Effectiveness of a Digital-Based Reproductive Health Education in Improving Literacy and Healthy Behavior among Indonesian Adolescents: A Mixed Methods Study

Anita Yuliani; Intan Putri Utami; Salma Husni Nurul Umi

doi:10.56741/IISTR.jphs.002415

Authors

Anita Yuliani
anita@unisa-bandung.ac.id
Universitas Aisyiyah Bandung https://orcid.org/0000-0002-0606-6196
Intan Putri Utami Universitas Aisyiyah Bandung https://orcid.org/0009-0007-9059-8913
Salma Husni Nurul Umi Universitas Aisyiyah Bandung https://orcid.org/0009-0007-7954-7031

Keywords:

Adolescent Literacy, Digital Education, Educational Innovation, Healthy Behavior, Reproductive Health

Abstract

Low reproductive health literacy and healthy behavior among Indonesian adolescents remains a major challenge in the digital era, especially amid the widespread circulation of invalid information. This study evaluates the effectiveness of a digital-based reproductive health education model in improving adolescents' literacy and healthy behavior, while also exploring students' needs, barriers, and expectations. A sequential explanatory design was used across two phases. Phase I used a quasi-experimental approach involving 100 junior and senior high school students in Bandung (50 intervention; 50 control). Literacy and behavior were measured before, after, and three months post-intervention using valid and reliable instruments (CVI 0.87; α>0.8). Phase II used focus group discussions with 8 adolescents and interviews with 8 stakeholders, which were analyzed thematically. Results showed a significant increase in reproductive health literacy in the intervention group (52.3±12.1 to 78.9±9.8; p<0.001) and in healthy behavior (+21.4%; p=0.003), with a large clinical effect (Cohen's d=1.15) that was sustained for three months. Perceived benefits, peer support, and curriculum integration were key success factors. Qualitative findings highlighted the need for relevant content, interactive features, ease of access, privacy protection, and online counseling services, while limited digital access and infrastructure remained barriers. In conclusion, digital-based reproductive health education is effective and well received by adolescents, and its national implementation requires curriculum integration, equitable digital access, support services, and multisectoral collaboration.

Downloads

Download data is not yet available.

Author Biographies

Anita Yuliani, Universitas Aisyiyah Bandung

is an education scientist and lecturer specializing in reproductive health and midwifery at Universitas Aisyiyah Bandung, West Java, Indonesia. Her academic activities focus on health education, reproductive health, and midwifery education. She contributes to teaching and academic development within her institution, supporting the preparation of future healthcare professionals. (email: anita@unisa-bandung.ac.id).

Intan Putri Utami, Universitas Aisyiyah Bandung

is an education scientist and midwifery lecturer at Universitas Aisyiyah Bandung, West Java, Indonesia. Her academic role involves teaching and supporting educational activities in the field of midwifery. She is interested in the development of midwifery education, maternal health, and professional healthcare learning. (email: intan.putri@unisa-bandung.ac.id).

Salma Husni Nurul Umi, Universitas Aisyiyah Bandung

is a midwifery student at Universitas Aisyiyah Bandung, West Java, Indonesia. Her academic interests encompass maternal health, reproductive healthcare, and midwifery practice. She is developing her knowledge and clinical understanding through academic coursework and educational activities. Her studies emphasize the importance of evidence-based care, maternal well-being, and reproductive health education. She aspires to contribute to improving healthcare services and promoting maternal and reproductive health in Indonesia. (email:salmahusni57@gmail.com).

References

Y. Rahyani, A. Utarini, S. A. Wilopo, and M. Hakimi, ‘Predictors of premarital sexual initiation on adolescents in Bali: a longitudinal study’, BMC Public Health, vol. 14, no. 1, p. O25, Jan. 2014, doi: 10.1186/1471-2458-14-S1-O25.

N. Alomair, S. Alageel, N. Davies, and J. V. Bailey, ‘Factors influencing sexual and reproductive health of Muslim women: a systematic review’, Reprod Health, vol. 17, no. 1, p. 33, Mar. 2020, doi: 10.1186/s12978-020-0888-1.

K. Goh, S. Contractor, and S. Van Belle, ‘A Realist-Informed Review of Digital Empowerment Strategies for Adolescents to Improve Their Sexual and Reproductive Health and Well-being’, J Urban Health, vol. 99, no. 6, pp. 1141–1156, Dec. 2022, doi: 10.1007/s11524-022-00678-8.

W. Diarsvitri and I. D. Utomo, ‘Medical perspective of reproductive health education in Indonesian schoolbooks’, Front. Public Health, vol. 10, Nov. 2022, doi: 10.3389/fpubh.2022.943429.

E. Kemigisha et al., ‘Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior’, Reprod Health, vol. 15, no. 1, p. 148, Aug. 2018, doi: 10.1186/s12978-018-0595-3.

I. Fridman, S. Johnson, and J. E. Lafata, ‘Health Information and Misinformation: A Framework to Guide Research and Practice’, JMIR Medical Education, vol. 9, no. 1, p. e38687, Jun. 2023, doi: 10.2196/38687.

K.-Y. Huang, M. Kumar, S. Cheng, A. E. Urcuyo, and P. Macharia, ‘Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review’, BMC Health Serv Res, vol. 22, no. 1, p. 1373, Nov. 2022, doi: 10.1186/s12913-022-08673-0.

F. I. Onukwugha et al., ‘The effectiveness and characteristics of mHealth interventions to increase adolescent’s use of Sexual and Reproductive Health services in Sub-Saharan Africa: A systematic review’, PLOS ONE, vol. 17, no. 1, p. e0261973, Jan. 2022, doi: 10.1371/journal.pone.0261973.

R. L. Evans, B. Harris, C. Onuegbu, and F. Griffiths, ‘Systematic review of educational interventions to improve the menstrual health of young adolescent girls’, BMJ Open, vol. 12, no. 6, p. e057204, Jun. 2022, doi: 10.1136/bmjopen-2021-057204.

L. Marciano, M. Ostroumova, P. J. Schulz, and A.-L. Camerini, ‘Digital Media Use and Adolescents’ Mental Health During the Covid-19 Pandemic: A Systematic Review and Meta-Analysis’, Front. Public Health, vol. 9, Feb. 2022, doi: 10.3389/fpubh.2021.793868.

D. de Sousa, A. Fogel, J. Azevedo, and P. Padrão, ‘The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review’, Nutrients, vol. 14, no. 6, p. 1258, Jan. 2022, doi: 10.3390/nu14061258.

M. P. Chavula, J. M. Zulu, and A.-K. Hurtig, ‘Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review’, Reprod Health, vol. 19, no. 1, p. 196, Sep. 2022, doi: 10.1186/s12978-022-01504-9.

C. Contreras, J. Rivas, R. Franco, M. Gómez-Plata, and B. P. L. Kanacri, ‘Medios digitales y participación cívica escolar: Un modelo de mediación paralela’, Comunicar: Revista Científica de Comunicación y Educación, vol. 31, no. 75, pp. 91–102, 2023, doi: 10.3916/C75-2023-07.

R. Hémono et al., ‘Digital self-care for improved access to family planning and reproductive health services among adolescents in Rwanda: preliminary findings from a pilot study of CyberRwanda’, Sexual and Reproductive Health Matters, vol. 29, no. 3, p. 2110671, Jan. 2022, doi: 10.1080/26410397.2022.2110671.

C. E. Kosasih, T. Solehati, and I. Maryati, ‘Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study’, Belitung Nursing Journal, vol. 10, no. 1, pp. 87–95, Feb. 2024, doi: 10.33546/bnj.3033.

S. Bergam et al., ‘WhatsApp-based sexual and reproductive health education for adolescents with perinatally acquired HIV: lessons learned from an mHealth pilot intervention in South Africa’, Sex Educ, vol. 25, no. 4, pp. 481–495, 2025, doi: 10.1080/14681811.2024.2357223.

M. C. Laurence et al., ‘The effect of WhatsApp-based reminders on enhancing knowledge and adherence to weekly iron-folic acid supplementation among adolescent girls in Maluku, Indonesia’, Frontiers in Digital Health, vol. 7, 2025, doi: 10.3389/fdgth.2025.1542006.

C. B. Draucker, S. M. Rawl, E. Vode, and L. Carter-Harris, ‘Integration Through Connecting in Explanatory Sequential Mixed Method Studies’, West J Nurs Res, vol. 42, no. 12, pp. 1137–1147, Dec. 2020, doi: 10.1177/0193945920914647.

S. Meherali et al., ‘Digital knowledge translation tools for sexual and reproductive health information to adolescents: an evidence gap-map’, Ther Adv Reprod Health, vol. 18, p. 26334941241307881, 2024, doi: 10.1177/26334941241307881.

E. Kurnaesih, C. Herbawani, and N. Febriani, ‘Barriers to Implementing Comprehensive Sexuality Education as a Strategy to Prevent Adolescent Pregnancy in Indramayu District, Indonesia’, Kesmas, vol. 20, no. 3, pp. 185–193, Aug. 2025, doi: 10.7454/kesmas.v20i3.2270.

R. F. Hamm, L. D. Levine, J. E. Szymczak, S. Parry, S. K. Srinivas, and R. S. Beidas, ‘An innovative sequential mixed-methods approach to evaluating clinician acceptability during implementation of a standardized labor induction protocol’, BMC Med Res Methodol, vol. 23, no. 1, p. 195, Aug. 2023, doi: 10.1186/s12874-023-02010-7.

V. Thongchotchat, Y. Kudo, Y. Okada, and K. Sato, ‘Educational Recommendation System Utilizing Learning Styles: A Systematic Literature Review’, IEEE Access, vol. PP, pp. 1–1, Jan. 2023, doi: 10.1109/ACCESS.2023.3238417.

R. Bannink, S. Broeren, E. J. Zwanenburg, E. van As, P. van de Looij-Jansen, and H. Raat, ‘Effectiveness of a Web-Based Tailored Intervention (E-health4Uth) and Consultation to Promote Adolescents’ Health: Randomized Controlled Trial’, Journal of Medical Internet Research, vol. 16, no. 5, p. e3163, May 2014, doi: 10.2196/jmir.3163.

J. Jardine, R. Bowman, and G. Doherty, ‘Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review’, Journal of Medical Internet Research, vol. 24, no. 8, p. e37851, Aug. 2022, doi: 10.2196/37851.

L. Stauch et al., ‘Digital Health Literacy of Children and Adolescents and Its Association With Sociodemographic Factors: Representative Study Findings From Germany’, J Med Internet Res, vol. 27, p. e69170, May 2025, doi: 10.2196/69170.

J. L. Freeman, P. H. Y. Caldwell, and K. M. Scott, ‘How Adolescents Trust Health Information on Social Media: A Systematic Review’, Acad Pediatr, vol. 23, no. 4, pp. 703–719, 2023, doi: 10.1016/j.acap.2022.12.011.

K. Reilly and A. Ebersole, ‘Confidentiality and privacy considerations for adolescents receiving contraceptive health services via telemedicine: A narrative review’, Womens Health (Lond), vol. 20, p. 17455057241233126, 2024, doi: 10.1177/17455057241233126.

K. A. Sinclair, A. Zamora-Kapoor, C. Townsend-Ing, P. A. McElfish, and J. K. Kaholokula, ‘Implementation outcomes of a culturally adapted diabetes self-management education intervention for Native Hawaiians and Pacific islanders’, BMC Public Health, vol. 20, no. 1, p. 1579, Oct. 2020, doi: 10.1186/s12889-020-09690-6.