Sexual health literacy and preventive behaviors among middle-school students in a rural area during the COVID-19 situation: A mixed methods study

Assessing sexual health literacy among Thai female adolescents in non-formal education: A mixed-methods study

Background

Adolescent pregnancy in Thailand and globally remains a major public health issue, often leading to significant health and social consequences. Among adolescents outside the formal education system, low levels of sexual and reproductive health literacy contribute to poor decision-making and increased risk of unintended pregnancy. Targeted, culturally sensitive interventions are essential to bridge these gaps and reduce associated hardships.

Objective

This study aimed to evaluate the sexual health literacy of Thai female adolescents in non-formal education, focusing on their knowledge levels, decision-making processes, and barriers to accessing accurate sexual health information and services.

Methods

A mixed-methods sequential explanatory design was used. Quantitative data were collected between November 2021 and September 2022, and qualitative data between December 2022 and August 2023. Multi-stage random sampling was used to select 270 participants aged 15-19 from non-formal education programs, yielding a final sample of 200 after excluding incomplete data (response rate = 74.07%). The qualitative phase involved semi-structured interviews with 30 participants who scored low on the sexual health literacy assessment. Information was gathered through semi-structured interviews to explore their knowledge and decision-making process. Descriptive statistics were used to analyze the quantitative data, and thematic analysis was used to analyze the qualitative responses.

Results

Participants demonstrated moderate overall sexual health literacy (M = 97.73, SD = 16.91). Decision-making regarding sexual practices scored the highest (88.79%), while access to health information and services scored the lowest (54.72%). Thematic analysis revealed four major themes: 1) The need for supplemental sexual education beyond formal classrooms, 2) Widespread misconceptions and reliance on unreliable contraceptive information sources, 3) Limited access to sexual health services for adolescents, and 4) The decision-making process prior to selecting a contraceptive method.

Conclusion

There is a clear need for targeted, comprehensive sexual health literacy programs that improve adolescents' knowledge, communication skills, and understanding of contraception. Engaging mothers and other female relatives as key influencers, along with the involvement of nurses and youth-friendly service providers, is essential. These initiatives should focus on preventing high-risk behaviors, delaying sexual initiation, and reducing unplanned pregnancies, especially in underserved non-formal education contexts.

Development and Validation of a Sexual Health Literacy Measurement Tool for Pregnancy Prevention Among Adolescents (SHL-PPA)

Purpose

Several measurement tools have been developed for health literacy. However, little emphasis has been placed on the development of sexual health literacy (SHL) in adolescents. This paper describes the development and validation of an SHL measurement tool for pregnancy prevention among adolescents (SHL-PPA).

Methodology

This study explores research and development (R&D) and presents three stages of R&D, including a literature review, the Delphi approach, and a valid and reliable questionnaire. Three groups were used for the population and sampling: 18 experts, five competent people, and 654 adolescents. An online self-assessment tool was used. The data analysis methods used were median, interquartile range, content validity index, Cronbach's alpha coefficient, and exploratory factor analysis.

Results

The results show that the definition of SHL for adolescents was "cognitive, social, and cultural skills that determine the motivation and ability of an adolescent to access and sufficiently understand sexual health information and services, which results in them being capable of sexual health assessment and making decisions to prevent pregnancy". The final devised SHL-PPA included 33 items and the three following components: 1) accessibility to sexual health information and services, 2) an understanding of sexual health information and services and appraisal of sexual health to prevent pregnancy, and 3) applying the obtained sexual health information and skills to prevent pregnancy.

Conclusion

This study proves that the SHL-PPA is appropriate for Generation Z teenagers, particularly for online self-assessment of SHL. An online self-evaluation using the SHL-PPA demonstrated that related organizations should develop online activities or programs to improve teenage girls' pregnancy-prevention behavior.