Determinant factors of sexual and reproductive health literacy among adolescents in Indonesia: A national population-based study

Wildan Satrio Darmawan; Sigit Ari Saputro; Sukarno Sono; Antonius Yansen Suryadarma; Monita Destiwi; Philip Etabee Bassey

doi:10.4103/jehp.jehp_92_26

. 2026 Aug 31;15:386. doi: 10.4103/jehp.jehp_92_26

Determinant factors of sexual and reproductive health literacy among adolescents in Indonesia: A national population-based study

Wildan Satrio Darmawan ^1,², Sigit Ari Saputro ^1,^3,^✉, Sukarno Sono ^4,⁵, Antonius Yansen Suryadarma ⁶, Monita Destiwi ⁷, Philip Etabee Bassey ⁸

PMCID: PMC13633799 PMID: 42829775

Abstract

BACKGROUND:

Sexual and reproductive health literacy (SRHL) among adolescents is a global public health concern. Almost half of all new cases of sexually transmitted infections have been associated with health literacy among youth. Limited SRHL has led to negative behaviours and their impact on health-related outcomes. Therefore, the purpose of this study was to identify the determinants of SRHL among adolescents in Indonesia.

MATERIALS AND METHODS:

This study drew on the most recent nationwide, population-based cross-sectional study and applied Nutbeam’s functional health literacy framework. SRHL was determined as a composite index and classified into three levels: limited, inadequate, and adequate. Pearson’s Chi-square test was used to determine the different proportions of SRHL. Binary logistic regression with a complex survey design was used to evaluate the factors associated with SRHL. The crude and adjusted odds ratios (AOR) along with 95% confidence intervals (CI) were reported.

RESULTS:

The magnitude of adequate literacy was 32.69% (95% CI, 31.92%–33.45%). Adolescents with advanced understanding and awareness of family function (AOR: 3.98; 3.36–4.72), female (AOR: 3.41; 2.90–4.02), internet usage (AOR: 3.07; 2.49–3.79), higher education (AOR: 2.96; 2.20–3.98), and dating experience (AOR: 2.52; 1.81–3.50) were associated with adequate SRHL in Indonesia. Moreover, parental knowledge (AOR: 2.03; 1.63–2.53), optimal information access (AOR: 2.35; 2.01–2.75), and liberal attitude toward early marriage (AOR: 2.16; 1.86–2.50) were more likely to have adequate literacy.

CONCLUSION:

Comprehensive public health strategies, including integrating reproductive health education, strengthening parental communication, and leveraging digital media were suggested to improve adolescent’s health literacy.

Keywords: Adolescents, health, literacy, reproductive, sexual

Introduction

Sexual and reproductive health literacy (SRHL) is an essential part of global public health with a major effect on the health and well-being of young people. The prevalence of mortality and morbidity among youth worldwide is linked to SRHL issues, especially in low-and middle-income countries. Poor SRHL leaves adolescents vulnerable to nearly half of all new sexual transmitted diseases (STIs) cases globally, teenage pregnancy, and adverse maternal–child outcomes because they are less able to prevent unsafe sexual practices and make informed reproductive decisions.[1,2] This vulnerability stems from limited access to sexual and reproductive health (SRH) education and increased exposure to gender-based violence and sexual exploitation.[3,4] In Asia, SRHL remains a persistent challenge due to a limited sexual education resources and cultural taboos that make discussions about SRH difficult. This gap has caused health concerns among adolescents and their families.[5,6,7]

In Indonesia, rising rates of teenage pregnancy and STIs underscores a critical deficiency in health literacy, driven by complex socioeconomic factors, regional disparities and the level of parental influence.[8,9] Many adolescents are unaware of contraceptive methods, which indicates a systemic failure to provide adequate SRH education and support. Previous systematic review shows that disparities in access to SRH services and socio-economic status are major causes of limited SRHL.[10,11] Moreover, the financial problems including household socioeconomic status has led to lowering SRHL among adolescents. Therefore, this barrier affects families and healthcare systems bearing the costs of unintended pregnancies and STIs treatments.[12]

A recent study has shown that improving adolescents sexual and reproductive health literacy (ASRHL) can have a transformative impact which is evidenced by adolescents who exhibit higher literacy levels are more likely to adopt safe behaviours and use healthcare services effectively.[13] This study applied Nutbeam’s framework to assess how functional health literacy affects Indonesian adolescents’ knowledge and use of sexual and reproductive health information. Adolescents with good SRH knowledge are more likely to have open conversations with their parents about these issues, which helps encourage healthier behaviours.[14] However, Indonesian adolescent still face systemic barriers including limited access to media and information, as well as restrictive social and economic factors, which hinder their access to reliable SRH education.[15]

Most of previous studies focusing on ASRHL in Indonesia are restricted to specific regions, limiting the findings’ generalisation. This population-based study addresses the gap by analysing several specific factors faced by Indonesian youth. Therefore, identifying these specific factors is essential for the development of evidence-based interventions. This study’s aim was to determine factors associated to ASRHL. It was hypothesised that ASRHL associated with sociodemographic, behaviours and attitudes, media exposure, and parental knowledge.

Materials and Methods

Study design and setting

This was a cross-sectional study design using secondary data analysis from the most updated family planning (FP) survey in Indonesia. This survey was implemented by the National Population and FP Board in 2019–2020. Data collection had occurred from January to December 2019 including 514 district levels across all 34 provinces of Indonesia. The survey provided relevant SRH information (i.e., socioeconomic status, birth prevention, maternal and child health, contraception usage, and adolescent health) as key indicators of population health.

A stratified multistage sampling procedure was used to recruit the nationally representative sample in the survey, with a high overall response rate ranging from 99.5% to 99.8%. Initially, villages and urban wards were selected using probability proportionate to size sampling according to households. Urban and rural regions were selected independently within each municipality. Then, cluster listing was selected according to each designated village or ward for each municipality. A cluster sampling method based on census blocks was applied to ensure geographic and demographic characteristics. Finally, enumerators recruited all households within each selected cluster which included 35 households by systematic random sampling. A total of 1935 villages including 67,725 households were selected as the study sample. For each selected household, unmarried adolescents aged 10–24 years and living together with their parents were included as adolescent’s participant.

Study participants and sampling

In the prior survey, a total of 41,788 adolescents who were interviewed from selected households were included into the sample size. The overall response rate of the youth questionnaire (YQ) was 99.5% with 206 participants rejecting the interview process, leaving 41,582. Adolescents were categorised into three groups: 10–14 years (n = 19,605), 15-19 years (n = 15,130), and 20-24 years (n = 6847). Only middle adolescents aged 15–19 years old who were high-school students were included. Within this age group, university students (n = 888) were excluded, since they might have different knowledge and experiences. Regarding the sample weight, a total of 14,242 adolescents were included in the final analysis, see Figure 1.

This study extracted the data of the YQ file dataset from the fifth phase of the nationwide FP survey. Then it applied complex survey data analysis by using sample weights to recognise probability sampling and non-response to get reliable statistical estimates. A normalised weight variable improved representativeness, with the “svyset” command which was applied to specify sampling design. Data editing, cleaning, and re-coding were performed. This study conducted a complete case analysis since missing data among the predictors recently observed was very small (<0.01%). A potential bias of the predictors and confounders in logistic regression should be minimised due to missing at random items which are common in survey data.[16]

Data collection tools and technique

Initially the study team requested the data by online local system following the study ID 688/B/UN3.FKM/I/PT.01.4/2025 to ensure the validity and confidentiality. The study team retrieved the survey data from their local system datasets platform (https://siapdata.bkkbn.go.id/) after getting permission. This study used the youth questionnaire (code: YQ), which was obtained from The Ministry of Population and Family Development of the Republic of Indonesia. The study team conducted prepared the main analysis through data pre-processing.

Nutbeam’s conceptual framework was adapted to assess the determinant factors of SRHL among adolescents in Indonesia, using several potential predictors available in the survey dataset, see Figure 2.

Analytical framework. ASRH = Adolescent sexual and reproductive health

The outcome variable was SRHL, defined using a standardised questionnaire. According to the Nutbeam’s framework for functional health literacy model, the following indicators were evaluated: fertility, puberty, knowledge of SRH (transmission of HIV and other STIs), FP, contraceptive use, pregnancy, early marriage, and exposure to adolescent health national program. This framework highlighted adolescents’ understanding about basic health information through different media, personal contacts and communication channels.[17] The adolescent’s literacy index was classified into three categories: limited (range = 0–8), inadequate (range = 9–16), and adequate (range = 17–44) based on quartile distribution of the index health literacy scores.[18,19]

Fifteen explanatory variables were used in this study, see 7. Sociodemographic factors included age in years, sex (male/female), education level (primary, middle, high), residence (urban/rural), region (Sumatra, Java, Sulawesi, Kalimantan, Bali and Nusa Tenggara, and Maluku and Papua), and wealth index (poorest, poor, middle, rich, and richest). The wealth index was calculated using principal component analysis (PCA) based on household asset ownership.

The predictors of adolescent behaviour and attitudes were considered as dating experience, sexual experience, and attitude towards early marriage. This study used media sources and information access to predict the media and information variables. Media sources and information access measured exposure to ASRH content through mass media, digital platforms, and healthcare professionals, supporting safe sexual behaviours. Parental involvement included parental knowledge of ASRH, fertility, and FP, with open communication improving adolescent health literacy, see Table S1.

Table S1.

Definition of variables used in the study of determinants of ASRHL in Indonesia

Variables	FPAPS Questionnaire	Categorisation	Description
Sociodemographic
Age	How old are you now?	15 years	Age refers to the chronological age of adolescents at the time of the survey, measured in completed years. For this study, age was categorised into five groups: 15 years, 16 years, 17 years, 18 years, and 19 years.
		16 years
		17 years
		18 years
		19 years
Sex	What is your sex?	Male	Sex refers to the biological classification of respondents, categorised as male or female, based on their self-reported identity in the survey
Sex	What is your sex?	Female
Education	What was your last education?	Primary	Education refers to the highest level of formal schooling completed by adolescents, categorised as primary (including those not attending school, no longer in school, or completing elementary school), middle (completed junior high school), and high (completed senior high school)
		Middle
		High
Residence	Where do you live?	Urban	Residence refers to the primary living area of adolescents, categorised as urban (living in city areas with modern infrastructure) and rural (living in village areas with limited infrastructure)
Residence	Where do you live?	Rural
Region	What province do you live in?	Sumatera	Region refers to the geographic region where adolescents live, categorised into six groups: Sumatera, Java, Bali and Nusa Tenggara, Kalimantan, Sulawesi, and Maluku and Papua
		Java
		Bali dan Nusa Tenggara
		Sulawesi
		Maluku and Papua
		Kalimantan
Wealth Index	1. Do you have certain items? 2. Observation of Home Physical Conditions	Poorest	Socioeconomic status of adolescents’ households, assessed based on ownership of assets, housing conditions (flooring, roofing, and walls), and animal ownership. It is categorised into five groups: poorest, poor, middle, rich, and richest
		Poor
		Middle
		Rich
		Richest
Adolescent behaviours and attitudes
Dating Experience	1. Have you ever had a boyfriend/girlfriend? 2. What behaviour have you ever done to express affection, when alone with your partner (current or former partner)?	Yes, With Moderately Intimate Behaviour	Dating experience is a combined variable of dating experience and dating behaviour, categorised as yes with moderately intimate behaviour (holding hands and cuddling during dating), yes with highly intimate behaviour (kissing and touching/stimulating during dating), and never (no dating experience at all),
		Yes, With Highly Intimate Behaviour
		Never
Sexual Experience	1. Have you ever had sexual intercourse? 2. At what age did you first have sexual intercourse?	Yes, ≤ 16 years	Sexual experience is a combined variable of sexual intercourse and the age at first sexual intercourse, categorised as yes, ≤16 years (engaged in sexual intercourse at 16 years old or younger), yes, >16 years (engaged in sexual intercourse at older than 16 years), and never (no sexual experience at all)
		Yes, > 16 years
		Never
Attitudes Toward Early Marriage Behaviour	1. In your opinion, what is an appropriate age for a woman to marry? 2. In your opinion, what is an appropriate age for a man to marry? 3. In your opinion, what is the appropriate age to plan marriage?	Liberal	Attitudes toward early marriage behaviour is a combination of three variables, namely attitudes on the appropriate age for a woman to marry, the appropriate age for a man to marry, and the appropriate age to plan marriage. It is categorised as liberal if the respondent answers any of these ages as<20 years and conservative if all answers are≥20 years
Attitudes Toward Early Marriage Behaviour		Conservative
Media and information
Media Sources	Have you ever heard/received information related to adolescent reproductive health from the following media information sources?	No Sources	Media access refers to the availability and use of media sources to obtain adolescent reproductive health information, categorised as no access (no use of media), internet only (accessing information solely through the internet), and internet and printed (accessing information through the internet
		Internet Only
		Internet and Printed
Media and information
			combined with other media like radio, television, newspapers, magazines/tabloids, pamphlets/leaflets/brochures, flipcharts, posters, banners, billboards, exhibitions, Mobile Family Planning Education Unit, murals/graffiti)
Information Access	1. Have you ever heard/received information related to adolescent reproductive health from the following officers/communities? 2. Have you ever heard/received information related to adolescent reproductive health from the following institutions?	Basic	ASRH information access refers to the extent of exposure to and utilisation of adolescent sexual and reproductive health information sources ASRH information access is a combined variable of access to information from personnel and institutions, categorised as basic (limited access from either personnel or institutions), intermediate (moderate access from both personnel and institutions), and optimal (extensive access from a combination of both personnel and institutions)
		Intermediate
		Optimal
Parental Influence
Family Knowledge about Adolescent Reproductive Health (ASRH)	1. Have you ever acquired/heard/seen/read information related to Adolescent Reproductive Health? 2. Have you ever obtained, heard, seen, or read information related to adolescent reproductive health (ARH) from the following media sources? 3. Have you ever heard or received information related to ARH from the following personnel or community sources? 4. Have you ever heard or received information related to ARH from the following institutions?	Poor	The understanding parents have regarding ASRH concepts. It is a combined variable encompassing knowledge of ASRH concepts, access to media, access to information from personnel, and access to information from institutions. It is categorised as poor (limited knowledge and minimal access), moderate (basic knowledge with moderate access), and good (comprehensive knowledge with extensive access).
		Moderate
		Good
Family Knowledge about Fertility	1. Have you ever heard/seen/read things related to population such as fertility? 2. Have you ever heard, seen, or read about population-related matters such as fertility from the following media sources? 3. Have you ever heard or received information about population-related matters such as fertility from the following personnel or community sources? 4. Have you ever heard or received information about population-related matters such as fertility from the following institutions?	Poor	The understanding parents have regarding reproductive health, particularly fertility-related concepts. It is a combined variable encompassing knowledge of fertility concepts, access to media, access to information from personnel, and access to information from institutions. It is categorised as poor (limited knowledge and minimal access), moderate (basic knowledge with moderate access), and good (comprehensive knowledge with extensive access).
		Moderate
		Good
Family Knowledge about Family Planning	1. Have you ever obtained/heard/seen/read information related to family planning? 2. Have you ever heard, seen, or read about family planning from the following media sources? 3. Have you ever heard or received information about family planning from the following personnel or community sources? 4. Have you ever heard or received information about family planning from the following institutions?	Poor	Understanding parents have regarding family planning concepts and access to relevant information. It is a combined variable that includes knowledge of family planning concepts, access to media, access to information from personnel, and access to information from institutions. It is categorised as poor (limited knowledge and minimal access), moderate (basic knowledge with moderate access), and good (comprehensive knowledge with extensive access)
		Moderate
		Good
Parental Influence
Understanding and Awareness of Family Function	1. What have you done to instil religious values in your family? 2. What have you done to instil socio-cultural values in your family? 3. What have you done to instil love and affection values in your family? 4. What have you done to instil protection values in your family? 5. What have you done to instil the basic values of reproductive function in your family? 6. What have you done to instil socialisation and educational values in your family? 7. What have you done to instil economic values in your family? 8. What have you done to instil environmental values in your family?	Basic	The understanding and application of 8 key family roles, categorised based on the level of implementation of religious, socio-cultural, affection, protection, reproductive, socialisation and education, economic, and environmental functions. It is classified as basic (limited implementation), medium (moderate implementation), and advanced (comprehensive implementation across all roles)
		Medium
		Advance

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Ethical consideration

This study has been conducted in accordance with the ethical guidelines and received ethical approval from the National Research and Innovation Agency (No. 047/KE.03/SK/03/2025) on March 24, 2025.

Statistical analysis

Descriptive statistics were explored to report the characteristics of ASRHL using frequencies and proportions for all categorical variables. Pearson’s Chi-square Test was used to test the association between independent and dependent variables.

For further analysis, it was dichotomised as limited and inadequate versus adequate (model A) and limited versus inadequate and adequate (model B). This study evaluated the magnitude of association between sociodemographic, adolescent behaviour attitudes, media and information, and parental influence with ASRHL by unadjusted and adjusted binary logistic regression. Collinearity was explored using correlation coefficient and variance inflation factor (VIF). The cut off value of the correlation coefficient was ≥0.8 whereas it was >5 for VIF and Tolerance score <0.2, see Table S2. To assess the efficiency of using binary logistic regression given its assumptions, the Brant test was calculated, see Table S3.

Table S2.

Multicollinearity correlation coefficient and variance inflation factor (VIF) for determinants of ASRHL

Variable	VIF	SQRT VIF	Tolerance	R ²
Sociodemographic
Age	1.14	1.07	0.8791	0.1209
Sex	1.06	1.03	0.9464	0.0536
Education	1.12	1.06	0.0931	0.1069
Residence	1.07	1.04	0.9320	0.0680
Region	1.12	1.06	0.8961	0.1039
Wealth index	1.13	1.06	0.8831	0.1169
Adolescent behaviours and attitudes
Dating experience	1.15	1.07	0.8719	0.1281
Sexual experience	1.08	1.04	0.9289	0.0711
Attitudes toward early marriage behaviour	1.05	1.02	0.9535	0.0465
Media and information
Media sources	1.27	1.13	0.7884	0.2116
Information access	1.29	1.13	0.7777	0.2223
Parental Influence
Parental knowledge about ASRH	1.59	1.26	0.6288	0.3712
Parental knowledge about fertility	1.18	1.09	0.8467	0.1533
Parental knowledge about family planning	1.42	1.19	0.7032	0.2968
Understanding and awareness of family function	1.17	1.08	0.8538	0.1462

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VIF: Variance inflation factor, SQRT: Square root

Table S3.

Brant test result for determinants of ASRHL

Coefficients	χ ²	P>χ²	df
All	228.24	0.000	34
Sociodemographic
1.age	2.86	0.091	1
2.age	1.07	0.077	1
3.age	0.74	0.391	1
4.age	0.32	0.573	1
1.sex	14.30	0.000	1
1.education	3.93	0.048	1
2.education	6.50	0.011	1
0.residence	3.61	0.058	1
1.region	1.28	0.257	1
2.region	0.54	0.461	1
3.region	0.00	0.974	1
4.region	2.29	0.131	1
5.region	2.17	0.141	1
1.wealth_index	0.00	0.956	1
2.wealth_index	0.48	0.487	1
3.wealth_index	0.09	0.763	1
4.wealth_index	0.40	0.528	1
Adolescent behaviours and attitudes
0.dating_ experience	5.11	0.024	1
1.dating_ experience	9.41	0.002	1
1.sex_experience	0.44	0.506	1
2.sex_experoence	3.21	0.073	1
0.attitude	6.19	0.013	1
Media and information
1.media	7.03	0.008	1
2.media	0.84	0.358	1
1.information	6.92	0.009	1
2.infoormation	0.10	0.751	1
Parental Influence
1.parents_asrh	14.79	0.000	1
2.parent_asrh	4.37	0.037	1
1.parents_fertility	7.65	0.006	1
2.parent_fertility	0.53	0.466	1
1.parents_familyplanning	0.00	0.977	1
2.parents_ familyplanning	0.73	0.392	1
1.family_function	25.64	0.000	1
2.family_function	101.15	0.000	1

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df: Degree of freedom

The logistic regression results were presented as crude odds ratios (COR) and adjusted odds ratios (AOR) along with 95% confidence intervals (CIs). Simple logistic regressions were used to determine predictors of ASRHL. A cut off P value less than 0.25 on simple logistic regressions were included as predictor candidates into adjusted logistic regression. An adjusted logistic regression model was developed using manual stepwise methods, where the smallest to the highest P values were added to the model manually step by step.

The association in the logistic regression was considered statistically associated if P value was < 0.05. Assumption of Hosmer and Lemeshow’s goodness-of-fit test was applied to determine if the final model had a good fit with P > 0.05. All analyses were performed using STATA version 17.0 (StataCorp LLC, 4905 Lakeway Drive, College Station, Texas, USA).

Results

Characteristics of study participants

The overall weighted prevalence of adequate literacy of SRH was 32.69% (95% CI, 31.92%–33.45%), whereas limited literacy was 23.34% (95% CI, 22.65%–24.04%). More than half of the adolescents (54.48%) were male, with the majority in the range of 15–17 years old (67.43%). Three-quarters of the study participants were in high school (71.94%). Of the total participants, 7,367 (51.73%) lived in urban areas, and mostly in the Java region (60.56%). Regarding wealth index, 61.49% of the adolescents were in the middle category, see Table 1.

Table 1.

Sociodemographic and behavioural characteristics of adolescent sexual reproductive health literacy in Indonesia

Variables	Weighted frequency (%)	ASRHL, n (%)
Variables	Weighted frequency (%)	Limited	Inadequate	Adequate	P
Sociodemographic
Age					<0.001
15 years	3315 (23.28)	1154 (34.33)	1449 (22.97)	712 (15.57)
16 years	3358 (23.58)	790 (23.50)	1615 (25.61)	953 (20.85)
17 years	2929 (20.57)	597 (17.78)	1311 (20.79)	1021 (22.32)
18 years	2596 (18.23)	417 (12.39)	1113 (17.66)	1066 (23.31)
19 years	2043 (14.34)	404 (12.01)	818 (12.98)	821 (17.95)
Sex					<0.001
Male	7759 (54.48)	2356 (70.06)	3469 (54.99)	1934 (42.30)
Female	6483 (45.52)	1007 (29.94)	2838 (45.01)	2638 (57.70)
Education					<0.001
Primary	736 (05.17)	380 (11.31)	254 (04.03)	102 (02.22)
Middle	3261 (22.89)	1212 (36.03)	1408 (22.32)	641 (14.02)
High	10,245 (71.94)	1771 (52.66)	4645 (73.65)	3829 (83.76)
Residence					<0.001
Urban	7367 (51.73)	1585 (47.14)	3328 (52.73)	2456 (53.73)
Rural	6875 (48.27)	1778 (52.86)	2981 (47.27)	2116 (46.27)
Region					<0.001
Sumatera	2875 (20.19)	697 (20.72)	1316 (20.87)	862 (18.85)
Java	8625 (60.56)	2073 (61.63)	3820 (60.57)	2732 (59.77)
Bali dan Nusa Tenggara	751 (05.28)	109 (03.24)	265 (04.21)	377 (8.24)
Sulawesi	989 (06.94)	211 (06.26)	458 (07.27)	320 (07.01)
Maluku and Papua	294 (02.06)	77 (02.29)	117 (01.85)	100 (02.19)
Kalimantan	708 (04.97)	198 (05.87)	330 (05.23)	180 (8.24)
Wealth index					<0.001
Poorest	164 (01.15)	80 (02.37)	55 (00.87)	29 (00.63)
Poor	2650 (18.60)	727 (21.62)	1236 (19.59)	687 (15.03)
Middle	8757 (61.49)	2042 (60.70)	3817 (60.53)	2898 (63.40)
Rich	2238 (15.72)	429 (12.76)	1040 (16.49)	769 (16.83)
Richest	433 (03.04)	86 (02.55)	159 (02.53)	188 (04.11)
Adolescent behaviours and attitudes
Dating experience					<0.001
Yes, with moderately intimate behaviour	8304 (58.31)	1552 (46.16)	3758 (59.57)	2994 (65.50)
Yes, with highly intimate behaviour	502 (03.53)	87 (02.60)	186 (02.95)	229 (05.01)
Never	5436 (38.17)	1723 (51.24)	2364 (37.48)	1349 (29.50)
Sexual experience					<0.001
Yes, ≤16 years	111 (00.78)	53 (01.58)	26 (00.41)	32 (00.70)
Yes, >16 years	40 (00.28)	6 (00.10)	9 (00.15)	25 (00.54)
Never	14,090 (98.94)	3303 (98.23)	6272 (99.44)	4515 (98.76)
Attitudes toward early marriage behaviour					<0.001
Liberal	7403 (51.98)	1082 (32.16)	3438 (54.51)	2883 (63.07)
Conservative	6839 (48.02)	2281 (67.84)	2870 (45.49)	1688 (36.93)
Media and information
Media sources					<0.001
No source	1945 (13.66)	1009 (30.02)	745 (11.81)	191 (04.18)
Internet only	703 (04.93)	158 (04.69)	326 (05.16)	219 (04.80)
Internet and printed	11594 (81.41)	2196 (65.30)	5237 (83.03)	4161 (91.02)
Information access					<0.001
Basic	6225 (43.71)	2223 (66.11)	2819 (44.69)	1183 (25.88)
Intermediate	3733 (26.21)	631 (18.77)	1875 (29.72)	1227 (26.83)
Optimal	4284 (30.08)	508 (15.12)	1614 (25.59)	2162 (47.29)
Parental Influence
Parental knowledge about ASRH					<0.001
Poor	2879 (20.21)	1289 (38.34)	1140 (18.07)	450 (09.84)
Moderate	4376 (30.73)	982 (29.20)	2201 (34.90)	1193 (26.09)
Good	6987 (49.06)	1092 (32.46)	2966 (47.03)	2929 (64.07)
Parental knowledge about fertility					<0.001
Poor	9480 (66.56)	2649 (78.76)	4214 (66.82)	2617 (57.23)
Moderate	886 (06.22)	162 (04.80)	473 (07.50)	251 (05.49)
Good	3877 (27.22)	552 (16.44)	1620 (25.58)	1705 (37.27)
Parental knowledge about family planning					<0.001
Poor	1488 (10.45)	687 (20.44)	582 (09.22)	219 (04.78)
Moderate	4005 (28.12)	1096 (32.58)	1893 (30.01)	1016 (22.23)
Good	8750 (61.44)	1580 (46.99)	3833 (60.77)	3337 (72.99)
Understanding and awareness of family function					<0.001
Basic	6357 (44.64)	1939 (57.65)	3247 (51.48)	1171 (25.63)
Medium	4817 (33.82)	1013 (30.11)	2063 (32.71)	1741 (38.09)
Advance	3068 (21.54)	412 (12.25)	997 (15.81)	1659 (36.28)

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ASRH=Adolescent sexual reproductive health; ASRHL=Adolescent sexual reproductive health literacy

Most adolescents had dating experience with moderately intimate (58.31%), but having no sexual experience report (98.94%). More than half of the adolescents have a liberal viewpoint on early marriage (51.98%). Internet and printed media sources (81.41%) were predominantly used among adolescents to get optimal information access (30.08%).

About two-third of the adolescents had poor knowledge about fertility from their parents (66.56%). However, roughly half of the adolescents had good parental knowledge of ASRH (49.06%) and FP (61.44%). In addition, only 44.64% of the adolescents had basic parental understanding of family function.

The different characteristics of sexual reproductive health literacy

A substantial difference in the proportion of SRHL groups among adolescents was determined by socio-demographics, behaviour and attitudes, media information, and parental influence, see Table 1.

The weighted percentage (34.33%) of limited SRHL among adolescents aged 15 years was higher than the inadequate and adequate groups (22.97% and 15.57% respectively; P < 0.001). The highest percentage of limited literacy was found among male (70.06%) whereas the female adolescent demonstrated adequate SRHL (57.70%). Regarding education, the percentage of adolescents with higher levels increased gradually from 52.66% in limited, 73.65% in inadequate and 83.76% of adequate SRHL (P < 0.001). Moreover, the percentage of those adolescents living in urban areas was higher (53.73%) than those with limited SRHL (47.14%) in rural areas. Adolescents with the middle to richest of wealth index, showed the percentage of limited, inadequate and adequate SRHL was slightly improved (from 61.49% to 63.40%, 12.76% to 16.83%, and 2.55% to 4.11% respectively).

Interestingly, adolescents with no dating experience with limited (51.24%) literacy were higher than inadequate (37.48%) and adequate SRHL (29.50%). Adolescents with limited literacy and having sexual experience before 16 years (1.58%) were found higher than adequate literacy (0.70%). It was also a similar sign that adolescents who had conservative attitudes towards early marriage were observed higher among limited (67.84%) literacy than adequate groups (36.93%), see Table 1.

Factors associated with adequate adolescents sexual and reproductive health literacy

Tables 2 and 3 reports the results of the magnitude association analysis of fifteen explanatory variables of ASRHL according to adequate literacy status versus limited and inadequate and limited only in the model A and model B, respectively.

Table 2.

Factors associated with adolescent sexual reproductive health literacy (model A: limited and inadequate vs. adequate) by binary logistic regression

Variables	ASRHL
	Model A (limited and inadequate vs. adequate)
	Crude OR	95% CI		P	AOR	95% CI		P

		Lower	Upper			Lower	Upper
Sociodemographic
Age
15 years	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
16 years	1.45	1.22	1.72	<0.001	1.30	1.05	1.60	0.014
17 years	1.95	1.64	2.31	<0.001	1.70	1.38	2.11	<0.001
18 years	2.54	2.12	3.05	<0.001	2.26	1.81	2.82	<0.001
19 years	2.45	2.03	2.97	<0.001	2.40	1.88	3.07	<0.001
Sex
Male	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Female	2.06	1.84	2.31	<0.001	2.56	2.24	2.93	<0.001
Education
Primary	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Middle	1.52	1.07	2.17	0.017	1.30	0.86	1.96	<0.001
High	3.73	2.68	5.19	<0.001	2.13	1.44	3.14	<0.001
Residence
Urban	1.12	1.01	1.24	0.019	-	-	-
Rural	Ref.	Ref.	Ref.		-	-	-
Wealth index
Poorest	Ref.	Ref.	Ref.		-	-	-
Poor	1.62	1.12	2.34	0.693	-	-	-
Middle	2.29	1.61	3.27	0.004	-	-	-
Rich	2.43	1.67	3.54	<0.001	-	-	-
Richest	3.55	2.21	5.71	<0.001	-	-	-
Adolescent behaviours and attitudes
Dating experience
Yes, with moderately intimate behaviour	1.70	1.52	1.92	<0.001	1.49	1.30	1.72	<0.001
Yes, with highly intimate behaviour	2.53	1.92	3.35	<0.001	2.52	1.81	3.50	<0.001
Never	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Sexual experience
Yes, ≤ 16 years	Ref.	Ref.	Ref.		-	-	-
Yes, > 16 years	3.92	1.76	8.73	0.001	-	-	-
Never	1.16	0.62	2.19	0.626	-	-	-
Attitudes toward early marriage behaviour
Liberal	1.94	1.74	2.17	<0.001	1.47	1.29	1.68	<0.001
Conservative	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Media and information
Media sources
No source	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Internet only	4.16	2.85	6.06	<0.001	2.85	1.88	4.31	<0.001
Internet and printed	5.13	3.96	6.65	<0.001	2.77	2.05	3.74	<0.001
Information access
Basic	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Intermediate	2.08	1.79	2.43	<0.001	1.44	1.21	1.71	<0.001
Optimal	4.34	3.80	4.95	<0.001	2.35	2.01	2.75	<0.001
Parental influence
Parental knowledge about ASRH
Poor	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Moderate	2.02	1.66	2.45	<0.001	1.44	1.15	1.81	<0.001
Good	3.89	3.28	4.62	<0.001	1.69	1.34	2.12	<0.001
Parental knowledge about fertility
Poor	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Moderate	1.03	0.80	1.34	0.078	1.07	0.80	1.44	0.607
Good	2.05	1.83	2.30	<0.001	1.20	1.04	1.39	0.013
Parental knowledge about family planning
Poor	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Moderate	1.97	1.53	2.53	<0.001	1.43	1.07	1.93	0.016
Good	3.58	2.84	4.50	<0.001	1.45	1.09	1.93	0.010
Understanding and awareness of family function
Basic	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Medium	2.50	2.19	2.86	<0.001	2.12	1.83	2.47	<0.001
Advance	5.21	4.50	6.02	<0.001	3.98	3.36	4.72	<0.001

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AOR=Adjusted odds ratio; ASRH=Adolescent sexual reproductive health; CI=Confidence interval; OR=Odds ratio, Ref.=Reference group; -=Not included in final model

Table 3.

Factors associated with adolescent sexual reproductive health literacy (model B: limited vs. inadequate and adequate) by binary logistic regression

Variables	ASRHL
	Model B (limited vs. inadequate & adequate)
	Crude OR	95% CI		P	AOR	95% CI		P

		Lower	Upper			Lower	Upper
Sociodemographic
Age
15 years	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
16 years	1.73	1.46	2.05	<0.001	1.54	1.26	1.89	<0.001
17 years	2.08	1.72	2.52	<0.001	1.69	1.33	2.16	<0.001
18 years	2.79	2.28	3.41	<0.001	2.25	1.76	2.86	<0.001
19 years	2.16	1.74	2.70	<0.001	2.04	1.55	2.69	<0.001
Sex
Male	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Female	2.37	2.08	2.70	<0.001	3.41	2.90	4.02	<0.001
Education
Primary	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Middle	1.80	1.39	2.34	<0.001	1.57	1.14	2.16	0.006
High	5.11	4.00	6.52	<0.001	2.96	2.20	3.98	<0.001
Residence
Urban	1.27	1.13	1.42	<0.001	-	-	-
Rural	Ref.	Ref.	Ref.		-	-	-
Wealth index
Poorest	Ref.	Ref.	Ref.		-	-	-
Poor	2.50	1.71	3.66	<0.001	-	-	-
Middle	3.11	2.14	4.52	<0.001	-	-	-
Rich	3.99	2.65	6.00	<0.001	-	-	-
Richest	3.82	2.26	6.47	<0.001	-	-	-
Adolescent behaviours and attitudes
Dating experience
Yes, with moderately intimate behaviour	2.01	1.77	2.29	<0.001	1.66	1.42	1.93	<0.001
Yes, with highly intimate behaviour	2.20	1.37	3.50	0.001	2.33	1.31	4.12	0.004
Never	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Sexual experience
Yes, ≤16 years	Ref.	Ref.	Ref.		-	-	-
Yes, >16 years	4.89	1.88	12.69	0.004	-	-	-
Never	2.98	1.42	6.25	0.001	-	-	-
Attitudes toward early marriage behaviour
Liberal	2.92	2.57	3.32	<0.001	2.16	1.86	2.50	<0.001
Conservative	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Media and information
Media sources
No source	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Internet only	3.73	2.58	5.38	<0.001	2.71	1.83	4.03	<0.001
Internet and printed	4.61	3.95	5.38	<0.001	3.07	2.49	3.79	<0.001
Information access
Basic	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Intermediate	2.72	2.34	3.17	<0.001	1.85	1.55	2.22	<0.001
Optimal	4.12	3.46	4.92	<0.001	2.21	1.80	2.72	<0.001
Parental influence
Parental knowledge about ASRH
Poor	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Moderate	2.80	2.38	3.29	<0.001	2.02	1.64	2.47	<0.001
Good	4.38	3.73	5.13	<0.001	2.03	1.63	2.53	<0.001
Parental knowledge about fertility
Poor	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Moderate	1.73	1.30	2.32	<0.001	1.69	1.22	2.34	0.002
Good	2.33	1.99	2.72	<0.001	1.33	1.10	1.61	0.002
Parental knowledge about family planning
Poor	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Moderate	2.27	1.88	2.76	<0.001	1.47	1.14	1.90	0.003
Good	3.89	3.25	4.66	<0.001	1.61	1.25	2.08	<0.001
Understanding and awareness of family function
Basic	Ref.	Ref.	Ref.		Ref.	Ref.	Ref.
Medium	1.64	1.43	1.88	<0.001	1.19	1.01	1.40	0.036
Advance	2.82	2.35	3.40	<0.001	1.62	1.31	2.02	<0.001

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AOR=Adjusted odds ratio; ASRH=Adolescent sexual reproductive health; CI=Confidence interval; OR=Odds ratio; ref.=Reference group; -=Not included in final model

In unadjusted logistic regression, adequate SRHL was found to be associated with age, sex, education level, residence, household wealth index, dating and sexual experiences, attitude towards early marriage, media and information accessibility, parental knowledge and parental awareness of family function.

Adolescents aged 18 and 19 years old were twice more likely to have adequate SRHL compared to the lowest age group. A similar pattern was observed among female adolescents which were twice higher to have adequate literacy compared to males. Adolescents in senior high school reached three times higher to have adequate literacy than those in primary and uneducated. Moreover, adolescents from the family with the richest wealth index showed increased odds of possessing good literacy (COR: 3.82; 2.22–6.47; P < 0.001) compared to their counterparts with the poorest economic status, see Tables 2 and 3.

The presence of media information and parental influence were also independently and associated with literacy. Adolescents with high intimate dating experience showed predominantly increased (COR: 2.53; 1.92–3.35; P < 0.001) adequate SRHL compared to those who had never dated. Interestingly, adolescents with adequate literacy were more likely to be found among youth with sexual experiences above 16 years. Adolescents with liberal attitudes towards early marriage were more likely to be three times higher to have sufficient literacy than conservative’s attitudes. Access to sources of both internet and printed SRH (COR: 5.13; 3.96–6.65; P < 0.001), along with optimal information access (COR: 4.34; 3.80–4.95; P < 0.001), were associated with adequate SRHL. Adolescents whose parents exhibited a good understanding of ASRH (COR: 4.38; 3.73–5.13; P < 0.001), fertility (COR: 2.05; 1.83–2.30; P < 0.001), and FP (COR: 3.58; 2.84–4.50; P < 0.001 were observed to demonstrate adequate SRHL. The advanced understanding and awareness of family functions exhibited by parents (COR: 5.21; 4.50–6.02; P < 0.001) has contributed to their adolescent’s adequate SRHL.

All predictors with P < 0.05 yielded in the unadjusted logistic regression were included. The detailed stepwise adjusted binary logistic regression to examine the fittest model were demonstrated, see Tables S2 and S3.

Tables 2 and 3 shows the results of the binary logistic regression models [Step-11, see Tables S4 and S5] examining the factors’ determinants of SRHL among adolescents. Adequate ASRHL was associated with a number of variables. Adjusted regression analysis for both models showed that adolescent’s age, gender, education, dating experience, attitude towards early marriage, media sources and information accessibility, as well as parental influences (i.e., knowledgeable about SRH, fertility, FP, and family function) were significant determinants of adequate SRH by Indonesian youth. An advanced understanding and awareness of family function (AOR: 3.98; 3.36–4.72; P < 0.001) showed a strong association compared to those with a basic understanding. Compared to male, female adolescents were more likely to have adequate ASRHL (AOR: 3.41; 2.90–4.02; P < 0.001). Adequate ASRHL was associated with a higher level of education (AOR: 2.96; 2.20–3.98; P < 0.001).

Table S4.

Multivariate weighted analysis for determinants of ASRHL Model A (Limited and Inadequate vs Adequate)

Variables	M1		M2		M3		M4		M5		M6		M7

	AOR	P	AOR	P	AOR	P	AOR	P	AOR	P	AOR	P	AOR	P
Understanding and Awareness of Family Function: Medium	2.50	<0.001	2.24	<0.001	2.06	<0.001	2.09	<0.001	2.08	<0.001	2.08	<0.001	2.07	<0.001
Understanding and Awareness of Family Function: Advanced	5.21	<0.001	4.06	<0.001	3.56	<0.001	3.67	<0.001	3.64	<0.001	3.64	<0.001	3.68	<0.001
Information Access: Intermediate	-	-	1.90	<0.001	1.77	<0.001	1.84	<0.001	1.81	<0.001	1.52	<0.001	1.48	<0.001
Information Access: Optimal	-	-	3.40	<0.001	3.06	<0.001	3.2	<0.001	3.15	<0.001	2.62	<0.001	2.53	<0.001
Parental Knowledge about ASRH: Moderate	-	-	-	-	1.81	<0.001	1.80	<0.001	1.65	<0.001	1.52	<0.001	1.47	<0.001
Parental Knowledge about ASRH: Good	-	-	-	-	2.18	<0.001	2.20	<0.001	1.95	<0.001	1.74	<0.001	1.68	<0.001
Sex: Female	-	-	-	-	-	-	2.32	<0.001	2.33	<0.001	2.50	<0.001	2.45	<0.001
Parental Knowledge about Family Planning: Moderate	-	-	-	-	-	-	-	-	1.50	0.004	1.44	0.010	1.44	0.011
Parental Knowledge about Family Planning: Good	-	-	-	-	-	-	-	-	1.56	0.001	1.47	0.005	1.46	0.006
Media Source: Internet Only	-	-	-	-	-	-	-	-	-	-	3.30	<0.001	3.22	<0.001
Media Source: Internet and Printed	-	-	-	-	-	-	-	-	-	-	3.11	<0.001	3.01	<0.001
Attitudes Toward Early Marriage Behaviour: Liberal	-	-	-	-	-	-	-	-	-	-	-	-	1.60	<0.001
Age: 16 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 17 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 18 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 19 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Education: Middle	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Education: High	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Parental Knowledge about Fertility: Moderate	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Parental Knowledge about Fertility: Good	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Dating Experience: Yes. With Moderately Intimate Behaviour	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Dating Experience: Yes. With Highly Intimate Behaviour	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Poor	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Middle	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Rich	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Richest	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Residence: Urban	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Yes. >16 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Never	-	-	-	-	-	-	-	-	-	-	-	-	-	-
cons	0.22	<0.001	0.13	<0.001	0.08	<0.001	0.05	<0.001	0.04	<0.001	0.017	<0.001	0.014	<0.001
n	14,242		14,242		14,242		14,242		14,242		14,242		14,242
GoF test	1.000		0.907		0.369		0.816		0.501		0.012		0.434

Variables	M8		M9		M10		M11*		M12		M13		M14

	AOR	P	AOR	P	AOR	P	AOR	AOR	P	AOR	P	AOR	P	AOR

Understanding and Awareness of Family Function: Medium	2.15	<0.001	2.12	<0.001	2.11	<0.001	2.12	2.15	<0.001	2.12	<0.001	2.11	<0.001	2.12
Understanding and Awareness of Family Function: Advanced	4.02	<0.001	4.00	<0.001	3.89	<0.001	3.98	4.02	<0.001	4.00	<0.001	3.89	<0.001	3.98
Information Access: Intermediate	1.48	<0.001	1.46	<0.001	1.46	<0.001	1.44	1.48	<0.001	1.46	<0.001	1.46	<0.001	1.44
Information Access: Optimal	2.48	<0.001	2.42	<0.001	2.40	<0.001	2.35	2.48	<0.001	2.42	<0.001	2.40	<0.001	2.35
Parental Knowledge about ASRH: Moderate	1.56	<0.001	1.51	<0.001	1.48	0.001	1.44	1.56	<0.001	1.51	<0.001	1.48	0.001	1.44
Parental Knowledge about ASRH: Good	1.85	<0.001	1.79	<0.001	1.71	<0.001	1.69	1.85	<0.001	1.79	<0.001	1.71	<0.001	1.69
Sex: Female	2.58	<0.001	2.48	<0.001	2.49	<0.001	2.56	2.58	<0.001	2.48	<0.001	2.49	<0.001	2.56
Parental Knowledge about Family Planning: Moderate	1.46	0.009	1.45	0.12	1.45	0.012	1.43	1.46	0.009	1.45	0.12	1.45	0.012	1.43
Parental Knowledge about Family Planning: Good	1.49	0.004	1.48	<0.001	1.46	0.007	1.45	1.49	0.004	1.48	<0.001	1.46	0.007	1.45
Media Source: Internet Only	3.08	<0.001	2.88	<0.001	2.89	<0.001	2.85	3.08	<0.001	2.88	<0.001	2.89	<0.001	2.85
Media Source: Internet and Printed	2.84	<0.001	2.76	<0.001	2.75	<0.001	2.77	2.84	<0.001	2.76	<0.001	2.75	<0.001	2.77
Attitudes Toward Early Marriage Behaviour: Liberal	1.52	<0.001	1.49	<0.001	1.48	<0.001	1.47	1.52	<0.001	1.49	<0.001	1.48	<0.001	1.47
Age: 16 years	1.57	<0.001	1.36	0.003	1.37	0.003	1.30	1.57	<0.001	1.36	0.003	1.37	0.003	1.30
Age: 17 years	2.21	<0.001	1.88	<0.001	1.89	<0.001	1.70	2.21	<0.001	1.88	<0.001	1.89	<0.001	1.70
Age: 18 years	3.02	<0.001	2.55	<0.001	2.58	<0.001	2.26	3.02	<0.001	2.55	<0.001	2.58	<0.001	2.26
Age: 19 years	3.21	<0.001	2.81	<0.001	2.85	<0.001	2.40	3.21	<0.001	2.81	<0.001	2.85	<0.001	2.40
Education: Middle	-	-	1.31	0.191	1.31	0.197	1.30	-	-	1.31	0.191	1.31	0.197	1.30
Education: High	-	-	2.13	<0.001	2.10	<0.001	2.13	-	-	2.13	<0.001	2.10	<0.001	2.13
Parental Knowledge about Fertility: Moderate	-	-	-	-	1.09	1.56	1.07	-	-	-	-	1.09	1.56	1.07
Parental Knowledge about Fertility: Good	-	-	-	-	1.20	0.014	1.20	-	-	-	-	1.20	0.014	1.20
Dating Experience: Yes. With Moderately Intimate Behaviour	-	-	-	-	-	-	1.49	-	-	-	-	-	-	1.49
Dating Experience: Yes. With Highly Intimate Behaviour	-	-	-	-	-	-	2.52	-	-	-	-	-	-	2.52
Wealth Index: Poor	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Middle	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Rich	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Richest	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Residence: Urban	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Yes. >16 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Never	-	-	-	-	-	-	-	-	-	-	-	-	-	-
cons	0.007	<0.001	0.004	<0.001	0.004	<0.001	0.003	0.007	<0.001	0.004	<0.001	0.004	<0.001	0.003
n	14,242		14,242		14,242		14,242		14,242		14,242		14,242
GoF test	0.901		0.558		0.076		0.425		0.548		0.533		0.469

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AOR: adjusted odds ratio, ASRH: adolescent sexual reproductive health, GoF: Goodness of fit, P: P, M: Multivariate, *Final model

Table S5.

Multivariate weighted analysis for determinants of ASRHL Model B (Limited vs Inadequate and Adequate)

Variables	m1		m2		m3		m4		m5		m6		m7

	AOR	P	AOR	P	AOR	P	AOR	P	AOR	P	AOR	P	AOR	P
Media Source: Internet Only	3.73	<0.001	3.11	<0.001	2.69	<0.001	2.37	<0.001	2.38	<0.001	2.33	<0.001	2.78	<0.001
Media Source: Internet and Printed	4.61	<0.001	2.98	<0.001	2.44	<0.001	2.39	<0.001	2.28	<0.001	2.24	<0.001	3.22	<0.001
Information Access: Intermediate	-	-	2.11	<0.001	1.97	<0.001	1.92	<0.001	1.86	<0.001	1.82	<0.001	1.88	<0.001
Information Access: Optimal	-	-	3.08	<0.001	2.73	<0.001	2.59	<0.001	2.45	<0.001	2.39	<0.001	2.40	<0.001
Parental Knowledge about ASRH: Moderate	-	-	-	-	2.50	<0.001	2.37	<0.001	2.27	<0.001	2.05	<0.001	2.08	<0.001
Parental Knowledge about ASRH: Good	-	-	-	-	2.83	<0.001	2.68	<0.001	2.53	<0.001	2.10	<0.001	2.10	<0.001
Education: Middle	-	-	-	-	-	-	1.39	0.020	1.42	0.017	1.40	0.022	1.24	0.159
Education: High	-	-	-	-	-	-	3.72	<0.001	3.61	<0.001	3.58	<0.001	2.99	<0.001
Attitudes Toward Early Marriage Behaviour: Conservative	-	-	-	-	-	-	-	-	2.36	<0.001	2.36	<0.001	2.28	<0.001
Parental Knowledge about Family Planning: Moderate	-	-	-	-	-	-	-	-	-	-	1.49	0.001	1.52	0.001
Parental Knowledge about Family Planning: Good	-	-	-	-	-	-	-	-	-	-	1.69	<0.001	1.73	<0.001
Sex: Female	-	-	-	-	-	-	-	-	-	-	-	-	3.12	<0.001
Understanding and Awareness of Family Function: Medium	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Understanding and Awareness of Family Function: Advance	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 16 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 17 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 18 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Age: 19 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Parental Knowledge about Fertility: Moderate	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Parental Knowledge about Fertility: Good	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Dating Experience: Yes. With Moderately Intimate Behaviour	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Dating Experience: Yes. With Highly Intimate Behaviour	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Poor	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Middle	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Rich	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Richest	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Residence: Urban	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Yes. >16 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Never	-	-	-	-	-	-	-	-	-	-	-	-	-	-
cons	0.92	0.275	0.83	0.009	0.48	<0.001	0.20	<0.001	0.15	<0.001	0.11	<0.001	0.06	<0.001
n	14,242		14,242		14,242		14,242		14,242		14,242		14,242
GoF test	1.000		0.986		<0.001		0.889		0.330		0.217		0.073

Variables	m8		m9		m10		m11*		m12		m13		m14

	AOR	P	AOR	P	AOR	P	AOR	AOR	P	AOR	P	AOR	P	AOR

Media Source: Internet Only	2.83	<0.001	2.77	<0.001	2.80	<0.001	2.71	2.83	<0.001	2.77	<0.001	2.80	<0.001	2.71
Media Source: Internet and Printed	3.19	<0.001	3.11	<0.001	3.09	<0.001	3.07	3.19	<0.001	3.11	<0.001	3.09	<0.001	3.07
Information Access: Intermediate	1.86	<0.001	1.90	<0.001	1.89	<0.001	1.85	1.86	<0.001	1.90	<0.001	1.89	<0.001	1.85
Information Access: Optimal	2.26	<0.001	2.28	<0.001	2.25	<0.001	2.21	2.26	<0.001	2.28	<0.001	2.25	<0.001	2.21
Parental Knowledge about ASRH: Moderate	2.02	<0.001	2.12	<0.001	2.04	<0.001	2.02	2.02	<0.001	2.12	<0.001	2.04	<0.001	2.02
Parental Knowledge about ASRH: Good	1.95	<0.001	2.13	<0.001	2.03	<0.001	2.03	1.95	<0.001	2.13	<0.001	2.03	<0.001	2.03
Education: Middle	1.23	0.174	1.56	0.006	1.57	0.005	1.57	1.23	0.174	1.56	0.006	1.57	0.005	1.57
Education: High	2.97	<0.001	2.95	<0.001	2.93	<0.001	2.96	2.97	<0.001	2.95	<0.001	2.93	<0.001	2.96
Attitudes Toward Early Marriage Behaviour: Conservative	2.28	<0.001	2.20	<0.001	2.18	<0.001	2.16	2.28	<0.001	2.20	<0.001	2.18	<0.001	2.16
Parental Knowledge about Family Planning: Moderate	1.51	0.001	1.53	0.001	1.51	0.001	1.47	1.51	0.001	1.53	0.001	1.51	0.001	1.47
Parental Knowledge about Family Planning: Good	1.67	<0.001	1.68	<0.001	1.64	<0.001	1.61	1.67	<0.001	1.68	<0.001	1.64	<0.001	1.61
Sex: Female	3.12	<0.001	3.32	<0.001	3.34	<0.001	3.41	3.12	<0.001	3.32	<0.001	3.34	<0.001	3.41
Understanding and Awareness of Family Function: Medium	1.15	0.069	1.20	0.021	1.18	0.036	1.19	1.15	0.069	1.20	0.021	1.18	0.036	1.19
Understanding and Awareness of Family Function: Advance	1.60	<0.001	1.68	<0.001	1.60	<0.001	1.52	1.60	<0.001	1.68	<0.001	1.60	<0.001	1.52
Age: 16 years	-	-	1.60	<0.001	1.62	<0.001	1.54	-	-	1.60	<0.001	1.62	<0.001	1.54
Age: 17 years	-	-	1.84	<0.001	1.88	<0.001	1.69	-	-	1.84	<0.001	1.88	<0.001	1.69
Age: 18 years	-	-	2.54	<0.001	2.58	<0.001	2.25	-	-	2.54	<0.001	2.58	<0.001	2.25
Age: 19 years	-	-	2.38	<0.001	2.43	<0.001	2.04	-	-	2.38	<0.001	2.43	<0.001	2.04
Parental Knowledge about Fertility: Moderate	-	-	-	-	1.71	0.001	1.69	-	-	-	-	1.71	0.001	1.69
Parental Knowledge about Fertility: Good	-	-	-	-	1.32	0.003	1.33	-	-	-	-	1.32	0.003	1.33
Dating Experience: Yes. With Moderately Intimate Behaviour	-	-	-	-	-	-	1.66	-	-	-	-	-	-	1.66
Dating Experience: Yes. With Highly Intimate Behaviour	-	-	-	-	-	-	2.33	-	-	-	-	-	-	2.33
Wealth Index: Poor	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Middle	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Rich	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Wealth Index: Richest	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Residence: Urban	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Yes. >16 years	-	-	-	-	-	-	-	-	-	-	-	-	-	-
Sex Experience: Never	-	-	-	-	-	-	-	-	-	-	-	-	-	-
cons	0.06	<0.001	0.03	<0.001	0.03	<0.001	0.25	0.06	<0.001	0.03	<0.001	0.03	<0.001	0.25
n	14,242		14,242		14,242		14,242		14,242		14,242		14,242
GoF test	0.219		0.083		0.658		0.060		0.096		0.235		0.045

Open in a new tab

AOR: adjusted odds ratio, ASRH: adolescent sexual reproductive health, GoF: Goodness of fit, P: P value, M: Multivariate. *Final model

Access to information was a key factor. Adolescents who used various media sources were more likely to have adequate ASRHL (AOR: 3.07; 2.49–3.79; P < 0.001). Similarly, optimal accessibility to SRH information was associated with a higher likelihood of adequate ASRHL (AOR: 2.35; 2.01–2.75; P < 0.001). Adequate ASRHL was associated with a high-intimate dating experience (AOR: 2.52; 1.81–3.50; P < 0.001), in comparison to never having dated. Adolescents with a liberal attitude toward early marriage had an adequate ASRHL (AOR: 2.16; 1.86–2.50; P < 0.001) compared to those with a conservative attitude. Adolescents with knowledgeable parents about SRH had adequate SRHL (AOR: 2.03; 1.63–2.53: P <0.001), compared to those with poor knowledgeable parents.

Discussion

To the best of this study team’s knowledge, this is the first study evaluating SRHL among school aged adolescents in Indonesia using big data from a nationwide population-based survey. The main findings of this paper indicate that adequate literacy about SRH in adolescents was associated with sociodemographic factors, behaviour and attitudes, media information access, and parental characteristics. Moreover, definitions of ASRHL were categorised according to Nutbeam’s functional health literacy model. In the context of functional health literacy, our study ascertained the outcomes of ASRHL by Nutbeam’s conceptual framework and social determinants of health literacy.[17] This study defined ASRHL used quartiles for categorisation of the index following several previous behavioural researches.[18,19]

Adequate literacy more likely was found among adolescents on the following characteristics: older age, female, higher education, living in urban areas, mostly in Bali and Nusa Tenggara, and middle to rich family wealth status. Adolescents from privileged backgrounds have higher literacy, suggesting unequal access to health information. Adolescents who had experienced dating with highly intimate behaviour showed adequate literacy, even though they had no sexual experience. They also had liberal views on early marriage. Young people with adequate SRHL were those who had access to a wide array of media sources, enabling them to acquire optimal information. In addition, adolescents whose parents exhibited good knowledge regarding ASRH, fertility, and FP, and who also received support in comprehending family function, demonstrated an adequate level of SRHL.

Females often had greater SRHL across Asian populations, including Indonesian, likely because health literacy programs are often targeted them due to their specific reproductive health needs.[20,21] Conversely, young men, specifically those in Indonesia tended to lack SRHL due to rigid socio-cultural norms and stereotypes about masculinity. These shaped their sexual behaviours.[7,22,23] These findings align with research which has shown that education and urban residency improve ASRHL.[13,14,24] Adolescents’ educational background influences access to SRH knowledge across South Asian countries and was linked to better reproductive health knowledge.[25] Urban adolescents have better access to information and services than rural ones due to lack of resources and restrictive traditional socio-cultural norms.[21,26] The relationship between liberal attitudes toward early marriage and adequate ASRHL supports previous studies that have also examined this issue.[1,10,27,28] It was more difficult in conservative societies since sexual health environment due to the sensitivity of the original issue of sexual health.[29] Compared to other studies,[30,31] there were several interesting findings in this study which indicate that the lower prevalence of sexual experience may be due to cultural differences in sexual behaviour and sex education. In Indonesia, sexual experience was shaped by societal and religious norms, which often stigmatise sexual activity.[32] For instance, adolescents perception of sexuality based on gender was still taboo in Indonesian communities that have strict religious preference. Adolescents with dating experience also had adequate ASRHL, suggesting that relationships influence knowledge acquisition.[33] In contrast, Chinese adolescents were exhibiting increased sexual behaviour, but lack sexual health literacy.[34] Engagement of parents and family members in SRH education were associated with these two difference evidences.[2]

Accessibility of numerous media sources greatly contributed to improving SRHL among adolescents. Both digital and print media played important roles in providing information. Access for several media resources should be a priority for comprehensive and accurate information in accordance to strengthening exercise their right to health status and good well-being. The digital platforms played a key role in educating and raising awareness about SRH for adolescents.[35,36] Consideration of online sexual health courses to enhance their understanding of sexual topics were suggested in future implementation.[37] Online resources allowed them to learn in a way that met their needs and made it easier to engage with interactive materials, which helped them better understand and remember the information.[38,39] Reproductive health promotion needs to be improved by leveraging digital platforms through online media based.[40] Although printed materials were not used as often, printed materials underwent review to ensure accuracy and reliability, delivering comprehensive, trustworthy SRH content.[41] Their continued value was particularly important for students in locations with limited internet access or low digital literacy.[42] However, this approach not be effective in providing reliable SRH content, as the message was incomprehensive among Malaysian adolescence.[41] Combining digital and print media may be associated with effective and accessible SRH education, fulfilling people’s right to information, not just those with access to technology. It allows holistic educational experience.[43]

Adolescents who had parents with an advanced understanding of family function were more likely to have adequate SRHL. Parents were the main source of SRH information for adolescents.[44,45,46] They provided guidance to avoid confusion and the risk of unreliable advice.[29] Parents are the primary facilitators in ensuring that adolescents’ right to health information is realized in a safe and supportive environment. Effective communication between parents and adolescents could improve attitudes, knowledge, and behaviours.[47]

Family dynamics-such as communication, support, and shared values-helped adolescents’ access and use SRH information effectively.[48,49] Open discussions between parents and adolescents promoted accurate knowledge and healthier behaviours. It could create a supportive home environment and positive role models which helped improve healthy choices.[50] This study emphasised that values about SRH were passed down through families, suggesting that engaging families in health education could strengthen adolescent SRHL and support better outcomes at the community level. Accurate ASRHL knowledge in parents improved adolescents’ understanding and supported better decision-making through guidance, leading to stronger SRH literacy in their adolescent children.[51]

Students in public schools and those with higher levels of education tended to have higher levels of literacy.[1] Comprehensive sex education in formal education improved adolescents’ knowledge of and attitudes toward SRH.[52] Schools served as a platform to provide adolescents with SRH education, which was an immediate need of this current generation in modern times to shape healthy young people for the future.[53] Comprehensive sexual education programmes improve adolescents’ knowledge, attitudes and behaviours related to adolescent health status, although their effectiveness still varies.[54] Inadequate sex education in schools may be associated with poorer mental health.[55] Recent evidence has indicated that interactive, dialogue-based interventions delivered via school, digital, or peer-led platforms yielded improvements in SRH knowledge and attitudes towards healthy sexual behaviours.[56] Additionally, mobile applications, online educational tools, and social media campaigns can provide accessible and engaging ways to increase reproductive health literacy, particularly in regions with limited formal education.[10]

There has been a nation-wide program that aimed to increase reproductive health literacy among Indonesian adolescents through FP education. This program was known as the youth planning generation, (called “GENRE”), which was managed by the National Population and Family Planning Board. Through the Youth Counselling Information Centre, it covered three major health problems facing Indonesian youth today: unhealthy sexual behaviour, HIV/AIDS and substance use.[57] Despite good intentions, the program has faced several barriers, including peer education, which has often failed to meet diverse adolescent needs.[58] Moreover, this strategy disseminated inaccurate information, which reduced their impact to improve ASRHL. Potential limitation including inadequate health services, lack of family and social support, integration difficulties of formal school curricula, socioeconomic disparities and lack of program evaluation were major limitations to achieve these youth development programs.[1,42,59,60]

This study yielded that ASRHL in Indonesia was shaped by several factors. Similar study findings in the United State, digital platforms helped adolescents’ access useful sexual health information.[35] Media exposure increases awareness of SRHL, as proven by studies conducted in Harari.[42] In line with a study from Taiwan,[61] families had an impact on adolescents’ health literacy in general. Adolescents were highly dependent on their families for information, especially when it came to health issues. Open communication and positive role modelling at home contributed to better SRHL outcomes.[48] These findings identified determinants that promoted universal access to ASRHL and indicated where stakeholders had direct efforts to ensure adolescents had universal access. ASRHL regulations were pursued to support human rights by ensuring adolescents had access to the information and services when they need decisions about their health.

Study strength and limitations

This study has several strengths, because it used a large nationally representative survey with a high response rate and high-quality data processing. This decreased potential bias related to sampling and measurement. While this study benefitted from a large sample size and broad sociodemographic analysis, limitations included self-reported data, which may be subject to bias, and cross-sectional design which limited conclusions about causality. Survey data might not have fully captured adolescent experiences with sexual health education and parental involvement. Nevertheless, the study ensured that the sample was diverse (e.g., age, sex, socioeconomic status, and location) to capture a broad range of experiences and perspectives.

Future direction

Future research should be beneficial for applying a qualitative study or a mixed-methods study design, for better understanding of the determinants and its barriers of ASRHL. Longitudinal studies are needed to assess ASRHL changes over time and evaluate the long-term effects of educational interventions. Future research should focus on using digital platforms like social media to educate adolescents about their health, as these platforms are used by teenagers.[62] Studies have also suggested looking at how digital tools and the influence of peers affect youth to understand about reproductive health.[59] Additionally, culture shapes how adolescents respond to health issues. Public health programs must consider cultural norms to create effective interventions for Indonesian adolescents.[63] Addressing these factors through policy and research can improve ASRHL, and contribute to better health outcomes for Indonesian adolescents.

Conclusion

This study analysed a large sample of adolescents across Indonesia, indicating that the findings could be generalised to the entire adolescent’s population. The findings revealed that a limited number of adolescents have adequate levels of SRHL, which are determined by several factors i.e., family function, access to reliable media sources and information, parental involvement, and adolescent behaviour. To improve ASRHL, efforts should focus on integrating sexual health education into school curricula, universal access by friendly user health services, promoting parental involvement, and utilising digital platforms to provide accessible and accurate education. Primary healthcare policy can be expanded through youth-friendly services provided integrated community health care, targeted to school aged adolescents. Further studies are needed to explore how socioeconomic status is related to ASRHL and how these barriers can be effectively addressed.

Conflicts of interest

There are no conflicts of interest.

Acknowledgement

WSD is a researcher pursuing a postgraduate program in Master of Public Health, Faculty of Public Health, Universitas Airlangga. He is an awardee of the Indonesia Endowment Fund for Education Agency (LPDP) scholarship batch 2024. This publication is a part of his thesis, which is used to obtain graduation. All authors would like to give thanks to the National Population and Family Planning Board for the research collaboration.

Funding Statement

This research was supported by the Indonesia Endowment Fund for Education Agency (LPDP) by number registration ID.202406110804579.

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[R25] 25.Sharma H, Singh SK. Socioeconomic inequalities in contraceptive use among female adolescents in south Asian countries: A decomposition analysis. BMC Womens Health. 2022;22:151. doi: 10.1186/s12905-022-01736-8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R26] 26.Yundianto D, Khatami M, Maharani W, Mutmainah I, Nawwaf MN, Vaľko M. Exploring sexual health and well-being in rural areas: A systematic literature review with case study from Indonesia. Int J Sex Health. 2026;7:1–21. doi: 10.1080/19317611.2025.2604836. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R27] 27.Muhammad T, Srivastava S, Kumar P, Patel SK. What predicts the early sexual debut among unmarried adolescents (10–19 years)? Evidence from UDAYA survey, 2015–16. PLoS One. 2021;16:e0252940. doi: 10.1371/journal.pone.0252940. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R28] 28.Vongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JE, Sychareun V, et al. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS One. 2019;14:e0209675. doi: 10.1371/journal.pone.0209675. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R29] 29.Arabkari Z, Alipour F, Fallahi-Khoshknab M, Momtaz YA, Khoie EE, Samiei M. Sexual health of adolescent girls in Tehran: Definition and dimensions. J Educ Health Promot. 2025;14:244. doi: 10.4103/jehp.jehp_358_24. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R30] 30.Shahrahmani H, Kariman N, Keshavarz Z, Ahmadi A, Nasiri M. Sexual health literacy and its related factors among couples: A population-based study in Iran. PLoS One. 2023;18:e0293279. doi: 10.1371/journal.pone.0293279. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R31] 31.Kusheta S, Bancha B, Habtu Y, Helamo D, Yohannes S. Adolescent-parent communication on sexual and reproductive health issues and its factors among secondary and preparatory school students in Hadiya Zone, Southern Ethiopia: Institution based cross sectional study. BMC Pediatr. 2019;19:9. doi: 10.1186/s12887-018-1388-0. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R32] 32.Ayuandini S, Habito M, Ellis S, Kennedy E, Akiyama M, Binder G, et al. Contemporary pathways to adolescent pregnancy in Indonesia: A qualitative investigation with adolescent girls in West Java and Central Sulawesi. PLOS Global Public Health. 2023;3:e0001700. doi: 10.1371/journal.pgph.0001700. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R33] 33.Klu D, Gyapong M, Agordoh PD, Azagba C, Acquah E, Doegah P, et al. Adolescent perception of sexual and reproductive health rights and access to reproductive health information and services in Adaklu district of the Volta Region, Ghana. BMC Health Serv Res. 2023;23:1456. doi: 10.1186/s12913-023-10447-1. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R34] 34.Zou X, Xue K, Zou S, Xiao AY, Cao W, Tang K. Association between Chinese youth’s sources of sexual knowledge and sexual and reproductive health: A mediation analysis of sexual knowledge level. Sex Reprod Health Matters. 2025;33:2517430. doi: 10.1080/26410397.2025.2517430. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R35] 35.Decker MJ, Atyam TV, Zárate CG, Bayer AM, Bautista C, Saphir M. Adolescents’ perceived barriers to accessing sexual and reproductive health services in California: A cross-sectional survey. BMC Health Serv Res. 2021;21:1263. doi: 10.1186/s12913-021-07278-3. [DOI] [PMC free article] [PubMed] [Google Scholar]

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[R37] 37.Mirmoghtadaie ZS, Mahbadi Z, Mahbadi Z. Effectiveness of E-learning on “Sexual Health” among students of Shahid Beheshti University of Medical Sciences based on the Kirkpatrick model. J Educ Health Promot. 2024;13:221. doi: 10.4103/jehp.jehp_852_23. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R38] 38.Levin‐Zamir D, Bertschi I. Media health literacy, eHealth literacy, and the role of the social environment in context. Int J Environ Res Public Health. 2018;15:1643. doi: 10.3390/ijerph15081643. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R39] 39.Pavarini G, Reardon T, Hollowell A, Bennett V, Lawrance E; Peer Support Young People’s Advisory Group , et al. Online peer support training to promote adolescents’ emotional support skills, mental health and agency during COVID-19: Randomised controlled trial and qualitative evaluation. Eur Child Adolesc Psychiatry. 2023;32:1119–30. doi: 10.1007/s00787-021-01933-0. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R40] 40.Karima UQ, Pristya TY, Herbawani CK. Information-seeking behavior of reproductive health based on socio-demographic among adolescents in Jakarta, Indonesia. J Educ Health Promot. 2023;12:271. doi: 10.4103/jehp.jehp_1131_22. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R41] 41.Ang PS, Taib F. Fear generation in the multimodal communication of sexual and reproductive health to Malaysian adolescents. Vis Commun. 2023;22:449–68. [Google Scholar]

[R42] 42.Debella A, Tamire A, Bogale K, Berhanu B, Mohammed H, Deressa A, et al. Sexual and reproductive health literacy and its associated factors among adolescents in Harar town public high schools, Harari, Ethiopia, 2023: A multicenter cross-sectional study. Front Reprod Health. 2024;6:1358884. doi: 10.3389/frph.2024.1358884. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R43] 43.Scull T, Malik C, Morrison A, Keefe E. Promoting sexual health in high school: A feasibility study of a web-based media literacy education program. J Health Commun. 2021;26:147–60. doi: 10.1080/10810730.2021.1893868. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R44] 44.Maina BW, Ushie BA, Kabiru CW. Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya. Reprod Health. 2020;17:79. doi: 10.1186/s12978-020-00938-3. [DOI] [PMC free article] [PubMed] [Google Scholar]

[R45] 45.Sandra Byers E, O’Sullivan LF, Mitra K, Sears HA. Parent-adolescent sexual communication in India: Responses of middle class parents. J Fam Issues. 2021;42:762–84. [Google Scholar]

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PERMALINK

Determinant factors of sexual and reproductive health literacy among adolescents in Indonesia: A national population-based study

Wildan Satrio Darmawan

Sigit Ari Saputro

Sukarno Sono

Antonius Yansen Suryadarma

Monita Destiwi

Philip Etabee Bassey

Abstract

BACKGROUND:

MATERIALS AND METHODS:

RESULTS:

CONCLUSION:

Introduction

Materials and Methods

Study design and setting

Study participants and sampling

Figure 1.

Data collection tools and technique

Figure 2.

Table S1.

Ethical consideration

Statistical analysis

Table S2.

Table S3.

Results

Characteristics of study participants

Table 1.

The different characteristics of sexual reproductive health literacy

Factors associated with adequate adolescents sexual and reproductive health literacy

Table 2.

Table 3.

Table S4.

Table S5.

Discussion

Study strength and limitations

Future direction

Conclusion

Conflicts of interest

Acknowledgement

Funding Statement

References

ACTIONS

PERMALINK

RESOURCES

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