the initial data collection. The data from these three participants were not included in the data analysis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; socio-demographic Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubgroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImmediate post-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOne-month post-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThree-months post intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile app\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave Teenage child\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile app\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.8 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.8 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.8 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44.8 (8.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.0 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.2 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.2 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.7 (7.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMobile app\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.2 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.2 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43.2 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43.5 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAverage number of classes per week\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.38 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.25 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.25 (7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.7 (7.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.7 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.0 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.9 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.8 (7.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMobile app\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.6 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.0 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.2 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.0 (6.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of years in service\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.2 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.2 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.3 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.3 (10.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.9 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.9 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.8 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.8 (9.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMobile app\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.4 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.4 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.8 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.8 (10.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e* Three teachers in control and two teachers selected to participate in standard groups did not show up on the day of the intervention\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnowledge of FLHE\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable two shows the proportion of participants with good knowledge of FLHE. Knowledge was categorized as good or poor using the mean score within the group as the cut-off point. Highest obtainable score was 20. Within each group there was significant increase in knowledge among standard and mobile group participants in the immediate post intervention period. However, mobile group participants had significant increase in knowledge one month and three months after intervention. Across the groups, in comparison to control groups, mobile participants reported significantly higher knowledge scores one month and three months after intervention (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge of FLHE within groups across time\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup/ Intervention period\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-Intervention N(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImmediate post intervention N(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOne month after N(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThree months after N(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (38.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26 (59.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21 (47.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37 (77.1) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e31 (64.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e30 (62.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile App\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36 (72.0) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e35 (70.0) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e35 (70.0) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge Comparison between groups across time\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-interventions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImmediate post intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOne month post intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThree months post intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.04 (0.89\u0026ndash;4.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3 (0.95\u0026ndash;5.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.8 (0.79\u0026ndash;4.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8 (0.80\u0026ndash;4.19)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.6 (0.70\u0026ndash;3.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8 (0.75\u0026ndash;4.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.3 (1.00\u0026ndash;5.44) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.6 (1.10\u0026ndash;5.96) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eSelf-reported capacity to teach FLHE\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs compared to baseline scores, the capacity of all participants increased significantly at one-month post intervention. However, while this capacity of participants in control group decreased at three-months post intervention, the capacity of standard and mobile group participants increased was still significantly higher at three-months as compared to the post intervention (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Across the groups, as compared to the control group, the self-reported capacity of participants in the standard and mobile app group were significantly higher at three-months post intervention (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). There was no significant difference in the self-reported capacity of standard and mobile group participants across the period of the study.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSelf-reported Capacity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-Intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImmediate post intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOne month after\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThree months after\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19 (43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20 (45.5) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e18 (40.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e30 (62.5) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e32 (66.7) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile app\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30 (60.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33 (66.0) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e33 (66.0) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSelf-reported capacity Comparison between groups across time\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-interventions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImmediate post intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOne month post intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThree months post intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.1 (0.88\u0026ndash;5.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.69 (0.74\u0026ndash;3.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.0 (0.87\u0026ndash;4.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.9 (1.24\u0026ndash;6.75) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMobile group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6 (1.06\u0026ndash;6.16) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.97 (0.87\u0026ndash;4.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.33 (1.01\u0026ndash;5.36) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.8 (1.21\u0026ndash;6.49) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the effectiveness of using mobile technology to improve teachers\u0026rsquo; knowledge and capacity to deliver FLHE compared to the traditional face-to-face training method. The findings provide valuable insights into the potential of digital tools as an alternative to traditional teaching methods, especially in resource-low settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnowledge of FLHE across groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere was significant increase in knowledge among participants in both the standard and mobile app groups as compared to the control immediately after the intervention. However, knowledge was significantly higher among standard group as compared to mobile app group. Notably, while knowledge declined slightly over time in both intervention groups, the mobile app group maintained significantly better knowledge retention at one-and-three-month post intervention compared to the control. This suggests that mobile technology has the potential to sustain knowledge over a longer period, due to its flexibility and the fact that participants can revisit materials at their own time and pace.\u003c/p\u003e\u003cp\u003eThe sustained knowledge in the mobile app group can be attributed to the accessibility of the app, which allowed participants to review content repeatedly at their convenience. According to the constructivist learning theory (CLT), learners can build their understanding through active engagement with content(25,26). The continuous engagement with content may have helped participants build their knowledge. The mobile app encouraged teachers to actively engage with the FLHE curriculum at their own pace. The interactive elements of the app (discussion forums, quizzes) supported experiential learning, aligning with the CLT. This study provides evidence that digital tools can enhance learning by fostering interaction and active participation. In contrast, the decline in knowledge among the standard group participants over time may highlight the limitations of the traditional didactic approach, where once the training ends, opportunities for reinforcement are minimal. Published reviews have highlighted the fact that one of training does not work in improving the capacity of teachers to teach FLHE (27). These findings underscore the need for ongoing engagement and the potential value of digital tools in addressing this gap.\u003c/p\u003e\u003cp\u003e The significant difference between the intervention groups at immediately after intervention and the sustained knowledge among participants in mobile app group, show a complimentary opportunity. While the face-to-face approach may be better at providing participants with significantly better knowledge, the mobile apps have the unique ability to sustain knowledge among participants. Studies have shown that a blended approach could yield a more significant results than either online or face-to-face approach alone (18,28).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelf-reported teaching capacity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSelf-reported capacity to deliver FLHE improved significantly in both the standard and mobile app intervention groups, with no significant differences between the two. This suggests that mobile applications are equally as effective as traditional face-to-face training in building teachers\u0026rsquo; confidence and perceived capability to deliver FLHE. A similar finding has been reported in studies that utilised digital platforms or online means to build capacity of teachers (15,29\u0026ndash;32). A 2023 systematic review comparing the effectiveness of face-to-face versus online delivery of continuing professional development for science teachers reported that there is a comparable effectiveness between use of online media and face-to- face. The review reported that the effectiveness of both modes was largely influenced by similar external factors(31).\u003c/p\u003e\u003cp\u003eDespite the similarities in capacity outcomes, the mobile app group\u0026rsquo;s consistent performance overtime suggests that mobile tools may provide more consistent reinforcement of training concepts. The sustained increase in capacity, despite slight knowledge declines, suggests that hands-on practice and interaction with the training materials could have played a crucial role in reinforcing participants\u0026rsquo; confidence. Teachers in both intervention groups may have had opportunities to apply what they learned in their teaching environments, leading to the consolidation of skills and capacity over time. This finding highlights the importance of practical application in translating knowledge into confidence and capability. Studies have shown that while face-to-face training events may be more valued and perceived as having better quality and engagement(16,33), online communities provide valuable resources and support for curriculum issues and can be more effective in conceptual understanding and overall teacher satisfaction(29,33).\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications of the findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe result of this study adds to the body of literature that confirms that mobile app-based training method is not only effective but also offers unique advantages over the traditional training approach. The accessibility and self-paced nature of the mobile app allowed participants to learn at their own convenience, which may have contributed to the better knowledge retention observed in the mobile group. Further, the digital platform\u0026rsquo;s multimedia capabilities (the audio-visual content) was a unique feature in the app tested and may have likely enhanced engagement and comprehension. The inclusion of a discussion forum also allowed for peer-to-peer learning, allowing for further discussions and engagement with the materials.\u003c/p\u003e\u003cp\u003eThe mobile app\u0026rsquo;s comparable effectiveness to face-to-face training has significant implications for scalability and sustainability. Mobile technology can overcome logistical challenges such as limited infrastructure, travel costs, and scheduling conflicts, which often hinder traditional training methods(13,14). This is particularly relevant in resource-constrained settings like Nigeria, where access to consistent training opportunities is limited.\u003c/p\u003e\u003cp\u003eThe findings have several broader implications. Mobile applications offer a scalable and cost-effective solution to teacher training, particularly in regions where traditional workshops are logistically challenging. The adaptability of mobile platforms allows for the inclusion of culturally relevant materials and supports learning at the teachers\u0026rsquo; convenience. These tools also enable ongoing professional development by providing refresher modules and updates, addressing the issue of knowledge decline observed in this and other studies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations and Future Directions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile the study highlights the effectiveness of mobile technology, it is important to consider potential challenges. Participants in the mobile app group may have benefited for the novelty of the digital platform, which could have influenced their engagement and motivation. Long-term studies are needed to assess whether the observed benefits are sustained over extended periods.\u003c/p\u003e\u003cp\u003eAdditionally, while this study focused on knowledge and self-reported capacity, future research could explore the impact of these training methods on actual teaching practices and student outcomes. Understanding how these approaches influence classroom delivery and adolescent learning will provide a more comprehensive evaluation of their effectiveness.\u003c/p\u003e\u003cp\u003eIn this study, participants were provided with mobile phones and internet services, highlighting the need for future research to assess the real-world application of these methods for scaling purposes. Conducting implementation research to evaluate the scalability of these approaches is essential.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eConclusively, this study provides strong evidence that mobile technology is a viable and effective alternative to traditional face-to-face training for improving teachers\u0026rsquo; knowledge and capacity to deliver FLHE. The sustained knowledge retention observed in the mobile group highlights the unique advantages of digital tools in promoting long-term learning. As education systems increasingly seek scalable and innovative solutions, mobile technology offers a promising pathway for enhancing teacher training, particularly in resource-constrained settings. Future interventions should focus on integrating periodic refresher training and exploring the broader impacts of these methods on educational outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFLHE Family Life and HIV Education\u003c/p\u003e\u003cp\u003emFLHE Mobile Family Life and HIV Education\u003c/p\u003e\u003cp\u003eRCT Randomized Controlled Trial\u003c/p\u003e\u003cp\u003eLGA Local Government Authority\u003c/p\u003e\u003cp\u003eANOVA Analysis of Variance\u003c/p\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003eEthical approval was granted by the Oyo State Research Ethics Review Committee (approval number: AD/13/479/4276\u003csup\u003eB\u003c/sup\u003e) and the University of Ibadan/University College Hospital Ethics Review Committee (approval number: UI/EC/21/0521).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eFunding for this project was provided by the Fogarty International Center and the National Institute of Child Health \u0026amp; Human Development (NICHD) of the National Institutes of Health under Award Number D43TW010543.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEA conceptualized the study with significant input from AO, AO, and WF. EA and AA were involved in data management and analysis. All authors were involved in data interpretation. EA wrote the first draft of the paper with inputs from all authors. All authors read the final draft of the paper.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to acknowledge Halimat Olaniyan and Babatunde Oluwagbayela who supported the data collection process.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJakobsson C, Sanghavi R, Nyamiobo J, Maloy C, Mwanzu A, Venturo-Conerly K, et al. Adolescent and youth-friendly health interventions in low-income and middle-income countries: a scoping review. BMJ Glob Health [Internet]. 2024 Sep 5 [cited 2025 Jan 30];9(9):e013393. 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(Lecture Notes in Computer Science; vol. 9378). Available from: http://link.springer.com/10.1007/978-3-319-25396-1_7\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescent Health, mHealth, Comprehensive Sexuality Education, Teacher training, Mobile application","lastPublishedDoi":"10.21203/rs.3.rs-7012994/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7012994/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAdolescents in Nigeria face several sexual and reproductive health issues, such as HIV/AIDS and other sexually transmitted infections. To help address these problems, the government introduced a school program called Family Life and HIV Education (FLHE). This program is meant to provide adolescents with important information and skills to protect their health. However, many teachers do not receive enough training to deliver the curriculum effectively, mostly due to limited resources and the high cost of in-person training. This study tested whether using mobile phone apps could help train teachers more efficiently. We worked with secondary schools in Ibadan-North, Oyo State, and divided them into three groups. One group received in-person training, another used a mobile app for training, and the third group received no training. The study looked at how much teachers learned and how confident they felt about teaching the curriculum. The results showed that both the in-person and mobile app trainings helped teachers improve their knowledge and teaching confidence. However, teachers who used the mobile app were better at retaining what they learned over time compared to the other groups. This suggests that mobile technology can be just as effective as traditional training and possibly even better for long-term learning. It also has the advantage of being easier to scale up, especially in areas with fewer resources. This study supports the use of mobile learning tools to improve how teachers are trained to deliver sexuality education in Nigeria and similar contexts.\u003c/p\u003e","manuscriptTitle":"Improving the capacity of teachers to teach Family Life and HIV Education (FLHE) in Nigeria through mobile technology: a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-13 03:47:53","doi":"10.21203/rs.3.rs-7012994/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"683ccc3d-a505-41ae-90f9-1e7c3162460b","owner":[],"postedDate":"August 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T12:38:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-13 03:47:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7012994","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7012994","identity":"rs-7012994","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}