Mobile Life Skills Education Adoption Among Internally Displaced Persons in Northern Nigeria and Health Systems Implications for Equitable Mental Health Support: A cross-sectional study

Introduction Internally displaced persons (IDPs) face significant mental health challenges amidst severely disrupted health systems. Digital interventions offer promising pathways to deliver psychosocial support, yet critical gaps remain in understanding what determines their acceptability and adoption among vulnerable populations in conflict settings.

This study investigates the sociodemographic, psychosocial, technological, and cultural determinants of interest in mobile-based life skills education (mLSE) among IDPs in Nigeria, integrating four theoretical frameworks to generate actionable insights for equitable digital mental health service delivery in fragile settings.

We analyzed cross-sectional data from 220 IDPs in the Durumi and Wassa camps of Abuja, Nigeria. Variable selection employed elastic net regression, identifying 22 key predictors. Modified robust Poisson regression estimated prevalence ratios for mLSE interest, with interaction effects modeled to capture demographic intersectionalities.

Among participants, 48.6% expressed interest in mLSE, with significant disparities across age, education, and camp location. Young adults aged 20-24 with prior counseling experience showed substantially higher interest (APR=3.49, 95% CI 1.72-7.10), while males with counseling history demonstrated markedly lower engagement (APR=0.33, 95% CI 0.19-0.57). Secondary education strongly predicted interest (APR=2.27, 95% CI 1.59-3.26), as did residence in the Wassa camp (APR=1.64, 95% CI 1.21-2.23). Notably, males aged 30-34 exhibited minimal interest (APR=0.09, 95% CI 0.01-0.75), revealing critical gender-age intersections.

These findings reveal actionable patterns for strengthening digital mental health service delivery in displacement settings. Health systems in fragile contexts must develop digitally delivered interventions that are culturally responsive, gender-sensitive, and age-appropriate, while addressing educational and technological barriers. Leveraging prior service engagement appears critical for sustainable implementation. This study provides a roadmap for policymakers and implementers to design equitable digital mental health interventions that address the disparate needs of displaced populations. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work is supported by Creating Hope in Conflict: a Humanitarian Grand Challenge; a partnership of the United States Agency for International Development (USAID), the Foreign, Commonwealth & Development Office, United Kingdom of Great Britain and Northern Ireland (FCDO), the Stabilisation and Humanitarian Aid Department, Ministry of Foreign Affairs, of the Netherlands (NL MFA), and His Majesty the King in right of Canada (His Majesty) represented by the Minister for International Development of Global Affairs Canada acting through The Department of Foreign Affairs, Trade and Development of Global Affairs Canada (DFATD) with support from Grand Challenges Canada [grant number R-HGC-POC-2408-67370]; and the Government of Canada, Canadian Institutes of Health Research, Institute of Population and Public Health [grant number PAA-192178]. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The National Health Research Ethics Committee of Nigeria (NHREC/01/01/2007 18/01/2024) gave ethical approval for this work. The Health Sciences Research Ethics Board of Dalhousie University (REB# 2024 7085) gave ethical approval for this work. Informed consent was obtained from all participants before their inclusion in the study. Participants were fully informed of the study objectives, procedures, risks, and benefits, as well as their right to withdraw at any time without penalty. All collected data were handled with confidentiality, and no personally identifiable information will be published or shared. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data availability All data supporting the article will be available upon reasonable request from the first and corresponding author.