Determinants of mHealth adoption for sexual and reproductive health services among university students in Ghana: A UTAUT and health belief model analysis

Abstract

Introduction Sexual and reproductive health (SRH) services remain inaccessible for many young adults in low-resource settings. Mobile health (mHealth) technologies present an innovative solution, yet adoption rates among university students in sub-Saharan Africa are poorly characterized. This study investigated the knowledge, utilization patterns, and key determinants of mHealth adoption for SRH services among Ghanaian university students using established behavioral frameworks. Methods We conducted a cross-sectional study of 390 undergraduates at Kwame Nkrumah University of Science and Technology, selected through multistage sampling across six residence halls. A validated questionnaire, incorporating constructs from the Unified Theory of Acceptance and Use of Technology and Health Belief Model, assessed: (1) mHealth knowledge, (2) SRH service utilization, and (3) psychosocial determinants of adoption. Confirmatory factor analysis validated measurement scales, while hierarchical regression analyzed predictors across three models (demographic, behavioral, and interaction terms). Results The study revealed three key findings: First, while 73.8% of respondents demonstrated mHealth awareness, actual usage for SRH remained low (mean = 3.40/7, SD = 1.83). Second, performance expectancy (β = 0.345, p < 0.001) and life quality improvements (β = 0.197, p < 0.05) significantly predicted adoption. Third, substantial barriers included social stigma (β = −0.210, p = 0.016), resistance to technology adoption (β = −0.221, p = 0.001), and privacy concerns (β = −0.208, p = 0.004). Notably, perceived health threats did not moderate the relationship between performance expectations and usage ( p = 0.488). Conclusions This study highlights a critical gap between awareness and actual use of mHealth for SRH among Ghanaian university students. It identifies key barriers—such as perceived usefulness, privacy concerns, and behavioral resistance—and reveals how sociocultural norms influence youth engagement with digital health tools. The findings underscore the need for culturally sensitive, trust-based mHealth initiatives that strengthen digital literacy and promote behavioral change. Such approaches could enhance youth-focused mHealth strategies in Ghana and offer valuable lessons for similar contexts across sub-Saharan Africa.