Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals born in a foreign country [1]. Globally, Canada has one of the highest percentages of immigrants, who comprise 21.9% of the total population [2]. Of all these newcomers, approximately 34% are under the age of 25, with over 60% of immigrant youth coming from Asia, the Middle East, and Africa [1]. Given these statistics, understanding health care service information needs and utilization by immigrant adolescents is vital for health care planning, policy, and delivery. Adolescence is a critical period in the transition from childhood into adulthood, during which young individuals aged 10 to 19 years undergo substantial physical, psychological, social, and emotional changes [3]. Adolescents are a vulnerable population because of their age-related psychosocial and biological changes and the challenges associated with navigating these changes [4]. As part of this development, it is common for adolescents to explore their sexual identities and feelings through sexual experimentation [5]. Depending on their knowledge about sexuality and social support, some may experience unintended consequences, such as unplanned pregnancy and sexually transmitted infections (STIs). Neglect of adolescents’ sexual and reproductive health (SRH) needs can affect their physical and mental health, future employment, economic well-being, and ability to reach their full potential [6-8]. A small but growing body of literature suggests that immigrant youth lack SRH knowledge, use fewer sexual health services, and receive fewer sex education resources than nonimmigrant youth [9-11]. This difference appears to be heavily influenced by religious and cultural practices [12]. Immigrant families from Southeast Asia and the Middle East have diverse cultural and religious views on dating, relationships, adolescent sexuality, gender roles and identity, and sexual orientation [13]. Studies have shown that many immigrant adolescents find it challenging to balance family expectations, cultural standards, and religious demands; dissonance can cause internal and external conflict [13-15]. In addition, many adolescents experience intergenerational conflict, a competition between their own values and those of elders of the community [16].

Despite the large number of immigrant adolescents in Canada, there is limited research on the SRH of this population. COVID-19 pandemic–driven changes in how services are provided, such as limiting in-person care and deferring new and walk-in patients, have created barriers for adolescents to access confidential SRH information and services. Individuals may want to avoid obtaining in-person care during this time to reduce the risk of viral transmission. Hence, it is imperative to promote and adopt innovative approaches such as digital health (mobile apps, information through SMS text messaging) to deliver culturally appropriate SRH and sexuality education to immigrant adolescents in Canada. Beyond pandemic concerns, there is evidence to suggest that mobile apps have the potential to promote adolescent health [17]. This study will address these gaps by exploring the SRH priorities and health information needs of immigrant adolescents and will develop an interactive sexual health promotion mobile app for immigrant adolescents in Canada.

The transition from adolescence to adulthood is complex, as new responsibilities materialize and confidence and independence emerge [18,19]. Yet, teens often have inadequate knowledge about the consequences of unprotected sex and are novices when it comes to implementing safe sex practices. These consequences include unwanted pregnancy, complications of unsafe abortion, and STIs [11]. In addition, due to fear, stigma, and confidentiality issues, many do not reveal their SRH problems and underutilize the health care services they need [9]. SRH is an important aspect of adolescent health and well-being, and it interconnects with various physical and mental health issues [20-22].

Globally, the SRH needs of adolescents have been largely unmet and pose a significant threat to the health and well-being of adolescents [9,23-25]. They are biologically more vulnerable to infections, more susceptible to peer pressure, developmentally more disposed to risk-taking, and lack the skills and confidence to negotiate safer sexual practices. STI rates among Canadian adolescents are on the rise [24-28]. Studies on adolescent SRH have found that the unintended teenage pregnancy rate is rising again in Canada [29]. The Canadian Community Health Survey reported that almost 15.5% of Canadian youth are at high risk of unintended pregnancy due to the nonuse of contraceptives [30,31]. The consequences of teenage pregnancy include anemia, hypertension, renal disease, eclampsia, and depressive disorders [29]. Research has found that adolescent mothers experience more mental health problems and higher rates of postpartum depression than women aged 25 and older [32]. Moreover, children of teenagers are more likely to have low birth weights and experience associated health problems [29]. Studies highlight an alarming gap in the sexual health knowledge of adolescents in Canada despite their completion of sexual education requirements in school [27,33-36]. Studies also found that sexually active Canadian teenagers commonly engage in risky sexual behaviors, including unprotected sex, multiple sexual partners, and intercourse before 15 years of age [35,37,38]. Moreover, many Canadian youths do not consider themselves at risk for HIV/AIDS, and their overall knowledge base about the disease has declined over the last 2 decades [9,39,40].

Mobile app platforms have the potential to advance SRH. Nearly 100% of youth in Canada aged 15 to 24 years use the internet daily or own a smartphone [41]. The use of mobile technology for health promotion offers privacy [42-47], access to personalized information [42,44,46,48], and convenience [42,47,49], making it a valuable way to provide accurate information about sexual health to adolescents [43-48]. Furthermore, young people are responsive to and excited about using new technologies for SRH promotion [42,45,50,51]. Innovative ways to deliver sexual health information are more important than ever before due to the impact of the COVID-19 pandemic on access to SRH services globally [52]. The absence of adolescent SRH services from “essential” health services during COVID-19 amplifies the potential role of technology to meet the SRH needs of vulnerable groups like adolescents. Amid the pandemic, technology has largely provided the means to support the recalibration of health systems, service provision, and information delivery [53]. Just as digital behavior changes, campaigns on hand washing, social distancing, and wearing masks have supported the pandemic response, we can digitally connect with young people to support their access to SRH information and services during times of social isolation and crisis. Although there are many mobile apps addressing SRH worldwide, we could not locate any research on co-designing a mobile app to improve immigrant adolescent SRH in Canada. Research has demonstrated that access to socially inclusive and culturally relevant SRH information significantly improves SRH knowledge and communication skills with partners and parents, improves contraceptive knowledge and use, and reduces risk-taking sexual behaviors by young people [15,27,54]. Therefore, the aim of this study is to engage immigrant adolescents in developing, implementing, and evaluating a mobile health (mHealth) app that will deliver evidence-based SRH information to this population.

Intersectionality places an explicit focus on differences among people and seeks to illuminate various interacting social factors that affect human lives, including social locations, health status, and quality of life [55]. Intersectionality asserts that people are often disadvantaged by multiple interlocking sources of oppression (ie, their race, class, gender identity, sexual orientation, religion, and other identity markers) [56]. The intersection of race, gender, age, and socioeconomic status may pose barriers to young immigrant populations seeking SRH education and services. This framework will help us understand these differences, considering gender, race, class, sexual orientation, and migration histories, as they impact immigrant adolescents seeking SRH services.

A community-based participatory action research (CBPAR) framework will guide our study [57-61]. CBPAR is a context-specific process driven by participants that requires innovative methodological approaches [62,63]. The principal outcome of this adolescent-partnered project is to develop an mHealth intervention that responds to SRH needs. Incorporating the end users’ voices into the design and development of these interventions is crucial, as it has been noted that few mobile interventions are truly effective and scalable [64-66]. A user-centered co-design approach will increase the likelihood that adolescents will use the app and that it will be scalable and transferable to other contexts. Our goal for this engagement approach is to create an environment that supports the metacriterion of respect, trust, legitimacy, fairness, competence, and accountability in the development of knowledge [66]. This project will have 4 stages based on user-centered co-design principles [67].

This study will develop a holistic, prescriptive model that can be used to ensure the sustainability and scalability of mHealth apps in the public health care sector in Canada and other countries. Our long-term community partners in all 3 cities will support the sustainability of the app. These organizations will host the app, as they need an evidence-based tool to help immigrant adolescents increase their awareness and uptake of SRH services to improve SRH outcomes.

This study received ethics approval from the University of Alberta Ethics Board (Pro0013664).

This study aims to develop a mobile SRH app designed by and targeted to immigrant adolescents in Canada. Our exciting and novel adolescent-engaged methods and mobile app have the potential to rapidly address the unmet SRH needs of immigrant adolescents and to improve the SRH of immigrant adolescents across Canada. This app is important because it allows immigrant adolescents to independently access resources related to SRH and mitigates the impact of familial bias on teens’ ability to seek out such information. Further, young people are very comfortable utilizing mobile apps. This engaging modality will make it easier for immigrant adolescents to learn about safe SRH practices and may support them in having the knowledge and motivation to access services. The expected outputs of this study include:

The potential impact of this mobile app development includes increasing SRH knowledge and awareness, access to SRH services, and the use of contraception while decreasing unintended pregnancies and the need for abortion among adolescents. Our overall program of research is to build upon the active engagement of immigrant youth to develop, evaluate, and implement innovative and evidence-based digital knowledge translation tools and to build the resilience that immigrant youth need to successfully integrate into Canadian society. This research epitomizes creativity and innovation by merging the arts, sciences, and the engagement of youth in research.

Targeting adolescents and using engaging modalities has a strong potential to effectively increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents’ SRH outcomes. We will disseminate the mobile app, along with other findings of our study, via community symposiums; public training sessions in Edmonton, Toronto, and Vancouver; and a website hosted by the University of Alberta Faculty of Nursing. Our findings will also be presented at academic conferences and published in open-access, peer-reviewed journals, advancing the body of knowledge on immigrant adolescents’ SRH needs.