Student perceptions of the School eHealth Education Program Pakistan (eSHEPP): a qualitative study of acceptability, feasibility, and awareness of non-communicable diseases

Background: Noncommunicable diseases are a leading cause of premature morbidity and mortality, and many associated risk behaviors emerge during adolescence. In Pakistan, school health education remains limited and largely lecture-based, leaving adolescents insufficiently equipped to adopt healthy behaviors. To address this gap, the School eHealth Education Program Pakistan, a multimedia and mobile application-supported intervention, was developed. This study explored secondary and higher secondary students' perceptions of the program's acceptability, feasibility, and perceived usefulness in improving awareness of noncommunicable diseases following implementation in school settings. Methods: A qualitative explanatory study was conducted in four schools in Karachi (two secondary and two higher secondary; two all-girls and two all-boys schools). The program was delivered over eight weeks through six classroom sessions. Each 20-30-minute session included a short dramatized video, followed by guided discussion and interactive quizzes facilitated by a trained facilitator and teacher representative. Twenty-seven students were purposively sampled to ensure variation by school type and gender. Data were collected through four focus group discussions conducted after the intervention using semi-structured guides in Urdu. Thematic analysis was performed using NVivo through a hybrid deductive-inductive approach. Results: Students described the program as acceptable and easy to understand, highlighting the engaging dramatized videos, clear language, and supportive subtitles. Participants reported increased awareness of noncommunicable diseases and related risk factors. Some students expressed intentions to make healthier dietary choices, increase physical activity, and discourage smoking among peers. The program was considered feasible within existing school schedules and required minimal technological or personnel resources. Students suggested expanding health topics, slightly extending session duration, and incorporating additional interactive features to enhance engagement. Conclusions: The program showed strong acceptability, feasibility, and perceived educational value in under-resourced school settings. With improvements in interactivity and integration into school curricula supported by teachers and parents, it may provide a promising model for adolescent health education in similar contexts.