Enhancing adolescent knowledge and attitudes: the impact of peer mentorship on sexual and reproductive health in senior high school, Batam

Introduction

One of the Sustainable Development Goals is to address health issues, including human reproductive health. The scope of reproductive health includes reproductive rights, easy access to health services, access to appropriate information, and freedom from sexual harassment [1], 2]. The World Health Organization (WHO) defines sexual health as a state of physical, emotional, mental, and social well-being related to sexuality, not merely the absence of disease or infirmity [3]. Each country has ways and strategies to improve its health status [4], 5].

Adolescents are individuals who are in a transition period from children to adults. Many changes occur in adolescence [6]. Physical changes can be seen at the beginning of adolescence, namely during puberty, such as rapid weight and height growth, significant changes in body composition, increased muscle mass, and fat distribution [7]. Increased oil production in the body causes adolescents to tend to acne. Development of primary and secondary sexual characteristics, such as breast development in girls and testicular enlargement in boys, occurs during this period [8]. Adolescent brain development has developed; they begin to analyze and think abstractly [9]. Psychological changes occur in adolescents, namely erratic mood [10]. Adolescents are also often easily influenced by their social environment, and curiosity leads them to follow the environment [11]. Therefore, peer influence for adolescents has an essential role in determining decision-making.

Based on data from various countries, the level of adolescent awareness about sexual and reproductive health is still relatively low. In Benin City, Nigeria, only 19.1 % of adolescents have a good level of knowledge about sexual and reproductive health [12]. Adolescents also show low awareness of pregnancy and abortion laws in Malaysia [12]. In Indonesia, the majority of adolescents have low to moderate knowledge related to sexual and reproductive health [13]. Likewise, the last study in 2022 found that the level of knowledge of adolescents in Batam City, Indonesia, is still mostly moderate [14].

Positive attitudes and perceptions of individuals will guide individuals in making positive decisions to act. Based on the KAP model, the level of knowledge is in line with attitudes and actions [15], 16]. But in reality, not all individuals with good knowledge have a positive attitude [17], 18]. This case is often found in the discussion of sensitive themes among adolescents, including sexual and reproductive health. Various factors affect adolescents in determining attitudes, such as the existence of norms and cultures that bind adolescents [19]. Therefore, adolescents need an environment that supports their decisions and allows them to share information they have previously considered taboo comfortably.

The peer approach is felt necessary to increase adolescent knowledge related to sexual and reproductive health [20]. With a mentor trained among them, they will become facilitators for adolescents in sharing experiences and information that they consider taboo. The peer environment makes adolescents feel comfortable, so later, they can direct adolescents in decision-making to develop a positive attitude. Therefore, this study aims to evaluate the effectiveness of peer mentoring interventions in improving adolescents’ knowledge and attitudes towards sexual and reproductive health.

Methods

Results

The distribution of knowledge levels of pre-test and post-test respondents can be seen from the table above. The results of the pre-test in the intervention group showed that the majority of respondents had a high level of knowledge, namely 61 respondents (67 %), followed by the moderate category of 29 respondents (31.9 %) and only one respondent (1.1 %) with a low level of knowledge before the intervention. Likewise, the control group initially dominated with a high level of knowledge of 17 respondents (78 %). Meanwhile, after being given the intervention, there were no more respondents with a low level of knowledge (0 %). Respondents with a high level of knowledge were 87 people (95.6 %).

Table 1 above shows the distribution of attitudes of pre-test and post-test respondents. The assessment of respondents’ attitudes was grouped into positive and negative. It can be seen that in the pre-test, the number of respondents had a negative attitude of 47 (51.6 %). This figure is more than that of respondents with a positive attitude, which is 44 (48.4 %). It is different when respondents are given interventions. The number of positive attitudes shifted slightly to 47 (51.6). Meanwhile, in the control group, the positive attitude of respondents decreased from 54 (59.3 %) to 50 (54.9 %). Figure 1 also briefly shows the changes before and after the intervention.

Figure 1:

Level of knowledge and attitude before and after intervention.

Table 2 above shows that most of the respondents are women, with a total of 52 people (57.1 %). Meanwhile, 39 respondents were male (42.9 %). When viewed based on age distribution, 18-year-old respondents seem to dominate the number of respondents, as many as 27 respondents (29.7 %). The youngest student was 15 years old, with only 14 respondents (15.4 %), while only one student was 19 years old. In the control group, the majority of women were 49 (53.8 %), with the majority aged 16 and 17 years.

Table 2 also shows the difference in the characteristics of respondents and their level of knowledge and attitudes. None of the respondents’ characteristics (gender and age) had significant differences in knowledge level or attitude. This means that the intervention provided is carried out comprehensively and does not have to be separated by gender or age range of respondents in high school.

Based on Table 3 above, it can be seen that respondents have been able to significantly increase their knowledge after the intervention about knowledge of sexuality, development of sexual organs, risks of premarital sex, the impact of drug use, effects of early pregnancy, and understanding of pregnancy. Respondents also had a positive attitude about sexual behaviour before marriage and a positive attitude towards the prevention of sexually transmitted diseases, and respondents believed that they were accepted when adolescents were pregnant at a young age.

Discussion

Based on the findings of the study, the majority of respondents are women. However, it is important to note that both male and female students participated in this study. The data shows female students’ high participation and interest in mentoring activities at school. These results show that female students are more interested in mentoring activities than male students [23], 24]. In addition, the number of female participants is also higher, making women more involved in mentoring activities. The older the respondent, the higher the academic score, so it is possible that at the time of the mentoring activities, 19-year-old students in the highest grade have a lot of time to study to prepare for the graduation exam.

In countries such as Malaysia and the United States, it has also been shown that the female population exceeds the male population [25]. These results are in line with previous findings that female students prefer to be actively involved in school activities that involve discussion and organization than male students [26]. Meanwhile, male students are more likely to be interested in physical school activities [27]. In addition, the number of female students at the study site is also higher than that of males, so their chances of being involved in activities are also higher.

Students are seen to already have a good level of knowledge at the beginning before being given an intervention. Nowadays, exposure to information is easy to obtain [28], 29]. Adolescents can freely access information online to find the information they are looking [30], 31]. When compared to 2022, internet usage among adolescents has risen significantly, providing them with greater potential to independently access information. However, previous findings indicate that most adolescents in Batam still possess a moderate level of knowledge regarding sexual and reproductive health. This suggests that while access to information has improved, the depth and accuracy of understanding remain limited, highlighting the necessity for structured and sustained interventions. Respondents’ knowledge and attitude after being given the intervention were seen to increase. The data prove that the mentoring interventions provided positively impact students. During mentoring, students share information based on their experiences. In addition, they can comfortably discuss the sensitive topics they discuss because the bond between group members is constantly established during the mentoring group interaction. In addition, the mentoring process also fosters confidence and motivation in adolescents [32]. This mutual trust and the development of social and emotional bonds make respondents feel comfortable in determining their attitudes in a positive direction [33]. This also means that communication support and social environment can increase adolescents’ resilience [34]. Through peer mentoring, adolescents have a supportive environment for decision-making [35]. Mentors have proven to carry out their role as companions who can persuade respondents to adopt positive attitudes.

Gender and age characteristics did not differ in respondents’ knowledge and attitudes. In one mentoring group, students are combined between men and women. They get the exact source of information and share it. This activity allows their knowledge and attitudes to be almost the same. This contrasts with previously conducted findings, which show mixed results. There are differences in adolescents’ knowledge about contraception [36]. Other findings found differences in adolescent boys’ and girls’ knowledge and attitudes regarding the impact of social media on their health [37]. These results also align with research on respondents aged 18–49 years.

There was no difference between the two groups based on the age of the respondents [38]. This is also in line with a study at athletic universities that found that there was no gender difference in respondents’ knowledge and attitudes [39]. The characteristics of sex and age were not significantly different; It could be due to exposure to information obtained from online sources that can be accessed easily. However, not all information obtained can be validated for its truth [40]. Adolescents need assistance and get information from trusted sources so they do not become misunderstood [41].

These findings align with the Knowledge, Attitude, Practice model, indicating that an individual’s knowledge influences their attitudes, ultimately leading to practice. In Sidoarjo, Indonesia, adolescents who had good knowledge about pregnancy prevention were also accompanied by positive attitudes [42]. Although findings suggested no direct link between adolescents’ knowledge and practices regarding safe sex behaviours, improving sexual attitudes was essential to promote safe sex practices among adolescents [43].

This study’s limitation is that it has not been able to reach all students in the school. Thus, not all students can experience the benefits of peer mentoring directly.

Conclusion and recommendation

It can be concluded that, overall, respondents’ knowledge level increased after being given a peer-to-peer approach intervention. Similarly, the respondents’ attitudes shifted in a positive direction after being given the intervention. There was no difference in the results of knowledge level and attitude based on the gender and age of the respondents. This means that education about reproductive sexual health can be carried out simultaneously or comprehensively to all students in high school without having to separate respondents based on gender or age. The implications of these findings suggest that the peer approach is more appropriate for adolescents to change knowledge and attitudes, especially on the theme of sexual and reproductive health. It is hoped that other schools in Batam City can apply the peer approach method in educating adolescents. In addition, researchers can then conduct research using similar methods with a broader scope. By approaching the school, it is hoped that this program can be included in the school program of the student affairs section.