# Acceptability, Feasibility, and Perceived Usefulness of the School eHealth Education Program Pakistan (eSHEPP) for Improving Adolescents’ Awareness of Noncommunicable Diseases in Secondary and Higher Secondary Schools

## TL;DR

A multimedia health education program for Pakistani schools was found to be well-accepted and effective in improving adolescents' awareness of noncommunicable diseases.

## Contribution

The eSHEPP program is a novel, app-supported, and culturally adapted intervention for promoting NCD awareness in low-resource school settings.

## Key findings

- Students found eSHEPP acceptable, user-friendly, and effective in increasing awareness of NCDs and related risk factors.
- The program was feasible to implement with minimal resource demands and successfully integrated into school schedules.
- Participants suggested improvements like adding interactive features and expanding health topics for better engagement.

## Abstract

Noncommunicable diseases (NCDs) are a leading cause of premature morbidity and mortality, and many risk behaviors emerge during adolescence. In Pakistan, school health education remains limited and primarily didactic, leaving adolescents insufficiently equipped to adopt healthy behaviors. To address this gap, the School eHealth Education Program Pakistan (eSHEPP), a multimedia, app-supported intervention, was developed. This study aimed to explore secondary and higher secondary students’ perceptions of eSHEPP’s acceptability, feasibility, and perceived usefulness in increasing awareness of NCDs following program delivery in school settings.

A qualitative explanatory study, guided by an integrated Technology Acceptance Model (TAM) and Task–Technology Fit (TTF) framework, was conducted in four schools (two secondary, two higher secondary; two all-girls, two all-boys) in Karachi. eSHEPP was delivered over eight weeks through six classroom-based sessions. Each 20–30-minute session included a 7–10-minute dramatized video, followed by guided discussion and interactive Q&A led by a trained facilitator and teacher representative. A total of 27 students participated in four focus group discussions (FGDs) conducted after program completion. Data were collected using piloted semi-structured guides in Urdu and analyzed thematically using a hybrid deductive–inductive approach in NVivo, following COREQ guidelines.

Students described eSHEPP as highly acceptable and user-friendly, appreciating the dramatized videos, clear language, and supportive subtitles. Most participants reported increased awareness of NCDs and risk factors, healthier dietary choices, greater recognition of the importance of physical activity, and peer-led discouragement of smoking. The program’s smooth integration into school schedules and minimal resource demands (technological and personnel) enhanced perceived feasibility. Participants suggested expanding health topics, slightly extending session duration, and incorporating interactive features such as quizzes, games, and peer-engagement tools to sustain interest.

eSHEPP demonstrated strong acceptability, high feasibility, and clear educational value in under-resourced Pakistani schools. With refinements in interactivity and delivery, and formal integration into school curricula supported by teachers and parents, eSHEPP has the potential to be a scalable and sustainable model for adolescent health promotion in low-resource settings. Future studies should evaluate long-term outcomes using mixed-method and longitudinal designs.