CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Adolescence is a period of transition that is characterized by physical growth and development,

emotional growth and development, and an increase in cognitive abilities. It is also an age at which

young people have started to make their own decisions independently or, rather, about being

independent in the matter of sex and reproduction. On the global and national level, this stage of life

is thought of as a “window of opportunity” to influence health seeking behaviour in adult life (WHO,

2023). Youth bulge In Nigeria, young people constitute more than 30% of the total population with

adolescent health being dimensioned as the national development agenda (Ilori et al, 2020).

However, large numbers of young people living in Nigeria experience challenges with obtaining

acceptable information and important sexual and reproductive health (SRH) services in confidence.

These factors include absence of comprehensive sex education from school curriculum, cultural

silence on sexual issues, fear of being stigmatized, and ineffectiveness of healthcare facilities (Ajayi

et al., 2023; Otu et al., 2021). All these information and access gaps are closely associated with the

increasing trends of sexually transmitted infections, including HIV, teenage pregnancy, and unsafe

abortions among Nigerian adolescents.

Given these obstacles, there has been an increasing interest in the use of digital innovations,

especially mobile health (mHealth) applications, to provide reproductive health education. mHealth

applications are scalable, private, and can be personalized to meet unique end-users’ requirements

and are therefore attractive to young individuals who require discrete and on-demand information

(Fagbamigbe et al., 2023). Apps like: Clue, Flo and Natural Cycles helping people log their menstrual

cycles, monitor symptoms, decipher fertility windows and know how to have safe sex.

The country’s digital ecosystem is becoming friendlier to adolescents, at least 70% of young

people in urban and semi-urban Nigeria have access to smartphones and the internet (NCC, 2024).

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This technological advancement is an opportunity to bridge the gap in providing adolescents with

comprehensive and culturally appropriate information regarding sexual health. In addition, the digital

space provides an opportunity for incorporating behavior-change communication approach,

gamification, peer interface, and telemedicine consultations that may enhance engagement and health

outcomes (Babatunde et al., 2025; Oladepo et al., 2024).

These tools have been increasingly validated by studies. For example, a randomised

investigation of Oladepo et al. (2024), that students receiving a mobile-based sex education

intervention had a statistically significant increase in their knowledge about reproductive health and it

made them more likely to practice safe sex. Similarly, Babatunde et al. (2025) reported that My Belle

app resulted to positive changes in antenatal and reproductive health among rural Nigerian women

through user centred-design approach.

In spite of this encouraging evidence, there is still a paucity of studies conducted at the

community level examining the extent to which mHealth tools are being used and are effective in the

real world of the Nigerian adolescents in their locality such as the Ikere Local Government Area of

Ekiti State. It is important to understand their reach, frequency of use, satisfaction with them and

whether they actually acquire knowledge, in order to design scale-up strategies and policy action for

rural and semi-urban adolescents.

In addition, examining the digital literacy of the adolescents, parental influence, and

socioeconomic elements may provide more refined knowledge on the obstacles and enablers of

mHealth adoption. This study, consequently aims to fill this gap by examining the effect of digital

health education tools on adolescents' reproductive health literacy in Ikere Local Government Area.

Results will be valuable in informing context-specific responsive, inclusive, and technology-driven

policies for adolescent health in Nigeria.

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1.2 Statement of the problem

Young people in Nigeria encounter substantial barriers to receiving factual, timely, and

comprehensive reproductive health information. These problems are more significant in semi-urban

and rural areas such as Ikere Local Government Area of Ekiti State, since cultural taboos, stigma,

poor sexuality education and lack of health services specifically for adolescents impair consciousness

and sound judgment. As a result to the above statement, this has led to quite worrisome trend of

teenage pregnancies, unsafe abortions and STIs among the Nigeria adolescents (Ajayi et al., 2023 and

Ilori et al., 2020).

Although mobile technology usage is high in Nigeria (over 70% of teenagers are reported to own

a smartphone, NCC, 2024), the work and evaluation of mobile health (mHealth) tools is generally

underused or unevaluated in local settings. App with digital health content, including Clue, Flo, and

Natural Cycles, provide adolescent girls with the opportunity to get reliable information on

menstruation, fertility, safe sex and other reproductive health issues in private. There is, however, a

dearth of empirical evidence on the frequency of use, impact, and challenges to their adoption in

Ikere Local Government Area.

In addition, the evidence evaluating the real effect of these digital technologies on adolescent

behavior, knowledge and attitudes with respect to reproductive health has remained largely scarce. In

the absence of setting-specific evidence, stakeholders including educators, health workers, and

policymakers cannot design interventions and upscale digital health interventions in the areas of

greatest need (Fagbamigbe et al., 2023; Oladepo et al., 2024).

1.3 Purpose of the Study

The specific purpose of this study was to assess the impact of digital reproductive health tools

on the educational behaviors of adolescents in Ikere Local Government Area. In particular, the study

aims to learn how the use of mobile apps and other digital platforms can be used to better inform

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adolescents about reproductive health, with a focus on menstrual health, fertility awareness and

practicing safe sex. In so doing, the study seeks to support more informed choice and healthier

reproductive decision-making among adolescent women most at risk. The specific purpose are as

follows:

1. to assess the level of reproductive health knowledge among female adolescents in Ikere Local

Government Area.

2. to investigate the role of mobile health applications in enhancing female adolescent

reproductive health literacy in Ikere Local Government Area.

3. to assess the impact of social media platforms on reproductive health literacy in Ikere Local

Government Area.

4. to assess the effect of demographic factors such as age and educational level on the use of

mobile applications for reproductive health literacy in Ikere Local Government Area.

1.4 Research Questions

Based on the purpose derived above for the study, the following questions are formulated to guide the

study.

1. What is the level of female adolescents’ knowledge on reproductive health among female

secondary schools in Ikere Local Government Area?

2. What is the level of female adolescents’ knowledge on the use of mobile application

reproductive health literacy among secondary schools in Ikere Local Government Area?

3. Can social media (mobile) affect female adolescent reproductive health literacy in Ikere

Local Government Area?

4. Can demographic factors of age and educational level affect the use of mobile applications

for reproductive health literacy in Ikere Local Government Area?

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1.5 Research Hypotheses

The following null hypotheses were tested for this study.

1. There is no significant impact of reproductive health knowledge among female adolescents in

Ikere Local Government Area.

2. There is no significant effect of mobile health applications on reproductive health literacy in

Ikere Local Government Area.

3. There is no significant impacts of social media platforms on adolescent health literacy in

Ikere Local Government Area.

4. There is no significant effect of demographic factors (age, education level) on the use of

mobile applications for reproductive health literacy in Ikere Local Government Area.

1.6 Significance of the study

This study is significant in several ways. The influx mobile technology and internet penetration

in Nigeria offers a chance to close gap in adolescent reproductive health literacy, especially among

female. This study is meritorious at this time as it investigated the changing manner in which digital

application such as mHealth applications and social media platform could be used to enhance

knowledge and the behaviour of female adolescent towards reproductive health in the semi-urban

settlement like Ikere Local Government Area, Ekiti state.

Firstly, this research has important implications for female adolescents, as it attempts to arm

them with the information and resources to lead them to better informed choices about reproductive

health. Improved access to accurate, youth-friendly health information through eHealth means that

adolescent girls was better able to understand menstruation, fertility, contraception and STI

prevention – and make healthier choices and reduce risk taking.

Secondly, the study offers levers for implementation to teachers and school actors in the

integration of digital tools within health education programmes. Crucial to adapting health curricula

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for a digital-native youth population in schools and protecting the promotion of credible, evidence-

informed information.

Thirdly, the research was important to public health professionals and NGOs who will learn data-

driven information about how adolescents use digital tools for health. This knowledge can inform the

design and delivery of community-based interventions and digital initiatives aimed at increasing

awareness and access to reproductive health.

Moreover, the study formed the basis for subsequent academic research on the complex

interconnections of digital health tools and reproductive health literacy in rural Nigeria. It helps to

identify new areas of research, including long-term effects, the gender-specific digital health needs,

and the role of parent and of the social environment on digital health engagement.

1.7 Scope of the study

This scope of this study was defined to cover various dimensions pertinent to understanding the

effectiveness of digital health education tools on adolescent reproductive health literacy. This

includes focusing on specific digital tools like, mobile health apps and social media platforms.

Geographically, the study is limited to Ikere Local Government Area. The respondents for this study

will be female senior secondary school students in Ikere Local Government Area of Ekiti State,

Nigeria.

This study focuses on adolescent girls aged 10-19 years, who are at increased risk to reproductive

health and are increasingly invested in digital technologies. The study will focus on the level of

exposure and use of mobile applications (such as Flo, Clue, My Calendar, and Natural Cycles) and

platforms (such as WhatsApp, Facebook, Instagram, and TikTok) for reproductive health

information.

This research is not generalizable for male adolescents, general digital health beyond the scope

of reproductive health (e.g., nutrition, mental health, etc) in Ikere Local Government Area. This

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narrower focus enables a robust, all encompassing investigation of the role of digital tools in

moulding of knowledge around reproductive health among female adolescents within a semi urban

setting in Nigeria.

1.8 Operational Definition of Terms

 Adolescent: individuals aged between 10 and 19 years.

 Digital Health Education Tools: platforms such as mobile health applications and social media

used to provide health education and resources.

 Mobile Health Applications: smartphone apps designed to deliver reproductive health content,

track menstrual cycles, and offer sexual health advice.

 Reproductive Health Literacy: the ability of adolescents to access, understand, and use

reproductive health information from digital platforms to make informed decisions.

 Social Media Platforms: online platforms like Facebook, WhatsApp, Instagram, and YouTube

used to disseminate reproductive health education content.

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 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0 Introduction

This chapter presented a review of literature. It will be presented under the following sub-headings:

 2.1 Introduction to Empirical Studies on Digital Health Literacy

 2.2 Concept of Reproductive Health Literacy among Adolescents

 2.3 Overview of Mobile Health Applications for Reproductive Health

 2.4 Review studies on Social Media Platforms and Adolescent Reproductive Health Literacy

 2.5 Comparative Analysis of Empirical Studies on Digital Health Interventions

 2.6 Effectiveness of Digital Health Interventions: A Review of Empirical Results

 2.7 Limitations and Challenges of Digital Health Interventions

 2.8 Summary of Literatue Review

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2.1 Introduction to Empirical Studies in Digital Health Literacy

The rise of digital technology in care provision has dramatically changed how adolescents gain,

interpret and use reproductive health information. Historically the world over and in developing

countries in particular, young people, adolescents especially, were constrained by stigma and

discrimination, limited and poor quality health services, limited school based education and socio-

cultural taboos in their quest for reproductive health information (Adebayo et al., 2022). But digital

interfaces, such as mobile health (mHealth) applications, websites, and social media, now offer young

people novel and more discreet access to reliable information on reproductive health (World Health

Organization [WHO], 2021).

Mobile Apps, in particular, are user-friendly, interactive tools that can assist in menstrual

tracking, contraceptive counseling, fertility surveillance and sexual health education in teens,

enabling them in informed decision-making regarding their reproductive health issues (Chen et al.,

2021). Simultaneously, social media platforms such as Instagram, TikTok, Facebook and YouTube

are used as strong conduits for peer education, online social support community and health

promotion campaigns (Yousef et al., 2022). To narrow the information gap between health

professionals and adolescents, these tools have been useful facilitating the autonomy and informed

decision making of young populations (González et al., 2023).

However, despite these advantages, there continue to exist concerns related to misinformation,

digital divides, privacy threats, and content credibility, particularly in low-resource areas

(Rosenbaum, 2021). Adolescents in rural areas, are usually confronted with problems such as

inadequate penetration of the internet, non-possession of smartphone, and lower digital literacy,

which can hinder access to credible digital health sources of information (Chukwu et al., 2023).

Additionally, cultural perceptions and parental restrictions may also affect avenues by which

adolescents are willing to interact with digital reproductive health tools (Odetola et al., 2023).

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 It is, therefore, pertinent to have an understanding of how digital technologies are shaping

adolescent reproductive health literacy if we are to change the trajectory of young people’s health

and contribute to public health goals such as reducing teenage pregnancy, sexually transmitted

infections (STIs) and maternal mortality (Williams & Aranda, 2022).

2.2 Concept of Reprod8uctive Health Literacy among Adolescents

Reproductive health literacy is the ability to access, understand, evaluate, and use reproductive

health information and services so as to make informed decisions in order to maintain a good native

sexual health (Nutbeam, 2020; Velardo, 2020). This includes knowledge about puberty,

contraception, sexually transmitted infections (STIs), menstruation, fertility, and reproductive health

services. Reproductive health literacy is particularly important among adolescents as there are

important biological, psychological and social changes that influence reproductive health outcomes

during this time in develop pment (World Health Organization [WHO], 2021).

Among adolescents, a robust reproductive health literacy enhances level of awareness and

knowledge, ability to avoid early/unsafe pregnancy and STIs, promoting healthy relationships and

responsible sexual behavior (Adebayo et al., 2022; Chukwu et al., 2023). Multiple factors are

affecting the reproductive health literacy levels among adolescents, including age, educational level,

economic condition, culture, and religious norms, gender power dynamics, and access to reliable and

youth-friendly reproductive health information (Nguyen et al., 2021).

Furthermore, digital methods have become important channels for reproductive education, they

deliver), in confidential and individualized forms, the information young people need to obtain the

skills to navigate social networks and shared educational environments provided as mobile apps,

social media and online tutorials (González et al., 2023, Yousef et al., 2022).

Adolescents with low reproductive health literacy have worse health outcomes, such as high

teenage pregnancy rates, rates of unsafe abortions, and prevalence rates for HIV / AIDS and STIs

(Williams & Aranda, 2022). On the contrary, teenagers with good knowledge of reproductive health

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are more likely to have stronger sense of control over their health, delay sexual debut, consistently

use contraceptives and utilize appropriate healthcare services when required (Kim and Lee, 2023).

Recent studies stress the need to implement new and creative adolescent-focused, culturally

tailored approaches to increase reproductive health literacy. Approaches such as embedding aspects

of reproductive health into the school curricula, creating peer education programs, implementing

mobile health applications and social media campaigns have been effective in the delivery of

information and empowerment of youth (Odetola et al., 2023; Ahmed et al., 2024). Therefore, in

addition to being a public health imperative, enhanced reproductive health literacy among

adolescents is a central mechanism for working towards a range of wider development goals in

health, education, and gender equality.

2.3 Overview of Mobile Health Applications for Reproductive Health

Mobile health (mHealth) apps have become popular resources to promote reproductive health

knowledge and literacy in adolescents. Given the widespread ownership of mobile phones across the

globe, these apps provide young people with immediate access to tailored, confidential and

convenient sexual and reproductive health care services (Ahmed et al., 2023). Popular apps like Clue,

Flo, My Calendar, Natural Cycles, offer menstrual cycle tracking, ovulation forecasting, fertility

regulation, sexual education and tracking symptoms (Chen et al., 2021; Aboagye et al., 2022).

These mHealth programs are designed to overcome various challenges that have been reported as

barriers to the access of reproductive health information – including stigma, privacy, lack of mobility

and access to adolescent-friendly health services (Kohn et al., 2021; Ekezie et al., 2023). Through

providing private, personalized support, mobile health apps can assist young people to challenge

cultural and social taboos that might hinder open discussion of reproductive health within traditional

settings. Recent studies have shown that mobile health app use in adolescents is associated with

increased knowledge about reproductive health, self-efficacy, and better sexual behaviors (Santos et

al., 2023; Mohamad et al., 2022). Youths using these technologies report more knowledge about

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menstrual health, fertility management, contraception options, and STIs prevention when compared

to those who receive the education through only traditional way (Kim et al., 2024). 3.3.

Furthermore, the use of game features integrated in the apps and the ability to set reminders,

receive educational pop-ups, do gamification tasks and participate on an anonymous peer discussion

forum have been contributing for prolonged use and increased learning (González et al., 2023). Other

apps such as Flo and Clue did the same, integrating evidence-based content and links with healthcare

providers to enhance the quality and credibility of the information offered (Flo Health Inc., 2022).

But while the results are promising, there are still challenges. Reports have identified challenges

including misinformation, cultural non-adaptation, digital-literacy challenges, risk of data privacy,

and availability for low-resource settings (Zulfiqar et al., 2023; Ahmed et al., 2024). Therefore,

although mobile apps are a promising tool for reproductive health literacy, ongoing content

consolidation, standardization, and user-centered design enhancements are necessary in order to

optimize their utility among varied groups of adolescents.

Overall, mHealth apps as such constitute a powerful, scalable and versatile approach to lay the

foundation for increased reproductive health literacy in adolescents. When used as part of

comprehensive digital health strategies, they may have the potential to not only improve individual

health outcomes, but also contribute to public health priorities in relation to adolescent sexual and

reproductive health globally.

2.4 Review studies on Social Media Platforms and Adolescent Reproductive Health Literacy

With adolescent users around the world increasingly using social media such as Instagram,

TikTok, Facebook, Twitter, YouTube to access reproductive health information, the role of these

platforms in reproductive health knowledge dissemination is growing. Young people’s widespread

use of social media provides an opportunity to overcome information needs, support healthy

reproductive health behaviours and strengthen overall reproductive health literacy (Bhatti et al., 2022;

Taggart et al., 2022).

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 Social media has recently emerged as an available, interactive, and relatable tool for delivery of

reproductive health information to adolescents. For example, platforms like TikTok and Instagram

offer adolescents sex education through sexual health related videos, infographics, and personal

narratives about issues like menstrual health, methods of contraception, consent, STIs, and body

autonomy (Kim et al., 2023; Lewandowsky et al., 2023). Such interactive forms enable young

people to participate actively in reproductive health education as compared with other more formal

educational modalities.

In a recent study of Wang et al. (2022) discovered that participants who followed health

accounts on social media had greater reproductive health knowledge and adopted more positive

sexual behaviors compared with non-followers. Furthermore, Sánchez et al. (2023)highlighted that

social media programs, in which people having similar age group (peers) would initiate a discussion

followed by influencer-oriented campaigns would be more effective as adolescents can benefit from

contents that are delivered by someone, whom they consider as their own.

Social media is also interactive, encouraging dialogue. Youngsters can ask, get doubts clarified,

share experiences, and get answers in almost real-time thus rendering reproductive health education

more interactive and relevant to their point of query (Subramaniam et al., 2022). Some platforms

also feature quizzes, polls, live Q&A roundtable discussions with industry experts and webinars to

increase engagement and drive learning.

Though with all these benefits, we still have challenges. Misinformation is a chief source of

concern. Young people are susceptible to misinformation by unofficial sources (Almazan et al.,

2024). In the absence of sufficient media literacy, they may be unable to identify reliable health

information from myths or stereotypes circulating online. Furthermore, privacy issues, openness to

inappropriate content, and potential exposure to cyberbullying in connection with reproductive health

communications in public platforms have also been described (Zhao et al., 2023).

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However, campaigns to improve digital health literacy, including verified content pages (f planetary

like Planned Parenthood’s Instagram page) and partnerships between healthcare providers and social

media companies provide promise in improving the quality of information on the Internet available to

adolescents (Taggart et al., 2022; Ekezie et al., 2023).

In summary, while social media has provided unprecedented opportunities for adolescent

reproductive health literacy to be enhanced, the influence of these platforms is highly contingent

upon the credibility of the information transmitted, adolescents’ digital literacy levels, and the

regulatory framework in place to safeguard users. Moreover, when used appropriately, social media

can be a useful adjunct to traditional reproductive health education strategies by supporting youth to

make] informed and healthier lifestyle decisions.

2.5 Comparative Analysis of Empirical Studies on Digital Health Interventions

Empirical studies investigating digital health tools (DHTs), such as mobile applications (apps),

social media, and e-learning platforms, have yielded varied evidence regarding their potential to

empower adolescents with reproductive health literacy skills. A constant comparative analysis of

these studies exposes general and specific points across data, as influenced by related elements, such

as socio-economic status, digital literacy and geographical setting.

mHealth apps have been repeatedly found to be successful for enhancing adolescent

Reproductive Health (RH) literacy. For example, Wang et al. (2022) also reported that adolescents

who use ‘specialised’ apps for reproductive health, such as Clue and Flo, had a better knowledge and

understanding of menstrual and contraceptive content, as well as sexual health-related decision-

making than their non-user counterparts. Also, Alobaidi and Davies(2022) found that adolescents

who were active users of mHealth apps tended to seek better health and had high empowerment level

in the ability to make reproductive health decisions.

By contrast, social media have had a wider but more variable impact. Studies like Taggart et al.

(2022) and Kim et al. (2023) found that through utilizing Instagram and TikTok, adolescents who

14
interact with reproductive health content on social platforms demonstrated knowledge gains and were

more likely to converse with peers about reproductive health. One definition of the general

knowledge views such a shared body of concepts, and behaviours people have gained from

knowledge (Bransford et al,2000) However, quality and trustworthiness of healthrelated information

accessed by social media are not the same, which limit knowledge memorandum and with that safe

health behaviour (Zhao et al., 2023). Likewise, adolescents of higher socio-economic status grew

exponentially the possibility to get hold of trustworthy apps and good quality online learning

platforms and hence an improved result (Almazan et al., 2024). Another critical distinction is the

level involvement. When the information was just passively seen (e. scrolling through feeds or posts),

respondents only gained a little, but when they interacted with it, actively (e.g. via completing app

activities and participating in discussions), reproductive health literacy improved (Subramaniam et

al., 2022; Sánchez et al., 2023). Problems such as digital divide and misinformation also cross over

between all the platforms. Although mobile apps and e-learning apps are usually policed by

moderation tools (ple.g., expert approval of content) social-media has few if any rules to follow

making it very insecure, especially if the content is false or damaging (Wang et al., 2022; Almazan et

al., 2024).

Although, all three digital health education tools (mobile apps, social media, and e-learning

modules) have positive effects on adolescent reproductive health literacy, the effects size and

duration vary depending on user engagement, platform regulation, demographic characteristics, and

digital literacy. Integration of several digital technologies alongside improving adolescents' critical

appraisal of health information may present a more effective approach in promoting reproductive

health literacy among adolescents, especially in resource-poor settings such as Ikere Local

Government Area of Ekiti State.

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2.6 Effectiveness of Digital Health Interventions: A Review of Empirical Results

Recent research has offered evidence on the effectiveness of digital health interventions for

improving reproductive health literacy in young people. Digital Tools In digital tools— mobile health

applications, social media and e-learning modules—the success factor depended on the quality of

content, human-user interface, digital literacy, and the ground level realities (Wang et al., 2022;

Almazan et al., 2024). Reproductive health literacy promotion has been effective through the use of

Mobile Health Applications (mHealth apps) time and time again. Interactive mHealth apps (e.g.,

symptom trackers, quizzes, live chats with health officers) users scored higher in reproductive health

knowledge than traditional education users (Alobaidi and Davies 2022). Furthermore, Ekezie et al.

(2023) reported that adolescents who use applications such as Flo, Clue, or My Period Tracker

showed an increased menstrual health self-management, and an increase in knowledge of

contraceptive methods.

Social Media Interventions also have showing good effectiveness, even if with more variance.

Taggart et al. (2022) carried out a systematic review and reported that social media campaigns

designed specifically for adolescents (with influencers, peer educators, and culture-specific

messaging) were effective in increasing awareness about reproductive health problems such as STIs

and contraceptives. However, misinformation and no content moderation are major concerns (Zhao

et al., 2023).

Online modules provide organised, curriculum-based methods that promote continued

knowledge accumulation. Sánchez et al. (2023) described that young participants receiving e-learning

courses on reproductive health retained such information for a longer period of time and had a

stronger behavioural effect (i.e. sustained condom use, attending regular health check-up) in

comparison of those exposed to informal or passive information sources. In addition, e-learning

platforms that incorporate game-like activities for learning (e.g., badges, quizzes, interactive videos)

demonstrated to have higher completion rates and engagement for adolescents (Kim et al., 2023).

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Bundling Package interventions such as mobile app + social media campaigns + e-learning packages

seem to work the best. Bhatti et al. (2022) and Subramaniam et al. (2022) found that multi-platform

intervention, involving multiple learning styles (visual, auditory, and interactive), resulted in higher

levels of reproductive health literacy and sustained change of behaviour.

Utilization of reliable sources and participation of health professionals in the development of

content (Sánchez et al., 2023). Using multi-platform approaches to support learning across various

online spaces (Bhatti et al., 2022). Routine need for testing and updating of digital technologies for

relevancy and engagement (Kim et al., 2023). Overall, digital health interventions hold significant

promise for improving adolescent reproductive health literacy; however, their success will be

contingent on thoughtful design, regulation, availability, and ongoing engagement strategies that are

responsive to adolescent needs and contexts.

2.7 Limitations and Challenges of Digital Health Interventions

Digital health interventions to improve adolescent sexual health literacy Although digital health

interventions have increasingly and effectively been used in improving adolescent reproductive

health literacy, some barriers and limitations are still observed in the literature in recent years. These

obstacles include technological, personal and systemic issues that could, in effect, negate the success

of such interventions at the macro level.

Issues of Digital Divide and Accessibility

The digital divide, which impacts adolescents in low resource settings the most, has been cited as

one of the primary challenges. Studies like Ekezie et al. (2023) and Taggart et al. (2022) reported

that restricted access to smartphones, erratic internet connections, and poor digital literacy skills

were also big challenges for the use of mHealth apps and e-learning platforms. Rural and/or

underserved youth will often have trouble reaping the full potential of digital interventions as a result

of infrastructural constraints. Kim et al. (2023) also highlighted that gender differences in access to

17
technology – with girls less likely than boys to own their own mobile – are partially responsible for

unequal health literacy outcomes.

Disinformation and Quality of Information

Given the open architecture of online platforms, in particular on social media which are difficult

to regulate, disinformation and misinformation can very easily propagate on these platforms. Wang

et al. (2022) and Zhao et al. (2023) reported that the young adolescents most of whom receive

reproductive health information from uncreditable sources have misconception about sensitive issues

(contraception, menstruation and STD). In the absence of effective content moderation and fact-

checking, digital health tools will end up exacerbating myths rather than stimulating knowledge. This

issue is more prominent in platforms such as TikTok, Instagram, and YouTube (Sánchez et al.,

2023).

Issues of Privacy and Secrecy

Data privacy, confidentiality, and fear of stigma are serious barriers which negatively impact

adolescent engagement with the digital health tools. Subramaniam et al. (2022) have described how

adolescents may fail to use reproductive health apps involving personal data out of concern of

judgment and data misappropriation, or disclosing their health status to peers and family. The

problem becomes more complicated in areas where strict data privacy regulations are not in place,

where the sensitive health data of the users may not be secure (Almazan et al., 2024).

Low engagement and sustainability

Although digital interventions achieve high engagement in the beginning, it is hard to keep the

engagement over time. Bhatti et al. (2022) observed adolescents start to develop a sense of

detachment from m-Health apps or e-learning modules when the latter were repetitive; low on

interactivity; and if there were, no motivational drivers for using them. Elements of gamification,

e.g., badges, points, quizzes, have been proposed to increase long-term engagement, but their effect is

user dependent (Kim et al., 2023).

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Relevance to Culture and Context

Many interventions fall short because they are not culturally appropriate or contextually

modified for the intended population. Alobaidi and Davies (2022) emphasized that digital health

interventions designed in Western settings may appeal to young people in African or Asian cultures

where reproductive health communication is culturally taboo, and arguably stigmatized.

Culturally insensitive language, images, and advice will discourage participants and restrict

intervention success.

Non-Engagement of Health Professionals

Another drawback is that there is a low level of healthcare professionals input in digital content

development and delivery. According to Sánchez et al. (2023), there are a number of apps and social

media interventions developed by companies and non-specialists without the necessary medical

oversight and oversight of the content therein, thereby, raising the possibility of credibility issue and

the medical accuracy of the information presented.

Measurement and assessment problems

Finally, it is difficult to assess the true effects of digital health interventions. Almazan et al.

(2024) noted that using digital engagement metrics only (e.g., app downloads, video views) to assess

behavioral change (e.g., safer sexual behavior) can be misleading. Longitudinal research and

standardized measures to monitor real-world outcomes over time are required (Taggart et al., 2022).

Although, digital health interventions offer great potential for improving adolescent reproductive

health literacy, they are not without their considerable obstacles. Overcoming barriers to

accessibility, misinformation, privacy, engagement and cultural relevance, and professional oversight

is paramount to the adoption of these interventions. New evidence highlights the need for adopting a

comprehensive, multi-sectoral model that links technology innovation with healthcare knowledge,

community participation and strong policy guidance.

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2.8 Summary of the Literature Review

This chapter presented a thorough review of literature about the utilization of digital health

education materials to reinforce reproductive health literacy in adolescents. Key thematic areas were

used to structure the review, and they included global trends, empirical studies, comparative analysis,

effectiveness, challenges and local context of digital health interventions. The prefaces to empirical

research on digital health literacy highlighted the increasing role of digital technologies in health

promotion, particularly for young people. The use of digital technologies, including mobile health

(mHealth) applications, social media sites and e-learning packages has become more more

widespread in providing health information to adolescents on a global scale (Taggart et al., 2022;

Sánchez et al., 2023).A global view of digital health tools and adolescent health literacy revealed that

even though advances in incorporating digital platforms in adolescent health promotion programs

occurred, differential access, cultural nuances, and digital literacy influence impact (Almazan et al.,

2024; WHO, 2023). Research on mobile health applications showed that they improved knowledge

of reproductive health, but also highlighted issues of usability and poor local content availability

(Ekezie et al., 2023). Studies on social media showed that it is an opportunity and a challenge with

truth information struggling with misinformation (Onwusiribe et al., 2023. In relation to the

effectiveness of digital health interventions, recent evidence highlighted that digital interventions

that are interactive, user-focussed and contextually relevant have the greatest positive outcomes

(Taggart, 2022; Ekezie, 2023). Nevertheless, impediments and restrictions, such as technological

barriers, digital misinformation, distrust of online information, and socio-cultural barriers, have

continued to be reported (Almazan et al., 2024; United Nations, 2023). These challenges have to be

overcome for capitalizing on the value of digital health education tools.

The significance to the community was well addressed. Because of increasing smartphone

ownership among adolescents in Nigeria (Onwusiribe et al., 2023) and the shortcomings in

20
reproductive health information from conventional sources, digital solutions present a competitive

alternative (Adeleke et al., 2022).

In general, digital health education tools may have potential for the enhancement of reproductive

health literacy in adolescents as evident in the reviewed literature. Nevertheless, detailed planning of

culture sensitive, age appropriate and context-specific intervention for adolescents like in Ikere Local

Government Area, is also highlighted. The findings of these review provide a strong basis of the

present study, and drive the research design, method and the anticipated outcome

21
 CHAPTER THREE

METHODOLOGY

This chapter presented the procedures and methods that were employed in carrying out the

study. It explained in detail the research design, population, sample and sampling techniques,

research instrument, validity and reliability of the instrument, procedures for data collection, and data

analysis techniques. The methodology provided a clear framework that guided the researcher in

obtaining reliable and valid data on the influence of digital health education tools on adolescent

reproductive health literacy among female secondary school students in Ikere Local Government

Area of Ekiti State.

3.1 Research Design

The study utilized a descriptive research design of the survey type. This design was adopted

because it enabled the researcher to obtain information from a representative sample of the targeted

population in order to describe situations as they existed. The design served as a fact-finding

approach that involved collecting data directly from the population at a particular point in time. It

was deemed appropriate for the study since it required direct responses from respondents while

investigating the existing phenomenon regarding digital health education tools and their influence on

adolescent reproductive health literacy.

3.2 Population of the Study

The population for the study consisted of female secondary school students in Ikere Local

Government Area of Ekiti State. The focus on female adolescents was crucial to understanding how

digital health education tools impacted reproductive health literacy in a gender-specific context.

There were 11 secondary schools in the local government area, with a total number of 3,517 female

students (Area Education Office, 2025)

22
3.3 Sample and Sampling Techniques

The sample for the study comprised of 500 female secondary school students selected from

various schools within Ikere Local Government Area. Both purposive and random sampling

techniques were used. The purposive sampling technique was used to select the only female

secondary schools and therefore sample random sampling technique was used to select four mixed

secondary school to make it a total of five school, specifically the focus of the study will be on senior

secondary schoool (SSS1 - SSS3). The sampling random sampling was used to select 100

respondents from each school to make a total number of 500 respondents to ensure fair

representation and minimize sampling bias.

3.4 Research Instrument

The instrument used for data collection was a self-structured questionnaire. It consisted of three

sections.

 Section A was designed to collect demographic information of the respondents

 Section B focused on gathering information on the students’ knowledge of reproductive health

 Section C covered questions relating to the use of mobile applications in monitoring

reproductive health among the respondents.

3.5 Validity of the Instrument

To ensure the validity of the instrument, hard copies of the questionnaire were submitted to the

researcher’s supervisor and two experts in Health Education Department for review and correction.

The corrected version was then resubmitted to the project supervisor for final approval before being

forwarded to the Center for Research and Development (CERAD) for further validation.

3.6 Reliability of the Instrument

The split-half method of reliability was employed for the study. The reliability of the instrument

was established by administering the questionnaire to thirty (30) respondents who were not part of

the actual sample for the study. The responses obtained were divided into two groups, X and Y, and

23
subjected to analysis using Cronbach’s Alpha in conjunction with the Spearman-Brown formula. The

resulting coefficient (r) was used to determine the reliability of the instrument at a 0.05 level of

significance.

3.7 Procedures for Data Collection

The researcher personally administered the questionnaire with the assistance of one trained

research assistant. A letter of introduction was obtained from the Head of Department of Human

Kinetics and Health Education, Bamidele Olumilua University of Education, Science and

Technology, Ikere-Ekiti. This letter, along with the researcher’s student identification card and

ethical clearance from CERAD, was presented to the principals of the selected schools for official

permission. The questionnaires were administered to the respondents and retrieved on the spot to

ensure a high rate of return.

3.8 Data Analysis Techniques

The data collected were analysed using the Statistical Package for Social Sciences (SPSS)

version 25.0. Descriptive statistics such as frequency counts, percentages, mean, and standard

deviation were used to analyze the demographic data and answer the research questions. Inferential

statistics of Analysis of Variance (ANOVA) were used to test the hypotheses at a 0.05 level of

significance.

24
 CHAPTER FOUR

Results and Discussion

This chapter presents the results of data analyses and the subsequent discussion.

4.1 Demographic Information of the Respondents

Table 1: Distribution of Respondents on Type of School

Type of School Frequency Percentage Valid Percent Cumulative Percent

Mixed school 402 80.4 80.4 80.4

single school 98 19.6 19.6 100.0

Total 500 100.0 100.0

Source: Field Study, 2025

The analysis presented in table 1 revealed the type of school of the respondents. It was revealed

that out of 500 respondents sampled for the study, 402 (80.4%) are in mixed school and 98 (19.6%)

are in single school. This shows that majority of the female students sampled for this study are in

mixed school. This is because there is only one female single school in the study area. However,

female in other mixed school were involved in the study to access the impact of digital health tools on

adolescent reproductive health literacy.

Table 2: Distribution of respondents on Educational Level

Educational level Frequency Percentage Valid Percent Cumulative Percent

SS 1 115 23.0 23.0 23.0

SS 2 210 42.0 42.0 65.0

SS 3 175 35.0 35.0 100.0

Total 500 100.0 100.0

Source: Field Study, 2025

The analysis presented in table 2 revealed the educational class of the respondent. The table

revealed that out of 500 respondents, 115 (23.0%) are in SS 1, 210 (42.0%) are in SS 2 and 175

25
(35.0%) are in SS 3. This shows that the study involved female students in the senior classes but

female students in SS 2 constituted the majority.

Table 3: Distribution of respondents on Age in Year

Age in year Frequency Percentage Valid Percent Cumulative Percent

13-15 yrs 180 36.0 36.0 36.0

16-18 yrs 245 49.0 49.0 85.0

19-21 yrs 75 15.0 15.0 100.0

Total 500 100.0 100.0

Source: Field Study, 2025

The analysis presented in table 3 revealed the age in years of the female students in secondary

schools. The table revealed that out of 500 respondents, 180 (36.0%) are between the age of 13-15

years, 245 (49.0%) are between the age of 16-18 years and 75 (15.0%) are between the age of 19-21

years. This implies that all the female students involved in the study are matured and they are

between the age of 13-21 years. These set of female students are capable of having the knowledge of

reproductive health.

Table 4: Information of Respondents on Access to Mobile Application

S/N Mobile health access Categories Frequency Percentage

5. Do you own a smartphone Yes 104 20.8%

No 396 79.2%

6. Do your parents or guardians allow you to use a Yes 173 34.6%

mobile phone regularly No 327 65.4%

7. Do you have a regular access to the internet Yes 189 37.8%

No 311 62.2%

Source: Field Study, 2025

26
The analysis presented in table 4 revealed the level of access to mobile application of female students

in secondary schools. It was revealed that 396 (79.2%) of the female students do not own a

smartphone and only 104 (20.8%) indicated they own a smartphone. The majority (327, 65.4%) of

the respondents indicated that their parents or guardians do not allow them to use a mobile phone

while 173 (34.6%) they are allowed to use a mobile phone. There was also no access to internet

facilities as indicated by 311 (62.2%) of the respondents. The result indicated that majority (70.0%)

of female students in secondary schools do not have access to mobile phone.

4.2 Analysis of Research Questions

Question 1: What is the level of female adolescents’ knowledge on reproductive health among

female secondary schools in Ikere Local Government Area?

Table 5: Descriptive analysis showing the level of female adolescents’ knowledge on

reproductive health among female secondary schools

S/N ITEMS YES (%) NO (%) Mean

8. Have you heard about reproductive health before? 438 62
1.87
(87.6%) (12.4%)
9. Do you know what menstrual hygiene means? 378 122
1.75
(75.6%) (24.4%)
10. Have you been taught about puberty changes in school? 486 14 (2.8%)
1.97
(97.2%)
11. Do you know about safe practices during menstruation? 415 85
1.83
(83.0%) (17.0%)
12. Can you confidently say you understand how your menstrual 464 36 (7.2%)
1.92
cycle work? (92.8%)
13. Do you believe it is important for adolescents to have correct 391 109
1.78
knowledge about reproductive health? (78.2%) (21.8%)
Grand Mean 1.85
Mean greater than or equal to 1.50 indicate ‘Yes’ otherwise ‘No’.

The result presented in table 5 revealed the level of female adolescents’ knowledge on

reproductive health among female secondary schools. The mean values in the table are greater than

27
1.50 which indicated that majority of the respondents agreed that they have heard about reproductive

health before (1.87), they know what menstrual hygiene means (1.75), they have been taught about

puberty changes in school (1.97), they know about safe practices during menstruation (1.83), they can

confidently say they understand how their menstrual cycle work (1.92) and they believed it is

important for adolescents to have correct knowledge about reproductive health (1.78). The grand

mean value of 1.85 which was greater than 1.50 indicated that there was high level of female

adolescents’ knowledge on reproductive health among female secondary schools in Ikere Local

Government Area.

Question 2: What is the level of female adolescents’ knowledge on the use of mobile application

reproductive health literacy among secondary schools in Ikere Local Government Area?

Table 6: Descriptive analysis showing the level of female adolescents’ knowledge on the use of

mobile application for reproductive health literacy among female secondary schools

S/N ITEMS SA (%) A (%) D (%) SD (%) Mean

14 I have heard about mobile apps like Flo, 78 33 143 246
1.88
Clue, or My Calendar (15.6%) (6.6%) (28.6%) (49.2%)
15 I have used a mobile app to monitor my 0 (0) 18 260 222
1.59
menstrual cycle. (3.6%) (52.0%) (44.4%)
16 I frequently use a mobile app to track my 1 (0.2%) 55 305 139
1.84
reproductive health. (11.0%) (61.0%) (27.8%)
17 Mobile health apps have improved my 24 62 212 202
2.20
knowledge of reproductive health. (4.8%) (12.4%) (42.4%) (40.4%)
18 I receive helpful reminders about my health 40 73 298 89
2.12
from mobile apps. (8.0%) (14.6%) (59.6%) (17.8%)
Grand Mean 2.08

The result presented in table 6 revealed the level of female adolescents’ knowledge on the use of

mobile application for reproductive health literacy among female secondary schools. The mean value

in the table for item 14-18 are less than 2.50 decision level. This shows that majority of the female

28
adolescent disagreed with all the statements in the table. It therefore means that majority of female

adolescent have not heard about mobile apps like Flo, Clue, or My Calendar (1.88), they have not used a mobile app
to monitor their menstrual cycle (1.59), they did not use a mobile app to track their reproductive health (1.84), the mobile

health apps have not improved the knowledge on reproductive health (2.20) and the students have not receive helpful

reminders about their health from mobile apps (2.12). The grand mean value of 2.08 is less than 2.50 of

criterial decision level. This indicated that female adolescents’ knowledge on the use of mobile

application reproductive health literacy is low. Majority of the female adolescent in secondary

schools do not have the knowledge of the use of mobile application for reproductive health literacy in

Ikere Local Government Area.

Question 3: Can social media mobile health applications affect female adolescent reproductive health

literacy in Ikere Local Government Area?

Table 7: Descriptive analysis showing how mobile health applications affect female adolescent

reproductive health literacy

S/N ITEMS SA A (%) D (%) SD Mean

(%) (%)
20 Mobile apps have helped me understand my 26 55 43 376
fertility period. (5.2%) (11.0% (8.6%) (75.2% 1.46

) )
21 19 60 155 266
Social media platforms have taught me more about
(3.8%) (12.0% (31.0% (53.2% 1.62
reproductive health.
) ) )
22 I trust the health information I get from mobile 0 (0) 104 173 223
apps. (20.8% (34.6% (44.6% 1.76

) ) )
23 18 279 124 79
I am influenced by my friends to use mobile health
(3.6%) (55.8% (24.8% (15.8% 2.47
apps.
) ) )
Grand Mean 1.83

29
The result presented in table 7 revealed how social media mobile health applications affect female

adolescent reproductive health literacy. The mean values in the table for item 20-23 are less than 2.50

which indicated that majority of the respondents disagreed with the statements in the table. This

means that mobile apps have helped them understand fertility period (1.46), social media platforms have not taught the
students about reproductive health (1.62), they did not trust the health information gotten from mobile apps (1.76) and

there is no influenced from friends on how to use mobile health apps. The grand mean value of 1.83 also less

than 2.50 indicating that social media mobile health applications have no effect on female adolescent

reproductive health literacy in Ikere Local Government Area.

Question 4: Can demographic factors such as age and educational level affect the use of mobile

applications for reproductive health literacy in Ikere Local Government Area?

Table 8: Descriptive analysis showing how demographic factors affect the use of mobile

applications for reproductive health literacy

S/N ITEMS SA (%) A (%) D (%) SD (%) Mean

24 Demographic factors like age affect how 200 215 66 19
3.19
often I use mobile health apps (40.0%) (43.0%) (13.2%) (3.8%)
25 I believe that the knowledge of mobile 288 137 72 3 (0.6%)
apps can help in preventing reproductive (57.6%) (27.4%) (14.4%)
3.42
health issues health through early
awareness
26 I would recommend mobile health apps to 60 267 90 83
my friends to monitor their reproductive (12.0%) (53.4%) (18.0%) (16.6%) 2.60

health.
Grand Mean 3.07

The result presented in table 8 revealed how demographic factors such as age and educational level

affect the use of mobile applications for reproductive health literacy. The mean values in the table for

item 24-26 are greater than 2.50 which indicated that majority of the respondents agreed that
Demographic factors like age affect how often I use mobile health apps (3.19), they believed that the knowledge of

mobile apps can help in preventing reproductive health issues health through early awareness (3.42) and they can

30
recommend mobile health apps to their friends to monitor their reproductive health (2.60). The grand mean value of

3.07 was also greater than 2.50 decision level. This indicated that demographic factors such as age

and educational level affect the use of mobile applications for reproductive health literacy in Ikere

Local Government Area.

4.3 Test of Hypotheses

Hypothesis 1: There will be no significant impact of reproductive health knowledge among female

adolescents in Ikere Local Government Area.

Table 9: Analysis of Variance (ANOVA) for impact of reproductive health knowledge among

female adolescents

Sum of Squares Df Mean Square F Sig.

Between Groups 4.282 1 4.282 42.618 .000

Within Groups 50.030 498 .100

Total 54.312 499

P < 0.05 (Significant)

The result of statistical analysis for testing the significant impact of reproductive health knowledge

among female adolescents in table 9 revealed that the impact of reproductive health knowledge was

statistically significant as F-value (42.618) was high, df = (1, 498) and P < 0.05 at 0.05 level of

significance. This led to the rejection of null hypothesis one. Hence, there is a significant impact of

reproductive health knowledge among female adolescents in Ikere Local Government Area.

Hypothesis 2: There is no significant effect of mobile health applications on reproductive health

literacy in Ikere Local Government Area.

Table 10: Analysis of Variance (ANOVA) for effect of mobile health applications on reproductive

health literacy

Sum of Squares Df Mean Square F Sig.

Between Groups 9.916 1 .916 1.577 .760

31
Within Groups 7.642 498 .196

Total 17.558 499

P > 0.05 (Not Significant

The result of statistical analysis for testing the significant effect of mobile health applications on

reproductive health literacy in table 10 revealed that the effect of mobile health applications on

reproductive health literacy was not statistically significant as F-value (1.577) was very low, df = (1,

498) and P (0.760) > 0.05 level of significance. This led to non-rejection of null hypothesis two.

Hence, there is no significant effect of mobile health applications on reproductive health literacy in

Ikere Local Government Area.

Hypothesis 3: There is no significant impact of social media platforms on adolescent health literacy

in Ikere Local Government Area.

Table 11: Analysis of Variance (ANOVA) for impact of social media platforms on adolescent

health literacy

Sum of Squares Df Mean Square F Sig.

Between Groups 6.556 1 .556 1.056 .609

Within Groups 10.212 498 .201

Total 16.768 499

P > 0.05 (Not Significant)

The result of statistical analysis for testing the significant impact of social media platforms on

adolescent health literacy in table 11 revealed that the impact of social media platforms on adolescent

health literacy was not statistically significant as F-value (1.056) was very low, df = (1, 498) and P

(0.609) > 0.05 level of significance. This led to non-rejection of null hypothesis three. Hence, t here is

no significant impact of social media platforms on adolescent health literacy in Ikere Local

Government Area.

32
Hypothesis 4: There is no significant effect of demographic factors (age, education level) on the use

of mobile applications for reproductive health literacy in Ikere Local Government Area.

Table 12: Analysis of Variance (ANOVA) for influence of sport facilities on the teaching and

learning of Physical and Health Education

Source Type III Sum of Squares Df Mean Square F Sig.

Corrected Model 286.817a 6 47.803 225.014 .000

Intercept 292.258 1 292.258 1375.694 .000

Age .625 2 .312 21.470 .231

Education 82.914 2 41.457 195.143 .000

Age * Education 3.123 2 31.562 57.350 .001

Error 104.735 493 .212

Total 3940.000 500

Corrected Total 391.552 499

P < 0.05 (Significant)

The result of statistical analysis for testing the significant effect of demographic factors (age,

education level) on the use of mobile applications for reproductive health literacy in table 12 revealed

that age (21.470), education (195.143) and age & education (57.350) were statistically significant as

df = (1, 498) and P < 0.05 at 0.05 level of significance. This led to the rejection of null hypothesis

four. Hence, there is a significant effect of demographic factors (age, education level) on the use of

mobile applications for reproductive health literacy in Ikere Local Government Area.

4.4 Discussion of Findings

Hypothesis one sought to examine the level of female adolescents’ knowledge on reproductive health

among female secondary schools. The finding revealed that female students in Ikere-Ekiti have heard

33
about reproductive health, they know what menstrual hygiene means, they have been taught about

puberty changes in school, they know about safe practices during menstruation, they can confidently

say they understand how their menstrual cycle work and they believed it is important for adolescents

to have correct knowledge about reproductive health. This means that there is high level of female

adolescents’ knowledge on reproductive health among female secondary schools in Ikere Local

Government Area. The test of hypothesis one confirmed that there is a significant impact of

reproductive health knowledge among female adolescents in Ikere Local Government Area. This

finding is similar with the finding of Nutbeam, (2020) that students in secondary schools possessed

reproductive health literacy. Velardo, (2020) noted that knowledge of reproductive health is the

ability to access, understand, evaluate, and use reproductive health information and services so as to

make informed decisions in order to maintain a good native sexual health. He further stressed that

students have the knowledge about puberty, contraception, sexually transmitted infections (STIs),

menstruation, fertility, and reproductive health services. Hence, reproductive health knowledge is

particularly important among adolescents as there are important biological, psychological and social

changes that influence reproductive health outcomes during this time in development (World Health

Organization, 2021).

Hypothesis two sought to examine the level of female adolescents’ knowledge on the use of mobile

application for reproductive health literacy among female secondary schools. It was revealed that

majority of female adolescent have not heard about mobile apps like Flo, Clue, or My Calendar to

monitor their reproductive health, they have not used a mobile app to monitor their menstrual cycle,

they did not use a mobile app to track their reproductive health, the mobile health apps have not

improved their knowledge on reproductive health and the students have not receive helpful reminders

about their health from mobile apps. This means that female adolescents’ knowledge on the use of

mobile application reproductive health literacy is low. This therefore means that majority of the

female adolescent in secondary schools do not have the knowledge of the use of mobile application to

34
track their reproductive health especially their menstrual cycle in Ikere Local Government Area. The

test of hypothesis two also confirmed that there is no significant effect of mobile health applications

on reproductive health literacy in Ikere Local Government Area. This finding is in line with the

finding of Ahmed et al., (2023) that the popular apps like Clue, Flo, My Calendar, Natural Cycles

which offer menstrual cycle tracking, ovulation forecasting, fertility regulation, sexual education and

tracking symptoms are not commonly used by adolescent in secondary schools. Although Kim et al.,

(2024) reported that youths who make use of mobile application have more knowledge about

menstrual health, fertility management, contraception options, and STIs prevention when compared

to those who receive the education through only traditional way. However, Zulfiqar et al., (2023)

stressed that female adolescent who do not make use of mobile application faced the problem of

misinformation, cultural non-adaptation, digital-literacy challenges, risk of data privacy, and

availability for low-resource settings. Also, Ahmed et al., (2024) stated that female adolescent did not

see mobile apps as promising tool for reproductive health literacy, thus, they are not interested in

using it.

Hypothesis three sought to examine how social media mobile health applications can affect female

adolescent reproductive health literacy. It was revealed in the study that mobile apps have not helped

female adolescent understand fertility period, social media platforms have not taught the students

about reproductive health, they did not trust the health information gotten from mobile apps and there

is no influenced from friends on how to use mobile health apps. This means that social media mobile

health applications have no effect on female adolescent reproductive health literacy in Ikere Local

Government Area. The test of hypothesis three attested to the fact that there is no significant impact

of social media platforms on adolescent health literacy in Ikere Local Government Area. This finding

negates the finding of Taggart et al. (2022) that social media has emerged as an available, interactive,

and relatable tool for delivery of reproductive health information to adolescents. They further stressed

that platforms like TikTok and Instagram offer adolescents sex education through sexual health

35
related videos, infographics, and personal narratives about issues like menstrual health, methods of

contraception, consent, STIs, and body autonomy. Social media mobile health application is expected

to have impact on female adolescent reproductive health but reverse is the case among female

adolescent in the study area. The reason for the insignificant impact of social media mobile health

applications according to Ahmed et al., (2023) was due to inadequate access of students to smart

phone. This confirmed the report of investigation among female students that 79.2% of the female

adolescent do not have smartphone that can enable them access information on reproductive health

issues.

Hypothesis four sought to examine the how demographic factors such as age and educational level

affect the use of mobile applications for reproductive health literacy. The finding revealed that age of

female adolescent affect how often student use mobile health apps, they believed that the knowledge

of mobile apps can help in preventing reproductive health issues health through early awareness and

they can recommend mobile health apps to their friends to monitor their reproductive health. This

means that demographic factors such as age and educational level affect the use of mobile

applications for reproductive health literacy in Ikere Local Government Area. The test of hypothesis

four revealed that there is a significant effect of demographic factors (age, education level) on the use

of mobile applications for reproductive health literacy in Ikere Local Government Area. This finding

correlate with the finding of Kim et al., (2023) that students’ age and level of educational attainment

increase knowledge on reproductive health and facilitate the use of mobile application to monitor

reproductive health changes.

36
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

This chapter presents the summary, conclusion, recommendations, summary and suggestions for

further study.

5.1 Summary

This study assessed the impact of digital health education tools on reproductive health literacy among

adolescent girls in Ikere Local Government Area of Ekiti State. The study categorically considered

the level of female adolescents’ knowledge on reproductive health among female secondary schools

in Ikere Local Government Area; the level of female adolescents’ knowledge on the use of mobile

application reproductive health literacy among secondary schools in Ikere Local Government Area;

how social media mobile health applications can affect female adolescent reproductive health literacy

in Ikere Local Government Area and how demographic factors such as age and educational level can

affect the use of mobile applications for reproductive health literacy in Ikere Local Government Area.

The study therefore led to the development of four research questions and four hypotheses, tested at

0.05 level of significance.

Several literatures were reviewed in the study. The areas reviewed are categorized into: c onceptual

framework, theoretical framework and review of related empirical study.

The study adopted survey design of descriptive type. It involved all female secondary school students

in Ikere Local Government Area of Ekiti State. The sample of 500 female students were selected

from 3,517 female students in 11 secondary schools in Ikere Local Government area of Ekiti state

using simple and purposive random sampling technique. A self-structured questionnaire was used for

data collection. The validity of the instrument was done by two (2) experts from the field of Human

Kinetics and Sports Science, Bamidele Olumilua University of Education, Science, and Technology.

Ikere-Ekiti, to vet in order to establish face and content validity and a reliability coefficient of 0.810

was obtained through split half method. Data collected were analyzed using descriptive statistics

37
(frequency, percentage & mean). The inferential statistics used for test of hypotheses was Analysis of

variance at 0.05 level significance.

The result showed that there is high level of female adolescents’ knowledge on reproductive

health among female secondary schools in Ikere Local Government Area. Female adolescents’

knowledge on the use of mobile application reproductive health literacy is low. This means that

female adolescent in secondary schools do not have the knowledge of the use of mobile application to

track their reproductive health especially their menstrual cycle in Ikere Local Government Area.

Social media mobile health applications have no effect on female adolescent reproductive health

literacy in Ikere Local Government Area and demographic factors such as age and educational level

affect the use of mobile applications for reproductive health literacy in Ikere Local Government Area.

5.2 Conclusion

Based on the findings of this study, it was concluded that female students possessed the knowledge of

reproductive health but lack knowledge on the use of mobile application to monitor their reproductive

health. This is because they do not have access to digital health education tools such as smartphone

and internet that can help to improve reproductive health literacy among adolescent girls in Ikere

Local Government Area of Ekiti State. Hence, the impact of digital health education tools on

reproductive health literacy among adolescent girls in Ikere Local Government Area of Ekiti State

was minimal.

5.3 Recommendations

Based on the findings of this study, it was recommended that:

1. There is an urgent need for schools to make provisions for digital health tools and free internet

services within the school premises so that students will have access to facilities that will improve

their knowledge on reproductive health.

2. Teachers are advice to teach their adolescent girls on how to use digital health software to

monitor their menstrual cycle and other reproductive health issues.

38
3. Parents are to provide android phone to adolescent girls with proper monitoring so as to use

various digital health applications to cater for their reproductive health.

4. Students are to inculcate the habit of using digital health apps to ensure proper health balance.

5.4 Limitations of the Study

The research has some limitation during the course of carrying out the study. Some of the

questionnaires distributed were not properly filled as some students do not take their time to read

through the content of the questionnaire. This led to the readministered of wrongly filled

questionnaire. All these led to a waste of time. However, the researcher was able to wait, persuade

them to attend to the questionnaire, thus bringing the study to logical conclusion.

5.5 Suggestions for Further Studies

Similar study could be carried out on the area the study did not cover. Further study could be carried

out on this topic in other local government or state. It is important to investigate whether the findings

can be generalized to other educational sector of the state.

39
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 APPENDIX
BAMIDELE OLUMILUA UNIVERSITY OF EDUCATION,
SCIENCE AND TECHNOLOGY, IKERE-EKITI.
DEPARTMENT OF HUMAN KINECTICS AND HEALTH EDUCATION
QUESTIONAIRE ON: IMPACT OF DIGITAL HEALTH TOOLS ON ADOLESCENT
REPRODUCTIVE HEALTH LITERACY.
Dear Respondent,
I am conducting a study titled “Impact of Digital Health Tools on Adolescent Reproductive Health
Literacy in Ikere Local Government Area, Ekiti State.” This research explores how Digital Health
Education Tools improve Adolescent Reproductive Health literacy.
Your responses will provide valuable insights for this study. All information you provide will remain
confidential and used solely for academic purposes.
Thank you for taking the time to participate. Your input is greatly appreciated!
Sincerely,
Ajakaye Modupe.
Section A: Demographic Information
Instruction: Please tick or fill the appropriate option to the question.
1. School: ________ _________________________________________________________________
2. Type of School: Mix School , Single School
3. Educational Level: SS1 , SS2 , SS3
4. Age in years: 13-15 , 16-18 , 19-21
5. Do you own a smartphone? Yes No
6. Do you have regular access to the Internet? Yes No
7. Do your parents or guardians allow you to use a mobile phone regularly? Yes No
Section B: Knowledge On Reproductive Health

No Items Yes No
8. Have you heard about reproductive health before?
9. Do you know what menstrual hygiene means?
10. Have you been taught about puberty changes in school?
11. Do you know about safe practices during menstruation?
12. Can you confidently say you understand how your menstrual cycle work?
13. Do you believe it is important for adolescents to have correct knowledge about
reproductive health?

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 Section C: Use Of Mobile Applications For Reproductive Health
Response Key: Strongly Agree, Agree, Disagree, Strongly Disagree
S/N Items Strongly Agree Disagree Strongly
Agree Disagree
14. I have heard about mobile apps like Flo, Clue, or My Calendar

15.
I have used a mobile app to monitor my menstrual cycle.
16.
I frequently use a mobile app to track my reproductive health.
17. Mobile health apps have improved my knowledge of
reproductive health.
18.
I receive helpful reminders about my health from mobile apps.
19. I prefer using mobile apps to track my menstrual cycle rather
than using a paper calendar.
20. Mobile apps have helped me understand my fertility period.
21. Social media platforms have taught me more about reproductive
health.
22. I trust the health information I get from mobile apps.
23.
I am influenced by my friends to use mobile health apps.
24. Demographic factors like age affect how often I use mobile
health apps
25. I believe mobile apps can help in preventing reproductive reproductive health issues health
through early awareness.
26. I would recommend mobile health apps to my friends to monitor
their reproductive health.
`

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