There has been a proliferation of digital sexual health interventions targeting adolescents; however, limited evaluative reviews have compared the effectiveness of multiple digital tools for sexual health literacy and behaviour change. This study conducted a systematic literature review, screened 9881 records and analysed 61 studies. Findings suggest that websites and mobile phones dominate digital sexual health interventions, with a majority effectively delivering cognitive (e.g. awareness and attitudes about sexual and reproductive health) and behavioural outcomes (e.g. abstinence and use of contraception). The most popular sexual health promotion mechanisms were interactive websites, text messaging and phone calls, and online education programmes, followed by mobile applications-fewer studies in this review utilized social media, games and multimedia. Previous reviews focused on single outcome measures (e.g. sexually transmitted infection testing) to assess interventions' effectiveness. The current review moves beyond single outcome measures to cover a wider range of behavioural and non-behavioural sexual health issues and contexts covered in the literature. Four main categories were analysed as outcomes: cognitive perceptions, promoting sexual health-related behaviours, promoting sexual health-related products and services, and impact (viral load). Seventy-nine per cent of interventions focused on preventive sexual health behaviours and products (e.g. condoms) and services (e.g. HIV testing). Overall, 75% of studies effectively changed sexual health behaviour and cognitive perceptions. However, the digital-only tools did not vary from the blended formats, in influence outcomes, even after categorizing them into behavioural or non-behavioural outcomes. Compared to previous systematic reviews, more studies from the last decade used rigorous research design in the form of randomized controlled trials, non-randomized control trials, and quasi-experiments and lasted longer.
Keywords: behaviour change; digital technology; sexual health interventions; systematic literature review; young adults.
Sexual health literacy among adolescents is essential to avert unwanted pregnancies or abortions and sexually transmitted diseases. Culturally sensitive and age-appropriate interventions are required to educate youth about safe-sex practices and increase their self-efficacy and accessibility to health products and services. Meta-analytical and systematic literature reviews have identified limitations in traditional interventions that rely heavily on classroom-based activities and lectures to educate adolescents about safe sex. In recent years, digital tools have proved productive; however, limited evaluative reviews have compared the effectiveness of multiple digital technologies (such as smartphones, web-based programs, social media, games and multimedia) used within sexual health interventions. This systematic review assessed 9881 articles and synthesized 61 experimental studies on adolescent sexual behaviour conducted in the last decade to identify tools that positively influence cognitive and safe-sex behaviour among youth. Interactive websites, mobile technology and online education programmes were popular promotional tools, but very few studies utilized multimedia alongside games and social media. Findings from this review could facilitate future research and practice in adolescent sexual health.
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