Lay health-worker delivered and technology-based interventions for sexual and reproductive health among adolescents and young adults in low- and middle-income countries: a scoping review.

Abstract

Adolescents and young adults (AYAs) in low- and middle-income countries (LMICs) are at high risk of harmful sexual and reproductive health (SRH) practices. Preventive and educational interventions by lay health workers or through technological means are a cost-effective and scalable solution. Unfortunately, to date, there is too little synthesised evidence on available lay health-worker delivered or technology-based interventions, their target populations and content, their implementation and effect on different SRH outcomes as well as facilitators and barriers to intervention effectiveness. To help fill this knowledge gap and to identify where further research is needed, we conducted a scoping review of technology-based or lay health-worker delivered preventive and educational SRH interventions targeting AYAs in LMICs. Scoping review. We searched MEDLINE (through PubMed) and Embase for eligible studies published from 1 January 2000 until 19 January 2026. Eligible were studies assessing the effect of preventive and educational lay health-worker delivered or technology-based interventions on any SRH outcomes among AYAs (aged 10-24 years) in LMICs published in English in peer-reviewed journals. Data extraction covers study details, methods, intervention strategies, outcomes and findings. The scoping review includes 101 studies based on 95 research projects evaluating 94 unique interventions. Studies were conducted in 40 different countries and most (n=65) were published since 2020. Included interventions range from single-session interventions lasting less than half an hour in total to multiyear whole-of-community interventions. Most (n=54) employ technological means such as websites or social media pages (n=18), smartphone apps (n=6), text-messaging (n=15), videos (n=11) or mass-media campaigns (n=4) for intervention delivery, while the remaining (n=47) typically centre around regular face-to-face educational sessions and are delivered by peers (n=23), adult community members (n=15) or a combination of both (n=9). Included studies investigate intervention effects on a wide range of SRH outcomes, with those pertaining to SRH knowledge or attitudes getting most attention. Most studies report significant improvements for most assessed outcomes. This is particularly true for SRH knowledge, while results are slightly more mixed when it comes to some SRH behavioural or physiological outcomes. No noticeable differences in intervention effectiveness were observed between lay health-worker delivered and technology-based interventions. Identified facilitators of intervention effectiveness include the role of community outreach, as practised by some of the lay health-worker delivered interventions, in overcoming culturally grounded resistance to SRH education of AYAs. Important gaps in the literature include a scarcity of interventions tailored to male or out-of-school AYAs and a lack of attention to the extent to which improvements in SRH knowledge and attitudes translate to improvements in behavioural and physiological outcomes. We identified a diverse variety of lay health-worker delivered and technology-based SRH interventions showing positive effects on many different SRH outcomes among AYAs in LMICs, testifying to the great potential of those approaches. However, more research is needed focusing on so-far understudied groups and outcomes. This scoping review adheres to a protocol previously published in this journal and that is registered on the Open Science Framework website (http://osf.io/vna2z).