Acceptability, Engagement, and Implementation of Mobile-Based Sexual and Reproductive Health Education among Adolescents and Youth in Ethiopia: A Qualitative Process Evaluation

Background Adolescents and youth in Ethiopia face persistent barriers to confidential, accurate, and youth-friendly sexual and reproductive health information, particularly in underserved settings. Low-bandwidth mobile learning may extend access, but evidence remains limited on how young people experience such interventions and how social, gender, and infrastructural conditions shape engagement. This study examined the acceptability, engagement, and implementation of the Leap Adolescent and Youth Health training, including engagement mechanisms, barriers, facilitators, and perceived outcomes. Methods We conducted a qualitative process evaluation in implementation areas in Oromia, Amhara, and South Ethiopia. Qualitative data collection and secondary program-data mapping occurred between December 2025 and April 2026. Data comprised 14 focus group discussions with 121 participants, 13 in-depth interviews, and 8 key informant interviews, involving 142 adolescents, youth, peer leaders, school representatives, supervisors, and implementation actors. Transcripts underwent hybrid inductive-deductive codebook thematic analysis. Aggregate program records were used descriptively to contextualize registration, initiation, and completion. Results Participants valued Leap’s low-bandwidth interactive voice response and short-message delivery, local-language storytelling, flexibility, privacy, and relevance to their sexual and reproductive health concerns. Engagement was constrained by unstable networks, electricity interruptions, shared or restricted phone access, changing phone ownership, and expectations of financial incentives. These barriers were particularly consequential for girls because device availability did not necessarily provide autonomous or confidential access. Peer reminders, troubleshooting, group discussions, and friendly competition supported initiation and continued engagement. Participants reported greater confidence in discussing sexual and reproductive health and seeking youth-friendly information and services, although these were perceived rather than independently measured outcomes. During the reporting period, 11,299 learners registered, 5,300 (46.9%) initiated training, and 3,508 completed all sessions, representing 66.2% of initiators and 31.0% of registered learners. Conclusions Low-bandwidth mobile learning can provide an acceptable and contextually relevant channel for sexual and reproductive health education in underserved settings, but technological simplicity does not ensure equitable participation. Scale-up should combine accessible mobile delivery with gender-responsive strategies for private and autonomous phone use, recovery mechanisms following connectivity interruptions, structured peer support, and stage-specific monitoring from registration through completion.