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

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.