Analysis of Factors Affecting Healthy Reproductive Behavior in Adolescents in the Digital Era

Zumrotul Ula; Rasi Rahagia; Suprapto; Peer Zada Muhammad Aamir Khan; Lorraine Turiano

doi:10.56741/hesmed.v4i03.1322

Authors

Zumrotul Ula
zumrotul.ula18@gmail.com
Institut Kesehatan dan Bisnis Surabaya https://orcid.org/0009-0002-9604-0420
Rasi Rahagia Institut Kesehatan dan Bisnis Surabaya https://orcid.org/0009-0003-1269-5460
Suprapto Politeknik Sandi Karsa https://orcid.org/0000-0003-4294-1469
Peer Zada Muhammad Aamir Khan Lady Reading Hospital
Lorraine Turiano King Khalid University

DOI:

https://doi.org/10.56741/hesmed.v4i03.1322

Keywords:

Adolescents, Digital Era, Parental Guidance, Reproductive Health, Risk Behavior

Abstract

Adolescents in the digital era face opportunities and challenges in maintaining healthy reproductive behavior due to easy access to information and social media influence. This quantitative cross-sectional study surveyed 320 high school students aged 15–19 in Surabaya, Indonesia, using stratified random sampling. Data collected from April–July 2025 via self-administered questionnaires were analyzed with descriptive statistics, chi-square tests, correlations, and logistic regression. The findings showed that 62.5% of adolescents had good reproductive behavior, which was significantly associated with high knowledge (73.3% vs. 36.8%, p < 0.001), positive attitudes (71.4% vs. 45.5%, p = 0.001), strong parental guidance (80.6% vs. 39.3%, p < 0.001), supportive peer influence (73.7% vs. 46.2%, p = 0.002), and controlled digital media exposure (80.0% vs. 41.4%, p < 0.001). Multivariate analysis identified strong parental guidance (AOR = 3.65; 95% CI: 2.12–6.28) and controlled digital media exposure (AOR = 3.21; 95% CI: 1.85–5.58) as the strongest predictors, followed by high knowledge (AOR = 2.45), positive attitudes (AOR = 1.78), and supportive peers (AOR = 1.92). In conclusion, adolescent reproductive behavior is shaped by a combination of individual, family, peer, and digital factors, with parental guidance and digital literacy emerging as the most critical protective elements. Strengthening family involvement and promoting responsible digital engagement are recommended to foster healthy adolescent reproductive behavior.

Downloads

Download data is not yet available.

Author Biographies

Zumrotul Ula, Institut Kesehatan dan Bisnis Surabaya

is an education scientist and senior lecturer in the Midwifery Study Program at Institut Kesehatan dan Bisnis Surabaya, Indonesia. Her academic interests focus on health education, midwifery education, instructional development, and improving teaching and learning practices in healthcare education. She is committed to advancing educational quality through research, innovative teaching approaches, and professional development to strengthen healthcare competencies and student learning outcomes. (email: zumrotul.ula18@gmail.com).

Rasi Rahagia, Institut Kesehatan dan Bisnis Surabaya

is an education scientist and senior lecturer in the Nursing Study Program at Institut Kesehatan dan Bisnis Surabaya, Indonesia. His academic interests include nursing education, health sciences, educational innovation, and professional competency development. He is dedicated to improving the quality of nursing education through effective teaching strategies, academic research, and the integration of evidence-based approaches that support student achievement and healthcare professional development. (email: jaemincute89@gmail.com).

Suprapto, Politeknik Sandi Karsa

is an education scientist and Professor in the Nursing Study Program at Politeknik Sandi Karsa, South Sulawesi, Indonesia. His academic interests encompass nursing education, healthcare professional development, educational leadership, and evidence-based nursing practice. He actively contributes to advancing nursing education through scholarly research, academic mentorship, and innovative instructional approaches aimed at strengthening professional competencies, educational quality, and healthcare service delivery in Indonesia. (email: atoenurse@gmail.com).

Peer Zada Muhammad Aamir Khan, Lady Reading Hospital

is a Resident Surgeon in the Department of General Surgery at Lady Reading Hospital, Peshawar, Pakistan. His clinical responsibilities involve surgical patient assessment, perioperative management, and postoperative care. His professional interests encompass general surgical practice, clinical decision-making, patient safety, and evidence-based surgical management. He is committed to advancing his clinical expertise through surgical training, professional development, and continuous medical education. (email: pzmaamirkhan@gmail.com).

Lorraine Turiano, King Khalid University

is an Assistant Professor at King Khalid University, College of Nursing, Saudi Arabia, in the Maternity and Neonatal Nursing Department. As an educator, she is very much interested in Public Health, Artificial Intelligence and at the same time New Pedagogical Approaches. (email: estadilla@kku.edu.sa).

References

A. Assifa and R. Y. Setiyani, “Self-Esteem and Dietary Behavior in Adolescent Women,” J. Heal. Sci. Med. Dev., vol. 2, no. 03, pp. 128–136, Oct. 2023, doi: https://doi.org/10.56741/hesmed.v2i03.419. DOI: https://doi.org/10.56741/hesmed.v2i03.419

N. Elise, Novianti, Suriyati, D. Himalaya, and Damayanti, “The Effect of Personal Hygiene Education During Menstruation on Knowledge and Attitudes of Adolescent Girls,” J. Heal. Sci. Med. Dev., vol. 4, no. 01 SE-Articles, pp. 42–52, Mar. 2025, doi: https://doi.org/10.56741/hesmed.v4i01.809. DOI: https://doi.org/10.56741/hesmed.v4i01.809

S. Jacob, “Oxytocin and its links through scientific lineage,” Compr. Psychoneuroendocrinology, vol. 18, p. 100230, 2024, doi: https://doi.org/10.1016/j.cpnec.2024.100230. DOI: https://doi.org/10.1016/j.cpnec.2024.100230

A. Gramegna et al., “Standards for the care of people with cystic fibrosis (CF); Planning for a longer life,” J. Cyst. Fibros., vol. 23, no. 3, pp. 375–387, 2024, doi: https://doi.org/10.1016/j.jcf.2024.05.007. DOI: https://doi.org/10.1016/j.jcf.2024.05.007

C. Beyrer et al., “Under threat: the International AIDS Society–Lancet Commission on Health and Human Rights,” Lancet, vol. 403, no. 10434, pp. 1374–1418, 2024, doi: https://doi.org/10.1016/S0140-6736(24)00302-7. DOI: https://doi.org/10.1016/S0140-6736(24)00302-7

M. Karaoglan and M. Karaoglan, “The evolution of obesity and the origin of adipose tissue,” Obes. Med.., vol. 52, p. 100561, 2024, doi: https://doi.org/10.1016/j.obmed.2024.100561. DOI: https://doi.org/10.1016/j.obmed.2024.100561

Y. Kim, H. Lee, J. Park, Y.-C. Kim, D. H. Kim, and Y.-M. Lee, “eHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study,” JMIR Form. Res., vol. 8, 2024, doi: https://doi.org/10.2196/59087. DOI: https://doi.org/10.2196/59087

P. D. McGorry et al., “The Lancet Psychiatry Commission on youth mental health,” The Lancet Psychiatry, vol. 11, no. 9, pp. 731–774, 2024, doi: https://doi.org/10.1016/S2215-0366(24)00163-9. DOI: https://doi.org/10.1016/S2215-0366(24)00163-9

S. Baird et al., “A call to action: the second Lancet Commission on adolescent health and wellbeing,” Lancet, vol. 405, no. 10493, pp. 1945–2022, 2025, doi: https://doi.org/10.1016/S0140-6736(25)00503-3. DOI: https://doi.org/10.1016/S0140-6736(25)00863-3

H. Wang, X. Li, X. You, and G. Zhao, “Harnessing the power of artificial intelligence for human living organoid research,” Bioact. Mater., vol. 42, pp. 140–164, 2024, doi: https://doi.org/10.1016/j.bioactmat.2024.08.027. DOI: https://doi.org/10.1016/j.bioactmat.2024.08.027

J. Xian et al., “Modelling multiscale infectious disease in complex systems,” Phys. Rep.., vol. 1113, pp. 1–57, 2025, doi: https://doi.org/10.1016/j.physrep.2025.01.006. DOI: https://doi.org/10.1016/j.physrep.2025.01.006

W. Liu, G. Zhang, and X. Zheng, “Future foodscape: Impact of population decline and aging on China’s dietary carbon footprint and food security,” Glob. Food Sec., vol. 46, p. 100875, 2025, doi: https://doi.org/10.1016/j.gfs.2025.100875. DOI: https://doi.org/10.1016/j.gfs.2025.100875

P. Wang, “Critically analyzing the overturning of Roe v. Wade: What is wrong with Dobbs v. Jackson and how it can provide implications for democratic education,” Soc. Sci. Humanit. Open, vol. 12, p. 101669, 2025, doi: https://doi.org/10.1016/j.ssaho.2025.101669. DOI: https://doi.org/10.1016/j.ssaho.2025.101669

F. Saraipour, S. Panahi, L. Nemati-Anaraki, and A. Shahraki-Mohammadi, “Adolescents’ Health Information–Seeking Behavior: A Scoping Review,” J. Adolesc. Heal., 2025, doi: https://doi.org/10.1016/j.jadohealth.2025.05.030. DOI: https://doi.org/10.1016/j.jadohealth.2025.05.030

E. Wilhelm et al., “Effects of the Modern Digital Information Environment on Maternal Health Care Professionals, the Role of Midwives, and the People in Their Care: Scoping Review,” J. Med. Internet Res., vol. 27, 2025, doi: https://doi.org/10.2196/70108. DOI: https://doi.org/10.2196/70108

T.-J. Chen et al., “Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents,” Lancet, vol. 403, no. 10438, pp. 1808–1820, 2024, doi: https://doi.org/10.1016/S0140-6736(23)02894-5. DOI: https://doi.org/10.1016/S0140-6736(23)02894-5

H. Comfort et al., “Global, regional, and national stillbirths at 20 weeks’ gestation or longer in 204 countries and territories, 1990–2021: findings from the Global Burden of Disease Study 2021,” Lancet, vol. 404, no. 10466, pp. 1955–1988, 2024, doi: https://doi.org/10.1016/S0140-6736(24)01925-1. DOI: https://doi.org/10.1016/S0140-6736(24)01925-1

R. A. Jessica and E. Puji, “Knowledge about menstruation with readiness to face menarche of elementary school students in the era of reproductive health education,” J. Ilm. Kesehat. Sandi Husada, vol. 14, no. 1, pp. 174–182, Jun. 2025, doi: https://doi.org/10.35816/jiskh.v14i1.1265. DOI: https://doi.org/10.35816/jiskh.v14i1.1265

E. Force and S. Debernard, “Endocrine regulation of reproductive behaviors in insects: a comprehensive review,” Curr. Opin. Insect Sci., vol. 69, p. 101360, 2025, doi: https://doi.org/10.1016/j.cois.2025.101360. DOI: https://doi.org/10.1016/j.cois.2025.101360

A. Wicaksono, W. Steeneveld, T. van Werven, H. Hogeveen, and B. H. P. van den Borne, “Knowledge, attitude and behaviour of farmers towards the use of reproductive hormones in dairy cattle,” Animal, vol. 19, no. 4, p. 101470, 2025, doi: https://doi.org/10.1016/j.animal.2025.101470. DOI: https://doi.org/10.1016/j.animal.2025.101470

U. Marbun, N. Sari, I. Irnawati, L. Sari, and D. Dahniar, “The effectiveness of reproductive midwifery care with the flour albus approach: A Case Study of handling vaginal discharge in women of childbearing age,” J. Ilm. Kesehat. Sandi Husada, vol. 13, no. 2 SE-Book Review, Dec. 2024, doi: https://doi.org/10.35816/jiskh.v13i2.1218. DOI: https://doi.org/10.35816/jiskh.v13i2.1218

J. Y. Lo, K. M. Adam, and J. L. Garrison, “Neuropeptide inactivation regulates egg-laying behavior to influence reproductive health in Caenorhabditis elegans,” Curr. Biol., vol. 34, no. 20, pp. 4715-4728.e4, 2024, doi: https://doi.org/10.1016/j.cub.2024.09.059. DOI: https://doi.org/10.1016/j.cub.2024.09.059

S. Sahid, N. S. Norhisham, and B. S. Narmaditya, “Interconnectedness between entrepreneurial self-efficacy, attitude, and business creation: A serial mediation of entrepreneurial intention and environmental factor,” Heliyon, vol. 10, no. 9, p. e30478, 2024, doi: https://doi.org/10.1016/j.heliyon.2024.e30478. DOI: https://doi.org/10.1016/j.heliyon.2024.e30478

A. Junça-Silva and L. Lourenço, “The relationship between attitudes toward telework and well-being: the mediating role of interpersonal interactions and the moderating role of neuroticism,” Comput. Hum. Behav. Reports, vol. 19, p. 100732, 2025, doi: https://doi.org/10.1016/j.chbr.2025.100732. DOI: https://doi.org/10.1016/j.chbr.2025.100732

S. Daud et al., “Linking attitude and ethical practices to energy Efficiency: The mediating role of household lifestyle,” Environ. Sustain. Indic., vol. 26, p. 100689, 2025, doi: https://doi.org/10.1016/j.indic.2025.100689. DOI: https://doi.org/10.1016/j.indic.2025.100689

Z. Xu, X. Wang, X. Jin, and M. Zhou, “The influence of proactive personality on laboratory safety attitude of graduate students: Chain mediating role of safety self-efficacy and safety motivation,” Educ. Chem. Eng., vol. 53, pp. 56–61, 2025, doi: https://doi.org/10.1016/j.ece.2025.07.005. DOI: https://doi.org/10.1016/j.ece.2025.07.005

M. Gerçek and C. G. Özveren, “Creative self-efficacy, learning agility, and proactive career behaviors: The moderated mediation effect of positive AI attitudes among young adults,” Think. Ski. Creat., vol. 58, p. 101895, 2025, doi: https://doi.org/10.1016/j.tsc.2025.101895. DOI: https://doi.org/10.1016/j.tsc.2025.101895

B. Young, L. Wheeler, and H. D. Dai, “Parental influence on youth cannabis use: The interplay between disapproval and warmth,” Addict. Behav. Reports, vol. 22, p. 100621, 2025, doi: https://doi.org/10.1016/j.abrep.2025.100621. DOI: https://doi.org/10.1016/j.abrep.2025.100621

R. Eads, S. Young, S. Yoon, C. R. Quinn, and M. Y. Lee, “Protective factors in intergenerational trauma: A mixed methods investigation of the role of holistic well-being and parental empowerment by parents’ gender,” Child. Youth Serv. Rev.., vol. 172, p. 108247, 2025, doi: https://doi.org/10.1016/j.childyouth.2025.108247. DOI: https://doi.org/10.1016/j.childyouth.2025.108247

Y. Yamamoto, J. Li, H. Yang, and I. Zhang, “Guidance and respect: Chinese American preschoolers’ perceptions of parental support for learning,” Early Child. Res. Q., vol. 69, pp. S140–S149, 2024, doi: https://doi.org/10.1016/j.ecresq.2024.03.005. DOI: https://doi.org/10.1016/j.ecresq.2024.03.005

W. S. Mabaso, S. Hein, G. Pavarini, and M. Fazel, “Exploring the Relationship Between Public Social Media Accounts, Adolescent Mental Health, and Parental Guidance in England: Large Cross-Sectional School Survey Study,” J. Med. Internet Res., vol. 26, 2024, doi: https://doi.org/10.2196/57154. DOI: https://doi.org/10.2196/57154

V. Piccoli, A. Carnaghi, M. Grassi, M. Stragà, and M. Bianchi, “Cyberbullying through the lens of social influence: Predicting cyberbullying perpetration from perceived peer-norm, cyberspace regulations and ingroup processes,” Comput. Human Behav., vol. 102, pp. 260–273, 2020, doi: https://doi.org/10.1016/j.chb.2019.09.001. DOI: https://doi.org/10.1016/j.chb.2019.09.001

Y. Qu, C. A. Yue, K. H. Kim, and A. Zhou, “A social influence perspective toward employee-organisation relationships: The role of relationship norms in employee peer networks,” Public Relat. Rev., vol. 51, no. 1, p. 102531, 2025, doi: https://doi.org/10.1016/j.pubrev.2024.102531. DOI: https://doi.org/10.1016/j.pubrev.2024.102531

G. T. DiGuiseppi et al., “Resistance to peer influence moderates the relationship between perceived (but not actual) peer norms and binge drinking in a college student social network,” Addict. Behav., vol. 80, pp. 47–52, 2018, doi: https://doi.org/10.1016/j.addbeh.2017.12.020. DOI: https://doi.org/10.1016/j.addbeh.2017.12.020

E. Chioatto, A. Davide, S. Mancinelli, and F. Nicolli, “Do firms consider their peers when going circular? Social norms among Italian firms in circular innovation adoption,” Ecol. Econ., vol. 237, p. 108707, 2025, doi: https://doi.org/10.1016/j.ecolecon.2025.108707. DOI: https://doi.org/10.1016/j.ecolecon.2025.108707

B. A. Morrongiello, M. Seasons, K. McAuley, and S. Koutsoulianos, “Child pedestrian behaviors: Influence of peer social norms and correspondence between self-reports and crossing behaviors,” J. Safety Res., vol. 68, pp. 197–201, 2019, doi: https://doi.org/10.1016/j.jsr.2018.12.014. DOI: https://doi.org/10.1016/j.jsr.2018.12.014