Literacy-sensitive sexual and reproductive health education for adolescents in Ghana: Evidence from a school-based quasi-experimental study.

Authors

Jacqueline Nkrumah

Published in

Public health in practice (Oxford, England). Volume 12. Pages 100854. Epub Sep 18, 2026.

Abstract

This study examined how the complexity and format of sexual and reproductive health (SRH) education materials influence adolescents' functional SRH literacy and its implications for literacy-sensitive SRH education.
Quasi-experimental study design.
This school-based quasi-experimental study was conducted among 317 adolescents aged 11-15 years (grades 7-8) in the Effutu Municipality. Schools were cluster-assigned to standard text, simplified text, picture-enhanced text, or comparison conditions. Participants engaged in six weekly guided reading and facilitated discussion sessions. Data were analyzed using SPSS 26.0 and STATA 17.0, applying regression-based difference-in-differences (DiD) and fixed-effects models.
Of the 317 adolescents assessed at baseline, 249 completed the intervention. The DiD results showed significant improvements in functional SRH literacy for simplified text (12.28 points; 95% CI: 6.79-17.77; p = 0.001) and picture-enhanced text (10.26 points; 95% CI: 4.37-16.14; p = 0.001), while the standard text showed no significant change. The fixed-effects estimates confirmed similar gains for the simplified (13.87 points; 95% CI: 7.33-20.42; p = 0.001) and picture-enhanced materials (13.06 points; 95% CI: 6.94-19.17; p = 0.001). Although pictorial supports improved textual comprehension, their contribution to numeracy-related literacy was limited and, in some school contexts, elicited sociocultural resistance.
The findings illustrate the pedagogical value of simplifying SRH educational materials and support literacy-sensitive school-based health promotion strategies. They also emphasize the need to consider sociocultural context when designing and implementing age-appropriate SRH education, particularly in underserved settings.

PMID:
42831045
Bibliographic data and abstract were imported from PubMed on 05 Oct 2026.

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