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Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada.
The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents.
We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app.
Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024.
Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale.
PRR1-10.2196/45389
Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals born in a foreign country [
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 [
The transition from adolescence to adulthood is complex, as new responsibilities materialize and confidence and independence emerge [
Globally, the SRH needs of adolescents have been largely unmet and pose a significant threat to the health and well-being of adolescents [
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 [
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 [
A community-based participatory action research (CBPAR) framework will guide our study [
For a user-centered design, it is important that we engage the people for whom we are planning to design the product. Therefore, we will first develop and convene adolescent advisory groups (AAGs) in Edmonton, Toronto, and Vancouver. These cities have the highest percentages of immigrant populations from all geographic locations [
To explore the experiences, information needs, and challenges of immigrant adolescents related to SRH and how to address these challenges, we will conduct qualitative individual interviews or focus groups (FGs) following the CBPAR methodology [
We will recruit immigrant adolescents aged 12 to 19 years who were born in a country other than Canada and who immigrated in the last 10 years or are part of a second-generation cohort. We will focus on this age group because we aim to understand the factors in early and late adolescence that predispose young people to subsequent sexual health risks. In addition, adolescents aged 12 to 19 years are generally mature enough to participate in individual interviews or FGs [
We will use a multifaceted, community-based strategy to recruit immigrant adolescents from diverse ethnic groups. Public, community, and immigrant service agencies will support participant recruitment. In addition, social marketing campaigns (eg, Instagram advertising as well as posting of study ads by youth and health-oriented organizations) and snowball sampling will be used to recruit participants. Peer RAs and graduate RAs hired as part of this project will also assist with recruitment. We will also include non-English speaking participants. Our peer RAs are bilingual, and we will hire multilingual graduate RAs for this project who speak Canada’s most common languages other than English to provide safe interpretation services for participants who do not speak English fluently.
We will conduct between 20 and 25 individual interviews or 3 to 4 FGs in each city. The participants for FGs will be divided into 2 groups (12 to 15 years and 16 to 19 years) to ensure that our data also capture the SRH needs of younger teens. The individual interviews or FGs will occur in person or over Zoom. The final sample size will be based on data saturation [
In accordance with CBPAR, we will use the DEPICT (dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing, and translating) model for participatory analysis (
Informed by the Stage 2 findings and with integrated, continuous input from the AAGs, we will develop a prototype of a mobile app to house SRH content. The content of the app will stem from two primary sources: (1) evidence-based resources such as the Society of Obstetricians and Gynecologists of Canada, the Public Health Agency of Canada, and the World Health Organization; and (2) themes and experiences generated from individual interviews and FGs in Stage 2. The app will include age-specific information separately so that adolescents of different age groups can easily navigate the information related to them. In addition, information related to accessing SRH services will also be provided to connect adolescents to SRH services in their community.
The AAGs and peer RAs will work with the app developer to iteratively revise and build the app to address questions of clarity, potential sources of bias or marginalizing design elements, ease of use, relevance, and other factors determined by the AAGs. The app will use an internal analytics system to run analysis on user demographics, feedback, and content views to gather information on how the app is being used. The app content will be approved by team members who have expertise in SRH to ensure evidence accuracy and appropriate evidence interpretation. We will initially develop the interventions in English only to consolidate the findings and best practice functionality. Once the app has demonstrated usability and effectiveness in English, we plan to apply for new funding to translate the app content into languages used by immigrant communities.
At the end of the project, we will run several FGs to evaluate the usability, acceptability, and effectiveness of the app; seek further input for refining it; evaluate the effectiveness of the project; and seek direction for future research. For usability testing of the app, we will conduct (1) 6 FGs with 5 to 10 immigrant adolescent participants (n=30-60) in Edmonton, Toronto, and Vancouver (2 FGs in each city) and (2) 3 FGs with 5 to 8 service providers, policy makers, and members of the communities’ informal support channels (n=15-20).
At the start of each FG, participants will be asked to download the app and use it on their own. Then, the researcher will begin the FG. Semistructured FGs will focus on questions about the app informed by a systematic search of over 180 usability evaluations [
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).
Recruitment and data collection will be completed by February 2023, and we will begin co-designing the mobile app in March 2023. We expect to share a prototype of the app, gather feedback on its usability, and then refine and release the app in the spring of 2024. We will engage immigrant adolescents and service providers as partners in the development of the mobile app to ensure that immigrant adolescents are aware of this tool and will use the app, helping contribute to positive SRH outcomes. This study will also evaluate the usability of the mobile app. In the future, we will conduct pragmatic trials to evaluate the effectiveness of the app in improving the SRH outcomes of adolescents.
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:
We will be able to identify the SRH needs of an underresearched population (ie, immigrant adolescents) in Canada.
Voices of the full spectrum of gender diversity (including transgender and gender nonconforming adolescents), cultural knowledge, and agency will inform the mobile app.
An innovative, adolescent-centered knowledge translation tool (ie, the mobile app) will be developed to help improve the SRH of immigrant adolescents in Canada.
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.
Adolescent advisory group training activities.
DEPICT steps, roles, and guiding questions.
Canadian Institutes of Health Research / Instituts de recherche en santé du Canada (CIHR/IRSC) - Operating Grant: Early Career Investigator Grants in Maternal, Reproductive, Child & Youth Health/Subv. de fonct.: Subventions de chercheurs en début de carrière en santé maternelle, en santé reproductive, et en santé des enfants/adolescents - Committee/Comité: Operating Grant: New Investigator Grants in Maternal, Reproductive, Child & Youth Health/Sub. de nouveaux chercheurs en santé maternelle, santé reproductive, et enfants/adolescents (Canada).
adolescent advisory group
community-based participatory action research
dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing, translating
focus group
mobile health
research assistant
sexual and reproductive health
sexually transmitted infection
This study is funded through the Canadian Institutes of Health Research (CIHR), Early Career Investigator Grant in Maternal, Reproductive, Child & Youth Health (RES0053962). WVN is supported as an Applied Public Health Chair of the Public Health Agency of Canada and CIHR (2014-2024, CPP-329455107837).
The data generated during this study are not publicly available yet because data collection is ongoing, and results have not yet been analyzed. However, data collection materials are available from the corresponding author upon reasonable request.
SM designed the study protocol and wrote the initial manuscript draft. All authors made substantial contributions to revising the initial manuscript and read and approved the final manuscript.
None declared.