Comparative Effectiveness of Educational Videos and Leaflets on Adolescent Self-Efficacy in Pregnancy Planning: A Quasi-Experimental Study
Abstract
Adolescent reproductive risk behaviors, including smoking and overt romantic involvement in school settings, may reflect limited self-control and decision-making capacity and may increase vulnerability to unintended pregnancy. Although reproductive health education is widely implemented, evidence comparing educational media for strengthening adolescents’ self-efficacy in pregnancy planning remains limited. This study aimed to compare the effectiveness of video-based and leaflet-based reproductive health education in improving adolescents’ self-efficacy for pregnancy planning. A quasi-experimental pretest–posttest two-group design was conducted among 46 female students at SMK PGRI 1 Magetan, East Java, Indonesia. Participants were randomly allocated to a video group (n=23) or a leaflet group (n=23). Both groups received standardized reproductive health education covering pregnancy planning, optimal reproductive age, pregnancy risks, physical, psychological, and social readiness, and reproductive decision-making. Self-efficacy was assessed using a 15-item, five-point Likert questionnaire based on the self-efficacy framework. Within-group changes were evaluated using the Wilcoxon Signed-Rank Test, while between-group differences were assessed using the Mann–Whitney U test. Self-efficacy increased significantly in both groups (p<0.01). The mean score in the video group increased from 35.00 to 53.35, representing a 52.42% increase, whereas the leaflet group increased from 34.87 to 43.52, representing a 24.81% increase. Baseline self-efficacy did not differ significantly between groups (p=0.690), while post-intervention scores differed significantly (p<0.01). Video-based education therefore produced a greater immediate improvement in adolescent self-efficacy for pregnancy planning than leaflet-based education. These findings support the use of audiovisual media as a potentially more engaging strategy for school-based reproductive health education, while larger studies with longer follow-up are needed to determine whether the observed gains are sustained and translate into behavioral outcomes.
Full text article
References
[1] World Health Organization, “Adolescent pregnancy,” World Health Organization, Geneva, Switzerland, Apr. 10, 2024.
[2] S. M. Myat, P. Pattanittum, J. Sothornwit, C. Ngamjarus, S. Rattanakanokchai, K. L. Show, N. Jampathong, and P. Lumbiganon, “School-based comprehensive sexuality education for prevention of adolescent pregnancy: A scoping review,” BMC Women’s Health, vol. 24, no. 1, p. 137, 2024, doi: 10.1186/s12905-024-02963-x.
[3] S. Mohamed, M. G. Chipeta, T. Kamninga, L. Nthakomwa, C. Chifungo, T. Mzembe, R. Vellemu, V. Chikwapulo, M. Peterson, L. Abdullahi, K. Musau, K. Wazny, E. Zulu, and N. Madise, “Interventions to prevent unintended pregnancies among adolescents: A rapid overview of systematic reviews,” Systematic Reviews, vol. 12, no. 1, p. 198, 2023, doi: 10.1186/s13643-023-02361-8.
[4] A. J. Mason-Jones, M. Freeman, T. Lorenc, T. Rawal, S. Bassi, and M. Arora, “Can peer-based interventions improve adolescent sexual and reproductive health outcomes? An overview of reviews,” Journal of Adolescent Health, vol. 73, no. 6, pp. 975–982, 2023, doi: 10.1016/j.jadohealth.2023.05.035.
[5] N. J. Wilkins, C. Rasberry, N. Liddon, L. E. Szucs, M. Johns, S. Leonard, S. J. Goss, and H. Oglesby, “Addressing HIV/sexually transmitted diseases and pregnancy prevention through schools: An approach for strengthening education, health services, and school environments that promote adolescent sexual health and well-being,” Journal of Adolescent Health, vol. 70, no. 4, pp. 540–549, 2022, doi: 10.1016/j.jadohealth.2021.05.017.
[6] A. W. Pinandari, A. E. Kågesten, M. Li, C. Moreau, M. van Reeuwijk, and S. A. Wilopo, “Short-term effects of a school-based comprehensive sexuality education intervention among very young adolescents in three urban Indonesian settings: A quasi-experimental study,” Journal of Adolescent Health, vol. 73, no. 1S, pp. S21–S32, 2023, doi: 10.1016/j.jadohealth.2023.01.030.
[7] Y. H. S. Putri, I. Maryati, and T. Solehati, “Interventions to improve sexual and reproductive health related knowledge and attitudes among the adolescents: Scoping review,” Risk Management and Healthcare Policy, vol. 18, pp. 105–116, 2025, doi: 10.2147/RMHP.S490395.
[8] S. Barriuso-Ortega, M. Fernández-Hawrylak, and D. Heras-Sevilla, “Sex education in adolescence: A systematic review of programmes and meta-analysis,” Children and Youth Services Review, vol. 166, p. 107926, 2024, doi: 10.1016/j.childyouth.2024.107926.
[9] R. Guo, H. Xie, W. Zhao, and J. Wang, “Web-based sexual and reproductive health education for adolescents aged 10–17 years: A systematic review and meta-analysis,” BMJ Paediatrics Open, vol. 9, no. 1, p. e003714, 2025, doi: 10.1136/bmjpo-2025-003714.
[10] X. Ma, Y. Yang, K. M. Chow, and Y. Zang, “Chinese adolescents’ sexual and reproductive health education: A quasi-experimental study,” Public Health Nursing, vol. 39, no. 1, pp. 116–125, 2022, doi: 10.1111/phn.12914.
[11] I. D. Saragih, S. I. Tonapa, C. M. Porta, and B.-O. Lee, “Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies,” Journal of Telemedicine and Telecare, vol. 30, no. 2, pp. 201–214, 2024, doi: 10.1177/1357633X211047762.
[12] J. E. Perez-Lu, F. Guerrero, C. P. Cárcamo, M. Alburqueque, M. Chiappe, M. J. Hindin, N. Habib, L. Say, L. Gonsalves, and A. M. Bayer, “The ARMADILLO text message intervention to improve the sexual and reproductive health knowledge of adolescents in Peru: Results of a randomized controlled trial,” PLOS ONE, vol. 17, no. 2, p. e0262986, 2022, doi: 10.1371/journal.pone.0262986.
[13] J. Yarger et al., “In the Know: A cluster randomized trial of an in-person sexual health education program integrating digital technologies for adolescents,” Journal of Adolescent Health, vol. 74, no. 5, pp. 1019–1025, 2024, doi: 10.1016/j.jadohealth.2023.12.012.
[14] M. J. Decker, C. G. Zárate, T. V. Atyam, and M. Saphir, “Improving adolescent perceptions of barriers and facilitators to sexual and reproductive health services through sexual health education,” Journal of Adolescent Health, vol. 72, no. 1, pp. 138–146, 2023, doi: 10.1016/j.jadohealth.2022.09.001.
[15] E. Jenner, S. Walsh, C. Henley, H. Demby, R. Leger, and G. Falk, “Randomized trial of a sexual health video intervention for Black and Hispanic adolescent females,” Prevention Science, vol. 24, no. S2, pp. 262–271, 2023, doi: 10.1007/s11121-023-01499-0.
[16] N. D. Yuliasih, P. Sari, A. D. Bestari, N. Martini, and B. Sujatmiko, “Does health education through videos and e-leaflet have a good influence on improving students’ reproductive health knowledge, attitudes, and practices? An intervention study in Jatinangor, Indonesia,” Advances in Medical Education and Practice, vol. 16, pp. 29–39, 2025, doi: 10.2147/AMEP.S487338.
[17] C. E. Kosasih, T. Solehati, and I. Maryati, “Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study,” Belitung Nursing Journal, vol. 10, no. 1, pp. 87–95, 2024, doi: 10.33546/bnj.3033.
[18] A. Setiyorini, M. N. Sitaresmi, and W. A. Nisman, “Development and validation of Adolescent Sexual and Reproductive Health–Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ),” International Journal of Adolescent Medicine and Health, vol. 36, no. 4, pp. 351–358, 2024, doi: 10.1515/ijamh-2024-0073.
[19] B. Sikoki, C. Larastiti, N. W. Suriastini, and S. Pujiastuti, “A qualitative study on perceptions of adolescents’ sexual and reproductive health education in Yogyakarta, Indonesia,” International Journal of Adolescent Medicine and Health, vol. 36, no. 5, pp. 425–432, 2024, doi: 10.1515/ijamh-2023-0036.
[20] E. Gamelia, Anies, B. Widjanarko, and Z. Shaluhiyah, “Systematic review: Risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions,” Journal of Public Health in Africa, vol. 14, no. 12, p. 2672, 2023, doi: 10.4081/jphia.2023.2672.
[21] A. W. Pinandari, A. E. Kågesten, M. Li, C. Moreau, M. van Reeuwijk, and S. A. Wilopo, “Short-term effects of a school-based comprehensive sexuality education intervention among very young adolescents in three urban Indonesian settings: A quasi-experimental study,” Journal of Adolescent Health, vol. 73, no. 1S, pp. S21–S32, 2023, doi: 10.1016/j.jadohealth.2023.01.030.
[22] S. M. Myat, P. Pattanittum, J. Sothornwit, C. Ngamjarus, S. Rattanakanokchai, K. L. Show, N. Jampathong, and P. Lumbiganon, “School-based comprehensive sexuality education for prevention of adolescent pregnancy: A scoping review,” BMC Women’s Health, vol. 24, art. no. 137, 2024, doi: 10.1186/s12905-024-02963-x.
[23] S. Hopewell, A.-W. Chan, G. S. Collins, A. Hróbjartsson, D. Moher, K. F. Schulz, et al., “CONSORT 2025 statement: Updated guideline for reporting randomised trials,” BMJ, vol. 389, p. e081123, 2025, doi: 10.1136/bmj-2024-081123.
[24] S. Mohamed, M. G. Chipeta, T. Kamninga, L. Nthakomwa, C. Chifungo, T. Mzembe, et al., “Interventions to prevent unintended pregnancies among adolescents: A rapid overview of systematic reviews,” Systematic Reviews, vol. 12, art. no. 198, 2023, doi: 10.1186/s13643-023-02361-8.
[25] S. Setiyorini, R. Sitaresmi, and M. Nisman, “ASRH-KASeQ: Development and validation of an adolescent sexual and reproductive health knowledge, attitude, and self-efficacy questionnaire,” International Journal of Adolescent Medicine and Health, 2024, doi: 10.1515/ijamh-2024-0073.
[26] E. Yuliasih, N. Sari, A. Bestari, M. Martini, and A. Sujatmiko, “Video and electronic leaflet-based reproductive health education among adolescents,” Advances in Medical Education and Practice, 2025, doi: 10.2147/AMEP.S487338.
[27] R. Barriuso-Ortega, C. Fernández-Hawrylak, and P. Heras-Sevilla, “Sex education in adolescence: A systematic review of programmes and meta-analysis,” Children and Youth Services Review, vol. 166, art. no. 107926, 2024, doi: 10.1016/j.childyouth.2024.107926.
[28] C. Barriuso-Ortega, C. Fernández-Hawrylak, and P. Heras-Sevilla, “Sex education in adolescence: A systematic review of programmes and meta-analysis,” Children and Youth Services Review, vol. 166, Art. no. 107926, 2024, doi: 10.1016/j.childyouth.2024.107926.
[29] S. M. Myat, P. Pattanittum, J. Sothornwit, C. Ngamjarus, S. Rattanakanokchai, K. L. Show, N. Jampathong, and P. Lumbiganon, “School-based comprehensive sexuality education for prevention of adolescent pregnancy: A scoping review,” BMC Women’s Health, vol. 24, Art. no. 137, 2024, doi: 10.1186/s12905-024-02963-x.
[30] N. Yuliasih, N. Sari, A. Bestari, M. Martini, and B. Sujatmiko, “Does health education through videos and e-leaflet have a good influence on improving students’ reproductive health knowledge, attitudes, and practices? An intervention study in Jatinangor, Indonesia,” Advances in Medical Education and Practice, vol. 16, pp. 29–39, 2025, doi: 10.2147/AMEP.S487338.
[31] H. Herlianty, A. Abdullah, E. S. Dahrianti, and N. K. Sumidawati, “Impact of reproductive health education on adolescents’ self-efficacy in maintaining reproductive health,” Jurnal Pengabdian Masyarakat Edukasi Indonesia, vol. 2, no. 2, 2025, doi: 10.61099/jpmei.v2i2.78.
[32] R. Guo, H. Xie, W. Zhao, J. Wang, and et al., “Web-based sexual and reproductive health education for adolescents aged 10–17 years: A systematic review and meta-analysis,” BMJ Paediatrics Open, vol. 9, no. 1, Art. no. e003714, 2025, doi: 10.1136/bmjpo-2025-003714.
[33] M. A. et al., “Exploring the use of digital educational tools for sexual and reproductive health in Sub-Saharan Africa: Systematic review,” JMIR Public Health and Surveillance, vol. 11, 2025, Art. no. e63309, doi: 10.2196/63309.
Authors
Copyright (c) 2026 Ajeng Mardiani, Bdn. Nana Usnawati, SST., M.Keb, Dr.Nurlailis Saadah,S.Kp.,M.Kes, Sulikah,SST.,M.Kes
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlikel 4.0 International (CC BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).