Adolescent Knowledge, Acceptance, Uptake, and Challenges of Telemedicine for Sexual Reproductive Health in Lagos, Nigeria: A Cross-Sectional Study

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Nakato, Sheila A. Okoroanyanwu, Olumide Akinwale Adedapo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6348228/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Low utilization of sexual and reproductive health (SRH) services among adolescents in sub-Saharan African countries has contributed to the high prevalence of adverse sexual and reproductive health outcomes, such as increased rates of sexually transmitted infections, teenage pregnancies, and limited use of modern contraception methods. In the last decade, telehealth has emerged as a tool to address barriers to SRH services, such as service availability, affordability, and distance to care—but despite its growing ubiquity, research on the usability and effectiveness of tele- health remains limited. This study assessed adolescents’ knowledge, acceptability, and challenges in using telemedicine for SRH services in Lagos, Nigeria. Methods: We conducted a cross-sectional study of adolescents aged 16-19 years from four public institutions of higher learning in Lagos, Nigeria. Self-administered paper-based questionnaires were used to assess study participant’s SRH-related characteristics. Descriptive analyses and risk ratios examined differences by age, gender, parental income, religion, sexual activity, and previous use of SRH care. Results: Among 505 students, 77% reported being sexually active. Knowledge of telemedicine for SRH care was reported by 25% (CI: 21, 29), but only 5% (CI: 3, 7) had ever used it. Fifty-two percent (CI: 47, 56) expressed willingness to use telemedicine, and 77% (CI: 73, 81) would recommend it to a peer. Sexually active participants had higher knowledge, uptake, and acceptability. Those who sought SRH care in the past 12 months were more likely to use telemedicine (Risk Ratio [RR (95% CI)]: 4.8 (2.2, 10.7)). Higher parental income was linked to increased telemedicine uptake. The most cited benefits of using telemedicine were ease of access (55%) and respect for privacy (50%). Challenges included concerns about virtual consultations (41%), internet access (15%), and affordability (14%). Conclusion : Despite limited knowledge and uptake of telemedicine for SRH care, adolescents expressed a strong willingness to use it. Creating awareness of the existence and feasibility of accessing care through telemedicine among adolescents and addressing barriers such as cost, and internet access is key to increasing its uptake. Sexual and Reproductive Health Care Adolescents Telehealth Lagos Nigeria Africa Barriers to care Plain English Summary Access to sexual and reproductive health (SRH) services is a challenge for adolescents in sub-Saharan Africa, contributing to a high rate of sexually transmitted infections, teenage pregnancy, and low contraceptive use. Telemedicine, the use of technology to provide healthcare remotely, has emerged as a potential solution to improve access to SRH services. However, little is known about its use among adolescents in Lagos, Nigeria. This study aimed to understand adolescents’ knowledge, acceptance, and challenges in using telemedicine for SRH services. We conducted a cross-sectional survey in June 2023 us- ing paper-based questionnaires among students from the four main public universities in Lagos, Nigeria. Our findings revealed that knowledge and uptake of telemedicine for SRH were generally low, with sexu- ally active adolescents and those from high-income families having higher uptake and acceptance of these services. Many participants were unaware that SRH services could be accessed through telemedicine, highlighting a gap in knowledge and exposure to digital healthcare platforms. The participants reported several challenges to using telemedicine for SRH care. These included concerns about affordability, limited internet accessibility, and doubts about telemedicine’s ability to address certain medical conditions. We used a convenience sample, meaning that participants were selected based on accessibility rather than randomly. This may limit how well our findings represent the broader adolescent population in Lagos. Addressing affordability, internet access, and knowledge barriers could improve adolescent SRH service delivery through telemedicine. Background With a population of over 200 million people, Nigeria has a large need for quality health care. Timely access to specialized health care, especially for the most vulnerable groups including adolescents, is needed. Of great public health concern is the high prevalence of sexually transmitted infections, such as HIV, and unintended pregnancies among adolescents, in sub-Saharan Africa, including Nigeria [1, 2]. Each of these outcomes is strongly associated with unprotected sexual activities [3]. Data on SRH outcomes in Nigeria highlight the importance of finding interventions to reduce risk among adolescents [4]. At 576 maternal deaths per 100,000 live births, Nigeria accounts for roughly 14 percent of the global burden of maternal mortality [4]. Teenage girls aged between 15 and 19 years old have higher rates of maternal mortality and morbidity than older women [4, 5]. Data shows that the average age at sexual debut is roughly 15 years of age among adolescent mothers in Nigeria [6–8]. A study on SRH services for adolescents in Enugu (a state in Nigeria) found that most SRH services were available and geographically accessible, but very few were financially accessible to adolescents [9]. Further, while in-person healthcare facilities provide an important setting for adolescents to access accurate SRH preventive information, testing, and treatment services, adolescents’ use of these facilities has remained low [10] due to fear of stigmatization, negative attitudes of healthcare providers towards adolescents seeking SRH care, and a lack of age-appropriate and adolescent-centered services [11–14]. The COVID-19 pandemic caused widespread disruption to essential health service provision in low- and middle-income countries, including SRH services [15, 16]. This presented a strong need for more flexible options for adolescents to access SRH care to alleviate the risks of unplanned pregnancy and sexually transmitted infections [17–19]. Telemedicine was adopted as a means to provide healthcare ser- vices under several pandemic-imposed restrictions [20]. Telemedicine has been useful in reducing health delivery inequalities by allowing for remote consultation, monitoring, and management of chronically ill patients [21, 22]. Smartphone penetration in Nigeria is forecasted to reach approximately 60% by 2025 [23]. This presents an incredible opportunity to bring more affordable and accessible SRH services to the adolescent population through telemedicine. Despite the dire need to improve access to sexual reproductive health care among adolescents in Nigeria and the potential benefits of leveraging telemedicine to bridge the gap between adolescents and care providers, little is known about the use of telemedicine in Nigeria among this demographic. This study aimed to identify the knowledge, uptake, and acceptability of telemedicine as a means of accessing SRH care among adolescents in Lagos, Nigeria. Methods Study Design and Study Participants We conducted a cross-sectional descriptive study of adolescents using self-administered paper-based questionnaires. Participants were selected from four public institutions of higher learning: Lagos State University, University of Lagos, Lagos State University of Science and Technology, and Yaba College of Technology. The study population included enrolled students aged between 16–19 years with access to mobile phones who consented to participate. The study was conducted in June 2023. Recruitment We used a convenience sampling method where trained research assistants approached students in pre- degree and freshman classrooms from across different faculties, at freshman dormitories, and residence halls. Information about the study was given after assessing eligibility. Prior to administering the questionnaire, a signed informed consent was obtained for participants who were 18 years of age and older and signed assent was obtained for participants younger than 18 years. Voluntary participation and confidentiality of participant information were emphasized. Assent language was tailored to the reading and comprehension level of the study population which included minors. Data Collection and Analysis Data was collected using a paper-based questionnaire in English which was the common language of instruction amongst the study participants. Basic demographic data was collected on age (coded continuously, in years), sex (coded dichotomously as female or male), area of study (STEM or non-STEM), religion, region of origin, and parental income. Additionally, we collected data on sexual activity and prior SHR care-seeking behavior. We also collected data on knowledge, attitude, and uptake of telemedicine. The 32-question survey was approved by the Committee for Protection of Human Subjects at the University of California, Berkeley, and by the Nigerian Institute of Medical Research in Lagos, Nigeria. After collection, data were transcribed into a spreadsheet and stored on a secured drive. We evaluated each participant’s knowledge, uptake, and acceptance of SRH care, as well as the challenges faced when using telemedicine for SRH services. For all key measures—knowledge, uptake, and acceptance—responses were coded as “yes” = 1 and “no” = 0. Knowledge was assessed by asking participants if they were aware that telemedicine could be used to access SRH care, followed by a question inviting them to name some telemedicine platforms they knew to better understand their knowledge. Uptake was measured by asking whether they had ever used telemedicine for SRH care and inviting them to specify the form of telemedicine they used and why they chose to use it. To assess acceptance, participants were asked if they would use telemedicine for SRH care access, along with questions exploring their reasons for using or not using telemedicine, how much they were willing to pay for it, and their preferred modes of access. The survey tool is included in the appendix. To understand how knowledge, uptake, and acceptance differed by participant characteristics, we calculated the proportion and its 95% confidence interval (CI) of participants that had each outcome (knowledge, uptake, or acceptance) separately for each respondent characteristic. We also used two- way tables to calculate risk ratios (RR) to determine the association between knowledge, uptake, and acceptance of telemedicine with participant characteristics such as age, sex, religion, sexual activity, and previous SHR-seeking behavior. Results Five hundred and eleven individuals were surveyed. Two participants who were citizens of other countries were excluded from the analysis. We also excluded four others due to cell sparsity for a total sample size of five hundred and five participants (Table 1 ). The participants were nearly equally divided between the female and male genders and had a median age of 18 years. Seventy-four percent of the participants were from the western region of Nigeria, which includes the state of Lagos. Seventy-seven percent were Christians, which is a dominant religion in this region, and 77% reported being sexually active. Seventy- two percent of the participants did not answer the question about the number of sexual partners. Among those who responded, 83% reported having one sexual partner and 17% reported having multiple partners at the time of the study. Only 26% had ever sought SRH care. Of these individuals, 59% had sought SRH care more than once in the last 12 months. Table 1 : Sociodemographic characteristics of study participants from four higher education institutions in Lagos State, Nigeria (2023) Knowledge, uptake, and acceptability Overall, 25% (CI: 21%, 29%) of the participants reported knowledge of telemedicine for SRH care, and 5% (3% 7%) reported having used telemedicine for SRH care (Table 2). Fifty-two percent (47%, 56%) of the participants reported that they would use telemedicine to access SRH care. The proportion of participants with knowledge of SRH care was similar across gender, age group (younger than 18 years of age vs. 18 and older), religion, region of origin, sexual activity, and prior seeking of SRH care, with some exceptions. Sexually active participants had more knowledge (Risk ratio [RR]: 1.3 [0.8, 2.0]), uptake (RR: 2.0 [0.6, 6.6]), and acceptance (RR: 1.2 [1.0, 1.5]) of SRH care compared to non-sexually active participants. Participants with parental income in the highest category reported more uptake of telemedicine (RR: 1.6 [0.3, 7.7]) than those in lower income categories. STEM participants reported lower uptake (RR: 0.4 [0.2, 1.0]) of telemedicine for SRH care than non-STEM, while participants with knowledge of SRH care was similar across gender, age group (younger than 18 years of vs. 18 and older), religion, region of origin, sexual activity, and prior seeking of SRH care, with some exceptions. Sexually active participants had more knowledge (Risk ratio [RR]: 1.3 [0.8, 2.0]), uptake (RR: 2.0 [0.6, 6.6]), and acceptance (RR: 1.2 [1.0, 1.5]) of SRH care compared to non-sexually active participants. Participants with parental income in the highest category reported more uptake of telemedicine (RR: 1.6 [0.3, 7.7]) than those in lower income categories. STEM participants reported lower uptake (RR: 0.4 [0.2, 1.0]) of telemedicine for SRH care than non-STEM, while participants who had sought SRH care before were more knowledgeable about telemedicine (RR: 1.4 [1.0, 2.0]) and reported more uptake (RR: 4.8 [ 2.2, 10.7]) than those who had not sought SRH care in the past. However, the participants who had sought SRH care more than once in the past 12 months using services other than telemedicine reported lower uptake (RR: 0.5 [0.2, 1.3]) and lower knowledge (RR: 0.5 [0.3, 0.8]) of telemedicine for SRH care than participants who never sought SRH care. When asked why they would use telemedicine, participants selected ease of access (55%) and respect for privacy (50%) as the main reasons. Thirty-six percent (CI: 32%, 41%) of participants were willing to pay to access SRH care through telemedicine with a median amount of ₦2,750 (USD 3.06) per consultation. Eighty-two percent (CI: [78, 86]) preferred accessing telemedicine through internet-based platforms like mobile applications as opposed to the Unstructured Supplementary Service Data (USSD) code. When asked whether they thought their parents would support them to use telemedicine, 41%(CI: 36%, 45%) of participants agreed, while 51% were unsure. The proportion who agreed that their parents would be supportive differed between males (47%) and females (34%). Table 2: Estimated proportions (%) of participants’ knowledge, uptake, and acceptability of telemedicine across participant characteristics, with unadjusted risk ratios (RR) contrasting each characteristic to the reference group among study participants from higher institutions in Lagos State, Nigeria, 2023. Challenges Participants were asked about the challenges they would face while using telemedicine to access SRH care. Ninety-six percent of participants listed at least one challenge. Among the most reported challenges were not being able to address some medical conditions virtually (41%), poor internet accessibility (15%), and affordability (14%). Other challenges included not having access to a mobile phone at all times (6%) as well as concerns about parental consent and facilitation (8%). Discussion This study evaluated adolescents’ knowledge, acceptance, and acceptability of telemedicine as a means of accessing sexual reproductive health care. We found that adolescents considered it acceptable to use telemedicine to access SRH care, although knowledge and uptake were low. Knowledge, uptake, and acceptability were generally similar across different groups of participants, with some exceptions. Sexually active participants had more knowledge, uptake, and acceptance of telemedicine for SRH care, which is consistent with the existing literature. For example, a similar study that was conducted in Plateau State, Nigeria found that being sexually active was the only significant factor associated with seeking care in healthcare facilities [24]. We also found that survey participants who had parents with higher incomes had a higher uptake of telemedicine compared to participants with parents with lower incomes. Previous studies found that the cost of services and commodities are one of the key barriers that adolescents face in SRH care-seeking [24, 25]. Therefore, the affordability of telemedicine, particularly for adolescents from lower-income families, is an important factor in promoting uptake. We also found that prior SRH care-seeking behavior was associated with a higher uptake of SRH care via telemedicine, implying that those who had not sought SRH care in the past were more likely to have a lower uptake of SRH through telemedicine. This highlights the possibility that SRH care provided in health facilities may have some overlapping barriers to SRH care provided by telemedicine. The primary reasons given by adolescents for preference of telemedicine were its convenience and the desire for privacy. These factors highlight the potential of telemedicine to overcome challenges that have been reported in previous studies as the main reasons for the underuse of in-person SRH services among adolescents [24–27]. Furthermore, respondents preferred using internet-based platforms including mobile applications. Mobile applications have been successfully used to deliver health interventions related to mental health and chronic illnesses [28, 29]. Building applications that are user-friendly and easy to navigate will be essential in promoting the uptake of telemedicine for the delivery of SRH care. When asked if their parents would support them (e.g., by purchasing data or providing money to pay for appointments) to access SRH care through telemedicine, somewhat less than half were positive, and about half were unsure. The high levels of uncertainty are comparable to existing literature that highlights the role of parents in health-seeking behaviors [30, 31]. An Ethiopian study revealed that fathers and mothers played an important role in all phases of adolescent health-seeking behavior [32]. This underscores the need to engage parents of adolescents while designing interventions for improving access and utilization of SRH. Some of the challenges anticipated during the use of telemedicine included not being able to address some medical issues virtually, poor internet accessibility, and affordability. Previous studies have identified similar challenges among this demographic [33, 34]. It is therefore important to educate adolescents on what SRH services can be easily accessed through telemedicine and dispel their fears around inadequacy and ineffectiveness. Additionally, affordable consultations are essential to addressing barriers due to income status. Limitations This study used a convenience sample, rather than a randomized sample, to identify survey participants. While convenience sampling is commonly employed when random sampling is not feasible due to logistical constraints like in our study, it may lead to biased results. For example, if the interviewers placed themselves in particular sections of the campuses where a non-random subgroup of students visited, then the respondents may not fully represent the underlying population of interest. However, we anticipate that this bias was minimal and that our findings are generalizable to adolescents in Lagos state, and possibly to Nigeria overall. As the survey discussed sensitive topics concerning sexual reproductive health, we cannot rule out the possibility of social desirability bias which might underestimate some of the measures, such as sexual history or the number of sexual partners. However, the survey was self- administered, which helped to minimize this bias. Some strengths include the large and diverse sample, which provides a robust representation of adolescents across different socioeconomic, ethnic, and cultural backgrounds in Lagos. Furthermore, the cross-sectional design allowed for the timely collection of data, offering a snapshot of current trends. Conclusion This study revealed low knowledge and uptake of telemedicine for SRH care among adolescents, but a willingness to use it. These findings suggest the need for creating awareness about telemedicine and its feasibility among adolescents and their caretakers. As telemedicine is a relatively new paradigm on the African continent, holistic school campaigns and youth-friendly social media platforms might play a critical role in raising awareness among adolescents. Making telemedicine services affordable and user- friendly will play a critical role in bridging the existing gap between SRH care providers and adolescents, which may contribute to reducing the occurrence of adverse sexual reproductive health outcomes, such as unintended pregnancies and sexually transmitted infections. Abbreviations SRH: Sexual and reproductive health CI: Confidence interval RR: Risk Ratio STIs: Sexually transmitted infections COVID-19: Coronavirus disease of 2019 MCP Insights: Monitoring Compliance Partner Insights Ref: Reference STEM: Science, Technology, Engineering, and Mathematics USD: United States Dollar USSD: Unstructured Supplementary Service Data also known as “Quick codes” Declarations Ethics approval and consent to participate All study participants provided informed consent as instructed during the ethical review. The Nigerian Institute of Medical Research (NIMR) provided approval for the study and consent forms (IRB/23/019). The study also received approval from the Committee for Protection of Human Subjects Institutional Review Board at the University of California, Berkeley (#2023-02-16077). The relevant ethical approval and consent details were received and are available on request by the editor or editorial office. The informed consent procedures were included in all ethics review materials and received ethics approvals in the US and Nigeria. The informed consent was read to the participants by a research assistant trained in ethical human subjects research. The consent form used lay language and the participants were given the opportunity to ask questions about the study before giving consent. Study participants provided informed consent by marking agreement using their signature. All methods were carried out in accordance with relevant guidelines and regulations and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for Publication Not applicable. Availability of data and materials Data supporting the findings of this study are available upon reasonable request. Due to ethical considerations and intent to protect the confidentiality of our study participants, researchers interested in accessing the de-identified dataset may contact the corresponding author, Sheila Okoroanyanwu at [email protected] . Access will be granted upon reasonable request and in compliance with applicable data-sharing policies and ethical guidelines. Competing Interests The authors declare no competing interests. Funding The University of California Global Health Institute, under the MASS (Masters Student Stipend) pro- gram, the Mastercard Foundation Scholars Program and the Center for Global Public Health (CGPH) provided funding and a technical review of the manuscript draft. The manuscript’s contents are the responsibility of the authors and do not necessarily reflect the views of either the University of California Global Health Institute or the Mastercard Foundation Scholars Program. Authors’ contributions ZJN and SAO led the study design and developed interview guides. ZJN analyzed data. OAA and IPP conducted and supervised the data collection. ZJN and SAO wrote the first draft of the manuscript. CAR supervised the analysis. SAO performed this work while at UC Berkeley. All authors reviewed and provided input into the final version of the manuscript. Acknowledgements The authors sincerely thank the students who shared their time and insights, making this research possible. We extend our gratitude to the research team in Lagos, Nigeria, for their dedication to data collection, which was instrumental in the completion of this study. We also thank the University of California Global Health Institute, the Mastercard Foundation Scholars Program, and the Center for Global Public Health (CGPH) at UC Berkeley for commissioning and funding this study. References Catherine F. Houlihan, Kathy Baisley, Ignacio G. 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Sundari Ravindran and Veloshnee Govender. Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries. Sexual and Reproductive Health Matters , 28(2):1779632, December 2020. ISSN 2641-0397. doi: 10.1080/26410397.2020.1779632. Parya Saberi, Robert Siedle-Khan, Nicolas Sheon, and Marguerita Lightfoot. The Use of Mobile Health Applications Among Youth and Young Adults Living with HIV: Focus Group Findings. AIDS Patient Care and STDs , 30(6):254–260, June 2016. ISSN 1087-2914. doi: 10.1089/apc.2016.0044. URL https://www.liebertpub.com/doi/full/10.1089/apc.2016.0044. Publisher: Mary Ann Liebert, Inc., publishers. Rabiya Majeed-Ariss, Eileen Baildam, Malcolm Campbell, Alice Chieng, Debbie Fallon, Andrew Hall, Janet E. McDonagh, Simon R. Stones, Wendy Thomson, and Veronica Swallow. Apps and Adolescents: A Systematic Review of Adolescents’ Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions. Jour- nal of Medical Internet Research , 17(12):e5043, December 2015. doi: 10.2196/jmir.5043. URL REFERENCES 18 https://www.jmir.org/2015/12/e287. Company: Journal of Medical Internet Research Distribu- tor: Journal of Medical Internet Research Institution: Journal of Medical Internet Research Label: Journal of Medical Internet Research Publisher: JMIR Publications Inc., Toronto, Canada. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Divi- sion of Behavioral and Social Sciences and Education; Board on Children, Youth, and Families; Committee on Applying Lessons of Optimal Adolescent Health to Improve Behavioral Outcomes for Youth. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century . National Academies Press (US), Washington (DC), 2019. ISBN 978-0-309-49677-3. URL http://www.ncbi.nlm.nih.gov/books/NBK554992/. Laurence Steinberg. We Know Some Things: Parent–Adolescent Relationships in Retrospect and Prospect. Journal of Research on Adolescence , 11(1):1–19, 2001. ISSN 1532-7795. doi: 10.1111/1532- 7795.00001. URL https://onlinelibrary.wiley.com/doi/abs/10.1111/1532-7795.00001. eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/1532-7795.00001. David P. Lindstrom, Mao-Mei Liu, and Challi Jira. The Role of Parents and Family Networks in Adolescent Health-Seeking in Ethiopia. Journal of Marriage and Family , 81(4):830–846, 2019. ISSN 1741-3737. doi: 10.1111/jomf.12567. URL https://onlinelibrary.wiley.com/doi/abs/10.1111/jomf.12567. eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/jomf.12567. Martha F. Perry. Confidential Telehealth Care for Adolescents: Challenges and Solutions Identified During the COVID-19 Pandemic. Current Pediatrics Reports , pages 1–8, June 2023. ISSN 2167- 4841. doi: 10.1007/s40124-023-00288-1. Angela Barney, Sabrina Mendez-Contreras, Nancy K. Hills, Sara M. Buckelew, and Marissa Raymond-Flesch. Telemedicine in an adolescent and young adult medicine clinic: a mixed methods study. BMC Health Services Research , 23(1):680, June 2023. ISSN 1472-6963. doi: 10.1186/s12913- 023-09634-x. URL https://doi.org/10.1186/s12913-023-09634-x. Tables Tables 1 to 2 are available in the Supplementary Files section Additional Declarations No competing interests reported. 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Nakato","email":"","orcid":"","institution":"University of California, Berkeley","correspondingAuthor":false,"prefix":"","firstName":"Joy","middleName":"Z.","lastName":"Nakato","suffix":""},{"id":476519722,"identity":"2a6f66d1-ceed-453f-8d38-531ea93c686b","order_by":1,"name":"Sheila A. 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Riddell","email":"","orcid":"","institution":"University of California, Berkeley","correspondingAuthor":false,"prefix":"","firstName":"Corinne","middleName":"A.","lastName":"Riddell","suffix":""}],"badges":[],"createdAt":"2025-04-01 00:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6348228/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6348228/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85486340,"identity":"9217abc2-6ed1-4a36-9252-015542d3aeb1","added_by":"auto","created_at":"2025-06-26 12:07:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":660319,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6348228/v1/5df50790-5737-4efa-821f-3b8e72d93505.pdf"},{"id":85484803,"identity":"7dff70cc-deba-48d3-8c19-93046a1494ed","added_by":"auto","created_at":"2025-06-26 11:43:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":38131,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6348228/v1/7b7a7eac97f5b68423f7dfb1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adolescent Knowledge, Acceptance, Uptake, and Challenges of Telemedicine for Sexual Reproductive Health in Lagos, Nigeria: A Cross-Sectional Study","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eAccess to sexual and reproductive health (SRH) services is a challenge for adolescents in sub-Saharan Africa, contributing to a high rate of sexually transmitted infections, teenage pregnancy, and low contraceptive use. Telemedicine, the use of technology to provide healthcare remotely, has emerged as a potential solution to improve access to SRH services. However, little is known about its use among adolescents in Lagos, Nigeria. This study aimed to understand adolescents’ knowledge, acceptance, and challenges in using telemedicine for SRH services. We conducted a cross-sectional survey in June 2023 us- ing paper-based questionnaires among students from the four main public universities in Lagos, Nigeria. Our findings revealed that knowledge and uptake of telemedicine for SRH were generally low, with sexu- ally active adolescents and those from high-income families having higher uptake and acceptance of these services. Many participants were unaware that SRH services could be accessed through telemedicine, highlighting a gap in knowledge and exposure to digital healthcare platforms. The participants reported several challenges to using telemedicine for SRH care. These included concerns about affordability, limited internet accessibility, and doubts about telemedicine’s ability to address certain medical conditions. We used a convenience sample, meaning that participants were selected based on accessibility rather than randomly. This may limit how well our findings represent the broader adolescent population in Lagos. Addressing affordability, internet access, and knowledge barriers could improve adolescent SRH service delivery through telemedicine.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eWith a population of over 200\u0026nbsp;million people, Nigeria has a large need for quality health care. Timely access to specialized health care, especially for the most vulnerable groups including adolescents, is needed. Of great public health concern is the high prevalence of sexually transmitted infections, such as HIV, and unintended pregnancies among adolescents, in sub-Saharan Africa, including Nigeria [1, 2]. Each of these outcomes is strongly associated with unprotected sexual activities [3].\u003c/p\u003e \u003cp\u003eData on SRH outcomes in Nigeria highlight the importance of finding interventions to reduce risk among adolescents [4]. At 576 maternal deaths per 100,000 live births, Nigeria accounts for roughly 14 percent of the global burden of maternal mortality [4]. Teenage girls aged between 15 and 19 years old have higher rates of maternal mortality and morbidity than older women [4, 5]. Data shows that the average age at sexual debut is roughly 15 years of age among adolescent mothers in Nigeria [6\u0026ndash;8].\u003c/p\u003e \u003cp\u003eA study on SRH services for adolescents in Enugu (a state in Nigeria) found that most SRH services were available and geographically accessible, but very few were financially accessible to adolescents [9]. Further, while in-person healthcare facilities provide an important setting for adolescents to access accurate SRH preventive information, testing, and treatment services, adolescents\u0026rsquo; use of these facilities has remained low [10] due to fear of stigmatization, negative attitudes of healthcare providers towards adolescents seeking SRH care, and a lack of age-appropriate and adolescent-centered services [11\u0026ndash;14].\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic caused widespread disruption to essential health service provision in low- and middle-income countries, including SRH services [15, 16]. This presented a strong need for more flexible options for adolescents to access SRH care to alleviate the risks of unplanned pregnancy and sexually transmitted infections [17\u0026ndash;19]. Telemedicine was adopted as a means to provide healthcare ser- vices under several pandemic-imposed restrictions [20]. Telemedicine has been useful in reducing health delivery inequalities by allowing for remote consultation, monitoring, and management of chronically ill patients [21, 22]. Smartphone penetration in Nigeria is forecasted to reach approximately 60% by 2025 [23]. This presents an incredible opportunity to bring more affordable and accessible SRH services to the adolescent population through telemedicine.\u003c/p\u003e \u003cp\u003eDespite the dire need to improve access to sexual reproductive health care among adolescents in Nigeria and the potential benefits of leveraging telemedicine to bridge the gap between adolescents and care providers, little is known about the use of telemedicine in Nigeria among this demographic. This study aimed to identify the knowledge, uptake, and acceptability of telemedicine as a means of accessing SRH care among adolescents in Lagos, Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Study Participants\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional descriptive study of adolescents using self-administered paper-based questionnaires. Participants were selected from four public institutions of higher learning: Lagos State University, University of Lagos, Lagos State University of Science and Technology, and Yaba College of Technology. The study population included enrolled students aged between 16\u0026ndash;19 years with access to mobile phones who consented to participate. The study was conducted in June 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecruitment\u003c/h3\u003e\n\u003cp\u003eWe used a convenience sampling method where trained research assistants approached students in pre- degree and freshman classrooms from across different faculties, at freshman dormitories, and residence halls. Information about the study was given after assessing eligibility. Prior to administering the questionnaire, a signed informed consent was obtained for participants who were 18 years of age and older and signed assent was obtained for participants younger than 18 years. Voluntary participation and confidentiality of participant information were emphasized. Assent language was tailored to the reading and comprehension level of the study population which included minors.\u003c/p\u003e\n\u003ch3\u003eData Collection and Analysis\u003c/h3\u003e\n\u003cp\u003eData was collected using a paper-based questionnaire in English which was the common language of instruction amongst the study participants. Basic demographic data was collected on age (coded continuously, in years), sex (coded dichotomously as female or male), area of study (STEM or non-STEM), religion, region of origin, and parental income. Additionally, we collected data on sexual activity and prior SHR care-seeking behavior. We also collected data on knowledge, attitude, and uptake of telemedicine. The 32-question survey was approved by the Committee for Protection of Human Subjects at the University of California, Berkeley, and by the Nigerian Institute of Medical Research in Lagos, Nigeria. After collection, data were transcribed into a spreadsheet and stored on a secured drive.\u003c/p\u003e \u003cp\u003eWe evaluated each participant\u0026rsquo;s knowledge, uptake, and acceptance of SRH care, as well as the challenges faced when using telemedicine for SRH services. For all key measures\u0026mdash;knowledge, uptake, and acceptance\u0026mdash;responses were coded as \u0026ldquo;yes\u0026rdquo; = 1 and \u0026ldquo;no\u0026rdquo; = 0. Knowledge was assessed by asking participants if they were aware that telemedicine could be used to access SRH care, followed by a question inviting them to name some telemedicine platforms they knew to better understand their knowledge. Uptake was measured by asking whether they had ever used telemedicine for SRH care and inviting them to specify the form of telemedicine they used and why they chose to use it. To assess acceptance, participants were asked if they would use telemedicine for SRH care access, along with questions exploring their reasons for using or not using telemedicine, how much they were willing to pay for it, and their preferred modes of access. The survey tool is included in the appendix. To understand how knowledge, uptake, and acceptance differed by participant characteristics, we calculated the proportion and its 95% confidence interval (CI) of participants that had each outcome (knowledge, uptake, or acceptance) separately for each respondent characteristic. We also used two- way tables to calculate risk ratios (RR) to determine the association between knowledge, uptake, and acceptance of telemedicine with participant characteristics such as age, sex, religion, sexual activity, and previous SHR-seeking behavior.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFive hundred and eleven individuals were surveyed. Two participants who were citizens of other countries were excluded from the analysis. We also excluded four others due to cell sparsity for a total sample size of five hundred and five participants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The participants were nearly equally divided between the female and male genders and had a median age of 18 years. Seventy-four percent of the participants were from the western region of Nigeria, which includes the state of Lagos. Seventy-seven percent were Christians, which is a dominant religion in this region, and 77% reported being sexually active. Seventy- two percent of the participants did not answer the question about the number of sexual partners. Among those who responded, 83% reported having one sexual partner and 17% reported having multiple partners at the time of the study. Only 26% had ever sought SRH care. Of these individuals, 59% had sought SRH care more than once in the last 12 months.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: \u003cb\u003eSociodemographic characteristics of study participants from four higher education institutions in Lagos State, Nigeria (2023)\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eKnowledge, uptake, and acceptability\u003c/h3\u003e\n\u003cp\u003eOverall, 25% (CI: 21%, 29%) of the participants reported knowledge of telemedicine for SRH care, and 5% (3% 7%) reported having used telemedicine for SRH care (Table\u0026nbsp;2). Fifty-two percent (47%, 56%) of the participants reported that they would use telemedicine to access SRH care. The proportion of participants with knowledge of SRH care was similar across gender, age group (younger than 18 years of age vs. 18 and older), religion, region of origin, sexual activity, and prior seeking of SRH care, with some exceptions. Sexually active participants had more knowledge (Risk ratio [RR]: 1.3 [0.8, 2.0]), uptake (RR: 2.0 [0.6, 6.6]), and acceptance (RR: 1.2 [1.0, 1.5]) of SRH care compared to non-sexually active participants.\u003c/p\u003e \u003cp\u003eParticipants with parental income in the highest category reported more uptake of telemedicine (RR: 1.6 [0.3, 7.7]) than those in lower income categories. STEM participants reported lower uptake (RR: 0.4 [0.2, 1.0]) of telemedicine for SRH care than non-STEM, while participants with knowledge of SRH care was similar across gender, age group (younger than 18 years of vs. 18 and older), religion, region of origin, sexual activity, and prior seeking of SRH care, with some exceptions. Sexually active participants had more knowledge (Risk ratio [RR]: 1.3 [0.8, 2.0]), uptake (RR: 2.0 [0.6, 6.6]), and acceptance (RR: 1.2 [1.0, 1.5]) of SRH care compared to non-sexually active participants. Participants with parental income in the highest category reported more uptake of telemedicine (RR: 1.6 [0.3, 7.7]) than those in lower income categories. STEM participants reported lower uptake (RR: 0.4 [0.2, 1.0]) of telemedicine for SRH care than non-STEM, while participants who had sought SRH care before were more knowledgeable about telemedicine (RR: 1.4 [1.0, 2.0]) and reported more uptake (RR: 4.8 [ 2.2, 10.7]) than those who had not sought SRH care in the past. However, the participants who had sought SRH care more than once in the past 12 months using services other than telemedicine reported lower uptake (RR: 0.5 [0.2, 1.3]) and lower knowledge (RR: 0.5 [0.3, 0.8]) of telemedicine for SRH care than participants who never sought SRH care.\u003c/p\u003e \u003cp\u003eWhen asked why they would use telemedicine, participants selected ease of access (55%) and respect for privacy (50%) as the main reasons. Thirty-six percent (CI: 32%, 41%) of participants were willing to pay to access SRH care through telemedicine with a median amount of ₦2,750 (USD 3.06) per consultation. Eighty-two percent (CI: [78, 86]) preferred accessing telemedicine through internet-based platforms like mobile applications as opposed to the Unstructured Supplementary Service Data (USSD) code. When asked whether they thought their parents would support them to use telemedicine, 41%(CI: 36%, 45%) of participants agreed, while 51% were unsure. The proportion who agreed that their parents would be supportive differed between males (47%) and females (34%).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;2: Estimated proportions (%) of participants\u0026rsquo; knowledge, uptake, and acceptability of telemedicine across participant characteristics, with unadjusted risk ratios (RR) contrasting each characteristic to the reference group among study participants from higher institutions in Lagos State, Nigeria, 2023.\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eChallenges\u003c/h2\u003e \u003cp\u003eParticipants were asked about the challenges they would face while using telemedicine to access SRH care. Ninety-six percent of participants listed at least one challenge. Among the most reported challenges were not being able to address some medical conditions virtually (41%), poor internet accessibility (15%), and affordability (14%). Other challenges included not having access to a mobile phone at all times (6%) as well as concerns about parental consent and facilitation (8%).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated adolescents\u0026rsquo; knowledge, acceptance, and acceptability of telemedicine as a means of accessing sexual reproductive health care. We found that adolescents considered it acceptable to use telemedicine to access SRH care, although knowledge and uptake were low. Knowledge, uptake, and acceptability were generally similar across different groups of participants, with some exceptions. Sexually active participants had more knowledge, uptake, and acceptance of telemedicine for SRH care, which is consistent with the existing literature. For example, a similar study that was conducted in Plateau State, Nigeria found that being sexually active was the only significant factor associated with seeking care in healthcare facilities [24]. We also found that survey participants who had parents with higher incomes had a higher uptake of telemedicine compared to participants with parents with lower incomes. Previous studies found that the cost of services and commodities are one of the key barriers that adolescents face in SRH care-seeking [24, 25]. Therefore, the affordability of telemedicine, particularly for adolescents from lower-income families, is an important factor in promoting uptake. We also found that prior SRH care-seeking behavior was associated with a higher uptake of SRH care via telemedicine, implying that those who had not sought SRH care in the past were more likely to have a lower uptake of SRH through telemedicine. This highlights the possibility that SRH care provided in health facilities may have some overlapping barriers to SRH care provided by telemedicine.\u003c/p\u003e \u003cp\u003eThe primary reasons given by adolescents for preference of telemedicine were its convenience and the desire for privacy. These factors highlight the potential of telemedicine to overcome challenges that have been reported in previous studies as the main reasons for the underuse of in-person SRH services among adolescents [24\u0026ndash;27]. Furthermore, respondents preferred using internet-based platforms including mobile applications. Mobile applications have been successfully used to deliver health interventions related to mental health and chronic illnesses [28, 29]. Building applications that are user-friendly and easy to navigate will be essential in promoting the uptake of telemedicine for the delivery of SRH care.\u003c/p\u003e \u003cp\u003eWhen asked if their parents would support them (e.g., by purchasing data or providing money to pay for appointments) to access SRH care through telemedicine, somewhat less than half were positive, and about half were unsure. The high levels of uncertainty are comparable to existing literature that highlights the role of parents in health-seeking behaviors [30, 31]. An Ethiopian study revealed that fathers and mothers played an important role in all phases of adolescent health-seeking behavior [32]. This underscores the need to engage parents of adolescents while designing interventions for improving access and utilization of SRH.\u003c/p\u003e \u003cp\u003eSome of the challenges anticipated during the use of telemedicine included not being able to address some medical issues virtually, poor internet accessibility, and affordability. Previous studies have identified similar challenges among this demographic [33, 34]. It is therefore important to educate adolescents on what SRH services can be easily accessed through telemedicine and dispel their fears around inadequacy and ineffectiveness. Additionally, affordable consultations are essential to addressing barriers due to income status.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study used a convenience sample, rather than a randomized sample, to identify survey participants. While convenience sampling is commonly employed when random sampling is not feasible due to logistical constraints like in our study, it may lead to biased results. For example, if the interviewers placed themselves in particular sections of the campuses where a non-random subgroup of students visited, then the respondents may not fully represent the underlying population of interest. However, we anticipate that this bias was minimal and that our findings are generalizable to adolescents in Lagos state, and possibly to Nigeria overall. As the survey discussed sensitive topics concerning sexual reproductive health, we cannot rule out the possibility of social desirability bias which might underestimate some of the measures, such as sexual history or the number of sexual partners. However, the survey was self- administered, which helped to minimize this bias. Some strengths include the large and diverse sample, which provides a robust representation of adolescents across different socioeconomic, ethnic, and cultural backgrounds in Lagos. Furthermore, the cross-sectional design allowed for the timely collection of data, offering a snapshot of current trends.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed low knowledge and uptake of telemedicine for SRH care among adolescents, but a willingness to use it. These findings suggest the need for creating awareness about telemedicine and its feasibility among adolescents and their caretakers. As telemedicine is a relatively new paradigm on the African continent, holistic school campaigns and youth-friendly social media platforms might play a critical role in raising awareness among adolescents. Making telemedicine services affordable and user- friendly will play a critical role in bridging the existing gap between SRH care providers and adolescents, which may contribute to reducing the occurrence of adverse sexual reproductive health outcomes, such as unintended pregnancies and sexually transmitted infections.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSRH:\u0026nbsp;Sexual\u0026nbsp;and\u0026nbsp;reproductive\u0026nbsp;health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u003c/p\u003e\n\u003cp\u003eRR:\u0026nbsp;Risk Ratio\u003c/p\u003e\n\u003cp\u003eSTIs:\u0026nbsp;Sexually transmitted infections\u003c/p\u003e\n\u003cp\u003eCOVID-19:\u0026nbsp;Coronavirus disease of 2019\u003c/p\u003e\n\u003cp\u003eMCP\u0026nbsp;Insights:\u0026nbsp;Monitoring\u0026nbsp;Compliance\u0026nbsp;Partner Insights\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRef:\u0026nbsp;Reference\u003c/p\u003e\n\u003cp\u003eSTEM: Science, Technology, Engineering, and Mathematics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUSD: United States Dollar\u003c/p\u003e\n\u003cp\u003eUSSD: Unstructured Supplementary Service Data also known as “Quick codes”\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eAll study participants provided informed consent as instructed during the ethical review. The Nigerian Institute of Medical Research (NIMR) provided approval for the study and consent forms (IRB/23/019). The study also received approval from the Committee for Protection of Human Subjects Institutional Review Board at the University of California, Berkeley (#2023-02-16077). The relevant ethical approval and consent details were received and are available on request by the editor or editorial office. The informed consent procedures were included in all ethics review materials and received ethics approvals in the US and Nigeria. The informed consent was read to the participants by a research assistant trained in ethical human subjects research. The consent form used lay language and the participants were given the opportunity to ask questions about the study before giving consent. Study participants provided informed consent by marking agreement using their signature. All methods were carried out in accordance with relevant guidelines and regulations and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData supporting the findings of this study are available upon reasonable request. Due to ethical considerations and intent to protect the confidentiality of our study participants, researchers interested in accessing the de-identified dataset may contact the corresponding author, Sheila Okoroanyanwu at [email protected]. Access will be granted upon reasonable request and in compliance with applicable data-sharing policies and ethical guidelines.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe University of California Global Health Institute, under the MASS (Masters Student Stipend) pro- gram, the Mastercard Foundation Scholars Program and the Center for Global Public Health (CGPH) provided funding and a technical review of the manuscript draft. The manuscript\u0026rsquo;s contents are the responsibility of the authors and do not necessarily reflect the views of either the University of California Global Health Institute or the Mastercard Foundation Scholars Program.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eZJN and SAO led the study design and developed interview guides. ZJN analyzed data. OAA and IPP conducted and supervised the data collection. ZJN and SAO wrote the first draft of the manuscript. CAR supervised the analysis. SAO performed this work while at UC Berkeley. All authors reviewed and provided input into the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the students who shared their time and insights, making this research possible. We extend our gratitude to the research team in Lagos, Nigeria, for their dedication to data collection, which was instrumental in the completion of this study. We also thank the University of California Global Health Institute, the Mastercard Foundation Scholars Program, and the Center for Global Public Health (CGPH) at UC Berkeley for commissioning and funding this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCatherine F. Houlihan, Kathy Baisley, Ignacio G. 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URL https://onlinelibrary.wiley.com/doi/abs/10.1111/jomf.12567. eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/jomf.12567.\u003c/li\u003e\n \u003cli\u003eMartha F. Perry. Confidential Telehealth Care for Adolescents: Challenges and Solutions Identified During the COVID-19 Pandemic. \u003cem\u003eCurrent Pediatrics Reports\u003c/em\u003e, pages 1\u0026ndash;8, June 2023. ISSN 2167- 4841. doi: 10.1007/s40124-023-00288-1.\u003c/li\u003e\n \u003cli\u003eAngela Barney, Sabrina Mendez-Contreras, Nancy K. Hills, Sara M. Buckelew, and Marissa Raymond-Flesch. Telemedicine in an adolescent and young adult medicine clinic: a mixed methods study. \u003cem\u003eBMC\u003c/em\u003e\u003cem\u003eHealth\u003c/em\u003e\u003cem\u003eServices\u003c/em\u003e\u003cem\u003eResearch\u003c/em\u003e, 23(1):680, June 2023. ISSN 1472-6963. doi: 10.1186/s12913- 023-09634-x. URL https://doi.org/10.1186/s12913-023-09634-x.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 2 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sexual and Reproductive Health Care, Adolescents, Telehealth, Lagos, Nigeria, Africa, Barriers to care","lastPublishedDoi":"10.21203/rs.3.rs-6348228/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6348228/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eLow utilization of sexual and reproductive health (SRH) services among adolescents in sub-Saharan African countries has contributed to the high prevalence of adverse sexual and reproductive health outcomes, such as increased rates of sexually transmitted infections, teenage pregnancies, and limited use of modern contraception methods. In the last decade, telehealth has emerged as a tool to address barriers to SRH services, such as service availability, affordability, and distance to care—but despite its growing ubiquity, research on the usability and effectiveness of tele- health remains limited. This study assessed adolescents’ knowledge, acceptability, and challenges in using telemedicine for SRH services in Lagos, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a cross-sectional study of adolescents aged 16-19 years from four public institutions of higher learning in Lagos, Nigeria. Self-administered paper-based questionnaires were used to assess study participant’s SRH-related characteristics. Descriptive analyses and risk ratios examined differences by age, gender, parental income, religion, sexual activity, and previous use of SRH care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among 505 students, 77% reported being sexually active. Knowledge of telemedicine for SRH care was reported by 25% (CI: 21, 29), but only 5% (CI: 3, 7) had ever used it. Fifty-two percent (CI: 47, 56) expressed willingness to use telemedicine, and 77% (CI: 73, 81) would recommend it to a peer. Sexually active participants had higher knowledge, uptake, and acceptability. Those who sought SRH care in the past 12 months were more likely to use telemedicine (Risk Ratio [RR (95% CI)]: 4.8 (2.2, 10.7)). Higher parental income was linked to increased telemedicine uptake. The most cited benefits of using telemedicine were ease of access (55%) and respect for privacy (50%). Challenges included concerns about virtual consultations (41%), internet access (15%), and affordability (14%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Despite limited knowledge and uptake of telemedicine for SRH care, adolescents expressed a strong willingness to use it. Creating awareness of the existence and feasibility of accessing care through telemedicine among adolescents and addressing barriers such as cost, and internet access is key to increasing its uptake.\u003c/p\u003e","manuscriptTitle":"Adolescent Knowledge, Acceptance, Uptake, and Challenges of Telemedicine for Sexual Reproductive Health in Lagos, Nigeria: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-26 11:43:27","doi":"10.21203/rs.3.rs-6348228/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-16T19:32:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T18:25:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224227967094359530287441096478582371416","date":"2026-01-02T12:05:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-05T02:22:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52485619587849252566736095651477994136","date":"2025-06-25T21:51:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19577673693899580575700604045831567225","date":"2025-06-23T12:19:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-23T09:01:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-04T08:19:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T22:38:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2025-04-01T00:28:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e07a9f21-af15-4d14-aa6d-151d97787e3d","owner":[],"postedDate":"June 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T01:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-26 11:43:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6348228","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6348228","identity":"rs-6348228","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}