Web-based sexual and reproductive health education for adolescents aged 10–17 years: a systematic review and meta-analysis

Abstract

Background

Sexual and reproductive health (SRH) education is crucial for adolescents aged 10–17 years, yet its effectiveness in this age group has not been quantified in prior meta-analyses. This study aims to address that gap.

Objective

The objectives of this systematic review and meta-analysis were to (1) evaluate the effectiveness of web-based SRH education for adolescents aged 10–17 years and (2) explore potential factors influencing intervention effectiveness by synthesising study characteristics, including study design, theoretical foundation, implementation approach and follow-up duration.

Data sources

We searched PubMed and Web of Science from database construction to October 2023.

Eligibility criteria

This review included randomised controlled trials of web-based SRH education for adolescents aged 10–17 years.

Study appraisal and synthesis methods

Data were extracted and examined by two researchers. The Cochrane risk-of-bias tool assessed the risk of bias. Analyses were divided into three groups, employing meta-analytic methodologies.

Results

11 articles involving 7876 participants were analysed. This study revealed a moderate effect on knowledge (standardised mean difference (SMD) 0.59, 95% CI 0.60 to 0.94)), a low effect on attitudes (SMD 0.16, 95% CI 0.11 to 0.22) and a moderate effect on sexual behaviour (OR 0.75, 95% CI 0.60 to 0.94), with no significant effect on self-efficacy. Comparisons between web-based and traditional face-to-face SRH education were inconclusive due to limited studies and methodological heterogeneity.

Limitations

The overall certainty of evidence is limited by risk of bias, high heterogeneity and the use of only two databases, which suggests that the findings should be interpreted with caution.

Conclusions and implications of key findings

Web-based SRH education has potential in enhancing adolescents’ knowledge, attitudes and behaviour. Future research must adhere to recognised reporting standards, thereby ensuring methodological consistency and enhancing the quality of evidence.

PROSPERO registration number

CRD42023400504.

Background

Sexual and reproductive health (SRH) education is essential for adolescents, encompassing physical, emotional, mental and social well-being—not merely the absence of disease or disability.¹ The United Nations Educational, Scientific and Cultural Organization (UNESCO) emphasises that unmet SRH needs in adolescence may hinder progress towards the 2030 Sustainable Development Goals.²

Adolescents aged 10–17 experience profound physical, emotional and social changes while exploring sexual relationships. This exploration is often accompanied by risks such as sexually transmitted infections (STIs) and unintended pregnancies, exacerbated by puberty-related changes and inadequate SRH education. Meanwhile, complex dynamics with peers and family heighten the importance of healthy relationship development to prevent abuse and exploitation. Age-appropriate and accurate SRH education is therefore vital to safeguarding adolescents’ well-being.³

Many countries, including the Netherlands, the USA, the UK and Sweden, have integrated SRH education into school curricula, resulting in positive outcomes.4,6 For example, evaluations of school-based programmes in the USA (eg, It’s Your Game) demonstrated significant gains in sexual health knowledge and delayed initiation of sexual activity among participants.⁷ In contrast, while nations like Kenya, South Africa and Indonesia have begun implementing SRH education,^{8 9} challenges such as shortages of trained teachers, limited materials and sociocultural resistance^{10 11} continue to undermine the effectiveness of face-to-face approaches.

Web-based SRH education is defined as systematic, scientific and targeted programmes or courses delivered through the internet that adolescents can access using internet-connected devices such as computers or tablets.^{12 13} Adolescents can engage with computer-based virtual interfaces, watch animated videos and participate in games to earn badges, thereby acquiring essential SRH knowledge and skills. Such approaches have been successfully applied in practice—for instance, a gamified mobile app was used to improve HIV prevention knowledge among Nigerian youth,¹⁴ while interactive video modules combined with quizzes were employed to promote media literacy and SRH awareness in US high schools.¹⁵ This approach aligns well with the learning preferences of adolescents and addresses barriers in traditional settings, including staffing, resources and cultural constraints. It also provides a cost-effective and inclusive method of delivering SRH education more broadly. However, the effectiveness of web-based SRH education specifically for adolescents aged 10–17 remains unclear, highlighting the need for rigorous evaluation.

Previous systematic reviews have focused mainly on older adolescents and adults, leaving the 10–17 age group understudied.^{16 17} This review addresses this gap by focusing exclusively on adolescents aged 10–17, thus enhancing the relevance and applicability of findings for this population.

Accordingly, this study aims to evaluate not only the characteristics of included interventions but also their implementation fidelity and effectiveness in improving adolescents’ knowledge, attitudes, self-efficacy and behaviours. Specifically, it explores:

1. What are the impacts of web-based SRH education on adolescents' knowledge, attitudes, self-efficacy and behaviours during adolescents aged 10–17 years?

2. What are the key components, delivery modes and implementation features of these interventions?

Methods

This systematic review and meta-analysis, aiming to evaluate the effectiveness of web-based SRH education, was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses¹⁸ and registered with PROSPERO (CRD42023400504).

Search strategy

We systematically searched two databases (PubMed and Web of Science) for studies on SRH for adolescents aged 10–17 years, all with a search timeframe from database construction to October 2023. The search strategy used a combination of terms, including ‘Sexual Education’, ‘Reproductive Health’, ‘Online’, ‘Computer’, ‘Web’, ‘Video’, ‘Internet’, ‘Adolescent’, ‘Randomized Controlled Trials (RCTs)’, ‘Early Adolescents’, ‘Early and Middle Adolescence’, ‘Aged 10–17’. The full search strategies for each database are provided in online supplemental appendix 1. Additionally, we meticulously reviewed the reference lists of relevant review articles (eg,Palmer et al, 2020, Manby et al, 2022; Widman et al, 2018; Alkhaldi et al, 2016)^{16 17 19 20} for potentially applicable studies. The reference sections of all primary studies included in the review were also systematically screened. Following an initial title and abstract screening, the literature was imported into Reference Manager software for in-depth analysis.

Eligibility criteria

Two researchers (JW and RG) screened the literature for eligible studies. Inclusion criteria were: (1) participants aged 10–17 years; (2) randomised controlled trials (RCTs) focusing on internet-based SRH education; (3) assessment of at least one SRH-related outcome—knowledge, attitudes, self-efficacy or behaviours; (4) availability of outcome data (means, SDs, event counts) or sufficient statistical information for analysis and (5) English-language full-text articles. Exclusion criteria included: (1) participants outside the 10–17 age range; (2) non-RCT designs; (3) no SRH outcome measures; (4) insufficient statistical data and (5) non-English publications.

Data extraction

Two independent reviewers, RG and HX, extracted key data from the included studies, including authorship, year, study design, participant age, intervention characteristics, follow-up duration, theoretical framework and outcome indicators. Any discrepancies or disagreements between the two reviewers were resolved through discussion with a third reviewer, JW, to ensure the accuracy and integrity of the data extraction process.

Data synthesis and subgroup analysis

This review synthesised outcomes related to SRH, focusing on knowledge, attitudes, self-efficacy and behaviours. Given its direct relevance to behaviour change, particular emphasis was placed on condom self-efficacy. Where multiple follow-up time points were available, the longest follow-up was prioritised to capture sustained intervention effects. Continuous outcomes (eg, knowledge, attitudes, self-efficacy) were analysed using means and SD, while dichotomous outcomes (eg, sexual behaviour) were analysed using incidence data and total participants. Missing SDs were estimated using F statistics when available, following Cochrane Handbook recommendations. PS software was used for any additional computations. Results were expressed as standardised mean differences (SMDs) for continuous outcomes and ORs for dichotomous outcomes, with interpretation guided by Cohen’s criteria (0.2=small, 0.4=moderate, 0.8=large).²¹ To address heterogeneity in intervention content and delivery, the included RCTs were grouped into three predefined comparison categories, in line with Cochrane Handbook guidance on subgroup analysis:

Web-based SRH education versus minimal or no intervention

These control groups received little to no SRH education, serving as baselines for assessing the impact of web-based programmes.

Web-based SRH education versus traditional face-to-face SRH education

This subgroup comparison contrasted digital interventions with conventional classroom-based programmes, which often face logistical limitations related to educator availability and access.

Web-based SRH education versus alternative web-based SRH education

This group focused on intradigital comparisons, capturing variation in programme design (eg, abstinence-only vs risk-reduction), content and target audience (eg, girls-only vs general adolescent populations).

These subgroups were defined a priori based on theoretical and practical distinctions between intervention types and were intended to enhance the interpretability of pooled results. Statistical heterogeneity was assessed using the I² statistic. An I² value >75% was interpreted as substantial heterogeneity, in which case a random-effects model was used to account for between-study variability. Prediction intervals were also reported to estimate the expected range of effect sizes in future studies.

Quality assessment

The methodological quality and reporting transparency of the included studies were assessed using two complementary tools. The Cochrane Risk of Bias (RoB) tool²² evaluated potential sources of methodological bias, while the Red–Amber–Green (RAG) framework, developed within the Best Evidence Medical Education Collaborative²³ and subsequently applied in Cochrane reviews,²⁴ appraised the clarity and completeness of reporting educational interventions across six domains: educational underpinning, content, setting, pedagogy, implementation fidelity and conclusion alignment (online supplemental appendix 2). Each domain was rated using an RAG system. Two reviewers (RG and HX) conducted assessments independently, with disagreements resolved by a third reviewer (WZ).

Summary of findings and assessment of the certainty of the evidence

We applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence for each primary outcome.²⁵ Because all included studies were RCTs, the starting level of certainty was ‘high’.” Ratings were downgraded based on ROB, inconsistency, imprecision, indirectness or publication bias. The main results were summarised in a Summary of Findings table. Each comparison and primary outcome was entered into GRADEpro software for assessment.²⁶ The certainty of evidence was categorised as high, moderate, low or very low, with definitions as recommended by the GRADE Working Group. Decisions to downgrade were documented with explanatory footnotes, and additional comments were provided where necessary to aid interpretation. Assessments were conducted independently by three reviewers (RG, HX, WZ), with disagreements resolved by discussion and, if necessary, adjudication by a fourth reviewer (JW).

Results

The preliminary search across two databases yielded 1102 articles. An initial screening of titles and abstracts narrowed this down to 273 articles potentially meeting our inclusion criteria. Further scrutiny of these 273 full-text articles led to the exclusion of 256 articles for specific reasons: 249 were not RCTs but rather included other study designs, such as observational studies and cross-sectional studies, and 7 did not align with our stringent definition of web-based SRH education. Six articles lacked essential data, specifically the means and SD for knowledge, attitudes, self-efficacy and behaviours related to SRH education. These papers were excluded after unsuccessful attempts to obtain the original research data from the authors. Ultimately, 11 studies were selected for analysis (figure 1). This selection underwent a final review and verification by all co-authors, with detailed descriptions provided in online supplemental appendix 3.

Figure 1. Flow Diagram of Study Selection Process.

Characteristics of web-based SRH interventions

Overview of included studies

The review included 11 RCTs comprising 7876 participants. Of these, 3988 received web-based SRH education, 3642 received only minimal or no intervention (ie, blank controls), 40 participated in face-to-face education and 206 engaged in alternative web-based formats. The mean age was 14.1 years (range 10–17), with 56% female participants. Studies were conducted in the USA (73%), China (18%) and Tanzania (9%) (figure 2), and were published between 2004 and 2022. Intervention duration ranged from 30 min to 18 months,^{14 27} peer videos,28,30 personalised skills training,729,31 animated videos^{28 32 33} and scenario-based storytelling.^{15 29 34} Some studies also used motivational tools, such as quizzes and game-based rewards.¹⁴

Figure 2. Summary of Included Educational Interventions. HPV, Human papillomavirus.

Study design

Only three studies reported detailed allocation concealment methods,^{28 30 32} while most lacked sufficient detail, limiting assessment of methodological rigour. Seven studies incorporated personalised or interactive components to support sexual health behaviour change.729,34 However, most relied on self-reported behavioural outcomes, raising concerns about social desirability and recall bias.

Theoretical foundations

Six studies explicitly reported theoretical underpinnings, most commonly drawing on behaviour change and social cognitive theories.^{7 29 35} Others applied health communication models such as the Health Belief Model and Extended Parallel Process Model,^{27 33} or educational frameworks like Activity Theory in game-based learning.¹⁴ One study integrated dual-process persuasion and information interpretation theories to address media literacy alongside sexual health education.¹⁵ Four studies did not specify any guiding framework (figure 2).

Education resources

The interventions employed diverse resources (figure 2), including videos/animations,714 28 29 31,33 36 quizzes/self-tests,^{14 15 30 31} peer or scenario-based storytelling,^{15 29 31 33 36} gamified/serious-game components^{7 14 27} and role-play/simulation tasks.^{15 33} Notably, the two China-based trials^{28 32} reported a standardised package (cartoon videos, slides, teacher manuals/scripts), offering the most fully documented resources.

Pedagogical approaches

The studies adopted three main pedagogical approaches (figure 2): five interventions were designed as fully self-directed digital modules,^{14 15 27 30 31} two employed blended formats combining digital modules with classroom components,^{28 32} and four applied structured teacher-led or facilitator-led sessions integrated with digital content.^{7 29 33} The two China-based trials were notable for their standardised classroom delivery supported by digital modules and preintervention teacher training, ensuring consistency across sites.^{28 32 36}

Interaction mechanisms

Interaction mechanisms were diverse (figure 2). Quizzes and self-tests were the most common,^{14 15 28} while videos—both animated and peer-led—were widely used to stimulate reflection.^{31 33} More interactive elements such as group discussions or focus groups were less frequent,^{32 33} and only a few programmes integrated scenario-based simulations or role-play.^{15 29}

Delivery

Responsibility for delivery varied across studies (figure 2). Four interventions were implemented by schoolteachers,^{7 28 29 32} while two involved trained facilitators or health educators.^{33 36} The remaining five were delivered entirely as self-directed digital programmes without live facilitation.^{14 15 27 30 31} Reporting on facilitator training and delivery fidelity was often limited, which reduces transparency.

Quality assessment of included studies

The quality of the included studies was assessed using two complementary tools: the Cochrane RoB tool and the RAG framework.

Risk of bias

All 11 studies applied randomisation, but only 3 provided sufficient detail on both random sequence generation and allocation concealment, and were rated ‘A’. Seven studies were graded ‘B’ due to incomplete reporting, and one study¹⁴ was graded ‘C’ because of within-institution allocation, raising contamination risk (figure 3).

Figure 3. Risk of Bias Assessment for Included Studies.

Reporting quality (RAG)

Across the six domains, most studies scored well in educational underpinning and conclusion alignment. However, implementation fidelity was reported in only 4/11 studies. Curriculum content, pedagogy and learning settings were partially described in 7/11 studies, while accessibility of educational resources was rarely reported, limiting reproducibility.

Certainty of evidence (GRADE)

Certainty of evidence differed across subgroups. Compared with no intervention, most outcomes were of moderate certainty with downgrades for inconsistency, while self-efficacy was high certainty. Compared with traditional education, evidence was low certainty as it relied on a single small trial. For comparisons between web-based formats, attitudes and behaviours were supported by moderate to high certainty, whereas knowledge and self-efficacy were low to very low certainty due to heterogeneity and imprecision (onlinesupplemental appendices 46).

Effects of web-based SRH education on knowledge, attitudes, self-efficacy and behaviours across three groups

Group 1: is web-based SRH education effective for adolescents aged 10–17 years?

Knowledge

Eight studies on SRH knowledge showed a significant positive effect, with a SMD of 0.59 (95% CI 0.20 to 0.98), indicating moderate effectiveness (online supplemental appendix 7). However, the high heterogeneity (I²=97%) and a wide prediction interval (−0.22 to 2.31) suggest variable outcomes. While two studies^{33 34} reported significant improvements in knowledge about sexually transmitted diseases and two others^{36 37} showed marked overall gains in knowledge, these studies were not included in the pooled analysis due to data incompatibility in the meta-analytical synthesis.

Attitude

Six studies were included in the meta-analysis on attitudes toward SRH, yielding an SMD of 0.16 (95% CI 0.11 to 0.22), indicating a small but noticeable impact of web-based education (online supplemental appendix 8). The high heterogeneity (I²=90%) led to the use of a random effects model, with a 95% prediction interval from −0.39 to 0.40, showing variability in the effects. One study³⁷ reported more positive attitudes towards reducing risky sexual behaviours in the intervention group, but it was excluded due to incompatible data.

Self-efficacy

Four studies found no significant effect on self-efficacy (SMD=0.04, 95% CI −0.11 to 0.28), indicating no impact on adolescents’ self-efficacy in SRH (online supplemental appendix 9). Although one study³⁷ reported increased self-efficacy regarding condom use, it was excluded from the meta-analysis due to incompatible data formats.

Sexual behaviour

The meta-analysis for sexual behaviours, treated as a dichotomous outcome in online supplemental appendix 10, included three studies, with two assessing sexual behaviours and one focusing on contraceptive use. Only one of these studies showed a statistically significant effect. The combined results produced an OR of 0.75 (95% CI 0.60 to 0.94), indicating that web-based education was more effective at reducing sexual behaviours than minimal interventions were, with moderate heterogeneity (I²=63%).

Summary (web-based SRH education versus minimal intervention)

In summary, the meta-analysis revealed that web-based SRH education significantly improved sexual health knowledge and had a small but positive effect on attitudes. These findings also suggested that these interventions had a beneficial impact on reducing sexual behaviours. However, there was no statistically significant difference in self-efficacy outcomes between the intervention groups and the minimal intervention group. These findings highlight the potential of web-based education in these areas but underscore the need for further research to solidify the understanding of its impact on self-efficacy in SRH.

Group 2: how does web-based education compare to traditional face-to-face models in terms of effectiveness?

Knowledge

Data comparing web-based SRH education with traditional face-to-face education are limited. One study showed a substantial effect of traditional face-to-face education (SMD=1.79, 95% CI 1.27 to 2.31), but due to a small sample size (n=120) and quality grade of ‘C’, these findings should be interpreted cautiously (online supplemental appendix 11). Another study³⁶ found no significant difference in STI knowledge between groups, despite overall knowledge increases, and was excluded from the meta-analysis due to lack of quantifiable data.

Summary (web-based SHR education versus traditional face-to-face intervention)

The lack of research makes it difficult to comprehensively compare the efficacy of traditional face-to-face and web-based SRH education, especially in attitudes, self-efficacy and sexual behaviour.

Group 3: how effective is web-based SRH education?

This review identified four studies where both experimental and control groups received web-based SRH education, enabling a comparative analysis of different interventions. Data on SRH came from three studies with varied programme approaches. Two studies^{30 31} used HEART (interactive learning and skill development) and Growing Minds (theoretical knowledge and social growth). The meta-analysis showed a large effect on SRH knowledge (SMD=0.96, 95% CI 0.08 to 1.85) (online supplemental appendix 12), and a medium effect on attitudes (SMD=0.73, 95% CI 0.53 to 0.93, I²=0%) (online supplemental appendix 13). No significant difference was found for self-efficacy (SMD=−0.17, 95% CI −0.89 to 0.55, p=0.65) (online supplemental appendix 14). One study²⁹ showed a significant effect on delaying sexual initiation (OR=0.78, 95% CI 0.61 to 0.99) (online supplemental appendix 15). However, two studies^{30 31} found no significant improvement in sexual assertiveness skills (SMD=0.24, 95% CI 0.05 to 0.43) (online supplemental appendix 16).

Summary (web-based SHR education versus another web-based SHR education)

A comparative meta-analysis between the HEART and Growing Minds programmes implemented by Widman et al^{30 31} suggested that Growing Minds might be more effective at enhancing knowledge and attitudes. Nevertheless, there was no significant difference in self-efficacy between the two programmes, suggesting that individuals may lack the confidence to change or adopt sexual skills, which resulted in changes in sexual skills that were not statistically significant.

Discussion

SRH knowledge, attitudes and self-efficacy are critical for adolescents aged 10–17, influencing behaviours such as safe sex practices and health-related decision-making. This review suggests that web-based SRH education may improve knowledge, attitudes and behaviours, although the certainty of evidence was generally very low to high. Evidence for self-efficacy was inconsistent and generally of low certainty. As a higher-order construct, self-efficacy may build on knowledge acquisition and positive attitudinal change. In our review, several interventions improved knowledge and attitudes but did not produce corresponding gains in self-efficacy. While social cognitive theory recognises that efficacy beliefs can be shaped by information, it emphasises that they are more strongly reinforced through mastery experiences, modelling and feedback. Although many web-based interventions in our sample incorporated elements of practice and feedback, these components were often limited in intensity or interactivity, which may explain why improvements in knowledge and attitudes did not consistently translate into stronger self-efficacy.³⁸ Current evidence remains insufficient to determine its superiority over traditional face-to-face approaches, largely due to the small number of comparative studies and methodological limitations.

ROB was prevalent across the included studies, particularly due to limited reporting on randomisation and allocation concealment. The RAG assessment highlighted these methodological limitations, while the GRADE evaluations reflected their impact on the certainty of evidence, with additional downgrades for inconsistency and imprecision in several outcomes. Several outcomes showed apparently favourable effects (eg, knowledge in Analyses 2.1 and 3.1) but were downgraded to low or very low certainty due to high heterogeneity or reliance on single small trials. Conversely, less favourable or null effects (eg, self-efficacy in Analysis 1.3) sometimes provided more credible estimates. This paradox underscores the importance of interpreting findings in light of evidence certainty rather than effect direction and highlights the need for more rigorous trial design and transparent reporting—particularly in educational intervention studies—to enhance the credibility and transferability of findings.

From a practical standpoint, web-based SRH education holds promise for adolescents aged 10–17 years, particularly in promoting safer behaviours. However, participant adherence emerged as a crucial factor affecting intervention success. Several studies highlighted the importance of maintaining engagement through incentives, reminders, shorter programme durations and school-based partnerships.³⁷ These strategies should be prioritised in future implementation efforts to optimise programme impact.

Geographically, most studies were conducted in high-income countries, with eight from the USA. Only 27% of participants were from low-income or middle-income countries, represented by studies in China and Tanzania. In China, programmes relied on classroom-based delivery with standardised manuals,^{28 32} whereas the Tanzanian trial faced limited internet access and used simplified digital modules.¹⁴ By contrast, US interventions frequently incorporated animations, gamified tools and multiplatform resources.^{7 31} This imbalance constrains generalisability and underscores the need to adapt interventions to diverse contexts.

The results align with prior reviews supporting the positive effects of digital SRH interventions on adolescent knowledge and behaviours. For example, previous studies have reported delayed sexual initiation and increased condom use.³⁹ However, conflicting findings exist, particularly regarding HIV prevention behaviours and self-efficacy, highlighting the need to better understand how self-efficacy interacts with other cognitive and behavioural outcomes in SRH education.^{16 20} Future studies should therefore explore how increases in knowledge and shifts in attitudes translate into greater perceived competence and confidence (self-efficacy), since the current evidence suggests that knowledge and attitude improvements alone are not always sufficient to empower behavioural change.

Finally, the cost-effectiveness of web-based SRH education remains an underexplored area. Despite preliminary insights from studies such as Zhang’s⁴⁰ study of the Smart Girlfriends programme and Lohan’s⁴¹ study of the delivery costs of web-based SRH education, conclusive evidence regarding the cost efficiency of web-based methods compared with conventional approaches is still lacking. Consequently, future research must delve into low-cost web-based SRH education strategies to ascertain their economic viability and impact.

Strengths and limitations

This systematic review and meta-analysis evaluated the effectiveness of web-based SRH education for adolescents aged 10–17 years—a population often underrepresented in SRH research. By including only RCTs, the study ensured a high level of evidence and minimised confounding, thereby enhancing result validity and supporting quantitative comparisons.

However, this focus on RCTs also excluded studies with alternative designs, potentially narrowing the scope of evidence. In addition, limited methodological transparency in several included studies—particularly in implementation reporting—hindered a full understanding of the intervention processes. Another limitation lies in the restricted scope of the literature search, which relied on only two databases. These databases (PubMed and Web of Science) were selected based on their high relevance to health sciences, accessibility and broad coverage, but we acknowledge that excluding other databases (eg, Scopus, Embase) may have led to omissions and increased the risk of selection bias. This may have resulted in the omission of relevant studies indexed in other major databases and increased the risk of selection bias. The exclusion of non-English language publications may have introduced language bias and led to the omission of relevant findings. To improve methodological rigour, this review applied both the GRADE and RAG tools, which strengthened the assessment of evidence certainty and reporting quality. Nonetheless, further high-quality RCTs with clearer documentation and broader geographical representation are needed to advance the field of adolescents aged 10–17 years SRH education.

Conclusions

This review of 11 studies indicates that web-based SRH education may improve knowledge, attitudes and behaviours among adolescents aged 10–17 years, though no significant effect on self-efficacy was observed. Evidence comparing web-based and face-to-face education remains inconclusive due to the limited number of studies. High ROB and poor adherence to reporting standards highlight the need for greater methodological rigour. Future research should follow Consolidated Standards of Reporting Trials guidelines and consider using tools such as GRADE and RAG to enhance transparency and interpretability, thereby strengthening the evidence base for adolescent SRH education.

Data availability statement

The data supporting the findings of this study are available within the respective articles cited in this review.