- PREDICTORS OF SEXUAL AND REPRODUCTIVE HEALTH LITERACY AMONG FEMALE STUDENTS IN BANGKOK, THAILAND
Predictors of SRHL among female students
Keywords:sexual and reproductive health literacy, associating factors, teenage pregnancy, high school students
Teenage sexual and reproductive health literacy (SRHL) may reduce sexual risk behaviors. In this study, we aimed to identify factors significantly associated with SRHL among female students aged 11-19 years in Bangkok, Thailand in order to guide efforts to improve SRHL in the study population. Inclusion criteria for study subjects were being aged 11-19 years, attending a study public high school in Bangkok, having no communication problems and being willing to participate in this study. The exclusion criterion was being absent during data collection. Study subjects were selected by a two-stage stratified random sampling technique. The minimum number of subjects calculated to be needed for the study was 383 but we added additional subjects to account for missing and incomplete data. Each subject was asked to complete a self-administered questionnaire asking about their sexual attitudes toward opposite sex, their perceived family relationships, their perceived sexual influence of peers, their perceived school connectedness, the type of living environment, sex education activities and their SRHL level. The SRHL level was assessed by asking questions about the subject’s ability to access, understand, appraise and apply sexual and reproductive health (SRH) information to their sexual health. Answers were quantified into a possible score of 0-150 points. Each subject’s score was categorized using Bloom’s cut-off points into one of three levels: low (<90 points), intermediate (90-119 points) and high (120-150 points) SRHL levels. The questionnaire was pilot-tested using 30 female students who met inclusion and exclusion criteria but were not included in the study. Multinomial logistic regression analysis was used to identify factors significantly associated with SRHL level. The study was conducted during February-March 2021. A total of 394 subjects were included in this study. The mean (± standard deviation (SD)) age of study subjects was 15 (+2) (range: 11-19) years. 52.5% of subjects (n = 207) were in grades 10-12. 6.3% (n = 25), 58.2% (n = 229) and 35.5% (n = 140) had low, intermediate and high SRHL levels, respectively. The factor significantly positively associated with an intermediate SRHL level was perceiving having a positive sexual influence by peers (adjusted odds ratio (aOR) = 1.43; 95% confidence interval (CI): 1.23-1.66, p<0.001). The factors significantly negatively associated with an intermediate SRHL level were: having a good sexual attitude toward the opposite sex (aOR = 0.89; 95% CI: 0.80-0.99, p = 0.030) and perceiving having positive sex education activities (aOR = 0.82; 95% CI: 0.68-0.99, p = 0.034). The factors significantly positively associated with a high SRHL level were: perceiving having a good family relationship (aOR = 1.12; 95% CI: 1.04-1.21, p = 0.004) and perceiving their peers had a positive sexual influence on them (aOR = 1.90; 95% CI: 1.60-2.25, p<0.001). The factor significantly negatively associated with a high SRHL level was having a good sexual attitude toward the opposite sex (aOR = 0.87; 95% CI: 0.78-0.98, p = 0.018). In summary, 93.7% of subjects had either an intermediate or high SRHL level. Factors significantly positively associated with having an intermediate or high SRHL level were perceiving their peers had a positive sexual influence on them and perceiving they had good family relationships. The factors significantly negatively associated with an intermediate or high SRHL level were having a good sexual attitude level toward opposite sex and perceiving having positive sex education activities. We conclude that to improve SRHL levels in the study population, it is important to encourage the positive factors and determine how the negative factor can be improved. Further studies are needed to determine how best to accomplish this in the study population.
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