Prevalence of factors related to active reproductive health behavior: a cross-sectional study Indonesian adolescent

Using the behaviour change wheel to examine facilitators and barriers to assertive contraception-use conversations for Indonesian women

Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia.

Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study

Background

Adolescent populations face reproductive health challenges. Persisting gaps in Triad Adolescent Reproductive Health (ARH) comprehension and risky behaviors emphasize the necessity of integrating social media apps into health education to address Triad ARH risks among youths. Teenagers commonly use WhatsApp and LINE for social media communication, and determining the effectiveness of these two apps is scarce.

Objective

This quasi-experimental study aimed to investigate and compare the impacts of educational interventions delivered through WhatsApp and LINE platforms on enhancing the knowledge, attitudes, and behaviors of adolescents concerning the Triad ARH.

Methods

A total of 154 senior high school students were randomly recruited from two public schools in Bandung Regency, West Java, Indonesia. These students were divided into two groups: Group A, consisting of 78 students who received material messages using LINE, and Group B, consisting of 76 students who received material messages using WhatsApp. Participants completed a pre-test prior to the intervention and a post-test one month after the intervention. Data were collected using validated questionnaires and analyzed using Chi-square and Wilcoxon tests.

Results

In the LINE group, there was an average increase in knowledge from 15.68 to 20.21, attitudes from 29.05 to 59.12, and behavior from 55.95 to 64.81 before and after the intervention period (p = 0.001). In the WhatsApp group, there was an increase in knowledge from 15.16 to 19.67, in attitudes from 34.71 to 59.54, and behavior from 54.75 to 65.97 before and after the intervention period (p = 0.001). Further analysis showed no significant difference between the LINE and WhatsApp groups in increasing the average level of knowledge (p = 0.973), attitude (p = 0.682), and behavior (p = 0.067) before and after the intervention. However, it was observed that the increase in knowledge and attitude was slightly higher in the LINE group, while the increase in behavior was slightly higher in the WhatsApp group.

Conclusion

This study demonstrates that educational interventions using LINE and WhatsApp both increased the knowledge, attitudes, and behavior of adolescents related to the Triad ARH. This finding is valuable, considering the popularity of LINE and WhatsApp as mobile applications. Leveraging these platforms by nurses and other healthcare professionals can significantly improve adolescents' health, influencing their knowledge, attitudes, and behavior regarding reproductive health.

The process of overcoming conflicts among teachers in the implementation of comprehensive sexuality education at ordinary public senior high schools in Mataram City, Indonesia: a qualitative study

BACKGROUND

Comprehensive sexuality education (CSE), which aims to help young people make responsible choices and acquire scientific knowledge and skills, has been promoted by UNESCO. Teachers experience conflicts in implementing CSE when teaching sexual topics in the local context, especially as the delivery of sexual knowledge and contraceptive methods is often prohibited by religious and traditional cultural norms. It was reported that there were multiple challenges in the implementation of sex education due to the religious and cultural background of societies and communities in Islamic countries. This study aimed to clarify the process of overcoming the conflicts, explore teachers' recognition and perception related to the implementation of CSE, and to suggest recommendations for promoting CSE in Islamic areas.

METHODS

This qualitative study combined the methods of focus group discussions (FGDs) and in-depth interviews (IDIs) to explore the conflict among teachers. Ten ordinary public senior high schools in Mataram City, Indonesia, agreed to participate, and in total, 59 participants were involved in this study. FGDs were conducted with teachers (n = 49), and IDIs were focused on school principals (n = 10) in each school. The collected interview data were analyzed using a deductive thematic analysis and the findings triangulated for both the FGDs and IDIs.

RESULTS

Overall, the teachers experienced conflicts in relation to religion, cultural background, and gender inequality in implementing CSE. The present study revealed the mutual recognition among teachers and acceptance of diverse backgrounds in the implementation of CSE at ordinary public senior high schools in Mataram City. Despite teachers reporting multiple conflicts, they made efforts to overcome these conflicts through mutual recognition and provided comprehensive guidance. The present findings indicated that teachers adapted CSE to follow multiple religions and cultural backgrounds.

CONCLUSIONS

The teachers accepted diverse backgrounds and provided CSE by collaborating with related educational subjects and external institutions to overcome conflicts. To provide more specialized education, it would be necessary to advocate a formal policy that might be accepted by diverse societies. Further research is necessary to apply the findings and recommendations for CSE implementation globally in the contexts of different countries.

Determinants of Adolescent Reproductive Health in West Java Indonesia: A Cross-Sectional Study

The problem of adolescent reproductive health (ARH) in Indonesia is worrying, especially regarding the Triad Adolescent Reproductive Health (Triad ARH) behavior. Many factors influence ARH behavior. This cross-sectional study explores the association factors between demographic factors, knowledge, and attitudes toward ARH behavior. Six hundred and sixty-eight junior high school and senior high school students were randomly selected from five public schools in Bandung Regency, West Java, Indonesia. The questionnaire used in this study consisted of four parts, namely: (1) demographic data of respondents; (2) knowledge including 20 questions used multiple choice questions; (3) attitude with 12 questions measured using the Likert scale; and (4) behaviors with seven questions measured using Likert scale. Results showed that gender (p = 0.006), age (p = 0.031), and level of education (p = 0.006) were associated with behavior toward ARH behavior, but knowledge (p = 0.582), religion (p = 0.628), ethnic (p = 0.276), and attitude (p = 0.094) were not associated with ARH behavior. Multivariate analysis showed that only gender (p < 0.010) significantly contributed to ARH behavior. Multivariate analysis showed that gender (OR: 2.168, 95% (CI: 1.204-3.904)) significantly contributed to ARH behavior. Based on the results, it can be concluded that the gender factor influences adolescent reproductive health behavior. This study provides further evidence that to promote positive ARH behavior's among youth in West Java, Indonesia, gender should be put in place and be sustainable, using the media and the Internet and involving the collaboration of parents, teachers, and peers to improve adolescent reproductive health.

Sexual and Reproductive Health Services Utilization among Wolaita Sodo University Students, Ethiopia: A Mixed Method Approach

Background

Youths have been facing different sexual and reproductive health problems such as HIV infections and unplanned pregnancies. Therefore, this study aimed to assess reproductive health services utilization and their associated factors among Wolaita Sodo University students in Wolaita Sodo, Ethiopia.

Methods

We conducted an institutionally-based mixed-method study among 759 regular undergraduate university students. Multistage random sampling and purposive sampling techniques have been used to recruit students for the quantitative and qualitative studies, respectively. A pretested self-administered questionnaire was used to collect the data. A logistic regression model was used for quantitative data analysis, whereas thematic analysis was used for qualitative data. We used open-code software-assisted qualitative data analysis. The statistical significance was declared at a P value less than 0.05.

Results

We found that 378 (49.8%) (95% CI: 46.20–53.34) of respondents had utilized sexual and reproductive health services within the 12 months preceding the current survey. Being a first-year student (AOR = 1.57, 95% CI: 1.01–2.46), having ever had sexual intercourse (AOR = 5.12, 95% CI: 3.31, 7.96), participating in peer-to-peer discussion (AOR = 1.46, 95% CI: 1.02–2.02), and having ever had sexual transmitted infection syndrome (AOR = 3.91, 95% CI: 1.41–10.85) have increased the odds of using sexual and reproductive health services.

Conclusion

Sexual and reproductive health services utilization among university students was inadequate and affected by several factors. Therefore, strengthening peer support networks and addressing the gap in services were highly recommended.

Determinants Factors of High-risk Sexual Behavior Pregnancy among Adolescent in Indonesia

BACKGROUND: The vulnerability of adolescent lifestyles, especially sexual behavior among adolescents, which causes an increase in pregnancy and early marriage. AIM: This study aimed to analyze the determinants of high-risk sexual behavior among adolescents in Indonesia. METHODS: A correlational analytic research design was used with a cross-sectional approach using secondary data for the 2017 Indonesian demographic and health survey data (IDHS). The data collection was carried out through filling in the instruments developed by the 2017 IDHS. The data were analyzed using percentages, Chi-square test, and logistic regression. The study population was all adolescents, totaling 9,971 women and 12,612 single men aged 15–24 and living in Indonesia in the 2017 IDHS. The sampling technique used total sampling. Time of research: August-November 2020. Place: research locations in 34 provinces in Indonesia. RESULTS: In male respondents, it was shown that the factors most influencing high-risk sexual behavior in adolescents were age (p = 0.000), knowledge (p = 0.003), place of residence (p = 0.000), discussion before wet dreams (p = 0.000), age at first wet dream (p = 0.000), age at first dating (p = 0.019), and internet usage (p = 0.000). Meanwhile, female respondents indicated that the most influential factors were age (p = 0.000) and place of residence (p = 0.032). CONCLUSION: Boys have many factors that influence high-risk sexual behavior than girls. Information on determinant factors of high-risk adolescent sexual behavior can be used as a basis for developing policies for developing interventions in solving problems of premarital pregnancy due to high-risk sexual behavior among adolescents.

Prevalence and determinants of condom use among male adolescents in Indonesia

Adolescent sexual and reproductive health problems remain a public health concern in Indonesia. An increase of premarital sex as well as early sexual debut among adolescents without any protection leads to a high risk of adverse sexual and reproductive health consequences. This study aimed to assess condom use prevalence and identify its determinants among male adolescents who are sexually active in Indonesia. This was a cross-sectional study using secondary data from the Adolescent Reproductive Health component of the Indonesia Demographic and Health Survey (IDHS) 2012. The sample for this study was 1341 sexually active male adolescents aged 15-24 years old. Data were analyzed descriptively and using binary logistic regression for bivariate and multivariate analysis. This study found that condom use prevalence among male adolescents at first and last sex accounted for 25.0% and 27.4%, respectively. Determinants of condom use varied by time of sexual intercourse. Knowledge of sexual and reproductive health and obtaining information about condoms were consistently related to condom use at first and last sexual encounter. Meanwhile, residential type, age at first sex, and sexual partner were significant determinants of condom use at sexual debut whilst educational level was only associated with condom use at last sex. As the level of protected sex among male adolescents was very low, providing comprehensive sexuality education (CSE) is suggested in order to develop the capacity among adolescents in making informed decisions and preventing unsafe sex.

Peer educator training program for enhancing knowledge on issues in the growth and development of adolescents and risk behavior problems in Indonesian context

Objective

This article aimed to evaluate the effects of an educational intervention programme on improving peer educator (PE) knowledge in issues around growth and development and its risk behavior problems of adolescents in Indonesia.

Methods

The study was conducted in 31 of PEs to evaluate their knowledge in adolescents. The PEs received health education and were assessed by individual work during the structured three-week programme. Data were collected before and after the training programme as pre- and post-tests.

Results

The PE demonstrated significant improvements in their knowledge after attending the three-week structured training programme. The post-test scores had significant effects on the dimensions of PE knowledge scores. The PE become knowledgeable to maintain and monitor adolescents health issues around growth and development and its risk behavior problems of adolescents.

Conclusions

The PE become knowledgeable to respond to the adolescent problems and readiness to become PE during puberty.

Development and Testing of the Family Structure and Family Functions Scale for Parents Providing Adolescent Reproductive Health Based on the Friedman Family Assessment Model

Background and Purpose:

To describe the development and testing of a psychometric of Family Structure and Functions (FSF) that measures parents’ ability to provide adolescent reproductive health (ARH).

Methods:

A cross-sectional study of Indonesian parents (n = 525). Multifactors FSF-ARH were examined using construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) and content validity (Content Validity Index [CVI]). Internal consistency was explored using Cronbach’s α coefficient.

Results:

EFA revealed nine factors with 26 items accounting for 61.64% of explained variance and CFA validity testing fit for the construct validity of FSF-ARH. The CVI indicated adequate content validity (0.80–0.10) and acceptable internal consistency (0.70).

Conclusions:

FSF-ARH contains valid, reliable, and robust measures although some subscales performed moderate reliability, establishing the purpose for further research.

A phenomenological study of families with drug-using children living in the society

Background and objectives

Adolescents have a risk of drug abuse during their development, which demands care by the parents in a family environment. This study explored the experiences of families with drug-using children.

Materials and methods

This study used a descriptive phenomenological qualitative design. Seven participants were recruited for the study using the snowballing sampling technique. The data collection instruments employed included interviews, field notes, and tape recorders. Sociodemographic data were collected comprising age, sex, religion, and relationships with other drug users. Interview guidelines were prepared based on the research objectives and they were further translated into a number of questions to explore the experiences of the families. Data were obtained using in-depth interviews. The Colaizzi method was used for data analysis.

Results

The results characterized the feelings of the parents/families, stigma felt by families, coping mechanisms used by families, family burden, ways of fixing the problem, obtaining the support of family, and family expectations of the parties involved. The families experienced a deep, prolonged, and repetitive grieving process.

Conclusions

This study identified several themes in the experiences of families with drug-using children. We suggest that drug service agencies assign a public health nurse to act as a counselor and advocate to help families manage and overcome their problems.

Structural model of factors relating to the health promotion behavior of reproductive health among Indonesian adolescents

Objectives

We aim to explore the factors related to the health promotion behavior of reproductive health (RH) among Indonesian adolescents via structural equation modeling.

Methods

A cross-sectional quantitative study was used to measure 108 adolescents aged 12–16 years. We employed a self-administered questionnaire developed from the health promotion model (HPM) and the empowerment model (EM) on the basis of self-efficacy to determine the factors related to health promotion in maintaining RH behavior. Structural equation modeling (SEM) was used to examine relationships among the variables. The Analysis of Moment Structures (AMOS) approach was used to evaluate if the proposed model is suitable for the data based on goodness-of-fit indices.

Results

The model is appropriate for the data. Three interrelationships emerge among independent variables (P > 0.05), namely, personal and cognitive behaviors (r = −0.01), cognitive and health promotion behaviors (r = 0.09), and affective and health promotion behaviors (r = −0.17). The strongest relationship is between empowerment and health promotion behavior (r = 0.72). Affection (interpersonal and situational influences), immediate competing demands and preferences, and empowerment (participation and control) are directly related to RH behavior maintenance. Meanwhile, willingness of adolescents, prior related behavior, personal factor, and commitment to a plan of action are indirectly related to RH behavior maintenance. The model explains 43.9% of the variance in maintaining RH behavior.

Conclusions

The HPM and EM models help determine the factors related to RH behavior maintenance among adolescents. Intervention to promote RH among Indonesian adolescents should begin from the level of child–parent–health care professional encounter for empowering the RH of adolescents.

Sex Education in Children and Adolescents With Disabilities in Yogyakarta, Indonesia From a Teachers’ Gender Perspective

Children and adolescents with disabilities (CAD) frequently engage in inappropriate sexual behaviors. In Indonesia, the need for sex education for CAD remains unclear. This study investigated teacher attitudes toward providing sex education in special schools to clarify the gender differences among teachers providing sex education. Questionnaires were sent to 180 teachers. The response rate was 72.2%. Eighty-three percent of responders were Muslim. Our findings revealed that teachers in special schools considered sex education to be important. However, the number of sex education contents was limited, and female teachers were more positive about teaching sex education than male teachers. Equally, female teachers taught a greater number of sex education contents than did male teachers. These findings were consistent with reports from developed countries although cultural and religious background differed from those of Indonesia. Sex education for CAD was accepted by teachers in Indonesia; however, materials and tools for education should be developed further.