Male youth perspectives on a pre-visit mobile health app for sexual and reproductive health and care

Abstract

Objective:

Adolescent males have distinct sexual and reproductive health (SRH) needs yet remain underrepresented in primary care SRH interventions. This qualitative study explored male adolescents’ preferences and perceptions regarding the design of a pre-visit mobile health (mHealth) app to enhance SRH knowledge and care engagement.

Methods:

We conducted 3 rounds of focus groups with 26 male youth aged 15–21 from diverse backgrounds. Using thematic analysis, we identified themes related to participants’ SRH knowledge and skills gaps, care engagement, and perceptions of an SRH app for male youth.

Results:

Participants were mostly cisgender (92%), non-Hispanic Black/African American (50%), and heterosexual (69%). Three themes emerged: (1) Systemic and social influences on SRH knowledge, behaviors, and care-seeking; (2) Perceived value of a male-tailored SRH app; (3) Preferences for an engaging and interactive app design. Participants traced SRH knowledge gaps to inadequate SRH education and described low self-efficacy for partner communication and accessing condoms. They identified barriers to clinical communication including confidentiality concerns and limited access to affordable services. Many expressed enthusiasm for a male-tailored SRH app to facilitate care engagement while also acknowledging concerns about sustained digital engagement.

Conclusions:

Participants emphasized their desire for comprehensive, accurate, and tailored SRH information delivered in engaging digital formats. They saw strong potential for an app to boost their confidence in navigating SRH behaviors and conversations with clinicians and partners. Findings will inform the development of a pre-visit SRH app for males that will be piloted in youth-serving primary care settings and assessed for effectiveness across diverse adolescent populations.

Introduction

By age 18, most males are sexually active [1] and experience high rates of STIs, HIV, and unintended partner pregnancy [2–4]. Disparities in adolescent sexual and reproductive health (SRH) indicators are especially pronounced among racial, ethnic, and gender and sexual minority (GSM) males, who are disproportionately affected due to intersecting systems of oppression and structural inequities in access to care and prevention [5,6]. As such, U.S. preventive care guidelines recommend primary care clinicians deliver SRH care to male adolescents [7,8]. The recommend SRH care package for adolescents includes: screening and counseling on sexual behaviors and risk reduction; sexually transmitted infection (STI) and human immunodeficiency virus (HIV) prevention, testing, and treatment (including vaccination and pre-/post-exposure prophylaxis (PrEP/PEP)); pregnancy prevention and contraceptive counseling; condom education and access; sexual function and anatomy education; and skills support for healthy relationships and communication (e.g., consent, boundary-setting, and partner negotiation) delivered in confidential, developmentally appropriate, and culturally responsive ways [7,8].

Despite recommendations, male adolescents receive SRH screening and counseling less consistently than females [9,10], and current approaches fail to adequately engage the diversity of young males presenting to care, including GSM individuals [6,11]. Several factors contribute to missed opportunities for prevention for young males underscoring the need for tools in the clinical setting that normalize young males’ SRH care, strengthen their knowledge and skills, and facilitate developmentally appropriate clinician-patient discussions. At the patient and social levels, young males discuss receiving fewer social cues that SRH care is “for them,” are less often socialized to seek preventive care, and may internalize masculinity norms that discourage help-seeking and disclosure about sexual concerns [12]. Many young males also enter sexual activity before receiving comprehensive, skills-based education [13,14], and services perceived as female-focused further deter care engagement [12,15,16].

Growing research has explored male adolescents’ SRH needs [2,17–19] however, none of this work has explored what young males’ need to improve comprehensive SRH care delivery in primary care. For example, a digital intervention targeted male adolescents’ condom use in an acute care setting, but did not address the fuller recommended SRH care package or assess its use primary care [17,20,21]. Existing work highlights young males’ needs related to STI knowledge and testing, condom access [17–19], and the protective role of reproductive health knowledge in preventing teen fatherhood [22], but has not examined ways to engage young males in comprehensive SRH care in primary care.

This formative study addresses gaps in the current literature and explores male adolescents’ desired content and features of a pre-visit mobile health (mHealth) app to enhance SRH knowledge, skills, and care engagement in the context of primary care. This study employs a user-centered design approach as part of the development of an SRH mHealth app for the diversity of young males presenting for care to ensure that it is relevant, usable, and responsive to their lived experiences [23]. Study findings will inform the development of a user-centered, male-focused pre-visit SRH app designed to facilitate young males’ receipt of comprehensive SRH care in primary care.

Methods

We conducted three rounds of virtual focus group discussions (FGDs) and in-depth interviews (IDIs) between April 2023 and February 2024. Rounds 1 and 2 were scheduled approximately 2–4 weeks apart within each cohort. Round 3 occurred in February 2024 after integrating prior feedback into the app prototype, maintaining the same group composition whenever possible. We recruited participants through local and national youth advisory boards, community organizations, and social media advertisements (Facebook, Instagram). Study materials directed interested youth to an online eligibility survey. Youth were eligible if they were assigned male at birth, 15–21 years old, resided in the United States, and could communicate in English or Spanish. Of 210 survey respondents, 138 met eligibility criteria and 26 consented to participate. At enrollment, participants indicated preferences for FGD or IDI and language.

A total of 26 participants (Table 1) completed 16 FGDs and 10 IDIs. Participants were assigned to small, age-stratified FGDs (2–5 participants; 15–17 years or 18–21 years) and invited to participate with the same group across all rounds. Two participants (both transgender) elected IDIs for all rounds citing comfort levels. For others who requested FGDs, IDIs were used when scheduling conflicts prevented reconvening their original group, allowing continuity of participation. Retention into rounds 2 and 3 was 81% and 86%, respectively. Two FGD cohorts were composed primarily of Spanish-speaking participants; while all indicated preference to conduct the discussions in English these groups included a bilingual facilitator and notetaker to support flexibility and language switching as needed.

Table 1.

Participants’ demographic characteristics (N=26)

	N	%
Age
15–17	10	38.5
18–21	16	61.5
Gender
Cisgender	24	92.3
Transgender	2	7.7
Race
White	4	15.4
Black or African American	13	50.0
Asian	8	30.8
Other	1	3.8
Ethnicity
Hispanic	3	11.5
Non-Hispanic	23	88.5
Sexual identity
Heterosexual or straight	18	69.2
Gay	3	11.5
Bisexual	5	19.2
Region
Northeast	13	50.0
Midwest	3	11.5
Southeast	2	7.7
Southwest	3	11.5
Northwest	3	11.5
Unknown	2	7.7

Semi-structured facilitation guides were co-developed by the research team and a youth advisory board and finalized after a pilot focus group. Guides explored content and feature preferences for an SRH app tailored for male youth (Supplemental Table 1). The same guides were used for FGDs and IDIs, with minor probe adaptations based on the format. Round 1 began by asking participants to share three most important SRH content areas from a provided list (Table 2). The remainder of Round 1 explored participants’ experiences about pregnancy prevention, condom use, STI/HIV prevention, and general SRH care experiences. Round 2 explored participants’ experiences related to SRH vaccine receipt, PrEP/PEP, and healthy relationships. Round 3 focused shared the app prototype, allowed for youth to interact with and navigate the app, then asked participants’ feedback on its aesthetics (e.g., color palette, layout), tone (e.g., language), gamification (e.g., interactive components like knowledge quizzes and activities), and overall user experience.

Table 2.

Top three most important sexual health topics (N=26)

Topic	N	%
Preventing & treating HIV & STIs	13	50
Healthy relationship skills	13	50
Preventing unintended pregnancy	5	19
Learning how mental, physical, & sexual health are connected	4	15
Understanding & supporting changes that happen during puberty	4	15
How to get & use condoms	2	8
Different birth control methods	2	8
Vaccines against cancer	1	4
Planning for a healthy pregnancy, when ready	1	4
Understanding & protecting one’s fertility	1	4
Learning how to have pleasurable sex	1	4
Support for gender & sexuality	0	0
Sexual performance & function	0	0

Note. Participants were asked “What SRH topics are most important to you?” and asked to rank their top 1–3 items from this predetermined list

The research team comprised five trained scientists with backgrounds in adolescent health, SRH, public health, youth-centered health design, and qualitative methods (four women, one man; two Hispanic, two White, one Black; two bilingual in English/Spanish). Prior to data collection, the team discussed positionality, anticipated assumptions, and strategies to promote rapport and minimize power differentials with participants (e.g., youth-centered language, confidentiality reminders, optional cameras, and offering IDIs for comfort/scheduling). Post-session debriefs between the facilitator and notetaker addressed reflexive considerations (e.g., how gender, race/ethnicity, and professional training might have shaped probing and interpretation) and informed iterative refinements to facilitation guides and practices.

Each FGD/IDI consisted of one facilitator and one notetaker. All sessions were conducted via secure videoconferencing platform, lasted approximately 75 minutes, and were audio-recorded. Participants aged 18 and older provided informed consent; minors provided assent and parental consent. Each participant received $35 per session. The study was approved by the [blinded] Institutional Review Board.

Data analysis

Audio recordings were transcribed verbatim by a professional service and checked for accuracy by the research team. Following best practices [24], three primary coders and a fourth senior analyst conducted thematic analysis in ATLAS.ti. Coders independently coded three transcripts (two coders per transcript) and each drafted an initial inductive codebook. The team then reconciled these into a single harmonized codebook. Using this unified codebook, two of the three coders double-coded all remaining transcripts, applying deductive codes and adding inductive codes when novel ideas arose. Discrepancies were resolved through discussion with the fourth analyst until consensus. After coding, the three coders co-developed candidate themes which were reviewed with the fourth analyst and study PIs; minor wording refinements were made and no new themes emerged. Table 3 presents illustrative quotations demonstrating themes and reflecting the diversity of participant voices.

Table 3.

Themes, subthemes, and representative quotes from male youth focus group participants (N=26)

Theme & subtheme	Illustrative quote(s)	Participant age & #
Theme 1. Structural & social influences on SRH knowledge, behaviors, & care-seeking
Gaps in SRH education	It depends where you live. I think that some states have abstinence-only sex education, which is a joke. And it results in people not knowing how to put on a condom, nor the reasons to put on a condom.	18-yr-old, #8
	I feel like [condom use] has decreased because schools…they don’t teach enough about sexual health, reproductive health… They don’t teach it at all. Some schools teach it, but it’s only like one class that they teach in. It’s not for over a long period of time.	15-yr-old, #3
	[Some individuals] don’t fully understand the risks…associated with having unprotected sex or not even…knowing the available resources for attaining condoms… A lot of people think you don’t need a condom for oral sex.	21-yr-old, #2
	I certainly had no awareness [of vaccines] outside of like, ‘Oh, I’m getting my hepatitis shot now at the doctor,’ and I didn’t even learn anything about it then. I just knew I was getting that shot. I’m pretty sure the experience for other people is similar.	17-yr-old, #7
	I feel like it’s just harder to get more information about where to get tested and things like that. So, I feel like if that was more accessible, and…if it was just more personalized, I feel like it’d be easier.	16-yr-old, #17
	[chat] Birth control scares me… If I’m not mistaken ISN’T birth control like a tube stuck up in your arm?? And sits there UNTIL next year?	15-yr-old, #4
Low SRH self-efficacy	I don’t know but what I always wonder the most about is how to talk to a partner about STDs, because that’s always a really tricky thing, especially for young people.	17-yr-old, #7
	…Condoms [are] not something you just go into the store to order, …like you order for candy. So sometimes, most times, young people can be quite shy about getting [them].	21-yr-old, #10
	…A lot of young people, they don’t feel like-- we don’t feel like-- we kind of feel ashamed now talking to our clinicians about some of these things.	19-yr-old, #22
	I think…the most difficult part is getting condoms. It’s embarrassing to go to the store as an 18 or 19-year-old or younger and try and buy condoms, particularly if they have to go with their parents to shop places.	20-yr-old, #18
	I also say it could be a social pressure thing. A lot of young males feel pressured into social expectations as in doing certain stuff and thinking like, ‘This is okay. This is cool’…They not thinking about their partner or whoever they having sex with. Some males believe that you don’t need a condom. They don’t believe in [intimacy] with a condom.	21-yr-old, #2
	…You would think in a situation like that, [using a condom] would just be…protocol, just to be safe. But then you consider all the different situations, like how the scenario might be. And then a lot of younger men…might just be so fixated on doing the deed that anything that strays away from it, quote-unquote, ‘will jeopardize it’.	16-yr-old, #13
Clinical SRH barriers	[The clinician] can’t come off ‘parental’ or report everything to my parents… Keep it between me and you [the clinician], and then I’ll talk to you [the clinician] more. It’s like a bond over time.	18-yr-old, #9
	…Things like healthy relationships, abuse in relationships, sexual assault… for me, have been things that I’ve been very uncomfortable, and even at times, prohibitively uncomfortable discussing with my clinicians, even clinician who I trust very, very much. And part of this is mandatory reporting laws… They do prevent a lot of young people from discussing certain things, particularly minors.	18-yr-old, #8
	Well, I think one of the reasons why the use of condoms decreased among teenagers is because they lack access to condoms. Some teenagers may not have easy access to condoms, either, because they are not available at school.	21-yr-old, #16
Theme 2. Perceived value of a male-tailored SRH app
Benefits for male youth	I don’t think about HIV and STDs often. If I see a link [in the app] saying, ‘Preventing HIV and STDs,’ I’m going to click on it because I want to know how to prevent HIV and STDs.	18-yr-old, #1
	This app from the slides that you’ve shared and from what I’ve seen, it’s very informative. I’ve got to know about things that I had no clue about. I think it’s empowering.	19-yr-old, #22
	I think kind of like we see in this [STIs & HIV] slide about just lessening the stigma, making it known that it’s not-- I don’t want to say it’s not a huge deal because it is a big deal--but, it’s not a thing that’s only applicable to the person. It’s a thing a lot of people may struggle with that can encourage it or de-stigmatize it.	16-yr-old, #13
Benefits for interacting with partners	[chat] [The app can help] getting the confidence to ask your partner to get tested. Some people could fear asking.	17-yr-old, #12
	I think the app should include maybe some conversation-starters [for how to talk to your partner about safe sex practices] because it’s definitely hard to have this conversation, but I guess the hardest part in having this conversation is actually starting it, actually bringing it up.	18-yr-old, #21
Benefits for interacting with clinicians	[The app] can [help someone] bring up topics [with their clinician] that they wouldn’t feel comfortable bringing up in person.	18-yr-old, #25
	They’ll be able to learn about certain parts of the[ir] health care and then ask the clinician about what questions they have or what they want to get expanded on instead of just getting a lot of general knowledge.	19-yr-old, #26
Concerns about engagement & sustained use	I would probably check the app just to see one thing… I wouldn’t use it constantly… I might have to check once or twice.	18-yr-old, #1
	I would click on [the “learn more” button] if it’s something that I want to know. And some teens might click on it if they don’t know about it, but some teens wouldn’t because some teens just don’t like to read that much, I would say.	15-yr-old, #20
Theme 3. Preferences for an engaging & interactive app design
Visual design & content presentation	I like the fact that [the app] had a graphical representation. It’s not just words… it gives a clear picture of what to understand.	19-yr-old, #22
	I feel we could pick on the two most visible colors on the app and use them for the back and the next button rather than just leaving them there as gray and white or black or something like that. That’s kind of boring.	21-yr-old, #5
	[chat] Some people might not read everything because it seems a bit wordy, but I like the use of different text colors, and it brings my attention to those parts.	18-yr-old, #25
	I know some apps have a thing where certain vocabulary that people don’t know, it’ll be in a different color, and you can tap on it, and it’ll have a small pop-up telling you what it is. That could be a nice way to show the information without overboarding the page.	18-yr-old, #6
	I think tips, recommendations, examples about what they’re going through, that would be helpful… Just be able to spark that conversation [about health relationships with a partner] in itself is challenging. We want to ease that path…maybe a video, but I’m just not sure how you would translate that into a video form, but I’m sure it could be done.	18-yr-old, #23
Interactive features & customization	I think that maybe it could also be possible for the user to choose what they want… for example, what would be the best method to present information to you? It could be text-based, audio-based, video-based, etc. So, I think when the user sets up the app, I think maybe they could put their own input and personalize [the] app to their needs.	15-yr-old, #24
	I was actually thinking about what if there was a quiz-- not even a quiz, but questions that the app would ask in an order. …It could be like yes or no questions about their health. And after those questions are answered, the app could give them personalized advice on their health. I think that could be engaging.	18-yr-old, #23
	I feel like you should have like a chat line where they can actually [ask] questions [to their clinicians] in real time. That would be good.	15-yr-old, #3
	If the app has a search [feature], I think that might be helpful. I think people would use that more than trying to click through each page to find the information they’re looking for.	19-yr-old, #26
	Maybe having a survey before your visit… easier to click a button than to bring it up with your doctor.	17-yr-old, #14

Note. [chat] indicates that the text is directly pulled from what the participant wrote in the videoconference chat feature during the focus group discussion.

Results

Most participants were aged 18–21 (62%), cisgender (92%), non-Hispanic Black/African American (50%), heterosexual (69%), and lived in the Northeast (50%) (Table 1). Participants’ two most important SRH topics were preventing/treating STIs/HIV and healthy relationship skills (Table 2), though many other topics were highlighted in subsequent discussions. Qualitative analysis revealed three major themes (Table 3): (1) Structural and social influences on SRH knowledge, behaviors, and care-seeking; (2) Perceived value of a male-tailored SRH app; and (3) Preferences for an engaging and interactive app design.

Theme 1. Structural and social influences on SRH knowledge, behaviors, and care-seeking

Participants described interconnected structural and social factors that shaped their SRH knowledge, comfort, and care-seeking, including inadequate SRH education, low SRH self-efficacy and structural barriers to confidential, affordable care.

1.1. Gaps in SRH education

Participants traced their SRH knowledge gaps to inconsistent or inadequate SRH education. Most described a patchwork of school-based curricula that failed to provide comprehensive, skills-based training. Some reported receiving no sex education or abstinence-only instruction, while others recalled brief, superficial lessons that omitted practical information.

Discussions revealed participants’ limited understanding of condom types, proper application and disposal, and the distinction between barrier and hormonal contraceptive methods—with some believing “the pill” or intrauterine devices provided equivalent viral protection to condoms. One participant noted, “A lot of people think you don’t need a condom for oral sex,” illustrating misconceptions about when and how barrier methods should be used. Many participants shared they were unaware of which STIs were preventable by vaccines or where to access free or low-cost condoms and confidential testing. One participant explained, “I certainly had no awareness [of vaccines] outside of like, ‘Oh, I’m getting my hepatitis shot now at the doctor,’ and I didn’t even learn anything about it then.” A minority who shared greater confidence in condom use credited more robust curricula, but most felt their formal education was inadequate.

1.2. Low SRH self-efficacy

Participants discussed having low confidence navigating SRH conversations with partners and in obtaining condoms, shaped by limited skills, relationship dynamics, and social pressures. Many participants expressed uncertainty about how to initiate conversations about protection and STI status. As one participant explained, “…what I always wonder the most about is how to talk to a partner about STDs, because that’s always a really tricky thing, especially for young people.” Participants also discussed how relationship dynamics often complicated condom use with several participants noting that in established relationships, condoms were frequently abandoned as “trust” developed; and reintroducing condom use could provoke questioning of one’s motives (e.g., infidelity). Others alluded to broader social pressures and expectations that discouraged condom use.

Beyond partner communication, participants identified embarrassment as a significant barrier to obtaining condoms. Participants also discussed how these barriers were compounded by limited knowledge about where to access free or affordable condoms.

1.3. Clinical SRH barriers

Participants generally viewed clinicians as trustworthy sources for SRH information, but most expressed discomfort discussing SRH topics with their clinician during visits. Younger participants (ages 15–17) were particularly hesitant, citing shyness, embarrassment, and uncertainty about how to initiate these sensitive conversations. Across age groups, participants feared being judged and worried about confidentiality, especially minors who discussed being concerned that conversations might be relayed to parents by the clinician or through the patient portal. As a result, participants discussed frequently withholding SRH questions during clinic visits. Participants emphasized that establishing rapport with their clinician and receiving explicit confidentiality assurances were foundational for engagement in SRH discussions.

Participants also identified structural barriers to accessing SRH content, including proximity and affordability of SRH products and services. Several participants discussed the perceived high cost of condoms and low accessibility of STI/HIV testing and desired easy-to-use online tools to locate affordable, youth-friendly testing services.

Theme 2. Perceived value of a male-tailored SRH app

Participants expressed enthusiasm for a pre-visit app tailored for males, describing potential benefits for themselves and their interactions with partners and clinicians. But, they acknowledged challenges that could limit effectiveness, including concerns about digital engagement and sustained use.

2.1. Benefits for male youth

Participants highlighted how an SRH app tailored for male youth would fill critical SRH gaps that could address their unique concerns. They noted that existing SRH resources often targeted females, leaving males feeling under-informed about topics such as STI/HIV prevention and healthy relationship dynamics. While some participants were curious about female-oriented contraceptive methods, most reflected this topic was less relevant to their own needs and preferred content directly applicable to male experiences (e.g., STI/HIV testing, condom negotiation). Some participants suggested including peer testimonials describing successful navigation of an SRH issue to help destigmatize certain SRH topics (e.g., having an STI) and show that “everyone” struggles with them.

2.2. Benefits for interacting with partners

Participants discussed that a tailored SRH app for males could teach them how to have difficult SRH conversations with their partners and overcome partner negotiation barriers with the use of partner conversation-starters to learn how to approach negotiating condom use or STI screening with a partner. For example, one participant shared a young person on the app could be talking to their partner and say something like: “I recently learned a few surprising facts about [condoms] and I thought I would share them.” Participants discussed how conversation-starters can help males learn how to break the ice, reduce awkwardness, and normalize exchanges within relationships and aim to reduce embarrassment, immaturity, uneven levels of trust, and what to say when one is in the “heat of the moment.” Many participants also recommended including short video vignettes that could model healthy partner communication and brief, sharable “myth-busting” content or “did you know” facts that could reframe condom negotiation as educational dialogue rather than confrontation.

2.3. Benefits for interacting with clinicians

Participants shared how using a tailored app before a clinic appointment could reduce their anxiety around discussing SRH topics with their clinician and foster more open, informed dialogue. Many noted how information gathered while exploring the app could also help users prepare targeted questions. Participants highlighted that pre-visit app features could bridge gaps in clinical communication, including topic checklists or writing brief notes to their clinician. They discussed how such tools are low-stakes strategies to signal health concerns and prompt clinicians to broach sensitive subjects during a visit.

2.4. Concerns about engagement and sustained use

Despite overall enthusiasm, some participants acknowledged challenges and questioned males’ consistency in digital engagement. These participants noted that peers might skip use of this app due to time constraints, lack of motivation, or disinterest in preventive health activities. As one participant noted, “A lot of guys aren’t going to download something unless they think they have a problem right now.” Others noted privacy concerns for information entered into the app about their sexual behaviors and topic interests.

Theme 3. Preferences for an engaging and interactive app design

Participants discussed preferences for visual content, language, and interactive features focused on enhancing engagement and usability with the importance of customization.

3.1. Visual design and content presentation

Participants favored video content as the primary format for conveying information. While some participants preferred live-action videos for authenticity, others favored “less-awkward” animated videos. Several participants also emphasized the importance of diverse representation in videos, including different races/ethnicities and relationship configurations. Participants also recommended using complementary brief and digestible bulleted text summaries, rather than lengthy text blocks, and infographics to accommodate diverse learning styles. Regarding tone, participants discussed use of casual language that is credible with clear definitions for technical terms and cautioned against using overly academic or authoritative language. However, they equally cautioned against using language that attempted to sound too youth-friendly (e.g., excessive use of slang or emojis). Participants also preferred use of vibrant color palettes and images to break up content and improve readability.

3.2. Interactive features and customization

Participants believed the app should include interactive features to enhance engagement and comprehension, such as expandable information bubbles, clickable bullet points, and brief pop-up quizzes to test knowledge. They suggested incorporating a search function to quickly locate specific topics and clickable definitions for unfamiliar terms. Participants particularly discussed use of customization options to indicate SRH topic preferences, select content presentation formats (e.g., animated vs. live-action videos), and personalize visual representations (e.g., skin tone in animations). Use of such an approach was also highlighted as a way to facilitate communication with clinicians, including being able to select topics to discuss during one’s visit (e.g., checklist) or write brief notes to their clinician before the appointment. However, some worried using secure messaging might feel awkward or be accessible by parents. Overall, participants emphasized that flexibility and user control were essential to making the app feel relevant and engaging for diverse adolescents with varying SRH knowledge, experiences, and comfort levels.

Discussion

This study explored young males’ needs and preferences regarding a pre-visit SRH app for primary care through a multi-round, user-centered design process. Through sustained engagement with the same participants across three rounds, we gained deep insights and built trust that enabled discussion of sensitive topics and iteratively identified preferred app features. Participants expressed strong interest in a pre-visit SRH app for males to fill critical information gaps and provide practical tools for navigating SRH conversations that could help overcome their described interconnected barriers to SRH and care, including inadequate sex education, low self-efficacy for partner and clinician communication, and structural obstacles to confidential care. Findings demonstrate young males’ primary barriers to SRH care are informational and skill-based rather than solely structural, and how a digital tool can support young males to build self-efficacy for SRH engagement.

A central study finding was that participants envisioned the pre-visit app as a practical toolkit to navigate difficult SRH-related conversations, not merely an educational resource. With partners, they discussed wanting conversation-starters, shareable facts, and video demonstrations of healthy communication. With clinicians, they discussed valuing pre-visit topic checklists and message prompts as ways to signal concerns and prompt clinician-initiated discussions. This content is particularly relevant given most male adolescents lack sex education before their first sexual encounter [2], clinicians are not filling this gap [14], and upwards of 30% of Black and Latine males report sexual onset by age 12 [13]. Integrating conversation scaffolding features into the app could also help males navigate SRH conversations while maintaining their sense of competence and combat cultural expectations of male self-reliance that may contribute to discomfort in acknowledging uncertainty or vulnerability around their SRH needs [12]. These findings underscore the value of user-centered design to ensure interventions are not only accessible but relevant, affirming, and responsive to young males’ lived experiences [25,26]. Future work should test an app with larger, more diverse samples to examine its efficacy in improving young males’ SRH outcomes within the context of primary care.

Study participants discussed lacking confidence to initiate SRH discussions, which is consistent with past research showing male adolescents prefer clinicians to lead such discussions [27]. While participants viewed clinicians as trustworthy, other research shows that clinicians are less likely delivery SRH care to male adolescents as compared to females [9,10]. This mutual hesitation creates a communication and care impasse. Our prior work shows primary care clinicians discussed barriers on both sides of this impasse: despite reporting high confidence delivering SRH care to male adolescents, clinicians provided only about half of recommended services, influenced by training gaps, assumptions about male patients’ needs, and constraints at clinic, system, and structural levels [28]. Digital pre-visit tools may help break this pattern by both empowering male youth to signal concerns and cueing clinicians about priority topics.

Our study participants prioritized STI/HIV prevention and healthy relationships skills as top content yet demonstrated knowledge and skills gaps in both areas. Participants discussed misunderstanding condom function, appropriate use, and access that undermined their confidence to advocate for their use with partners. They also more generally shared lacking confidence in partner communication skills, including fears that condom negotiation implies infidelity. This latter finding was consistent with past work that has found suggesting protection, particularly in established partnerships, can be perceived as a signal of mistrust [29–31]. Future work should examine whether framing condom negotiation as an act of mutual care and providing scripts that reframe protection as shared responsibility improve self-efficacy and reports of health relationships.

Study participants’ narratives were primarily rooted in low confidence performing SRH behaviors (e.g., purchasing condoms, initiating conversations), anxiety about judgment, and limited communication skills—rather than external stigma or direct experiences of discrimination. This distinction is supported by prior research showing adolescent males often lack interpersonal and emotional competencies needed to confidently navigate SRH discussions [12,15,16]. Young people in the current study requested integrating conversation-starters and communication scripts into the app to directly target their current gaps in confidence and skills. They suggested peer testimonials and video demonstrations that use concrete language and examples, interactive quizzes, and customizable content that can help them practice and build competence in a low-stakes environment. Use of such approaches align with evidence from behavioral intervention meta-analyses showing that skills-building components enhance intervention effectiveness [32,33].

Study participants discussed wide-ranging knowledge gaps—misconceptions about contraception, limited vaccine awareness, and uncertainty about accessing testing. These findings are consistent with past research showing males report lower SRH knowledge than females and often lack information needed to protect their sexual health [2,12,34]. While prior literature has emphasized structural barriers (e.g. stigma, access) as central obstacles to male SRH engagement [15,16], participants’ discussions in the present study highlighted informational and self-efficacy barriers functioned as distinct issues that are also readily addressable. Technology-based solutions are well-suited to address gaps in knowledge and confidence simultaneously by providing comprehensive, easily-updatable content combined with skill-building features [21,25] and can be scaled for use with diverse settings and populations.

This study has limitations. The sample was geographically concentrated in the Northeast and predominantly non-Hispanic Black/African American, which may limit transferability but also represents a strength given these populations experience highest SRH disparities [5,6]. Future research should recruit from diverse regions and racial/ethnic groups. Gender diversity was limited (two transgender participants), and future work must prioritize including transgender and gender-diverse perspectives to ensure app inclusivity and adaptability. Some study recruitment was conducted via social media, which may have introduced selection bias towards individuals who are comfortable with technology, potentially skewing their perceptions of app usability and acceptability. This technology affinity may have also inflated enthusiasm for an app-based intervention and limited our ability to capture barriers or skepticism from less tech-engaged youth. Despite these limitations, this study’s strength lies in its multi-round qualitative design, which allowed for sustained engagement with the same individuals over time and supported deeper exploration of participants’ SRH needs, preferences, and iterative feedback on app features, enabling richer, more reflective insights than single sessions typically allow.

This study found young males experienced critical gaps in their SRH knowledge, skills, and care engagement. Participants endorsed the need for personalized, interactive content to support their SRH care-seeking and communication with partners and clinicians. Participants’ insights on app-specific design features provide a roadmap for designing youth-centered digital interventions that are responsive to male adolescents’ diverse lived experiences.

Acronyms.

GSM

gender and sexual minority

HIV

human immunodeficiency virus

PEP

post-exposure prophylaxis

PrEP

pre-exposure prophylaxis

SRH

sexual and reproductive health

STI

sexually transmitted infection