Navigating recruitment and retention challenges in a social media health intervention in francophone West Africa

Abstract

Sexual and reproductive health (SRH) remains a concern for youth in West Africa, where access to health information and services is limited. Interventions on social media offer promising avenues for SRH promotion, but challenges related to participant recruitment, verification, and retention persist in research. This study evaluated recruitment and retention patterns in a digital SRH intervention conducted in Burkina Faso, Côte d'Ivoire, and Senegal from August 2023 to February 2024. A randomized factorial trial design was implemented, targeting youth aged 15–24 through Facebook advertisements featuring youth-centred visuals and participation incentives. Participants underwent a two-phase screening and verification process prior to enrolment and were randomized into four study groups. Key outcomes included attrition rates across recruitment, verification, enrolment, and survey completion stages. χ² tests assessed demographic differences in retention. Of 7013 individuals recruited, 3803 passed initial screening, and 1412 were verified and randomized into study groups. Following drop-out during verification and attrition in the enrolment phase, 492 of the 1412 (34.8%) completed enrolment. χ² goodness-of-fit tests indicated that gender and age distributions remained consistent across study stages, but retention varied by country, with Senegalese participants exhibiting higher completion rates than those from Côte d'Ivoire (P < .001). Privacy concerns, technical barriers, and platform-specific limitations contributed to attrition. This study highlights both the potential and challenges of SRH interventions on social media. While Facebook effectively facilitated outreach, high attrition rates underscore the need for diverse platform engagement, automated verification tools, and localized retention strategies to enhance digital health interventions in West Africa.

Contribution to Health Promotion.

• Shows how social media can be a powerful tool for recruitment and campaign delivery for youth in resource-limited settings.

• Highlights key barriers to retention, like privacy concerns, platform restrictions, and trust issues, and offers insights on how to address them in future campaigns.

• Highlights the need for rigorous verification to ensure data quality while balancing the risk of higher drop-out rates.

• Demonstrates that Facebook worked well for recruitment, but relying on a single platform may not be enough and future interventions should consider multi-platform strategies and alternative outreach methods like WhatsApp follow-ups.

INTRODUCTION

Sexual and reproductive health (SRH) remains a critical area of concern in West Africa, where youth face significant barriers in accessing accurate health information, essential services, and family planning resources like contraception (Ayanore et al. 2015, Melesse et al. 2020). Despite recent advancements, existing SRH knowledge and service access among young people in this region remain inadequate, particularly in light of high rates of unintended pregnancies, sexually transmitted infections, and unmet family planning needs (Ayanore et al. 2015, Newton-Levinson et al. 2016, Melesse et al. 2020).

Access to SRH services and contraception for adolescents in West Africa is shaped by a patchwork of legal and cultural factors, with no uniform regional policy. National laws and provider discretion vary widely, and social norms often fill the gaps where policy is unclear. Many countries lack explicit or enforced laws specifying the age at which adolescents can independently access contraceptive services, often leaving decisions to individual providers (UNFPA 2017). In Niger, for example, a 2006 law made contraceptives legally limited to married couples, while in Burkina Faso, implementation gaps hinder enforcement of non-discriminatory access laws (UNFPA 2017). In Senegal, providers (e.g. pharmacists) frequently impose informal age or marital restrictions based on personal beliefs or ambiguous guidance (Sidze et al. 2014, Cissé et al. 2025).

These legal and systemic challenges are compounded by a range of barriers across the socioecological spectrum that limit young people’s ability to seek and use contraception confidently and consistently. Personal and cognitive barriers, such as fears of infertility, weight changes, and menstrual disruption, play key roles and are exacerbated by misinformation and limited access to trusted information sources (Cohen et al. 2020, Bain et al. 2021, Schaub et al. 2022). Social stigma around premarital sex and contraception, reinforced by community attitudes and parental disapproval, further discourages youth from seeking care (Cohen et al. 2020, Schaub et al. 2022). Structural barriers, like poor provider attitudes, limited privacy, and a lack of accessible youth-friendly services, also undermine adolescents’ confidence in accessing contraception (Bain et al. 2021, Schaub et al. 2022). Together, these factors contribute to an environment that limits informed decision-making, underscoring the urgent need for alternative strategies to reach and engage youth around SRH.

Digital platforms have emerged as promising tools for health promotion, particularly in low- and middle-income countries (LMICs), where traditional healthcare services can be difficult to access (Ayanore et al. 2015, Islam et al. 2019, Melesse et al. 2020, Ferretti et al. 2023). Social media, in particular, offers a direct channel to engage youth, who are highly active online and responsive to tailored digital content (Glik et al. 2016, Topolovec-Vranic and Natarajan 2016, Darko et al. 2022, Seiler et al. 2022, Ferretti et al. 2023).

Digital SRH campaigns present both opportunities and challenges in LMICs. Use of platforms, like Facebook (Meta), can enhance reach and enable health campaigns to efficiently connect with large audiences at a relatively low cost (Glik et al. 2016, Topolovec-Vranic and Natarajan 2016, Islam et al. 2019, Darko et al. 2022, Seiler et al. 2022). Social media also allows for interactive engagement, which can strengthen message retention and encourage SRH-related behaviour change (Gabarron and Wynn 2016, Kubheka et al. 2020). However, digital health interventions also face significant methodological and logistical hurdles (Topolovec-Vranic and Natarajan 2016, Pozzar et al. 2020, Pratap et al. 2020). Challenges such as ensuring data reliability, verifying participant authenticity, and addressing drop-out at different engagement stages can impact the validity and overall effectiveness of such interventions (Topolovec-Vranic and Natarajan 2016, Pozzar et al. 2020, Pratap et al. 2020, Thompson et al. 2024). Previous studies have highlighted participant retention as a major concern, as attrition throughout recruitment and follow-up phases can compromise study outcomes (Pratap et al. 2020, Darko et al. 2022).

Despite the growing potential of digital platforms for SRH interventions, there remains limited evidence on effective digital recruitment and retention strategies in LMIC settings, particularly in West Africa (Islam et al. 2019, Seiler et al. 2022, Ferretti et al. 2023). Research on digital SRH interventions in this region is sparse, and more studies are needed to refine methodologies that enhance engagement and long-term impact (Seiler et al. 2022). This study addresses these gaps by evaluating a digital SRH intervention on social media targeting youth in Burkina Faso, Côte d'Ivoire, and Senegal, with a focus on recruitment and retention challenges.

This study aims to examine the recruitment and retention challenges faced in a social media SRH campaign conducted in Burkina Faso, Côte d'Ivoire, and Senegal. Additionally, it seeks to provide methodological insights for improving future digital health interventions in similar contexts. By analysing participant engagement patterns and the effectiveness of different outreach strategies, this study offers practical guidance on both the opportunities and limitations of using digital platforms to promote SRH among youth in West Africa.

METHODS

Study design and setting

This study utilized a randomized factorial trial design to assess the effectiveness of a digital social media-based SRH intervention. The intervention targeted youth aged 15–24 across three West African countries: Burkina Faso, Côte d'Ivoire, and Senegal. The six-month study, conducted from August 2023 to February 2024, aimed to evaluate the influence of SRH content delivered by peer and online influencers on social media platforms, specifically Facebook. This study was designed in collaboration with the African Network for Health Education (RAES), a Senegalese non-governmental organization that played a central role in the intervention's implementation and participant engagement.

Participant recruitment

Participants were recruited online from August to October 2023 using targeted still-image Facebook advertisements featuring youth-centred visuals and participation incentives (Fig. 1). Complementary recruitment efforts across digital platforms (i.e. Google advertisements and Instagram) helped expand outreach and attract a diverse youth audience. Recruitment materials were tailored to the cultural and linguistic contexts of each target country, incorporating visuals, language adaptations, and culturally relevant messaging. Interested individuals were directed to a Qualtrics survey where they completed an eligibility screener.

Figure 1.

Sample recruitment advertisements used in the digital SRH campaign, 2024.

Participants who completed the eligibility screener were passed through a two-phase screening and verification process, with oversight by UCLA and RAES, to ensure the integrity and authenticity of participants. Inclusion criteria included: (i) age between 15 and 24 years, (ii) residency in Burkina Faso, Côte d'Ivoire, or Senegal, (iii) active Facebook account, (iv) ability to read and write in French, and (v) willingness to provide informed consent. The recruitment, screening, and verification process is outlined in Fig. 2.

Figure 2.

Flowchart of participant recruitment, screening, verification, and enrollment process, 2024.

Screening

The screening process, conducted by UCLA via a Qualtrics survey, verified eligibility through demographic and social media engagement questions. During the eligibility screening, participants provided their Facebook profile links or unique Facebook IDs to confirm account validity. The screener also assessed Facebook usage frequency to ensure participants were active on the platform.

To maintain data integrity, Qualtrics’ fraud detection features (e.g. bot detection and duplicate prevention) were used. Duplicate IP addresses were flagged for manual review rather than automatic exclusion, acknowledging shared device use in the region through places like schools or internet cafes. Demographic details were cross-referenced to prevent multiple entries. Participants who successfully passed this screening advanced to the verification process.

Verification

Verification, conducted by Senegalese collaborators RAES, was a critical step to confirm the authenticity of participants who passed the initial screening. This process ensured that only ‘real’ (i.e. not bots) and unique individuals who met study requirements advanced to the intervention stage. It combined manual reviews and systematic checks to safeguard the quality and reliability of the sample.

First, RAES manually reviewed participants’ Facebook profiles to confirm they were real individuals, examining account information and activity history as available. Accounts deemed inactive, incomplete, or fictitious were flagged and excluded. Profiles with insufficient online presence or unverifiable details were removed to maintain data quality. Additionally, RAES implemented an account duplication check to identify multiple entries. This involved cross-referencing participant data, including demographic details and Facebook identifiers, to ensure no duplicates were inadvertently included.

By the end of the verification process, participants who successfully passed both the screening and verification stages were invited to enrol. This thorough approach ensured a high-quality sample for the study while reflecting the intended target population.

Enrolment

Following verification, participants were invited to enrol in the study on Facebook. Participants were randomly assigned to one of four groups: control, peer influencer intervention, online influencer intervention, or a combined peer and online influencer intervention. A stratified block design was used during the randomization process to ensure balanced representation across age (15–19, 20–24), gender (female, male, other gender identity), and country (Senegal, Burkina Faso, Côte d'Ivoire), creating 18 unique strata (2 × 3 × 3). Within each stratum, participants were randomly assigned using permuted blocks of size four, minimizing bias and ensuring proportional representation across groups.

To maintain confidentiality and ensure accurate data tracking, each participant received a unique ID assigned by UCLA. These IDs were linked to individualized Qualtrics survey links, allowing for precise matching of pre- and post-intervention data while preserving participant anonymity.

The intervention was delivered via private Facebook groups, providing controlled access to content and structured engagement. Participants received similar SRH information through interactive discussions, personal narratives, and educational materials. In the peer influencer group, messages were delivered through relatable youth figures. The online influencer group received the same core messages but voiced by popular regional influencers with broader digital followings. The combined group received content from both peer influencers and online influencers. All posts were designed using the same educational materials and campaign assets to ensure consistency across groups, with the messenger and tone tailored to reflect the assigned intervention model. Regularly scheduled posts, videos, and discussions encouraged active participation and engagement, reinforcing key SRH messages. Message content focused on increasing knowledge of contraceptive methods, strengthening self-efficacy in choosing and using contraception, and promoting awareness of regional SRH service providers. The intervention also encouraged use of digital SRH services including websites, WhatsApp, and chatbots. Content was framed through personal narratives to address common misconceptions and reduce stigma related to contraceptive use. See Supplemental Materials for sample content.

Incentives

Incentives were incorporated to promote engagement and sustain participation throughout the study. Recruitment advertisements highlighted the opportunity for participants to be randomly awarded high-value incentives (e.g. mobile phones) to encourage participation (Fig. 1). Additionally, participants received smaller rewards upon completing key study components (e.g. the equivalent of $4 USD in phone credits), including the pre-test and post-test questionnaires. Incentives were tailored to appeal to youth in the study’s target population. A phased incentive structure was implemented to maintain consistent participant involvement from initial recruitment through to the study’s conclusion.

Data collection and analysis

Data collection occurred at two time points: pre-intervention and post-intervention. Participants received unique Qualtrics survey links tied to their study IDs to ensure data consistency and anonymity. Surveys used validated instruments to measure SRH knowledge, attitudes, behaviours, and digital engagement.

Quantitative analyses included descriptive statistics to assess retention patterns and demographic distributions. χ² goodness-of-fit tests were conducted to examine the extent to which the demographic distribution (age, gender, and country) at the enrolment (N = 492) and completion (N = 403) stages may have diverged from the initial distribution at randomization (N = 1412) due to attrition. Specifically, the demographic distribution of the sample who enrolled in the study and of the sample who completed baseline or endline were each compared to the distribution of the initially randomized sample.

Ethical considerations

The study was reviewed and approved by the Institutional Review Board (IRB) at UCLA, ensuring that ethical standards were upheld throughout the research process. Participants were provided a study information sheet that described the study’s purpose, procedures, and their right to withdraw at any point without penalty. For participants aged 15–17, a waiver of parental consent and documentation of consent was approved by the UCLA IRB due to the minimal risk of the study and the cultural context. After reviewing the study information sheet, individuals chose whether or not to participate. Data confidentiality and participant anonymity were prioritized, with all data securely stored and de-identified to protect participant privacy.

RESULTS

Participant recruitment, screening, and verification

A total of 7013 participants were recruited through targeted Facebook advertisements, leveraging the platform’s extensive reach among youth aged 15–24 in Senegal, Côte d’Ivoire, and Burkina Faso. The campaign generated over 1 million impressions and 25 000 clicks, leading to 7013 potential participants responding to the ads and completing the initial screening.

Age screening excluded 612/7013 individuals (8.7%) who were outside the target age range of 15–24. Residency screening excluded 179/7013 (2.6%) individuals who were not in one of the three eligible countries. The Facebook ID screening step excluded 1949/7013 (27.8%) individuals. Among those remaining, 87/7013 (1.1%) were excluded for indicating they did not use their Facebook account. Language proficiency in French resulted in 24/7013 (0.3%) excluded. Finally, a de-duplication check in which submissions with identical IP addresses, as well as matching demographic data, removed 341/7013 duplicate accounts (4.9%).

Of the 3803 participants who passed the initial eligibility screening, 2391 (62.9%) were excluded during the Facebook verification phase in which a manual profile assessment was conducted by the RAES team. Reasons for exclusion included inactive or deleted accounts, Facebook links that were missing, broken, or did not direct to a valid profile, and identification as duplicate or fraudulent entries. These exclusions reduced the pool to 1412 participants, representing 20.1% of the original 7013 recruited individuals. Despite this significant reduction, the rigorous verification process was critical to maintaining the integrity of the study and ensuring high-quality data.

Participant enrolment

Of the 1412 verified participants who were invited to enroll in the study and randomly assigned to study arms, 492 (34.8%) successfully joined the private Facebook groups. The enrolment process was designed to be seamless, incorporating personalized links and clear instructions to guide participants. However, attrition was noted during this phase, primarily due to privacy concerns, technical difficulties, or participant withdrawal. Observations and internal monitoring suggested several Facebook-specific issues contributed to this drop-out, such as participants not receiving group invitations due to message filtering, difficulty accessing links on mobile devices or public computers, and strict privacy settings that prevented group join requests or obscured profiles. A small number of participants also expressed difficulty navigating to the private group or concern about visibility of their participation on the social media platform. The recruitment, screening, and verification process results is outlined in Fig. 2.

Among the 492 enrolled participants, the majority (n = 373, 75.8%) were aged 20–24, while 119 participants (24.2%) were aged 15–19. Gender distribution was nearly even, with 238 participants (48.4%) identifying as male, 232 (47.1%) as female, and 22 (4.5%) as other gender identities (Table 1). Geographically, participants from Senegal formed the largest group (n = 220, 44.7%), followed by 148 participants (30.1%) from Côte d’Ivoire and 124 participants (25.2%) from Burkina Faso.

Table 1.

Participant demographics and survey completion by age, gender, country, and intervention group, 2024.

		Randomized N = 1412 (%)	Enrolled N = 492 (%)	Completed pre- and/or post-test N = 403 (%)
Age group	15–19	357 (25.3)	119 (24.2)	91 (22.6)
	20–24	1055 (74.7)	373 (75.8)	312 (77.4)
Gender	Female	653 (46.4)	232 (47.1)	191 (47.4)
	Male	716 (50.7)	238 (48.4)	193 (47.9)
	Other	43 (3.1)	22 (4.5)	19 (4.7)
Countrya,b	Burkina Faso	325 (23.0)	124(25.2)	99 (24.6)
	Côte d’Ivoire	548 (38.8)	148 (30.1)	117 (29.0)
	Senegal	539 (38.2)	220 (44.7)	187 (46.4)
Study arms	Control	353 (25.0)	125 (25.4)	111 (27.5)
	Online Influencer	353 (25.0)	125 (25.4)	107 (26.6)
	Peer influencer	353 (25.0)	122 (24.8)	94 (23.3)
	Online + peer Influencer	353 (25.0)	120 (24.4)	91 (22.6)

^aχ² goodness-of-fit tests showed that there was a significant difference in the country distribution of the sample when comparing the randomization and enrolment stages (χ² = 16.15, P = .0003).

^bχ² goodness-of-fit tests showed that there was a significant difference in the country distribution of the sample when comparing the randomization and completion of pre- and/or post-test stages (χ² = 17.44, P = .0002).

Table 2 describes additional demographic characteristics of participants who enrolled into the private Facebook groups. Among the 397 participants who reported their location, most (n = 355, 89.4%) spent the majority of their time in urban areas, while smaller proportions reported splitting their time between urban and rural areas (n = 22, 5.6%) or living primarily in rural areas (n = 20, 5.0%). Regarding education (N = 399), 43.4% (n = 173) had attended college or university, 40.4% (n = 161) attained a ‘superior’ level of education, 14.0% (n = 56) completed secondary education, and 2.2% (n = 9) reported ‘other’ forms of education. For relationship status (N = 400), the majority were single (n = 300, 75.0%), while 23.0% (n = 92) were in relationships but not married, and 2.0% (n = 8) indicated another status. Among the 396 participants who reported their profession, most were students (n = 324, 81.8%), while smaller proportions worked in the informal sector (n = 27, 6.8%), formal sector (n = 24, 6.1%), or other professions (n = 21, 5.3%). Regarding religion (N = 396), 51.5% (n = 204) identified as Muslim, 25.8% (n = 102) as Catholic, 17.9% (n = 71) as Protestant/Evangelical, and 4.8% (n = 19) as another religious affiliation.

Table 2.

Sociodemographic profile of enrolled participants, 2024.

Category		Count (%)
Location (N = 397)	Urban	355 (89.4)
Where do you spend most of your time during the week?	Urban and rural	22 (5.6)
	Rural	20 (5.0)
Education (N = 399)	College/university	173 (43.4)
What is your level of education?	Superior	161 (40.4)
	Secondary	56 (14.0)
	Other	9 (2.2)
Relationship status (N = 400)	Single	300 (75.0)
What is your relationship status?	Relationship (not married)	92 (23.0)
	Other	8 (2.0)
Profession (N = 396)	Student	324 (81.8)
What is your profession?	Informal sector	27 (6.8)
	Formal sector	24 (6.1)
	Other	21 (5.3)
Religion (N = 396)	Muslim	204 (51.5)
What is your religion?	Catholic	102 (25.8)
	Protestant/Evangelical	71 (17.9)
	Other	19 (4.8)

Survey completion rates

Participant engagement rates served as a key indicator of retention and the effectiveness of follow-up procedures, described in Table 1. Among the 492 enrolled participants, 244 (49.6%) completed both the pre- and post-test questionnaires. An additional 159 participants (32.3%) completed only one questionnaire, with 23 (4.7%) completing only the pre-test and 136 (27.6%) completing only the post-test. A total of 89 participants (18.1%) did not complete either survey.

Analysis of those who completed at least one questionnaire (N = 403) revealed several demographic trends. Participants aged 20–24 accounted for a greater proportion of survey completers (n = 312, 77.4%) compared to those aged 15–19 (n = 91, 22.6%). Additionally, a higher proportion of enrolled participants aged 20–24 (83.7%) completed at least one survey compared to those aged 15–19 (76.5%). χ² goodness-of-fit tests showed no significant differences in age distributions across enrolment and survey completion stages, when compared to the age distributions at randomization.

Gender differences in survey completion were minimal, with male participants (n = 193, 47.9%) and female participants (n = 191, 47.4%) completing surveys at comparable rates. Participants identifying as ‘other gender’ accounted for 4.7% (n = 19) of those who completed at least one survey. χ² goodness-of-fit tests showed no significant differences in gender distributions across enrolment and survey completion stages, when compared to the gender distributions at randomization.

Geographical trends showed variation in retention. Participants from Senegal had the highest survey completion rate (n = 187, 46.4%), followed by Côte d’Ivoire (n = 117, 29.0%) and Burkina Faso (n = 99, 24.6%). Additionally, χ² goodness-of-fit tests confirmed significant differences in country distributions across study stages. Specifically, significant differences in country distributions were identified when comparing the sample at randomization to the sample at the enrolment stage (χ² = 16.15, P = .0003), and also when comparing the randomization and survey completion stages only (χ² = 17.44, P = .0002). In looking at the frequency distributions at each stage, the data shows that participants from Côte d’Ivoire were more likely to be lost to follow-up, leading to a higher proportion of Senegalese participants in later stages.

DISCUSSION

This study highlights both the successes and challenges of using social media platforms, particularly Facebook, to recruit and engage youth in a digital SRH intervention in West Africa. Targeted advertisements and culturally tailored content proved effective in attracting a large pool of participants, demonstrating the potential of social media for health promotion in LMICs. However, significant attrition during screening, verification, and enrolment stages revealed critical limitations that reduced the final sample size. While Facebook's reach facilitated broad initial engagement, this study highlights possible limitations of a single-platform approach. Privacy settings, message filtering, and platform-specific barriers contributed to participant drop-out, suggesting that multi-platform strategies and community-based outreach could improve recruitment and retention in future interventions (Topolovec-Vranic and Natarajan 2016, Russomanno et al. 2019, Darko et al. 2022). However, prior research has noted that increasing the number of social media platforms does not necessarily enhance recruitment success, and in some cases resulted in lower recruitment rates (Topolovec-Vranic and Natarajan 2016). This suggests that rather than simply expanding to additional platforms, future interventions should carefully consider which platforms are most effective for their target population and tailor outreach strategies accordingly (Islam et al. 2019). Messages inviting participants to join private groups or complete surveys may not have been displayed and irregular Facebook users may not have received timely reminders, contributing to disengagement. Future studies should explore alternative recruitment methods, including SMS or WhatsApp-based reminders, to complement social media engagement and mitigate attrition at the enrolment stage.

Strict inclusion criteria, while essential for data validity and quality, contributed to participant exclusion and may have disproportionately affected some groups (Topolovec-Vranic and Natarajan 2016). Barriers to participation, particularly for individuals with restrictive privacy settings or less frequent social media use, may have reduced the diversity and generalizability of the sample. Challenges were compounded by the manual verification process, which required substantial time and resources and likely contributed to attrition by extending the time between recruitment (August–October 2023), screening (November–December 2023), enrolment (December 2023), and data collection (January–February 2024). Participants awaiting verification may have lost interest or disengaged. This reflects a trade-off in digital health research: balancing inclusivity with rigorous verification standards. Future interventions should explore automated verification tools, such as AI-powered identity confirmation or mobile number validation, to reduce manual burden while maintaining integrity.

Privacy and trust concerns may have also played a role in participant drop-out, as some individuals may hesitate to provide personal information for verification (Islam et al. 2019, Russomanno et al. 2019, Ferretti et al. 2023, Thompson et al. 2024). Previous studies suggest that distrust in digital health interventions can be exacerbated by limited information transparency and a lack of early and meaningful community engagement (Till et al. 2023, Ezeudoka and Fan 2024). Future interventions should consider proactive transparency strategies, such as visible affiliations with trusted local organizations, to enhance participant confidence and minimize distrust-related attrition (Ferretti et al. 2023).

Retention patterns revealed that while participants aged 20–24 were more likely to complete surveys than those aged 15–19, statistical analysis showed no significant differences in age distribution across study stages. This suggests that while engagement strategies for younger participants could still be optimized, age alone was not a primary determinant of retention. Adolescents in the 15–19 age group may have engaged less due to perceived irrelevance of digital SRH content, lower digital literacy, or competing priorities. Prior research has noted lower involvement of younger adolescents (<18 years) in digital health studies due to various engagement barriers like parental consent (Darko et al. 2022). Future interventions could enhance engagement among this demographic by incorporating gamified content or leveraging more youth-engaged platforms (e.g. TikTok). Further, while gender did not appear to influence survey completion, broader social norms may still shape engagement with SRH interventions.

When comparing sample demographic distributions across the randomization, enrolment, and recruitment stages, statistical differences emerged among country distributions when comparing the randomized sample to enrolment and completion samples. This suggests that follow-up and retention efforts that occur across different countries, particularly in global health settings, must consider the unique contextual differences that may hinder or facilitate sample retention in future studies. Notably, Senegalese participants had the highest retention rates, while participants from Côte d'Ivoire were more likely to drop out. One possible explanation is that RAES, the implementing partner, is based in Senegal, though they have community presence in all three countries. This may have influenced intervention design, verification procedures, or participant trust. The greater familiarity of RAES with Senegalese social media behaviours may have improved verification efficiency, inadvertently biasing retention in favour of Senegalese participants. Additionally, given the observed differences in participation by country, future studies evaluating programme outcomes should consider adjusting for country-level variables, by including country as a covariate in multivariate models, to better account for contextual differences that may influence both engagement and impact (Markham et al. 2023).

Collaboration with local partners, particularly RAES, was a cornerstone of this study. Their involvement ensured culturally relevant verification processes and strengthened participant trust. Local expertise was instrumental in adapting the study’s methods to the regional context, demonstrating the broader value of community-based partnerships in global health research (Littman-Quinn et al. 2013, Ndlovu et al. 2014, Labrique et al. 2018, Benson et al. 2023). The success of culturally tailored advertisements in this study stresses the importance of localized approaches in reaching target audiences. This collaborative model offers a blueprint for similar interventions, where leveraging local knowledge can enhance the reliability, scalability, and sustainability of digital health campaigns.

Limitations

This study’s findings should be considered in light of several limitations. High attrition rates during verification and enrolment may have introduced sample biases, reducing the generalizability of results. While the manual verification process ensured participant authenticity, it likely excluded individuals with infrequent social media use, limited or shared internet access, or restrictive privacy settings, inadvertently disadvantaging specific subgroups.

Relying on Facebook for recruitment and engagement posed additional challenges. Privacy policies, account activity requirements, and message filtering features limited outreach and contributed to participant attrition (Thompson et al. 2024). This platform-specific approach may have disproportionately excluded individuals who engage more actively on other platforms. The single-platform design further constrained the study’s scalability and participant diversity. Although Facebook provided cost-effective targeting, it limited the diversity of the participant pool and the generalizability of findings.

CONCLUSION

This research contributes to the growing evidence base on digital health interventions in LMICs, particularly in West Africa, where social media platforms are increasingly being used for health promotion. Findings from this study emphasize the importance of scaling digital health interventions through a combination of social media engagement and outreach. While Facebook proved effective for initial recruitment, integrating multiple digital touchpoints, such as WhatsApp messaging for follow-up, community-based representatives for trust-building, and TikTok for youth engagement, could significantly enhance long-term participation. Future research should explore hybrid models that blend digital strategies with in-person support systems to optimize reach and retention. While challenges such as high attrition rates and platform-specific limitations remain, this study demonstrates the potential for digital campaigns to engage youth in SRH topics. By refining platform selection, verification strategies, and engagement methods, future efforts can maximize the reach and impact of digital health initiatives while addressing barriers unique to resource-limited settings.

Author contributions

Conceptualization: P.M.M., R.S., M.D., and A.R. Methodology: P.M.M., C.M.C., and N.W. Software: C.M.C., L.O., and N.W. Formal analysis: C.M.C. and L.O. Investigation: D.W. and N.W. Data Curation: N.W., D.W., and L.O. Writing—Original Draft: N.W. and P.M.M. Writing—Review & Editing: C.M.C., L.O., R.S., M.D., and D.W. Visualization: N.W., C.M.C., P.M.M., and L.O. Supervision: P.M.M., R.S., and C.M.C. Project administration: D.W., R.S., and N.W. Funding acquisition: M.D., A.R., and P.M.M.

Supplementary data

Supplementary data is available at Health Promotion International online.

Conflict of interest

None declared.

Funding

This work was supported by The Gates Foundation (INV-037914).

Data availability

The data underlying this article are not publicly available due to participant confidentiality but may be shared by the corresponding author upon reasonable request.

Ethical approval

Ethical approval for this study was obtained from the University of California, Los Angeles Institutional Review Board (IRB-23-0752).

Consent

All participants were provided with a study information sheet outlining the purpose, procedures, and voluntary nature of participation. All individuals agreed to participate in the study prior to data collection.