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Health Literacy and Utilization of Reproductive Health Services Among High School Students

*Izzatul Arifah  -  Departement of Public Health, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Indonesia
Afrin Linda Dewi Safari  -  Departement of Public Health, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Indonesia
Diella Fieryanjodi  -  Departement of Public Health, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Indonesia
Open Access Copyright (c) 2022 Jurnal Promosi Kesehatan Indonesia

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Background: Utilization of reproductive health service may improve adolescent health and prevent reproductive health problems in adulthood. However, the proportion of adolescents who uses the available services remains low. Many factors influenced the services use among adolescents. The relation of adolescents’ health literacy and reproductive health service use was not fully understood. This study intended to examine the relationship between health literacy and use of reproductive health counseling service among high school students in one school in Banyumas Regency, controlling other variables (knowledge, acceptability, age, and sex).

Method:  A cross-sectional study was conducted in March-April 2021 in one high school (SMA Negeri 4 Purwokerto), Banyumas regency, Central Java Province. Samples were 170 students purposively chosen from the first and second grade who were willing to fill the self-administered online questionnaire. Data of health literacy were collected using eHEALS questionnaire. Other data were obtained using valid and reliable self-design questionnaires. Multiple logistic regression was deployed to analyze the relationship between variables.

Results: Health literacy had a significant relationship with the use of reproductive health services among adolescents. The probability of the reproductive health counseling service was doubled if they had a good health literacy level among students who had high acceptability toward the service and were female with an OR value of 2.1 (95% CI 1.01-4.49). In conclusion, adolescent’s health literacy level is associated with the utilization of reproductive health services. Further research is needed to confirm the association between the variables in more extensive settings. 

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Keywords: exclusive breastfeeding;adolescents;reproductive health service;health literacy;health service utilization

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  1. Chandra-Mouli V, Svanemyr J, Amin A, Fogstad H, Say L, Girard F, et al. Twenty years after international conference on population and development: Where are we with adolescent sexual and reproductive health and rights? J Adolesc Heal. 2015 Jan 1;56(1):S1–6
  2. Haberland N, Rogow D. Sexuality Education: Emerging Trends in Evidence and Practice. J Adolesc Heal [Internet]. 2015 [cited 2021 Apr 26];56:S15–21. Available from:
  3. BKKBN, BPS, Kementrian Kesehatan RI, USAID. Indonesia Demographic and Health Survey (IDHS) 2017. Jakarta: BKKBN, BPS, Kemenkes RI and USAID; 2018
  4. Indonesian Ministry of Health. Infodatin Reproduksi Remaja. Situasi Kesehatan Reproduksi Remaja. Jakarta; 2018
  5. BKKBN. Laporan Akuntabilitas Kinerja Instansi Pemerintah Badan Kependudukan dan Keluarga Berencana Nasional Tahun 2017. Badan Kependud dan Kel Berencana Nas. 2018;1(1):1–108
  6. Nurmansyah, Aufa, Amran. Role of Family, Society and Media as a Source of Information on Reproductive Health Amongst University Students. 2012;3(2):16–23
  7. Tarmidi M, Demartoto A, Pamungkasari EP. Factors Associated with Pre-Marital Sexual Behavior Among Adolescents in Bima, West Nusa Tenggara: Theory of Planned Behavior. J Heal Promot Behav [Internet]. 2018 [cited 2021 Jun 28];3(1):78–85. Available from:
  8. Arifah I, Muna N, Paramastri I. Does Indonesian adolescent counseling and information center affect adolescent reproductive health outcome? EurAsian J Biosci [Internet]. 2020 [cited 2021 Apr 27];14(2):5347–54. Available from:
  9. Arifah I, Kusumawardani LA, Hendriyaningsih D, Wibisono MA, Lestari EP. The determinants of access to adolescent-friendly health service: A Case Control study. J Adm Kesehat Indones [Internet]. 2020 [cited 2021 Apr 27];8(2). Available from:
  10. Nursal DGA, Mardatillah M, Desirman Pratiwi S, Rahmadona S, Kesehatan Masyarakat I, Kesehatan Masyarakat F, et al. Pemanfaatan pusat informasi dan konseling remaja (PIK-R) oleh remaja di SMK kota Padang tahun 2020. IAKMI J Kesehat Masy Indones [Internet]. 2020 [cited 2021 Apr 27];1(3). Available from:
  11. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: An analytical framework for selectingappropriate interventions in low-income Asian countries. Health Policy Plan. 2012;27(4):288–300
  12. Afrima A, Emilia O. Akseptabilitas dan Pemanfaatan Pusat Informasi dan Konsultasi Kesehatan Reproduksi Remaja (PIK-KRR) pada siswa SMU Di Kota Bima NTB. 2011 [cited 2021 Apr 26]; Available from:
  13. Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: A systematic review. J Adolesc [Internet]. 2018;62:116–27. Available from:
  14. 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
  15. Norman CD, Skinner HA. eHEALS: The eHealth literacy scale. J Med Internet Res [Internet]. 2006 Nov 14 [cited 2021 Apr 24];8(4):e507. Available from:
  16. Wijaya MC, Kloping YP. Validity and reliability testing of the Indonesian version of the eHealth Literacy Scale during the COVID-19 pandemic. Health Informatics J [Internet]. 2021 Jan 1 [cited 2021 May 27];27(1). Available from:
  17. Park A, Eckert TL, Zaso MJ, Scott-Sheldon LAJ, Vanable PA, Carey KB, et al. Associations Between Health Literacy and Health Behaviors Among Urban High School Students. J Sch Health [Internet]. 2017 Dec 1 [cited 2021 May 25];87(12):885–93. Available from: /pmc/articles/PMC5669371/
  18. Ibegbulam IJ, Akpom CC, Enem FN, Onyam DI. Use of the Internet as a source for reproductive health information seeking among adolescent girls in secondary schools in Enugu, Nigeria. Heal Inf Libr J [Internet]. 2018 Dec 1 [cited 2022 Jan 27];35(4):298–308. Available from:
  19. 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 [Internet]. 2012 [cited 2021 Apr 24]. Available from:
  20. Nisaa, F.A. Arifah I. Akses informasi kesehatan reproduksi dan seksual komprehensif melalui internet pada remaja SMA. In: Seminar nasional prodi kesehatan masyarakat UMS. Sutrakarta: Fakultas Ilmu Kesehatan Universitas Muhammadiyah Surakarta; 2019. p. 64–72
  21. Chang FC, Chiu CH, Chen PH, Miao NF, Lee CM, Chiang JT, et al. Relationship between Parental and Adolescent eHealth Literacy and Online Health Information Seeking in Taiwan. Cyberpsychology, Behav Soc Netw. 2015 Oct 1;18(10):618–24
  22. Mcluckie A, Kutcher S, Wei Y, Weaver C. Sustained improvements in students’ mental health literacy with use of a mental health curriculum in Canadian schools. BMC Psychiatry. 2014 Dec 31;14(1)
  23. Videto D, practice JD-H promotion, 2019 undefined. Promoting health literacy through defining and measuring quality school health education. [Internet]. 2019 Nov 1 [cited 2021 May 27];20(6):824–33. Available from:
  24. Levin-Zamir D, Lemish D, Gofin R. Media Health Literacy (MHL): development and measurement of the concept among adolescents. Int J Environ Res Public Heal [Internet]. 2018 [cited 2021 Apr 24];15:1643. Available from:
  25. Chandra-Mouli V, Chatterjee S, Bose K. Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents. Reprod Health [Internet]. 2016 Feb 6 [cited 2021 May 27];13(1):1–8. Available from:
  26. Pastrana-Sámano R, Heredia-Pi IB, Olvera-García M, Ibáñez-Cuevas M, De Castro F, Hernández AV, et al. Adolescent Friendly Services: Quality assessment with simulated users. Rev Saude Publica [Internet]. 2020 Apr 6 [cited 2021 May 27];54:36. Available from:
  27. Hayrumyan V, Grigoryan Z, Sargsyan Z, Sahakyan S, Aslanyan L, Harutyunyan A. Barriers to utilization of adolescent friendly health services in primary healthcare facilities in Armenia: a qualitative study. Int J Public Health [Internet]. 2020 Nov 1 [cited 2021 May 27];65(8):1247–55. Available from:
  28. Char A, Saavala M, Kulmala T. Assessing young unmarried men’s access to reproductive health information and services in rural India. BMC Public Health. 2011;11(1):476
  29. Eisenberg ME, Garcia CM, Frerich EA, Lechner KE, Lust KA. Through the eyes of the student: What college students look for, find, and think about sexual health resources on campus. Sex Res Soc Policy. 2012;9(4):306–16
  30. Regmi PR, Van Teijlingen E, Simkhada P, Acharya DR. Barriers to sexual health services for young people in Nepal. J Health Popul Nutr. 2010;28(6):619
  31. Amissah C. Factors Influencing Accessibility and Utilization of Reproductive Health Services Among Adolescent in Ga East Municipality [Internet]. 2019 [cited 2021 May 27]. Available from:
  32. Cudjoe KF, Francis K. Assessing the knowledge, access and utilization of Adolescent friendly health service in Kumbungu District, Ghana. [Internet]. Universities for Development Studies; 2018 [cited 2021 May 27]. Available from:
  33. Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, et al. Adolescence: A foundation for future health. Lancet. 2012;379(9826):1630–40
  34. Kreager DA, Staff J, Gauthier R, Lefkowitz ES, Feinberg ME. The Double Standard at Sexual Debut: Gender, Sexual Behavior and Adolescent Peer Acceptance. Sex Roles. 2016 Oct 1;75(7–8):377–92
  35. Cvetkovi´ccvetkovi´c VM, Nikoli´cnikoli´c N, Radovanovi´c U, Nenadi´c RN, Öcal A, Noji EK, et al. Preparedness and Preventive Behaviors for a Pandemic Disaster Caused by COVID-19 in Serbia. Int J Environ Res Public Heal [Internet]. 2020 [cited 2021 May 27];17:4124. Available from:

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    Ayu Wulandari, Ayu Khoirotul Umaroh. Advances in Health Sciences Research, 61 , 2023. doi: 10.2991/978-94-6463-184-5_19

Last update: 2023-12-03 18:55:45

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