Journal of Health Literacy

Journal of Health Literacy

Sexual and Reproductive Health Literacy among Junior High School Students: Evidence from Surakarta, Indonesia

Document Type : Original Article

Authors
Murni Ramli 1
Wafiyah Wahyuningsih Wilma Noor Syabani 2
Febriani Sarwendah Asri Nugraheni 2
1 Research Group Biology Education, Department of Biology Education Faculty of Teacher Training and Education, Universitas Sebelas Maret, Surakarta, Indonesia
2 Department of Natural Science Education, Faculty of Teacher Training and Education, Universitas Sebelas Maret, Surakarta, Indonesia.
10.22038/jhl.2026.81138.1596
Abstract
Background and Objectives: Cases of early marriage and sexual violence remain prevalent in Indonesia, highlighting the urgent need for adolescents to possess adequate sexual and reproductive health literacy (SRHL). Junior high school students should have too to prevent risky sexual behaviors, such as premarital or casual sex. However, limited research has examined Indonesian adolescents’ perspectives and understanding of SRHL, and factors influencing the literacy levels. This study aimed to investigate the level of SRHL among junior high school students in Surakarta and to analyze the factors that influence it.

Material and Methods: An ex post facto survey was conducted in 2023 involving 447 students aged 13–15 years from eight schools representing the diversity of Indonesia’s school system (public, private, Islamic, and Catholic). Schools were purposively selected to ensure proportional representation, and students were randomly chosen. Data were collected through an online questionnaire consisting: demographic information, a 51-item knowledge test, and a 47-item attitude scale. Instrument validity and reliability were confirmed through expert judgment and field testing. Eta correlation was applied for nominal variables (age, gender, and school type), while Pearson’s correlation was used to analyze relationships between interval variables (knowledge and attitude). SRHL levels were categorized as inadequate, problematic, sufficient, or excellent.

Results: Of the total participants, 53.2% demonstrated a sufficient level of SRHL, 19.7% were excellent, 25.5% problematic, and 1.6% inadequate. Weak correlations were found between SRHL and both age (η² = 0.201) and school type (η² = 0.349), while gender showed no significant relationship (η² = 0.099). Knowledge and attitude showed strong positive correlations with SRHL (R = 0.524 and R = 1.000, respectively).

Conclusion: Most junior high school students in Surakarta demonstrated sufficient SRHL. Knowledge and attitude were found to be strongly and positively associated with sexual and reproductive health literacy levels.
Keywords
Junior High School Student
Knowledge and Attitude
Survey
School Type

Acknowledgments: The study was supported by LPPM UNS, which funded this research through the Group Research Grant led by Murni Ramli with contract number 228/UN27.22/PT.01.03/2023.


Availability of data and materials: The authors confirm that the data generated or analyzed during this study are included in this published article.


Conflict of interests: We declare that there is no competing of interest.


Consent for publication: Not applicable.


Ethical approval and consent to participate: This research followed the ethical principles outlined in Helsinki Declaration for studies involving human subjects. The ethical issue in the instruments had been validated by the gender experts and psychologists who are the members of Center for Demography and Gender Studies of Sebelas Maret University. 


Funding: Research Group Grant of Sebelas Maret University in fiscal year 2023/2024.


Author’s contribution: All authors equally contribute.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

  1. Marbun SM, Stevanus K. Sex education in teenagers. FIDEI J Teol Sist dan Prakt 2019; 2(2):325-43 (Indonesian). https://doi.org/10.34081/fidei.v2i2.76
  2. Nurfadhilah & Ariasih. Abstinence and adolescent sex education rapid survey in Jakarta and surrounding areas. J Pendidik Lingkungan dan Pembangunan Berkelanjutan 2019; 20(01):17-27 (Indonesian). https://doi.org/10.21009/PLPB.201.02
  3. Hakiki, G., U. Asnita, Khoer, MI., Supriyanto, S., Basoruddin, M., Larasati, W., et al. Badan Pusat Statistik, Unicef, Puskapa UI. Prevention of Child Marriage: An Acceleration That Cannot Be Delayed. Jakarta; 2020 (Indonesian).
  4. Ministry of Women's Empowerment and Child Protection. (2021). Number of violence for the 2020-2021 period. https://kekerasan.kemenpppa.go.id/ringkasan (Indonesian)
  5. Budianto, EE. (2023, February 4). 449 teenagers of elementary and high school age apply for early marriage in Mojokerto in a year. https://www.detik.com/jatim/berita/d- 6550927/449-remaja- usia-sd-sma-ajukan-pernikahan-dini-di-mojokerto- dalam-setahun (Indonesian)
  6. Widiyana, E. (2023, January 27). 19 children in Surabaya apply for marriage dispensation, City Government intensifies education. https://www.detik.com/jatim/berita/d- 6538328/19-anak-di-surabaya- ajukan-dispensasi-nikah-pemkot-gencarkan- edukasi. (Indonesian)
  7. Dinas Administrasi Kependudukan dan Pencatatan Sipil Kota Surakarta. (2021). Population development profile book in 2021. Dinas Administrasi Kependudukan dan Pencatatan Sipil. https://dispendukcapil.surakarta.go.id/download/buku-profil-kependudukan-2021/ (Indonesian)
  8. Biro Pusat Statistik. The results of the Population Census (SP2020) in September 2020 recorded a population of 270.20 million people. https://www.bps.go.id/id/pressrelease/2021/01/21/1854/hasil-sensus-penduduk--sp2020--pada-september-2020-mencatat-jumlah-penduduk-sebesar-270-20-juta-jiwa-.html (Indonesian)
  9. Awaru AOT. Social construction of sexual education among parents in Bugis-Makassar families. Society 2020; 8(1):182-99 (Indonesian) https://doi.org/10.33019/society.v8i1.170
  10. Sørensen K, Van Den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012; 12(1):80. https://doi.org/10.1186/1471-2458-12-80 PMid:22276600 PMCid:PMC3292515
  11. Ma X, Yang Y, Wei Q, Jiang H, Shi H. Development and validation of the reproductive health literacy questionnaire for Chinese unmarried youth. Reprod Health 2021; 18(1):1-11. https://doi.org/10.1186/s12978-021-01278-6 PMid:34774064 PMCid:PMC8590315
  12. World Health Organization. Sexual health and its linkages to reproductive health: An operational approach. World Health Organization 2017; 1-12 p. https://www.who.int/publications/i/item/978924151288
  13. Väisänen H, Moore AM, Owolabi O, Stillman M, Fatusi A, Akinyemi A. Sexual and reproductive health literacy, misoprostol knowledge and use of medication abortion in Lagos State, Nigeria: A mixed methods study. Stud Fam Plann 2021; 52(2):217-37. https://doi.org/10.1111/sifp.12156 PMid:34043236 PMCid:PMC8362169
  14. Warta, Wardiati, Andria D. Factors influencing the level of adolescent reproductive health literacy among female students at SMA Negeri 5 Simeulue Barat, Simeulue Regency in 2022. J Heal Med Sci 2022; 1(2):254-66 (Indonesian)
  15. Akpama EG. Parental perception of the teaching of sex education to adolescents in secondary school in Cross River State, Nigeria. Himal J Sociol Antropol 2014; 6:134-45. https://doi.org/10.3126/hjsa.v6i0.10714
  16. Martin, KA., & Torres, JMC. Where did I come from? US parents' and preschool children's participation in sexual socialisation. Sex Edu 2014; 14(2), 174-190. https://doi.org/10.1080/14681811.2013.856291
  17. Ursula, PA., Yaniasti, NL., Setiawan, GD., Puger, IGN., Dewi, KYF., Mudarya, IN., et al. The role of guidance and counseling teachers in preventing pregnancy outside of marriage through adolescent reproductive health literacy. Jurnal Jnana Karya 2020; 3(2), 31-38 (Indonesian)
  18. Briñez, DKR., Panqueva, ÁHG., & Hinojos, IAF. How should I teach sex education in middle school? An action research study on an ICT- based intervention. The Qualitative Report 2019; 24(2), 405-428. https://doi.org/10.46743/2160-3715/2019.3610
  19. Susanto, P., Waluyanti, SHD., Respati, DD., Normawarni, D., Januar, E., Mardiany, L., et al. Learning to Prevent Sexual Violence at Middle School Level. Center for Strengthening Character, Ministry of Education, Culture, Research and Technology 2023. https://uploads.belajar.id/document/files/Pembelajaran_Pencegahan_Kekerasan_Seksual_Jenjang_SMP_01hy3ndktr74mgacddn30z04ff.pdf (Indonesian)
  20. Graf, AS., & Patrick, JH. Foundations of life-long sexual health literacy. Health Education 2015; 115(1), 56-70. https://doi.org/10.1108/HE-12-2013-0073
  21. Ministry of Education and Culture. Republic of Indonesia Minister of Education and Culture Regulation Number 146 of 2014 concerning the 2013 Curriculum for Early Childhood Education. 2014; 139 (Indonesian)
  22. Ministry of Education and Culture. Republic of Indonesia Minister of Education and Culture Regulation number 37 of 2018 concerning amendments to the Minister of Education and Culture Regulation number 24 of 2016 concerning core competencies and basic competency lessons in the 2013 curriculum in basic education and secondary education. 2018;1-534 (Indonesian)
  23. Amin A. Synergy of family, school and community education: Tricenter analysis of education. At-Ta'lim Media Inf Pendidik Islam 2018; 16(1):106-25 (Indonesian)
  24. Meilani N, Shaluhiyah Z, Suryoputro A. The mother's behavior in sexual education for early adolescent. Jurnal Kesehatan Masyarakat Nasional 2014;8(8):411-7. https://doi.org/10.21109/kesmas.v8i8.413
  25. Simanjuntak, E. & Prayitno, ISP. The role of Sunday School teachers in sex education for early Sunday School children. Fidel: Jurnal Teologi Sistematika dan Praktika 2022; 5(2): 169-192 (Indonesian) https://doi.org/10.34081/fidei.v5i2.324
  26. Amir AA, Fitri R, Zulyusri. Perceptions of sexual education in adolescents: A Literature Review. Khazanah Pendidik Jurnal Ilmu Kependidikan 2022;16(2):111-6 (Indonesian) https://doi.org/10.30595/jkp.v16i2.14103
  27. Febriyansyah MS. Student perceptions regarding sex education (qualitative descriptive study) in upper class students at SDN Bandungan 03 Semarang Regency. Dwijaloka Jurnal Pendidikan Dasar dan Menengah 2021; 2(3):405-12 (Indonesian)
  28. Mardiah, Muflihah, Laily R. The relationship between adolescent reproductive health counseling and students' perceptions of adolescent sexuality in class XI of SMA Negeri 1 Jejangkit, Barito Kuala Regency. Jurnal Midwefery Dan Reproduksi 2020; 3(2):18-26 (Indonesian) https://doi.org/10.35747/jmr.v3i2.468
  29. Sejati, DW. The trend of early marriage in Solo is still high, this year there have been 29 cases. Solopos 12 Mei 2023; 16:53 (Indonesian)
  30. Dania. Case of violences in Solo are increasing. RRI co.id ; 23 April 2024; 22:28 (Indonesian). https://www.rri.co.id/daerah/650400/kasus-kekerasan-di-solo-makin-meningkat#:~:text=Dalam%20kesempatan%20yang%20sama%20Direktur,dan%2038%20adalah%20kekerasan%20seksual.
  31. Rea, LM., & Parker, RA. Designing and conducting survey research: A comprehensive guide (4th ed.). San Fransisco: Jossey-Bass, A Wiley Brand, 2014
  32. Taherdoost, H. What is the best response scale for survey and questionnaire design; Review of different lengths of rating scale/ attitude scale/ Likert Scale. Inter J of Acad Res in Manag 2019; 8(1), 1-10 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3588604
  33. Vongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JEW, Sychareun V, et al. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS One 2019; 14(1):1-14. https://doi.org/10.1371/journal.pone.0209675 PMid:30650100 PMCid:PMC6334956
  34. Directorate of Family Education Development. Parent education series: Protecting children from sexual violence. 1st ed. Solihin AM, Suradi, editors. Jakarta: Kementerian Pendidikan dan Kebudayaan 2017; 1-40 (Indonesian)
  35. Susanti AI, Indraswari N. Information literacy about adolescent reproductive health education (KRR). J Menara Med 2020; 3(1):87-94 (Indonesian)
  36. Hermawan B. Teacher module: Reproductive health and sexuality education for adolescents with intellectual disabilities. 1st ed. Kurniawan H, Ardha O, editors. Jakarta: Kementerian Pendidikan dan Kebudayaan 2020. 1-164p (Indonesian)
  37. Chung H, Ho R. Impact of parental involvement, teacher- student relationship, and resilience on academic performance among middle school students in Kang Won Province, in South Korea. Sch Hum Sci 2017; 8(2):122-9.
  38. Primasasti, A. (2022). Fasilitas Kesehatan di Kota Surakarta. https://surakarta.go.id/?p=26940
  39. Fonner VA, Armstrong KS, Kennedy CE, O'Reilly KR, Sweat MD. School based sex education and HIV prevention in low and middle-income countries: A systematic review and meta-analysis. PLoS One 2014; 9(3). https://doi.org/10.1371/journal.pone.0089692 PMid:24594648 PMCid:PMC3942389
  40. Hamson Z, Maryam A, Atrianingsi A, Rahmawati. Counseling on communication patterns and sexual health literacy for adolescents in Makassar City. J Character Educ Soc 2018; 1(2):1-8 (Indonesian)
  41. Nayoan CR, Haninuna GY. Increasing adolescent reproductive health literacy through training of adolescent posyandu cadres in island areas. J Pengabdi Kesehat Masy 2022; 4(1):1-10 (Indonesian)https://doi.org/10.37905/jpkm.v4i1.16512
  42. Nurbaya S, Qasim M. Implementation of sex education (underwear rules) to prevent sexual violence against children and parents at SD Negeri 52 Welonge, Soppeng Regency. Media Kesehat Politek Kesehat Makassar 2018; 13(2):19 (Indonesian) https://doi.org/10.32382/medkes.v13i2.612
  43. Wibowo M, Gustina E, Hastuti SKW. Efforts to increase the knowledge of peer educators at youth counseling information centers about reproductive health. J Peng dan Pemb Masy 2020; 4(2):187-93 (Indonesian) https://doi.org/10.30595/jppm.v4i2.5726
  44. Nurmuhammad A. Characteristics and development of cognitive processes such as perception, memory, imagination in students at junior school age. Pedagog Resp Ilmiy Jurnali 2023; 6(4):693-8.
  45. Martin JC, Mak JY. College students' sexual knowledge and attitudes. KAHPERD J 2013; 51(1).
  46. Aini RQ, Rachmatullah A, Ha M. Indonesian primary school and middle school students' attitudes toward science: Focus on gender and academic level. J Balt Sci Educ 2019; 18(5):654-67. https://doi.org/10.33225/jbse/19.18.654
  47. Shin-jeong K, Jeong-eun L, Seong-hee K, Kyung-ah K. The effects of sex education on sexual knowledge and sexual attitudes of elementary school students: One district elementary school students. J Korean Public Heal Nurs 2012; 26(3):389-403. https://doi.org/10.5932/JKPHN.2012.26.3.389
  48. Xu D, Li Q. Gender achievement gaps among Chinese middle school students and the role of teachers' gender. Econ Educ Rev 2018; 67:82-3. https://doi.org/10.1016/j.econedurev.2018.10.002
  49. Febriawati H, Padila P, Anita B. Adolescent Sexual Education through Poskesja. J Pengabdi Masy Bumi Raflesia 2018; 1(1):45-54 (Indonesian) https://doi.org/10.36085/jpmbr.v1i1.193
  50. Andriani R, Suhrawardi, Hapisah. The relationship between the level of knowledge and attitudes of adolescents with premarital sexual behavior. J Inov Penelit 2022; 2(10):3441-6 (Indonesian)
  51. Misrina, Safira S. The relationship between knowledge and attitudes of adolescent girls and premarital sexual behavior at State High School 2 Mereudu, Meurah Dua District, Pidie Jaya Regency. J Health Technol Med 2020; 6(1):373-82 (Indonesian)
  52. Mona S. The relationship between adolescent knowledge and attitudes about reproductive health and students' premarital sexual behavior. J Penelit Kesmasy 2019; 1(2):58-65 (Indonesian)
  53. Kumah NYG, Kyere F, Agyemang AB. An analysis of students' perception of sex education programmes and their effects on adolescent sexual behaviour in KNUST Junior High School, Kumasi. J Educ Pract 2017; 8(32):26-40.
  54. Hatami M, Kazemi A, Mehrabi T. Effect of peer education in school on sexual health knowledge and attitude in girl adolescents. J Educ Health Prom 2015; 4:1-6.https://doi.org/10.4103/2277-9531.171791PMid:27462620 PMCid:PMC4944604
  55. Perbawaningsih Y. Questioning the elaboration likelihood model (ELM) and rhetorical theory. J Ilmu Kom 2012; 9(1):1-17 (Indonesian) https://doi.org/10.24002/jik.v9i1.50
  56. Petty RE, Brinol P. The elaboration likelihood and metacognitive models of attitudes: Implications for prejudice, the self, and beyond. In: Sherman JW, Gawronski B, Trope Y, editors. Dual-process theories of the social mind. New York: Guilford Press; 2014. p. 172-87.