Reproductive Health Literacy and Associated Factors among High School Adolescents in Boke District, Oromia Region, Eastern Ethiopia

Reproductive Health Literacy and Associated Factors among High School Adolescents in Boke District, Oromia Region, Eastern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reproductive Health Literacy and Associated Factors among High School Adolescents in Boke District, Oromia Region, Eastern Ethiopia Getachew Bejiga Batu, Lemessa Oljira, Mekonnen Sisay, Jemal Yusuf Kebira This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4235944/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Health literacy has recently attracted global interest in public health. Sexual and reproductive health literacy, in particular, affects people's ability to make sound sexual and reproductive health decisions and is shown as a strong predictor of adolescent sexual and reproductive health outcomes. This study aimed to determine the reproductive health literacy status and associated factors among high school adolescents in Boke District, Oromia Region, Eastern Ethiopia. Methods : Institutional-based Cross-sectional study was conducted on 403 adolescents aged 15 to 19 years from January 1-5, 2021. A systematic random sampling technique was used to recruit the study participants. Pre-tested, structured, self-administered questionnaire was used to collect the data. Data were entered using Epi data version 3.1 and analyzed by SPSS version 20. Both bivariate and multivariable logistic regression analyses were executed. The model fitness and Multicollinearity were checked using the Hosmer-Lemeshow goodness of fitness test and variance inflation factor, respectively. The significant statistical association was determined at a P-value <0.05 using an adjusted odds ratio (AOR) with 95% CI. Results: The study revealed that the overall prevalence of adequate reproductive health literacy among adolescents was 18.4% with a 95% CI (14.8%-22.5%). Female sex was about 52% times (AOR = 0.48, 95% CI: 0.26, 0.88) less likely to have adequate reproductive health literacy status. School adolescents never attending reproductive health topics in class were about 56% times (AOR = 0.44, 95% CI: 0.23, 0.84) less likely to have adequate reproductive health literacy status. School adolescents who never used reproductive health services ever were also about 60% times (AOR = 0.40, 95% CI: 0.23, 0.70) less likely to have adequate reproductive health literacy status. Conclusion: The finding of this study showed a large proportion of school adolescents have limited reproductive health literacy, suggesting school adolescents are at higher risk of reproductive health literacy-related problems. Thus, efforts should be made to improve adolescent reproductive health literacy with due attention to school sexual and reproductive health education. Reproductive health Literacy school adolescents Oromia Ethiopia Figures Figure 1 Figure 2 PLAIN LANGUAGE SUMMARY Health literacy has recently attracted global interest in public health. Sexual and reproductive health literacy, in particular, affects people's ability to make sound sexual and reproductive health decisions and is shown as a strong predictor of adolescent sexual and reproductive health outcomes. Schools are a venue to promote adolescents' sexual and reproductive health. However, the extent to which health literacy is recognized and prioritized varies considerably within and between countries, and schools. In Ethiopia, given that reproductive health literacy is a new concept, there is a pausity of information regarding reproductive health literacy, especially among school adolescents. Therefore, this study we assessed adolescents reproductive health literacy status and associated factors through school based cross-sectional study design.Our finding revealed that nealy one out of five adolescent had adequate reproductive health literacy, suggesting a large proportion of school adolescents have limited reproductive health literacy. Thus, efforts should be made to improve adolescent reproductive health literacy with due attention to school. INTRODUCTION Health literacy refers to social and cognitive skills that entail an individual’s motivation and competencies to access, understand, appraise, and utilize information to make appropriate health decisions to promote and maintain good health [ 1 ]. In recent years, health literacy has attracted global interest in public health [ 2 ], essentially in adolescent health [ 3 ]. Health literacy is a key determinant of health that should be given priority in public health [ 4 ], hence recognized as one of the key health promotion strategies to meet health-related Sustainable Development Goals [ 5 ]. Low health literacy is a global problem. For instance, according to a recent systematic review analysis, approximately, 48%, 64.8%, and 67.5% of adults in Europe, and Sub-Saharan Africa, and Southern Asia are thought to have limited health literacy, respectively [ 6 – 8 ]. Empirical evidence suggests that limited health literacy is associated with adverse health outcomes [ 9 ], poor reproductive health decisions [ 10 ], the higher financial cost of healthcare, and health Inequality [ 11 ]. Consequently, sexual and reproductive health (SRH) literacy is of particular, affects people’s ability to make sound SRH decisions and is shown as a strong predictor of SRH outcomes[ 12 , 13 ]. Adolescents are at a critical stage when new and different health problems related to the onset of sexual activity, emotional control, and behavior typically emerge and pose a major threat to their current and future health and well-being [ 14 ]. Notably, adolescents are at a crucial developmental stage when advances in cognitive abilities, information-processing capacities, and reasoning skills are achieved [ 15 ]. Based on these vulnerabilities and opportunities, adolescence is a suitable developmental stage to promote health literacy, especially in the domain of sexual and reproductive health, as promoting health literacy at a younger age has a positive health impact across the life course [ 16 ]. In Ethiopia, adolescents face numerous risks to their sexual and reproductive health including Teenage pregnancy, sexual violence, early marriage, unintended pregnancy, and sexually transmitted infections including HIV [ 17 ]. One of the contributing factors to the rising sexual and reproductive health burden among the adolescent population is low sexual and reproductive health literacy [ 12 ]. Considering adolescent health as a priority concern for social, political, and economic development, the government of Ethiopia has been undertaking different initiatives over the last two decades [ 18 , 19 ]. Different policies and guidelines to support the implementation of youth-friendly services have been developed. One of the interventions modalities suggested to promote adolescents' health was innovative health education and prevention information through the school systems, as a venue to reach the majority of adolescents[ 13 , 19 ]. Furthermore, the newly adopted strategy calls for a new intervention to continually improve the health and development of adolescents through participation [ 19 ]. Thus, sexual and reproductive health literacy is crucial for adolescents to actively participate in their SRH care, interact with the health system, and access health information to mold their actions and behaviors. Despite, schools are considered a critical setting for health literacy development, however, the extent to which health literacy is recognized and prioritized varies considerably within and between countries, and schools [ 20 ]. It is also important to note that, institutional commitment and priority, workplace culture, and awareness of needy people can influence the level of health literacy [ 4 , 21 ]. Given that health literacy is a new concept and has been positioned as a means to promote health [ 22 ], especially adolescents' sexual and reproductive health [ 23 ], it is essential to generate evidence regarding the level of SRH literacy and associated factors among adolescents in Ethiopia. Therefore, this study aimed to determine the level of reproductive health literacy and associated factors among high school adolescents in the Boke District of Oromia region, Eastern Ethiopia. This study will contribute to the design of intervention strategies aimed at improving the SRH of adolescents. METHODS AND MATERIALS Study Design, Setting, and Period Institutional-based Cross-sectional study design was conducted on high school adolescent students in Boke District, Oromia Region, Eastern Ethiopia from January 1–5, 2021. Administratively, the District is divided into 23 Kebele (the smallest administrative unit in Ethiopia). Regarding the health and education infrastructure, the District has twenty-seven health facilities (five health centers and twenty-two health posts) and fifty-five schools ( three high schools and 52 primary schools). In 2020, the total population of the District was 144658 (based on the projection of the 2007 national census, CSA). Sample Size Determination and Sampling Technique The sample size for this study was calculated by a single population proportion formula [n= (Z α/2) 2 P (1-P)/d 2 ] considering the following assumptions; 50% prevalence of adequate reproductive health literacy, 95% confidence level, 5% tolerable margin of error, and 5% expected non-response rate. The final sample size was become 403. A stratified multistage sampling technique was used to select the representative adolescent students. First, three high schools were randomly selected from high schools in the District. To achieve representativeness, the study participants were stratified based on their schooling level (grades 9,10, 11, and 12) in each randomly selected high school. Then, the total number of adolescents aged 15–19 years in each stratum was identified based on their registration numbers. Accordingly, a total of 2368 adolescents were identified. Next, the probability to proportional sampling was used to allocate the total sample size proportional to the size of study participants in each stratum. Finally, eligible study participant was selected using a systematic sampling technique. Students who have serious health problems that hinder them not to respond to the interview during the data collection and those, who could not provide formal informed consent from their parent or guardian (if their age were less than 18 years) were excluded. Data collection tools, procedures, and quality control Due to lack of standardized and validated tool to measure in school adolescent’s sexual and reproductive health literacy at national level, the researcher designed questionnares (measuring reproductive health literacy in four functional areas of health literacy), based on the adolescent health literacy framework [ 21 ] and Health Literacy Measure for Adolescents (HELMA) which is a valid and reliable tool for the measurement of the health literacy of adolescents aged 15–19, and validated reproductive health questionnaires among unmarried youth in China [ 24 , 25 ]. In addition, the researcher designed questionnnare reviewing related literature and validated questionnares in another area [ 26 – 29 ] and contextualized to the study objectives. Finally, the questionnares were finalized in four parts: Socio-demographic, adolescents information-seeking behavior and reproductive health service utilization, and items for measuring reproductive health literacy in four functional dimentions (access, understand, appraise, and apply RH information). Data were collected by pre-tested, structured self-administered questionnaires. The data collection instrument was pretested on 5% of the sample in Bedesa High School adolescents ( near non-study adjacent Districts school). Six nurses and two public health officers who are fluent in the local language were assigned as data collectors, and supervisors respectively after having two days of training on the study objectives, responsibilities, and rights of respondents. The questionnaire was prepared in English first then translated into the Afan Oromo (local language) and again was re-translated to English to maintain consistency in translation. All completed questionnaires were checked daily to ensure completeness, and consistency at all stages of the data collection period. Double data entry was done for 20% of the questionnaire to see consistency in data entry using a programmed computer software package (Epi-Data version 3.1). Measurements and variables The measurable outcome variable was reproductive health literacy status. It was dichotomized as limited and adequate RHL. A comprehensive questionnaires were designed to measure adolescent’s reproductive health literacy. Adolescents were asked to rate their perceived ability to access, understand, appraise, and apply RH information using a five-point Likert scale scored from 0 to 4, which stands for a scale of don't know = 0' to very easy = 4'. A total of 31 questions were measured and transformed into a scale from 0 to 50, where 0 represents the lowest and 50 is the highest reproductive health literacy score level. Based on this score, reproductive health literacy was categorized into four levels: inadequate (0–25), problematic ( > 25–33), sufficient ( > 33–42), and excellent ( > 42–50). Finally, those who scored inadequate or problematic reproductive health literacy were defined as limited health literacy and those with sufficient and excellent health literacy were defined as adequate health literacy. Operational Definitions Adequate reproductive health literacy status: those respondents with sufficient or excellent reproductive health literacy scores. Limited reproductive health literacy status: those respondents with inadequate reproductive health literacy or Problematic health literacy. Inadequate health literacy: a literacy status marked for a respondent with a mean index score of 0–25. Problematic health literacy: a literacy status marked for a respondent with a mean index score of 25 < 33. Sufficient health literacy: a literacy status marked for a respondent with a mean index score of 33 < 42 Excellent health literacy: a literacy status marked for a respondent with a mean index score of 42 < 50 Data Processing and Analysis Data were entered using Epi-data version 3.1 (EpiData Association, Odense, Denmark) and exported to Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, U.S.A) for analysis. Descriptive statistics were computed and mean (standard deviation) for continuous data as well as frequency and percentage for categorical data were used to describe adolescents’ characteristics. Both binary and multivariable logistic regression models were used. First, binary logistic regression analysis was done, and then variables that showed association with the outcome variable at a p-value ≤ 20% in the bivariate logistic regression model were entered into a multivariable logistic regression analysis was conducted to identify factors significantly associated with the outcome variable. The model fitness was checked using the Hosmer-Lemeshow goodness of fitness test. Multicollinearity was also checked to see the correlation between independent variables by using the variance inflation factor. The significant statistical association was determined at a P-value < 0.05 using an adjusted odds ratio (AOR) with 95% CI. RESULTS Socio-demographic Characteristics of the Study Participants Out of 403 High School adolescent students targeted to participate in the study, 391 students were interviewed, resulting response rate of 97.02%. The mean age (±SD) of the adolescent was 17.21(±1.22) years. Male adolescents accounted for 247 (63.2%) of the study participants. The majority of the students, 325 (83.1%) were Muslims in their religion. Of most of the study participants,367 (93.9%) were never married. Nearly a third (33.5%) of participants were grade 9 attendants ( Table 1 ). Source of Reproductive Health Information and Information-seeking Behavior among the Study Participants Slightly more than a third (34.8%) of the adolescents had never attended reproductive health subjects in class and more than three-quarters (76%) of them tend to have learned more reproductive health topics in school. The majority of adolescents (69.1%) had never used any reproductive health services and more than a third (37.9%) participated in school adolescent sexual and reproductive health (SRH) club activities. Concerning the source of reproductive health information, the most preferred source of information for adolescents was health workers (40.9%) followed by school teachers (28.6%) ( Table 2 ). Levels of Reproductive Health Literacy Regarding the Prevalence of reproductive health literacy, nearly one out of five adolescents has adequate reproductive health literacy status, 18.4% (95% CI: 14.8- 22.5) (Figure 1). Based on four health literacy domains, the overall average reproductive health literacy score was 23.9/50. The highest score (26/50) was related to understanding reproductive health information, whereas the lowest score (22.4/50) was related to appraising reproductive health information (Figure 2). Factors Associated With Reproductive Health Literacy Among High school Adolescents In this study, multivariate logistic regression analysis revealed, that the sex of adolescents, ever-attended reproductive health topics in class, and ever-use of reproductive health services were significantly associated with reproductive health literacy. Female adolescents were 52 % less likely to have adequate reproductive health literacy compared to male adolescent students (AOR=0.48, 95% CI: 0.26, 0.88). School adolescents never attending reproductive health topics in class were about 56% times (AOR = 0.44, 95% CI: 0.23, 0.84) less likely to have adequate reproductive health literacy status. School adolescents who never used reproductive health services were also about 60% times (AOR = 0.40, 95% CI: 0.23, 0.70) less likely to have adequate reproductive health literacy status ( Table 3 ). DISCUSSION The study aimed to assess the level of reproductive health literacy and associated factors among high school adolescents. The study revealed that most high school adolescents were found to have limited reproductive health literacy. The sex of adolescents, ever attending reproductive health subjects in class, and ever use of reproductive health services, were found to be associated factors with the reproductive health literacy status of adolescents. The present study revealed that the proportion of limited reproductive health literacy among high school adolescents was high (82%). The finding is consistent with the study done on youth in Bander Abbas, Iran (85%) [ 30 ], and school adolescents in Lao People’s Democratic Republic (92.4%) [ 27 ]. The high proportion of limited reproductive health literacy in the current study might be related to the difficulty of adolescents in accessing the right reproductive health information, and poor habits of applications of reproductive health information, as overall adolescents’ competency of reproductive health information was low (23.9/50). Sex was found to be significantly associated with the reproductive health literacy status of school adolescents in the current study. Male adolescents had lower odds of having limited reproductive health literacy compared to their female counterparts (AOR = 0.48, 95% CI: 0.26, 0.88). Even though comparable literature is lacking specific to reproductive health literacy, the present finding is supported by previous studies [ 31 , 32 ], which reported higher odds of limited health literacy among female participants. However, this finding contrasts with the study conducted in Iran which reported no association between reproductive health literacy with gender [ 30 ]. The possible explanation may be due to gender inequalities and roles that hinder female students’ access to appropriate reproductive health information. Restrictions on women’s movement, participation in politics, and social affairs limit their access to various sources of health information [ 33 ], which in turn contributes to their lower health literacy. Ever-attending reproductive health topics in class was found to be significantly associated with the reproductive health literacy status of school adolescents in the present study. It was found adolescents who regularly attended reproductive health topics in class were 56% times less likely to have limited reproductive health literacy compared to their counterparts (AOR = 0.44, 95% CI: 0.23, 0.84). The finding is consistent with previous studies [ 27 ]. This may be possibly due to access to reproductive health information from educational sources in advance. Ever use of reproductive health services was also found to be significantly associated with adolescents’ reproductive health literacy status. The odds of limited reproductive health literacy were higher among the school adolescents who ever had used reproductive health care services than non-users. This is incontrast with the previous study [ 33 ] and the authors' expectations. It is logically anticipated that people with high health literacy scores have better decision-making capability and; thus better healthcare-seeking than those with low health literacy scores [ 12 , 34 ]. Even though there is no clear explanation, the contradiction in the current finding may be due to participants’ distinctions in understanding operationalized reproductive health care services utilization. This study has admitted a few limitations. First, since data were collected through self-administered questionnaires and not validated domestically, the study may be subjected to self-reporting bias. Second, as it was a cross-sectional design, the study cannot recognize changes in reproductive health literacy over longer periods and cannot establish the cause-effect relationship between outcome and independent variables. Finally, due to the limited sample size, the findings of this study may not be generalizable to school adolescents in Ethiopia. Conclusion In conclusion, this study showed that a large proportion of school adolescents have limited reproductive health literacy, suggesting school adolescents lack adequate competencies in reproductive health literacy; thus are at higher risk of reproductive health literacy-related problems. Sex of adolescents, ever attending reproductive health subjects in class, and ever use of reproductive health services, were found to be predictors of reproductive health literacy status among school adolescents in the study area. Thus, efforts should be made to improve adolescent reproductive health literacy with due attention to school sexual and reproductive health education. Declarations Ethics Approval and Consent to Participate Written and verbal informed consents were obtained from all participants. Regarding minors (under 18 years), verbal assent was obtained from the participants, and signed informed consent was obtained from their parents or guardians as well. The study obtained ethical approval from the Institutional Health Research Ethics Review Committee (IHRERC), College of Health and Medical Sciences, Haramaya University, Ethiopia. Confidentiality was secured through an anonymous questionnaire. Availability of Data and Material The data analyzed and reported in this study will be available from the corresponding author upon reasonable request. Competing Interests The authors have no competing interests that could seem to influence the work reported in this article. Funding The authors received no financial support from any agency for conducting this research, and /or publication of this article. Authors’ Contributions GB, LO, and MS, made a significant contribution to the conception of the idea and design, participated in proposal development and data collection, and analyzed and interpreted the data. JK wrote the original draft of the manuscript. MS, JK, and LO reviewed and edited the manuscript for important intellectual content. All authors read and approved the final manuscript. Acknowledgments The authors would like to thank Haramaya University, College of Health and Medical Sciences for providing an opportunity to conduct this study. 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Variables Frequency Percent Age (in ears) 15-16 17-19 120 271 30.7 69.3 Sex Female Male 144 247 36.8 63.2 Marital status Married Single 24 367 6.14 93.86 Religion Muslim Non-Muslim 325 66 83.1 16.9 Schooling level Grade 9-10 Grade 11-12 207 184 52.9 47.1 Table 2: Source of reproductive health information and information-seeking behavior among high school adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021 (n=391). Characteristics Frequency Percent Ever attended reproductive health subject in class Yes No 255 136 61.2 34.8 Tend to learn more reproductive health topics in class Yes No 297 94 76.0 24.0 Ever used sexual and reproductive health services Yes No 104 287 26.6 73.4 Participated in school adolescent and youth SRH club Yes No 156 235 39.9 60.1 Preferred source of reproductive health information Books/magazine Health workers/Doctors Friend/peer Internet Parent School teacher 16 160 34 13 56 112 4.1 40.9 8.7 3.3 14.3 28.6 Table 3: Factors associated with reproductive health literacy among high school Adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021(n=391) Variables Adequate RH literacy status COR(95%CI) AOR(95%CI) Yes No N (%) N (%) Sex Female 16(11.1) 128(88.9) 1 1 Male 56(22.4) 191(77.6) 0.46 (0.25,0.83) 0.48 (0.26,0.88)* Marital status Married 4(16.7) 20(83.3) 1 1 Single 68(18.5) 299(81.5) 0.88 (0.32,1.28) 1.0 (0.32,3.15) Religion Non-Muslim 8(21.1) 30(78.9) 1 1 Muslim 64(18.1) 289(81.9) 1.2(0.53,2.74) 1.48(0.61,3.60) Ever attend RH topics in class No 122(89.7) 14(10.3) 1 1 Yes 197(77.3) 58(22.7) 0.39 (0.21, 0.73) 0.44(0.23,0.84)* Ever use RH service No 248(86.4) 39(13.6) 0.34 (0.2, 0.58) 0.40 (0.23,0.7)* Yes 71(68.3) 33(31.7 1 1 Participated in SRH club Never/rare 34(14.5) 201(85.5) 0.52(0.31,0.88) 0.71(0.41,1.23) Regular 38(24.4) 118(75.6) 1 1 Notes: *significant at P-Value <0.05 for AOR; CI: Confidence Interval; COR: Crude Odd Ratio; AOR: Adjusted Odd Ratio ; RH: Reproductive Health; SRH: Sexual and Reproductive Health. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4235944","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":289130202,"identity":"517fb77b-5b7b-4a63-8aa1-407bb12dc082","order_by":0,"name":"Getachew Bejiga Batu","email":"","orcid":"","institution":"Boke District Health Office, Oromia Regional Health Bureau","correspondingAuthor":false,"prefix":"","firstName":"Getachew","middleName":"Bejiga","lastName":"Batu","suffix":""},{"id":289130203,"identity":"a0058fdc-ea17-4b3c-8a47-869ace446309","order_by":1,"name":"Lemessa Oljira","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Lemessa","middleName":"","lastName":"Oljira","suffix":""},{"id":289130204,"identity":"748e795d-5769-4f98-a50b-5f66d5ced336","order_by":2,"name":"Mekonnen Sisay","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Mekonnen","middleName":"","lastName":"Sisay","suffix":""},{"id":289130205,"identity":"a8924402-d8d3-4f17-8adf-2a1b7be119ae","order_by":3,"name":"Jemal Yusuf Kebira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYBACxgYg8QDEYj6Q+OBDBYjB3EBYSwKIxZbw2HDGGZAWRvxawACiJfGZNGcb3BjcgLm9O/FDYtthe4NjzGnSjPNqo/nbgVp+VGzD7bCes5slgFoSNxxjS7Yu3HY8d8ZhxgbGnjO3cWuZkbsBpCXB4H5P4u2Z247lNgC1MDO24dEy/+3mHxCH8X+Q5p1zLHc+QS0zeLeBbGHccIwhSZq3oSZ3A0EtPbnbLBLOpSfOPMaQbDjj2IHcjUAtB/H5xbD97OYbH8qs7fmOMQCjsqYud975wwcf/KjAo6UBZBUbnH8YTB7AqR4I5MHkHzi/Dp/iUTAKRsEoGKEAAKagZsJPLxpEAAAAAElFTkSuQmCC","orcid":"","institution":"Haramaya University","correspondingAuthor":true,"prefix":"","firstName":"Jemal","middleName":"Yusuf","lastName":"Kebira","suffix":""}],"badges":[],"createdAt":"2024-04-08 11:14:27","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4235944/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4235944/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54576741,"identity":"1d970a39-fd87-41c0-bad2-19070b0baedd","added_by":"auto","created_at":"2024-04-12 13:51:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23409,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePrevalence of Reproductive Health Literacy among High School Adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4235944/v1/77d12fa185e537a58787f5fd.png"},{"id":54577686,"identity":"f3458b5a-ce37-4535-91fd-3f0630dee640","added_by":"auto","created_at":"2024-04-12 13:59:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29829,"visible":true,"origin":"","legend":"\u003cp\u003eAverage score of reproductive health literacy based on four health literacy domains among high school adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4235944/v1/de0b5180b0ba80398694ce06.png"},{"id":54693596,"identity":"f760d809-6d23-43a3-b09b-b4099c010b3f","added_by":"auto","created_at":"2024-04-15 10:42:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1130085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4235944/v1/58cee1b6-69ad-41f4-ab48-ce003e99837c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reproductive Health Literacy and Associated Factors among High School Adolescents in Boke District, Oromia Region, Eastern Ethiopia","fulltext":[{"header":"PLAIN LANGUAGE SUMMARY","content":"\u003cp\u003eHealth literacy has recently attracted global interest in public health. Sexual and reproductive health literacy, in particular, affects people\u0026apos;s ability to make sound sexual and reproductive health decisions and is shown as a strong predictor of adolescent sexual and reproductive health outcomes. Schools are a venue to promote adolescents\u0026apos; sexual and reproductive health. However, the extent to which health literacy is recognized and prioritized varies considerably within and between countries, and schools. In Ethiopia, given that reproductive health literacy is a new concept, there is a pausity of information regarding reproductive health literacy, especially among school adolescents. Therefore, this study we assessed adolescents reproductive health literacy status and associated factors through school based cross-sectional study design.Our finding revealed that nealy one out of five adolescent had adequate reproductive health literacy, suggesting a large proportion of school adolescents have limited reproductive health literacy. Thus, efforts should be made to improve adolescent reproductive health literacy with due attention to school.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eHealth literacy refers to social and cognitive skills that entail an individual\u0026rsquo;s motivation and competencies to access, understand, appraise, and utilize information to make appropriate health decisions to promote and maintain good health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, health literacy has attracted global interest in public health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], essentially in adolescent health [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Health literacy is a key determinant of health that should be given priority in public health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], hence recognized as one of the key health promotion strategies to meet health-related Sustainable Development Goals [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLow health literacy is a global problem. For instance, according to a recent systematic review analysis, approximately, 48%, 64.8%, and 67.5% of adults in Europe, and Sub-Saharan Africa, and Southern Asia are thought to have limited health literacy, respectively [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Empirical evidence suggests that limited health literacy is associated with adverse health outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], poor reproductive health decisions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the higher financial cost of healthcare, and health Inequality [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Consequently, sexual and reproductive health (SRH) literacy is of particular, affects people\u0026rsquo;s ability to make sound SRH decisions and is shown as a strong predictor of SRH outcomes[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdolescents are at a critical stage when new and different health problems related to the onset of sexual activity, emotional control, and behavior typically emerge and pose a major threat to their current and future health and well-being [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Notably, adolescents are at a crucial developmental stage when advances in cognitive abilities, information-processing capacities, and reasoning skills are achieved [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Based on these vulnerabilities and opportunities, adolescence is a suitable developmental stage to promote health literacy, especially in the domain of sexual and reproductive health, as promoting health literacy at a younger age has a positive health impact across the life course [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ethiopia, adolescents face numerous risks to their sexual and reproductive health including Teenage pregnancy, sexual violence, early marriage, unintended pregnancy, and sexually transmitted infections including HIV [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. One of the contributing factors to the rising sexual and reproductive health burden among the adolescent population is low sexual and reproductive health literacy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering adolescent health as a priority concern for social, political, and economic development, the government of Ethiopia has been undertaking different initiatives over the last two decades [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Different policies and guidelines to support the implementation of youth-friendly services have been developed. One of the interventions modalities suggested to promote adolescents' health was innovative health education and prevention information through the school systems, as a venue to reach the majority of adolescents[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Furthermore, the newly adopted strategy calls for a new intervention to continually improve the health and development of adolescents through participation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Thus, sexual and reproductive health literacy is crucial for adolescents to actively participate in their SRH care, interact with the health system, and access health information to mold their actions and behaviors.\u003c/p\u003e \u003cp\u003eDespite, schools are considered a critical setting for health literacy development, however, the extent to which health literacy is recognized and prioritized varies considerably within and between countries, and schools [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is also important to note that, institutional commitment and priority, workplace culture, and awareness of needy people can influence the level of health literacy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Given that health literacy is a new concept and has been positioned as a means to promote health [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], especially adolescents' sexual and reproductive health [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], it is essential to generate evidence regarding the level of SRH literacy and associated factors among adolescents in Ethiopia. Therefore, this study aimed to determine the level of reproductive health literacy and associated factors among high school adolescents in the Boke District of Oromia region, Eastern Ethiopia. This study will contribute to the design of intervention strategies aimed at improving the SRH of adolescents.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Setting, and Period\u003c/h2\u003e \u003cp\u003eInstitutional-based Cross-sectional study design was conducted on high school adolescent students in Boke District, Oromia Region, Eastern Ethiopia from January 1\u0026ndash;5, 2021. Administratively, the District is divided into 23 Kebele (the smallest administrative unit in Ethiopia). Regarding the health and education infrastructure, the District has twenty-seven health facilities (five health centers and twenty-two health posts) and fifty-five schools ( three high schools and 52 primary schools). In 2020, the total population of the District was 144658 (based on the projection of the 2007 national census, CSA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Determination and Sampling Technique\u003c/h2\u003e \u003cp\u003eThe sample size for this study was calculated by a single population proportion formula [n= (Z α/2)\u003csup\u003e2\u003c/sup\u003e P (1-P)/d\u003csup\u003e2\u003c/sup\u003e] considering the following assumptions; 50% prevalence of adequate reproductive health literacy, 95% confidence level, 5% tolerable margin of error, and 5% expected non-response rate. The final sample size was become 403.\u003c/p\u003e \u003cp\u003eA stratified multistage sampling technique was used to select the representative adolescent students. First, three high schools were randomly selected from high schools in the District. To achieve representativeness, the study participants were stratified based on their schooling level (grades 9,10, 11, and 12) in each randomly selected high school. Then, the total number of adolescents aged 15\u0026ndash;19 years in each stratum was identified based on their registration numbers. Accordingly, a total of 2368 adolescents were identified. Next, the probability to proportional sampling was used to allocate the total sample size proportional to the size of study participants in each stratum. Finally, eligible study participant was selected using a systematic sampling technique. Students who have serious health problems that hinder them not to respond to the interview during the data collection and those, who could not provide formal informed consent from their parent or guardian (if their age were less than 18 years) were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools, procedures, and quality control\u003c/h2\u003e \u003cp\u003eDue to lack of standardized and validated tool to measure in school adolescent\u0026rsquo;s sexual and reproductive health literacy at national level, the researcher designed questionnares (measuring reproductive health literacy in four functional areas of health literacy), based on the adolescent health literacy framework [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Health Literacy Measure for Adolescents (HELMA) which is a valid and reliable tool for the measurement of the health literacy of adolescents aged 15\u0026ndash;19, and validated reproductive health questionnaires among unmarried youth in China [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In addition, the researcher designed questionnnare reviewing related literature and validated questionnares in another area [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and contextualized to the study objectives. Finally, the questionnares were finalized in four parts: Socio-demographic, adolescents information-seeking behavior and reproductive health service utilization, and items for measuring reproductive health literacy in four functional dimentions (access, understand, appraise, and apply RH information).\u003c/p\u003e \u003cp\u003eData were collected by pre-tested, structured self-administered questionnaires. The data collection instrument was pretested on 5% of the sample in Bedesa High School adolescents ( near non-study adjacent Districts school). Six nurses and two public health officers who are fluent in the local language were assigned as data collectors, and supervisors respectively after having two days of training on the study objectives, responsibilities, and rights of respondents. The questionnaire was prepared in English first then translated into the Afan Oromo (local language) and again was re-translated to English to maintain consistency in translation. All completed questionnaires were checked daily to ensure completeness, and consistency at all stages of the data collection period. Double data entry was done for 20% of the questionnaire to see consistency in data entry using a programmed computer software package (Epi-Data version 3.1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements and variables\u003c/h2\u003e \u003cp\u003eThe measurable outcome variable was reproductive health literacy status. It was dichotomized as limited and adequate RHL. A comprehensive questionnaires were designed to measure adolescent\u0026rsquo;s reproductive health literacy. Adolescents were asked to rate their perceived ability to access, understand, appraise, and apply RH information using a five-point Likert scale scored from 0 to 4, which stands for a scale of don't know\u0026thinsp;=\u0026thinsp;0' to very easy\u0026thinsp;=\u0026thinsp;4'. A total of 31 questions were measured and transformed into a scale from 0 to 50, where 0 represents the lowest and 50 is the highest reproductive health literacy score level. Based on this score, reproductive health literacy was categorized into four levels: inadequate (0\u0026ndash;25), problematic (\u003cem\u003e\u0026gt;\u003c/em\u003e\u0026thinsp;25\u0026ndash;33), sufficient (\u003cem\u003e\u0026gt;\u003c/em\u003e\u0026thinsp;33\u0026ndash;42), and excellent (\u003cem\u003e\u0026gt;\u003c/em\u003e\u0026thinsp;42\u0026ndash;50). Finally, those who scored inadequate or problematic reproductive health literacy were defined as limited health literacy and those with sufficient and excellent health literacy were defined as adequate health literacy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definitions\u003c/h2\u003e \u003cp\u003eAdequate reproductive health literacy status: those respondents with sufficient or excellent reproductive health literacy scores.\u003c/p\u003e \u003cp\u003eLimited reproductive health literacy status: those respondents with inadequate reproductive health literacy or Problematic health literacy.\u003c/p\u003e \u003cp\u003eInadequate health literacy: a literacy status marked for a respondent with a mean index score of 0\u0026ndash;25.\u003c/p\u003e \u003cp\u003eProblematic health literacy: a literacy status marked for a respondent with a mean index score of 25\u0026thinsp;\u003cem\u003e\u0026lt;\u003c/em\u003e\u0026thinsp;33.\u003c/p\u003e \u003cp\u003eSufficient health literacy: a literacy status marked for a respondent with a mean index score of 33\u0026thinsp;\u003cem\u003e\u0026lt;\u003c/em\u003e\u0026thinsp;42\u003c/p\u003e \u003cp\u003eExcellent health literacy: a literacy status marked for a respondent with a mean index score of 42\u0026thinsp;\u003cem\u003e\u0026lt;\u003c/em\u003e\u0026thinsp;50\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Processing and Analysis\u003c/h2\u003e \u003cp\u003eData were entered using Epi-data version 3.1 (EpiData Association, Odense, Denmark) and exported to Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, U.S.A) for analysis. Descriptive statistics were computed and mean (standard deviation) for continuous data as well as frequency and percentage for categorical data were used to describe adolescents\u0026rsquo; characteristics. Both binary and multivariable logistic regression models were used. First, binary logistic regression analysis was done, and then variables that showed association with the outcome variable at a p-value\u0026thinsp;\u0026le;\u0026thinsp;20% in the bivariate logistic regression model were entered into a multivariable logistic regression analysis was conducted to identify factors significantly associated with the outcome variable. The model fitness was checked using the Hosmer-Lemeshow goodness of fitness test. Multicollinearity was also checked to see the correlation between independent variables by using the variance inflation factor. The significant statistical association was determined at a P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 using an adjusted odds ratio (AOR) with 95% CI.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics of the Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 403 High School adolescent students targeted to participate in the study, 391 students were interviewed, resulting response rate of 97.02%. The mean age (\u0026plusmn;SD) of the adolescent was 17.21(\u0026plusmn;1.22) years. Male adolescents accounted for 247 (63.2%) of the study participants. The majority of the students, 325 (83.1%) were Muslims in their religion. Of most of the study participants,367 (93.9%) were never married. Nearly a third (33.5%) of participants were grade 9 attendants (\u003cstrong\u003e\u003cu\u003eTable 1\u003c/u\u003e\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Reproductive Health Information and Information-seeking Behavior among the Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSlightly more than a third (34.8%) of the adolescents had never attended reproductive health subjects in class and more than three-quarters (76%) of them tend to have learned more reproductive health topics in school. The majority of adolescents (69.1%) had never used any reproductive health services and more than a third (37.9%) participated in school adolescent sexual and reproductive health (SRH) club activities. Concerning the source of reproductive health information, the most preferred source of information for adolescents was health workers (40.9%) followed by school teachers (28.6%) (\u003cstrong\u003e\u003cu\u003eTable 2\u003c/u\u003e\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevels of Reproductive Health Literacy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding the Prevalence of reproductive health literacy, nearly one out of five adolescents has adequate reproductive health literacy status, 18.4% (95% CI: 14.8- 22.5) (Figure 1).\u003c/p\u003e\n\u003cp\u003eBased on four health literacy domains, the overall average reproductive health literacy score was 23.9/50. The highest score (26/50) was related to understanding reproductive health information, whereas the lowest score (22.4/50) was related to appraising reproductive health information (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors Associated With Reproductive Health Literacy Among High school Adolescents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In this study, multivariate logistic regression analysis revealed, that the sex of adolescents, ever-attended reproductive health topics in class, and ever-use of reproductive health services were significantly associated with reproductive health literacy.\u003c/p\u003e\n\u003cp\u003eFemale adolescents were 52 % less likely to have adequate reproductive health literacy compared to male adolescent students (AOR=0.48, 95% CI: 0.26, 0.88). School adolescents never attending reproductive health topics in class were about 56% times (AOR = 0.44, 95% CI: 0.23, 0.84) less likely to have adequate reproductive health literacy status. School adolescents who never used reproductive health services were also about 60% times (AOR = 0.40, 95% CI: 0.23, 0.70) less likely to have adequate reproductive health literacy status (\u003cstrong\u003e\u003cu\u003eTable 3\u003c/u\u003e\u003c/strong\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study aimed to assess the level of reproductive health literacy and associated factors among high school adolescents. The study revealed that most high school adolescents were found to have limited reproductive health literacy. The sex of adolescents, ever attending reproductive health subjects in class, and ever use of reproductive health services, were found to be associated factors with the reproductive health literacy status of adolescents.\u003c/p\u003e \u003cp\u003eThe present study revealed that the proportion of limited reproductive health literacy among high school adolescents was high (82%). The finding is consistent with the study done on youth in Bander Abbas, Iran (85%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and school adolescents in Lao People\u0026rsquo;s Democratic Republic (92.4%) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The high proportion of limited reproductive health literacy in the current study might be related to the difficulty of adolescents in accessing the right reproductive health information, and poor habits of applications of reproductive health information, as overall adolescents\u0026rsquo; competency of reproductive health information was low (23.9/50).\u003c/p\u003e \u003cp\u003eSex was found to be significantly associated with the reproductive health literacy status of school adolescents in the current study. Male adolescents had lower odds of having limited reproductive health literacy compared to their female counterparts (AOR\u0026thinsp;=\u0026thinsp;0.48, 95% CI: 0.26, 0.88). Even though comparable literature is lacking specific to reproductive health literacy, the present finding is supported by previous studies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], which reported higher odds of limited health literacy among female participants. However, this finding contrasts with the study conducted in Iran which reported no association between reproductive health literacy with gender [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The possible explanation may be due to gender inequalities and roles that hinder female students\u0026rsquo; access to appropriate reproductive health information. Restrictions on women\u0026rsquo;s movement, participation in politics, and social affairs limit their access to various sources of health information [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], which in turn contributes to their lower health literacy.\u003c/p\u003e \u003cp\u003eEver-attending reproductive health topics in class was found to be significantly associated with the reproductive health literacy status of school adolescents in the present study. It was found adolescents who regularly attended reproductive health topics in class were 56% times less likely to have limited reproductive health literacy compared to their counterparts (AOR\u0026thinsp;=\u0026thinsp;0.44, 95% CI: 0.23, 0.84). The finding is consistent with previous studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This may be possibly due to access to reproductive health information from educational sources in advance.\u003c/p\u003e \u003cp\u003eEver use of reproductive health services was also found to be significantly associated with adolescents\u0026rsquo; reproductive health literacy status. The odds of limited reproductive health literacy were higher among the school adolescents who ever had used reproductive health care services than non-users. This is incontrast with the previous study [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and the authors' expectations. It is logically anticipated that people with high health literacy scores have better decision-making capability and; thus better healthcare-seeking than those with low health literacy scores [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Even though there is no clear explanation, the contradiction in the current finding may be due to participants\u0026rsquo; distinctions in understanding operationalized reproductive health care services utilization.\u003c/p\u003e \u003cp\u003eThis study has admitted a few limitations. First, since data were collected through self-administered questionnaires and not validated domestically, the study may be subjected to self-reporting bias. Second, as it was a cross-sectional design, the study cannot recognize changes in reproductive health literacy over longer periods and cannot establish the cause-effect relationship between outcome and independent variables. Finally, due to the limited sample size, the findings of this study may not be generalizable to school adolescents in Ethiopia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study showed that a large proportion of school adolescents have limited reproductive health literacy, suggesting school adolescents lack adequate competencies in reproductive health literacy; thus are at higher risk of reproductive health literacy-related problems. Sex of adolescents, ever attending reproductive health subjects in class, and ever use of reproductive health services, were found to be predictors of reproductive health literacy status among school adolescents in the study area. Thus, efforts should be made to improve adolescent reproductive health literacy with due attention to school sexual and reproductive health education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten and verbal informed consents were obtained from all participants. Regarding minors (under 18 years), verbal assent was obtained from the participants, and signed informed consent was obtained from their parents or guardians as well. The study obtained ethical approval from the Institutional Health Research Ethics Review Committee (IHRERC), College of Health and Medical Sciences, Haramaya University, Ethiopia. Confidentiality was secured through\u0026nbsp;an anonymous questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analyzed and reported in this study will be available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests that could seem to influence the work reported in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support from any agency for conducting this research, and /or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGB, LO, and MS, made a significant contribution to the conception of the idea and design, participated in proposal development and data collection, and analyzed and interpreted the data. JK wrote the original draft of the manuscript. MS, JK, and LO reviewed and edited the manuscript for important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Haramaya University, College of Health and Medical Sciences for providing an opportunity to conduct this study. The authors also would like to thank West Hararghe Zone Health Bureau and Boke District Health and Education Office staff for their genuine help throughout the data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLevin-Zamir D, Lemish D, Gofin R: \u003cstrong\u003eMedia Health Literacy (MHL): development and measurement of the concept among adolescents\u003c/strong\u003e. \u003cem\u003eHealth education research \u003c/em\u003e2011, \u003cstrong\u003e26\u003c/strong\u003e(2):323-335.\u003c/li\u003e\n\u003cli\u003eVan den Broucke S: \u003cstrong\u003eHealth literacy: a critical concept for public health\u003c/strong\u003e. 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Adolescence \u003c/em\u003e2018, \u003cstrong\u003e62\u003c/strong\u003e:116-127.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable\u0026nbsp;1: Socio-demographic characteristics of high school adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021 (n=391).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003eAge (in ears)\u003c/p\u003e\n \u003cp\u003e15-16\u003c/p\u003e\n \u003cp\u003e17-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003cp\u003e69.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eMarried \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.14\u003c/p\u003e\n \u003cp\u003e93.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003cp\u003eNon-Muslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e325\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003eSchooling level\u003c/p\u003e\n \u003cp\u003eGrade 9-10\u003c/p\u003e\n \u003cp\u003eGrade 11-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003cp\u003e47.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Source of reproductive health information and information-seeking behavior among high school adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021 (n=391).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.45454545454545%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.303030303030305%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.45454545454545%\" valign=\"top\"\u003e\n \u003cp\u003eEver attended reproductive health subject in class\u003c/p\u003e\n \u003cp\u003eYes \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.303030303030305%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.2\u003c/p\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.45454545454545%\" valign=\"top\"\u003e\n \u003cp\u003eTend to learn more reproductive health topics in class\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.303030303030305%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.45454545454545%\" valign=\"top\"\u003e\n \u003cp\u003eEver used sexual and reproductive health services\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003cp\u003e287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.303030303030305%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.45454545454545%\" valign=\"top\"\u003e\n \u003cp\u003eParticipated in school adolescent and youth SRH club\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.303030303030305%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.45454545454545%\" valign=\"top\"\u003e\n \u003cp\u003ePreferred source of reproductive health information\u003c/p\u003e\n \u003cp\u003eBooks/magazine\u003c/p\u003e\n \u003cp\u003eHealth workers/Doctors\u003c/p\u003e\n \u003cp\u003eFriend/peer\u003c/p\u003e\n \u003cp\u003eInternet\u003c/p\u003e\n \u003cp\u003eParent\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSchool teacher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.303030303030305%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3: Factors associated with reproductive health literacy among high school Adolescents in Boke District, Oromia Region, Eastern Ethiopia, 2021(n=391)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.49019607843137%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAdequate RH\u003c/p\u003e\n \u003cp\u003eliteracy status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e16(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e128(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e56(22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e191(77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e0.46 (0.25,0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e0.48 (0.26,0.88)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e4(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e20(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e68(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e299(81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e0.88 (0.32,1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1.0 (0.32,3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eReligion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eNon-Muslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e8(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e30(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e64(18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e289(81.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1.2(0.53,2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1.48(0.61,3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eEver attend RH topics in class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e122(89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e14(10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e197(77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e58(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e0.39 (0.21, 0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e0.44(0.23,0.84)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eEver use RH service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e248(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e39(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e0.34 (0.2, 0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e0.40 (0.23,0.7)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e71(68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e33(31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eParticipated in SRH club\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eNever/rare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e34(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e201(85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e0.52(0.31,0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e0.71(0.41,1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.35294117647059%\" valign=\"top\"\u003e\n \u003cp\u003eRegular \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e38(24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.745098039215685%\" valign=\"top\"\u003e\n \u003cp\u003e118(75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.58823529411765%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes: *significant at P-Value \u0026lt;0.05 \u0026nbsp;for AOR; CI: Confidence Interval; COR: Crude Odd Ratio; AOR: Adjusted Odd Ratio\u003c/strong\u003e\u003cstrong\u003e; RH: Reproductive Health; SRH: Sexual and Reproductive Health.\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Reproductive health, Literacy, school adolescents, Oromia, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4235944/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4235944/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHealth literacy has recently attracted global interest in public health. Sexual and reproductive health literacy, in particular, affects people's ability to make sound sexual and reproductive health decisions and is shown as a strong predictor of adolescent sexual and reproductive health outcomes. This study aimed to determine the reproductive health literacy status and associated factors among high school adolescents in Boke District, Oromia Region, Eastern Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Institutional-based Cross-sectional study was conducted on 403 adolescents aged 15 to 19 years from January 1-5, 2021. A systematic random sampling technique was used to recruit the study participants. Pre-tested, structured, self-administered questionnaire was used to collect the data. Data were entered using Epi data version 3.1 and analyzed by SPSS version 20. Both bivariate and multivariable logistic regression analyses were executed. The model fitness and Multicollinearity were checked using the Hosmer-Lemeshow goodness of fitness test and variance inflation factor, respectively. The significant statistical association was determined at a P-value \u0026lt;0.05 using an adjusted odds ratio (AOR) with 95% CI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study revealed that the overall prevalence of adequate reproductive health literacy among adolescents was 18.4% with a 95% CI (14.8%-22.5%). Female sex was about 52% times (AOR = 0.48, 95% CI: 0.26, 0.88) less likely to have adequate reproductive health literacy status. School adolescents never attending reproductive health topics in class were about 56% times (AOR = 0.44, 95% CI: 0.23, 0.84) less likely to have adequate reproductive health literacy status. School adolescents who never used reproductive health services ever were also about 60% times (AOR = 0.40, 95% CI: 0.23, 0.70) less likely to have adequate reproductive health literacy status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The finding of this study showed a large proportion of school adolescents have limited reproductive health literacy, suggesting school adolescents are at higher risk of reproductive health literacy-related problems. Thus, efforts should be made to improve adolescent reproductive health literacy with due attention to school sexual and reproductive health education.\u003c/p\u003e","manuscriptTitle":"Reproductive Health Literacy and Associated Factors among High School Adolescents in Boke District, Oromia Region, Eastern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-12 13:51:32","doi":"10.21203/rs.3.rs-4235944/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5d4434c0-3a71-4a5c-9349-ffd923fd8516","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-15T10:42:32+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-12 13:51:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4235944","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4235944","identity":"rs-4235944","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}