Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
7
, No
.
2
, Jun
e
201
8
, pp.
81
~
90
IS
S
N: 22
52
-
8806
,
DOI: 10
.11
591/ij
phs
.
v7
i
2.
1
15
84
81
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Health P
ro
m
otio
n Model
"
Extrac
urricul
ar" Appr
oach of
Reproductiv
e H
ealth am
on
g Early
Adoles
cents
Li
dia Hast
ut
i
1
, Wu
ri
an
i
2
, Li
li
s Lesta
ri
3
,
L
esta
ri
M
ak
m
u
ri
an
a
4
, H
id
ay
ah
5
1
Depa
rt
m
ent
of C
om
m
unit
y
Nur
sing,
STIK Muh
amm
adiy
ah
Pont
ia
nak
,
Indon
esia
2,3,5
Depa
rt
m
ent o
f
Mate
rn
ity
and
Chil
d
N
ursing,
STIK Muham
m
adiy
ah
Ponti
ana
k
,
I
ndonesia
4
De
par
t
m
ent
of M
edi
cal
Surgic
a
l
N
ursing,
STIK
Muham
m
adi
y
ah P
onti
ana
k
,
Indo
nesia
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
Feb
10
, 201
8
Re
vised
A
pr 11
, 2
01
8
Accepte
d
J
un
6
, 2
01
8
The
b
eha
vior
to
m
ai
nte
nan
ce
of
rep
roduc
t
ive
o
rg
ans,
and
self
-
adjus
tment
on
cha
nges
during
puber
t
y
b
ec
om
e
it
s
ow
n
proble
m
s
on
ea
rl
y
adol
esc
ence
(10
-
14
y
e
ars
old).
True
knowl
edge
ca
n
improve
rep
roduc
t
ive
hea
lt
h
an
d
pre
vent
of
fre
e
sex
beha
vior
end
up
with
uns
afe
abor
t
ion
ev
en
dea
th
in
adol
esc
ence.
Sc
hool
has
a
m
aj
or
role
in
shaping
positi
ve
at
t
it
ude
s
in
chi
ldr
e
n
towar
ds
rep
roduc
ti
v
e
hea
l
th
at
p
uber
t
y
.
It
is
important
to
f
ind
an
d
deve
lop
a
progra
m
of
rep
r
oduct
iv
e
he
al
th
school
-
base
d
in
the
form
of
"ext
rac
urri
cular"
hea
l
th
rep
rodu
ctive
in
e
arly
ad
ole
sce
n
ce
(10
-
1
4
y
ea
rs
o
ld)
no
t
exi
st
ed
in
Indone
sia
up
to
now.
To
f
ind
and
design
a
m
odel
school
-
b
ase
d
he
al
th
prom
oti
on
progr
ams
in
the
form
of
"ext
r
ac
urri
cular"
rep
rodu
ct
iv
e
health
that
ca
n
be
applied
t
o
the
e
arly
adol
e
sce
nce
in
school
.
Q
ual
i
ta
t
ive
r
ese
arc
h
wi
th
a
phenomenolog
y
appr
oac
h
,
to
expl
ore
m
od
el
s
of
rep
rodu
ct
iv
e
health
prom
oti
on
progra
m
s
in
the
e
arly
adol
esc
ence.
The
m
ini
n
g
data
wa
s
qual
itati
v
e
of
foc
us
group
di
scuss
ion
(FG
D)
and
in
-
dept
h
int
e
rvie
w
.
Parti
ci
p
ant
s
in
t
his
rese
arc
h
wer
e
36
peopl
e
of
p
urposive
sam
pli
ng
te
chni
q
u
e
int
o
a
cc
oun
t
m
axi
m
um
var
ia
t
i
on
sam
pli
ng,
a
nd
data
an
aly
z
e
used
th
e
the
m
at
i
c
anal
y
s
i
s.
T
he
stud
y
r
esu
lt
s
found
a
rep
roduc
ti
v
e
healt
h
prom
oti
on
m
odel
school
-
b
ase
with
ext
ra
c
urric
ul
ar
appr
o
a
ch
of
re
pro
duc
ti
ve
healt
h.
The
progra
m
is
ca
rrie
d
out
ou
tside
school
ho
urs
le
arn
ing
a
c
ti
vities
on
rep
roduc
t
ive
he
al
th
,
with
a
stu
d
y
of
th
e
se
lf
-
d
eve
lopment
,
soc
ia
l
,
ph
y
s
ical
,
sexua
l
violence
and
the
pre
v
ent
ion
of
sexu
al
l
y
tr
ansm
it
te
d
infe
ctions.
Program
appl
ie
d
b
y
using
app
roa
ch
m
et
hod
and
i
nnovat
iv
e
m
edi
a
bal
an
ce
t
o
age
of
adol
esc
e
nt’s
deve
lopmen
t
and
invol
ve
h
ea
l
th
workers,
te
ac
h
ers
and
par
ent
s.
Ke
yw
or
d
s
:
Early
ad
olesce
nts
Extrac
urricular
Re
producti
ve
hea
lt
h
Copyright
©
201
8
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Lidia
H
ast
uti,
Dep
a
rt
m
ent o
f Pu
blic Heal
th
and Com
m
un
it
y Nursin
g
,
STIK M
uham
m
adiy
ah
Ponti
anak
Sung
ai
Ray
a
D
al
a
m
Street, Ponti
anak
West
Born
eo
, In
done
sia
.
Em
a
il
:
l
idya
_zain@yah
oo.c
om
1.
INTROD
U
CTION
The
kn
ow
le
dge
of
re
pro
duct
ive
healt
h
is
a
determ
inant
of
beh
a
vior
to
wa
rd
the
pr
e
ve
ntion
of
healt
h
pro
blem
s.
Ad
ol
escent beh
a
vi
or
ass
ociat
ed wit
h
unsafe se
x
is par
t o
f
a lac
k
of ad
olescents’ kn
ow
le
dge, lack o
f
acce
ss,
s
kill
s
and
sel
f
-
e
ff
ic
a
cy
to
ne
goti
at
e
[1
]
.
Re
se
arc
h
prov
e
s
that
early
sex
e
ducat
ion
will
preve
nt
pr
em
arit
al
pr
egn
a
ncy
[
2].
S
urveys
in
a
dole
scents
age
d
15
-
24
s
how
t
he
lo
w
kn
ow
le
dg
e of
re
producti
ve
healt
h,
21%
of
ad
oles
cent
girls
a
re
unawa
re o
f
c
ha
nges
in
t
heir
sel
ves
wh
e
n
they
are
pu
ber
ty
ph
ase,
as
m
any
as
2.7%
of
girls
an
d
14
.2
%
of
bo
ys
a
re
known
t
o
ha
ve
pr
em
arit
al
sex
ual
interc
ourse
[
3].
Approx
im
at
el
y,
33
.
2%
of
girls
an
d
44.8%
of
boys
ag
r
ee
on
prem
arital
sexu
al
inter
course
[4
]
.
Adolescents
se
xu
al
beh
a
vior
are
su
ch
a
s
ho
l
ding
hands
(m
al
e
60
.1
%
an
d
fem
al
e
62%),
kissin
g
(m
al
e
30.9
%
an
d
fem
al
e
23
.2
%
)
an
d
petti
ng
(
m
al
e
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
81
–
90
82
19.2%
an
d
fe
m
al
e
6,
5%
)
[5]
.
4%
of
ad
ole
scents
a
ged
13
-
14
a
re
re
porte
d
to
ha
ve
ha
d
sex
ual
interc
ourse
a
nd
the
pe
rcen
ta
ge
is
rising
al
on
g
with
the
a
dd
it
ion
of
te
e
na
gers
‘ag
e
[6
]
,
e
ve
n
ab
out
1%
of
bo
ys
a
nd
4%
of
girls
in
I
ndonesi
a
ar
e
repo
rted
to
ha
ve
had
s
ex
ual
interco
urse
be
fore
the
a
ge
of
13
ye
ars,
e
ve
n
s
om
e
hav
e
s
exu
al
interco
urse
under 1
0
ye
ar
s [7
]
.
The
l
ow
kn
ow
l
edg
e
of
a
dole
s
cents’
res
ults
in
pr
em
arit
al
sexu
al
be
ha
vio
r
,
pr
em
arit
al
pr
e
gn
a
ncy,
an
d
aborti
on
te
rm
i
nated
i
n
a
do
le
s
cent
deat
h,
sex
ual
assa
ult
an
d
sex
ually
trans
m
itted
diseases
[8
]
.
Strate
gic
valu
e
in
ad
olescents
has
res
ulted
evide
nce
base
for
c
reati
ng
po
li
ci
es
a
nd
pro
gr
am
s
for
a
do
le
sce
nts
[
9].
So
m
e
evide
nce
-
base
d
stu
dies
s
how,
the
ef
fect
is
prov
e
n
t
o
be
str
onge
r
w
hen
t
he
ta
r
get
pro
gr
am
was
early
ado
le
sce
nt
[
10
]
.
In
c
reasin
g
a
do
le
sce
nts’
kn
ow
le
dg
e
an
d
f
or
m
ing
posit
iv
e
at
ti
tud
es
an
d
beh
a
viors
ca
n
pr
e
ve
nt
the
occ
urre
nce
of
ad
olescent
repr
oductive
healt
h
prob
le
m
s
su
ch
as
f
re
e
sex,
se
xual
ly
transm
it
te
d
diseases,
sex
ual
vi
olenc
e,
un
wan
te
d
preg
na
ncies,
a
nd
un
s
afe
a
bort
ion
t
hat
ca
n
e
nd
in
te
e
na
ge
deaths
.
I
nc
reas
ing
t
he
knowle
dge
is
m
or
e
eff
ect
ive
wh
e
n
ad
dr
es
s
ed
to
stu
den
ts
at
the
early
s
ta
ge
of
dev
el
opm
ent
and
not
ye
t
sex
ually
acti
ve
.
Ann
ual
Tech
ni
cal
Re
po
rt
2011
sta
te
d
t
ha
t
the
eff
ect
i
ve
re
pro
duct
iv
e
healt
h
inte
r
ven
ti
ons
on
ado
le
sce
nts
in
dev
el
op
i
ng
co
un
t
ries
are
ess
entia
l
[11].
T
he
co
ns
e
qu
e
nce
s
of
un
sa
fe
se
xual
be
ha
vior
ar
e
su
c
h
as
prem
arit
al
pr
e
gnancy,
ab
or
ti
on
a
nd
se
xual
ly
transm
it
t
ed
diseases
i
nc
lud
in
g
H
IV
i
nf
ect
io
n
[8
]
.
Sexual
healt
h
is
cu
rrentl
y
pr
i
or
it
iz
ed
i
n
ea
rly
a
do
le
sce
nce
[
12]
beca
us
e
it
can
pr
e
ve
nt
te
enag
e
pr
e
gn
a
nc
y
an
d
sex
ually
transm
itted
diseases
[13].
E
ff
ect
i
ve
repr
oductiv
e
healt
h
interv
entions
in
ado
l
escents
in
de
ve
lop
in
g
countries a
re e
ssentia
l [
11
]
.
School
-
base
d
r
esearch
by
t
he
SA
T
Z
P
roject
on
stu
de
nts
of
12
-
14
ye
ar
s
old
is
pro
ve
n
to
incr
ease
ado
le
sce
nts’
knowle
dge
an
d
po
sit
ive
at
ti
tud
es
towa
r
d
re
pro
du
ct
ive
hea
lt
h
[1
0].
Sc
ho
ol
curricula
ha
ve
not
sp
eci
fical
ly
include
d
m
at
eria
l
about
re
pro
duct
ive
healt
h.
Li
m
it
ed
rep
r
oductive
healt
h
inf
or
m
at
ion
is
only
ob
ta
ine
d
i
n
sc
ie
nce
le
ssons.
Ther
e
is
an
urgen
t
nee
d
to
i
m
pr
ov
e
unde
rs
ta
nd
in
g
a
bout
it
through
str
a
te
gic
researc
h
a
nd
t
o
sup
port
go
ve
rn
m
ents
in
ad
dressi
ng
yo
uth
gro
up
s
.
Th
e
re
su
lt
s
of
t
he
stu
dy
will
giv
e
a
m
od
el
of
sc
hool
-
ba
se
d
re
pro
duct
ive
healt
h
prom
oti
on
pro
gr
am
in
the
f
or
m
of
e
xtracurric
ular
th
at
can
be
ap
plied
on
early
ad
olesce
nce.
Re
s
earc
h
on
t
he
dev
e
lop
m
ent
of
s
chool
-
base
d
r
epro
du
ct
ive
he
al
th
pro
gram
s
with
extrac
urricula
r
ap
proac
hes
for
ea
rly
ad
ol
escents
in
pri
m
ary
scho
ol
has
not
be
en
c
onduct
ed
in
a
com
pr
ehe
ns
ive
way.
It
is
i
m
po
rtant
to
find
a
nd
de
vel
op
m
od
el
s
of
school
-
based
rep
r
oductive
healt
h
prom
otion
pr
ogram
s,
in
ext
r
acurric
ular
f
orm
fo
r
early
ado
le
sce
nts
in
sch
oo
l
b
ef
or
e
they
ex
per
ie
nc
e
the
pube
rty
ph
a
se.
Objecti
ve:
T
o
fin
d
a
nd
de
velop
"Sch
ool
-
ba
sed
reprod
uctive
healt
h
pr
omoti
on
pro
gram
m
od
el
in
the
f
or
m
of
extrac
urricular
re
pro
du
ct
ive
healt
h"
ai
m
ed
at
early
ad
oles
cents
in
sc
hool
be
fore
e
xperie
ncin
g
pube
rty
ph
ase
and
ca
n
be
a
r
ecom
m
end
e
d
pro
gr
am
fo
r
poli
cy
m
aker
s
as
an
al
te
rn
at
ive
con
ce
pt
or
m
od
el
of
sch
oo
l
-
base
d r
epro
du
ct
ive
h
e
al
th progr
am
s in
e
xtrac
urricul
ar fo
rm
in
early
ad
olesce
nce.
2.
RESEA
R
CH MET
HO
D
2.1.
Res
earc
h
D
esi
gn
This
researc
h
us
e
d
qu
al
it
at
ive
resea
rch
de
s
ign
with
phe
nom
en
olo
gy
ap
proac
h.
T
he
r
e
search
w
as
locat
ed
in
pr
i
m
ar
y
school
in
Kub
u
Ra
ya
di
stric
t
.
This
loc
at
ion
is
re
pr
es
e
nting
t
he
c
har
a
ct
erist
ic
of
ur
ba
n
an
d
rural ad
olesce
nc
e
.
2.2.
P
art
ic
ipa
nt
s
and
Chara
cteris
tic
o
f Pa
rtici
pa
n
t
Re
searche
rs
wer
e
c
oncer
ne
d
with
the
cred
i
bili
ty
and
w
eal
th
of
inf
or
m
at
ion
,
e
xp
l
or
i
ng
t
he
ph
e
nom
eno
n
in
de
pth
with
non
-
prob
a
bili
ty
sam
pling
[1
4
-
15
]
.
Re
searc
h
su
bject
s
or
pa
r
ti
ci
pan
ts
in
this
stud
y
a
m
ou
nte
d
to
34
pe
ople
.
T
he
nu
m
ber
of
par
t
ic
ipants
f
or
da
ta
colle
ct
ion
usi
ng
t
he
FGD
m
et
ho
d
c
onsist
ed
of
three
gro
up
s
.
T
hey
we
re
12
pe
rsons
of
ad
oles
cents,
se
ve
n
pe
rsons
of
pa
re
nts,
an
d
15
per
s
ons
of
te
ac
her.
Data
colle
ct
ion
us
e
d
in
-
de
pth
inte
rv
ie
w
m
e
tho
d
consi
ste
d
of
two
par
ti
ci
pa
nts
of
reli
gi
ous
le
ader
s
,
one
f
r
om
the
Mi
nistry of R
e
li
gio
us A
ff
ai
r
s,
and
on
e
fro
m
the E
ducat
ion
Office
.
Characte
risti
cs
of
par
e
nt
pa
rtic
ipants
w
ere
in
the
age
ra
nge
of
26
-
42
ye
ar
s
old
,
i
nclu
ded
a
s
Java
nese
,
Ma
la
y,
and
bu
gis,
had
va
riat
ion
s
of g
e
nd
e
r,
ag
e,
e
ducat
io
n,
occ
up
at
io
n,
num
ber
of
c
hild
ren
and h
a
d
t
ee
nag
e
rs
with
va
ryi
ng
m
enar
che/sem
enar
c
he
sta
tus,
so
m
e
par
ti
ci
pan
ts
ha
d
child
ren
w
ho
ha
ve
akh
il
ba
li
q
(
getti
ng
pube
rty
)
.
Me
a
n
wh
il
e,
a
dole
s
cent
pa
rtic
ipan
ts
wer
e
in
t
he
age
range
of
10
-
14
ye
ars
ol
d,
w
hich
ha
d
vari
at
ion
s
of
sex
,
s
om
e
t
eenag
e
rs
ha
d
e
xp
e
rienc
e
d
ak
hi
l
ba
li
q
an
d
ot
her
s
ha
d
not
e
xp
e
rience
d
it
.
The
c
harac
te
risti
cs
of
te
acher
pa
rtic
ipants
w
ere
(
1)
com
ing
from
two
pu
blic
pr
i
m
ary
scho
ols
who
we
re
te
achin
g
sci
ence,
r
el
igion,
and
guida
nce
and
c
ouns
el
i
ng
cl
asses,
(2)
in
the
age
range
of
26
-
55
ye
ars
with
dif
f
eren
t
gender,
(3)
the
m
ajo
rity
ed
uca
ti
on
le
vel
is
S
1(u
nd
e
rgra
du
at
e
degree)
with
the
dif
fer
e
nt
discipli
ne,
(4)
hav
i
ng
e
xperie
nce
in
te
aching a
bout
5
-
18 yea
rs
. T
he
num
ber
of
pa
rtic
ipants i
n
thi
s stu
dy w
as
34 peo
ple.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Hea
lt
h Pr
omot
ion
Mo
del
"
Ext
ra
c
ur
ric
ul
ar" Ap
pr
oac
h of R
epr
oductiv
e
He
alth…
(
Lidi
a Ha
st
uti
)
83
2.3
. Res
earc
h
Inst
r
umen
ts a
nd
Data
C
ollec
tion Me
thod
s
The
data
c
ollec
ti
on
te
c
hn
i
ques
us
e
d
i
n
t
his
re
searc
h
was
i
n
-
dep
t
h
intervie
w
a
nd
f
ocu
s
gro
up
discuss
i
on
(
FGD)
w
hich
ref
e
r
red
t
o
the
instr
um
ents
that
ha
d
been
prepa
re
d
by
resea
rche
rs.
Partic
ipa
nts
were
sel
ect
ed
by
pur
po
si
ve
sam
pling
.
Data
colle
ct
ion
was
sta
rted
with
colle
ct
ing
secondary
dat
a
about
ado
le
s
cents
and
their
re
pro
du
ct
ive
healt
h
in
sc
hools.
The
resea
rch
e
r
c
oo
rd
i
nated
with
the
e
ducat
ion
office
a
nd
the
sc
hool
.
Data
colle
ct
ion
was
c
onduct
ed
with
the
ai
m
of
diggin
g
deep
e
r
in
form
at
ion
f
ro
m
part
ic
ipants
to
fin
d
an
d
dev
el
op
sc
hool
-
base
d
re
pro
duct
ive
healt
h
prom
otion
m
od
el
s.
FGD
i
m
ple
m
entat
ion
wa
s
done
ba
sed
on
t
he
gro
up
that
ha
d
bee
n
create
d
be
fore,
pa
re
nts,
te
acher
s
and
ea
rly
ado
le
scents,
with
t
he
durati
on
of
60
-
90
m
inu
te
s.
I
n
-
de
pth
int
er
vie
w
s
wer
e
c
ondu
ct
ed
sepa
ratel
y
in
accor
dance
with
the
agr
eem
ent
with
the
par
ti
ci
pa
nts.
T
he
m
os
t
i
m
po
rtant
thing
w
as
to
bu
il
d
tr
us
t
with
pa
rtic
ipan
ts
at
the
t
i
m
e
of
data
colle
ct
ion
.
It
took
a
long
ti
m
e
to
con
duct
FG
Ds
with
ea
rly
ado
le
sce
nts,
and
researc
h
ers
m
ade
adj
ustm
ents
in
the
us
e
of
la
nguag
e
or
re
pro
du
ct
ive
hea
lt
h
te
rm
s
that
wer
e
po
or
ly
un
der
st
ood
by
th
e
m
.
Me
anwhil
e,
w
he
n
hav
i
ng
F
G
Ds
with
par
e
nts,
r
esearche
rs
nee
d
to
e
nc
oura
ge
the
pa
re
nts
to
be
op
e
n
i
n
e
xpressi
ng
opini
on
s
.
M
os
t
of
pa
ren
ts
felt
e
m
bar
r
ass
ed,
i
nappro
pr
i
at
e
and
ta
boo
to
ta
lk
ab
ou
t
sexu
al
a
nd
reprod
uctive
healt
h
prob
le
m
s
in
ado
le
sce
nts.
V
al
idit
y
and
reli
abili
ty
of
r
ese
arch
re
ferred
to
5
cat
eg
ori
es:
desc
riptive
va
li
dity
,
interp
retat
ive
validit
y,
theo
r
et
ic
al
validit
y,
ge
ner
al
iz
abili
ty
,
an
d
e
va
luati
ve
validit
y
[16
]
.
Vali
datio
n
of
data
was
do
ne
by
us
in
g
tria
ngula
ti
on
(d
at
a s
our
ce, m
et
ho
do
l
ogy
,
a
nd the
or
y)
,
m
e
m
ber
ch
ec
king a
nd audit
ing.
2.4. Ethic
al C
on
sider
at
i
on
In
ge
ner
al
,
t
he
et
hics
of
thi
s
researc
h
m
et
the
pri
nciples
of
:
ben
e
ficen
ce,
justi
ce,
an
d
in
form
ed
consent
[17]
.
This
r
esearc
h
was
begu
n
by
app
ly
in
g
resea
rch
pe
rm
issi
on
to
the
Ethic
s
Com
m
ittee
of
STIK
Muh
am
m
adiy
a
h
P
on
ti
an
ak
.
Re
searche
rs
got
et
hical
cl
earance
a
nd
pe
r
m
issi
on
to
c
onduct
res
earc
h
fro
m
relat
ed
insti
tuti
on
s
(
137/
II
.
I.A
U/KET
.E
T
IK
/
S
-
1/
XII/2
017)
.
Data
analy
sis
aim
ed
to
ex
plore
the
relat
ion
s
hip
betwe
en
at
ti
tud
es
,
be
hav
i
or
s
an
d
exp
e
rience
s
,
dev
el
op
i
ng
ph
eno
m
enon
an
d
theor
y
e
xp
la
na
ti
on
s.
It
was
s
eei
ng
the
rela
ti
on
s
hip
bet
we
en
the
cat
eg
ori
es
or
patte
rn
s
t
hat
ar
ise
[18]
.
This
s
tud
y
us
e
d
the
m
at
ic
analy
sis
to
fin
d
patte
r
ns
ou
t
that
m
ay
no
t
be
f
ound
by
oth
e
r
researc
hers.
3.
RESU
LT
S
A
ND AN
ALYSIS
3.1.
In
fo
r
ma
t
ion
on
Repr
oductive
He
alth
The
res
ults
show
s
te
ena
gers
an
d
par
e
nts
ha
d
heard
i
nform
at
ion
ab
out
r
epro
du
ct
ive
he
al
th
but
th
e
inf
or
m
at
ion
obta
ined
was
i
nc
om
plete
.
Re
pr
oductive h
eal
th
was
unde
rstood
by
pa
ren
ts
i
nclu
ding
the
ar
rival
of
m
enstru
al
a
nd
wet
dream
s
as
one
of
t
he
s
ign
s
of
pu
ber
t
y.
Like
the
f
ol
lowing
narrati
ve
f
r
om
on
e
of
the
par
ti
ci
pa
nts:
“Th
e
sig
ns
of
puberty
ar
e
th
e
growt
h
of
Ad
am’s
apple
in
men,
the
v
oice
is
enlar
ge
d,
t
he
hair
gr
ows
in
the
armpit
an
d
the
che
st
be
gin
s
to
fi
el
d
and
me
ns
tr
uati
on
i
n
wo
m
en”
(
FGD
wi
th
ad
olescent
par
ti
ci
pa
nts)
"
.
..
ac
cor
ding
t
o
my
k
no
wl
ed
ge
of
ee
..,
rep
r
oductiv
e
he
alth
is
li
ke
pu
bert
y,
the
body
c
hangin
g
on
c
hild
..,
li
ke
her
hips
,
he
r
br
ea
sts,
t
hen
the
ar
riv
al
of
menst
ruati
on
…
Ke
epin
g
t
he
cl
ea
nlines
s,
it
ching
on
the
gen
it
als
....
"
(FGD
w
it
h pa
re
nt
p
arti
ci
pa
nts)
In
ad
diti
on,
th
e
stud
y
found
that
ado
le
scents
did
not
under
sta
nd
a
bout
good
re
pro
duct
ive
or
ga
ns
m
ai
ntenan
ce,
t
he
us
e
of
pa
ds,
m
enstru
al
proces
ses,
m
enstru
al
prob
le
m
s,
va
gin
al
disc
harge
a
nd
sex
ually
transm
itted
inf
ect
ion
s.
But
a
do
le
sce
nts
know
that
ci
rcu
m
ci
sion
was
do
ne
to
kee
p
t
he
re
producti
ve
orga
ns
cl
ean
in
m
en
a
nd
knowin
g
ab
ou
t
the
disease
on
re
pro
duct
ion
that
is
relat
ed
to
sex
ually
transm
itted
diseases.
As wit
h o
ne of
the
fo
ll
owin
g partic
ipa
nts:
"
Re
product
iv
e
disease
s
ar
e s
uc
h as
sex
uall
y transmit
te
d
dise
as
es,
"
(FG
Ds wit
h
a
do
le
sce
nt
p
arti
ci
pa
nts)
Prob
le
m
s
arisen
we
re
that
pa
ren
ts
c
onside
r
ed
in
form
at
ion
about
re
pro
du
ct
ive
healt
h
as
so
m
et
hin
g
ta
boo
t
o
ta
lk
ab
ou
t
beca
use
pa
ren
ts
felt
em
bar
rasse
d,
an
d
did
not
h
a
ve
t
he
rig
ht
w
ords
to
exp
la
in
.
The
diff
ic
u
lt
y
in
ex
plainin
g
ab
out
re
pro
du
ct
ive
healt
h
was
du
e
t
o
the
la
ck
of
unde
rstan
ding
ab
out
reprod
uction h
eal
th as
quoted
f
r
om
the foll
owin
g partic
ipa
nt stat
em
ent:
"
.
..
never.
I
’m
sh
y,
sti
ll
young,
I
'm
co
nfu
s
ed
to
expl
ain
i
t
and
I’
ll
expl
ain
le
te
r.
.."
(FGD
wit
h
pa
re
nt
par
ti
ci
pa
nts)
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
81
–
90
84
The
res
ults
sh
owed
that
kn
owle
dg
e
ab
out
re
pro
du
ct
ive
hea
lt
h
in
early
ado
le
scents
(10
-
14
ye
ars)
was
ver
y
li
m
i
te
d.
This
diff
e
re
nc
e
in
know
le
dge
occurre
d
due
to
la
ck
of
orga
nized
ac
cess
an
d
i
nform
at
ion
expos
ur
e
a
bout
info
rm
at
ion
need
e
d
an
d
la
ck
of
ex
per
ie
nc
e
gaine
d
by
ado
le
sce
nts.
Wh
il
e
ot
her
te
enag
e
rs
kn
e
w
a
bout
re
pro
du
ct
ive
hea
lt
h
was
li
nke
d
to
se
xu
al
ly
tr
ansm
itted
dise
ases.
I
n
li
ne
with
the
res
ul
ts
of
Ind
on
esi
a
a
dole
scent
re
pro
duct
ive
healt
h
s
ur
vey
(SKRR
I
)
i
n
a
do
le
sce
nts
a
ged
15
-
24
ye
ar
s
old
m
entione
d
that
the
knowle
dge
of
ad
olescents
about
rep
r
oduc
ti
ve
healt
h
w
as
low
[5]
.
Te
enag
e
rs
re
qu
i
r
ed
m
or
e
info
r
m
at
ion
about
repr
oduc
ti
ve
healt
h
in
accor
da
nce
with
the
need
s
an
d
pr
oble
m
s
that
wer
e
oft
en
e
xperience
d
or
will
be
exp
e
rience
d.
R
epro
du
ct
ive
he
al
th
ed
ucati
on
pro
gr
am
s
wer
e
essenti
al
in
pr
epar
i
ng
reli
abl
e
inf
or
m
at
ion
acce
ss
and
em
power
i
ng
t
hem
to
m
a
ke
wise
decisi
on
s
in
us
in
g
s
ocial
m
edia
[19]
.
Co
rr
ect
pro
visio
n
of
in
for
m
at
ion
about
repr
oductive
healt
h
pr
eve
nted
a
do
le
sce
nts’
s
exu
al
be
ha
vio
r
,
includi
ng
sexu
al
ly
transm
itted
infecti
ons
[
13
]
.
Adolesce
nts
reli
ed
on
fam
i
li
es,
com
m
un
ities,
schools,
a
nd
healt
h
care
to
le
arn
i
m
portant
sk
il
ls, to
help
c
op
e
w
it
h t
he p
r
essures they
fa
ced
durin
g
t
heir
tra
ns
it
ion.
3.2.
Pr
ob
le
ms
a
n
d
Causes
of Re
pr
od
uc
tiv
e
Heal
th
Pr
obl
ems i
n Ea
rl
y Ad
olescence
The
c
omm
on
reprod
uctive
he
al
th
pro
blem
s
identifie
d
on
young
girls
wer
e
a
bout
m
enstr
ual
an
d
vag
i
nal
pro
blem
s
and
it
chin
g
of
the
gen
it
al
s
.
Un
li
ke
boys
who
te
nd
to
ha
ve
no
com
plaints,
but
ex
hib
it
risky
beh
a
vior,
this s
ta
te
m
ent w
as a
s con
veyed
by
on
e
of t
he parti
ci
pan
ts as
foll
ows:
"
.
..
usua
ll
y
th
ey
co
mp
l
ain
about
me
ns
tr
uati
on
up
t
o
2
ti
mes
in
1
month
co
ntin
uous
ly
he
als
o
experience
vag
ina
l
disch
arge,
feel
p
ai
n d
ur
in
g men
str
uati
on"
(FGD
w
it
h t
e
acher
p
a
rtic
ipa
nt)
The
occ
urr
e
nc
e
of
loss
c
on
t
ro
l
an
d
delay
s
in
giv
in
g
un
der
sta
nd
i
ng
opene
d
the
c
ha
nce
f
or
the
occurre
nce
of
fr
ee
sex
be
ha
vior
res
ulted
in
unsa
fe
a
bortio
n
act
s.
P
aren
ta
l
m
on
it
ori
ng
an
d
as
sist
ance
in
childre
n
in
see
king
in
form
at
i
on
we
re
nee
de
d
to
be
done.
The
bu
sy
ness
a
nd
la
c
k
of
pa
ren
ta
l
at
te
ntio
n
had
a
neg
at
ive
im
pa
ct
on
t
he
chil
d
on
reprod
uc
ti
ve
healt
h
iss
ues,
s
uc
h
as
t
he
ex
pressi
on
of
par
ti
ci
pa
nts
in
the
fo
ll
owin
g
sta
te
m
ent:
"
Pr
omisc
uity,
ha
vi
ng
boyf
rie
nd
/
girlf
rie
nd
,
too
y
oung,
and
the
us
e
of
m
ob
il
e
ph
ones
M
a’
am
...
seei
ng
the
things
tha
t
sh
ould
not
be
seen,
loss
co
ntro
l,
the
n
the
y
sh
ould
be
given
early
unde
rstandin
g
of
wha
t
is
calle
d
as
ab
or
ti
on
or
fre
e
sex,
shou
l
dn’t
they
?.
.
.,
t
he
attenti
on
of
pa
re
nts
is
ver
y
determi
ning
the
guid
an
ce
of
his
family,
where
we
kn
ow
no
w
,
m
an
y
par
ents
ar
e
busy
ma
ki
ng
a
li
vi
ng,
ei
ther
fat
her
or
m
oth
er
,
so
t
he
pare
nts
'
att
ention
t
o
the
c
hild
was
tot
ally
ab
se
nt,
and
if
pa
re
nts
co
me
or
go
ho
me
late at
night,
a
nd com
municat
ion
is
not
good
...
"
(
I
ndept
h
int
erv
ie
w wit
h ke
y partic
ipa
nts)
Var
i
ou
s
fact
ors
af
fected
ris
ky
behavi
or
i
n
ado
le
sce
nts,
suc
h
as
pee
r
-
ris
k
be
ha
vio
r
,
la
c
k
of
par
e
ntal
su
pe
r
visio
n,
a
nd
par
e
ntal pe
r
m
issi
ve
beh
a
vi
or
patte
r
ns
. I
n add
it
io
n,
horm
on
al
e
ff
ect
s
, s
y
nchr
onous
bio
l
og
ic
al
,
ps
yc
holo
gical
and
so
ci
al
devel
op
m
ents
m
a
y
al
so
co
ntribute
to
se
xual
be
hav
i
or
i
n
a
dole
scents.
A
dol
escent
s
who ha
d diff
ic
ulty
in
co
ntr
olli
ng
t
heir
im
pu
lse
wou
l
d
tri
gger th
e
cu
riosity
and
wan
t t
o
tr
y. Fact
ors that
protec
t
ado
le
sce
nts
w
ere
inclu
ding
sel
f
-
c
on
tr
ol,
optim
iz
at
ion
of
fam
il
y
edu
cat
ion
,
par
e
nt
in
g
in
fam
ilies
including
stren
gth
e
ning
r
el
igiou
s
f
ound
at
ion
s,
pa
ren
ti
ng
r
ole
in
gi
vi
ng
e
xam
ples
of
go
od
be
hav
i
or,
rei
nforce
d
by
good
com
m
un
ic
at
ion
betwee
n pare
nts a
nd teac
he
r
s in
c
hildr
e
n'
s
edu
cat
io
n.
Exter
nal
fact
ors
su
c
h
a
s
s
ocial
env
i
ronm
ent,
j
uve
nile
li
fe
st
yl
e,
m
ultim
edi
a
ex
posure,
a
nd p
eers
we
r
e
al
so
ver
y
in
fl
uen
ti
al
on
a
dole
scent
be
ha
vior.
Me
dia
or
inter
net
sit
e
s
that
ca
n
be
acce
ssed
easi
ly
al
so
influ
e
nce
d
ad
olescents
’
be
ha
vior.
T
he
m
edia
ha
d
bo
t
h
posit
ive
an
d
neg
at
i
ve
im
pacts
on
a
do
l
escent
knowle
dg
e,
bel
ie
fs,
a
nd
at
ti
tud
es
a
bout
repr
oductive
healt
h.
M
od
el
s
of
ri
sk
beh
a
vi
or
i
n
ado
le
sce
nts
c
onsist
ed
of
pr
e
disposi
ng
facto
rs
a
nd
protect
ive
factor
s
t
hat
each
ha
d
e
ndogen
ous
an
d
ex
ogen
ous
factor
s
.
In
pre
disposin
g
facto
rs,
en
do
geno
us
facto
rs
con
sist
ed
of
co
gnit
ive
i
m
m
a
turity
,
depressi
on,
low
sel
f
-
es
te
e
m
,
gende
r,
ge
netic
s,
views
of
va
lues,
horm
on
al
eff
ect
s
an
d
th
e
synchro
nizat
ion
of
bio
lo
gic
al
,
ps
yc
holo
gical
and
so
ci
al
dev
el
opm
ents.
Exoge
nous
factors
consi
ste
d
of
ris
ky
beh
a
vior
from
peer
s
,
la
ck
of
par
e
ntal
su
pe
r
visio
n,
sch
oo
l
fail
ure,
pover
ty
,
re
j
ec
ti
on
of
the
s
oc
ia
l
env
ir
on
m
ent,
pa
ren
ta
l
involvem
ent
in
risky
be
hav
i
or,
an
d
par
e
ntal
per
m
i
ssive
pa
ren
ti
ng.
P
ro
te
ct
ive
factors
co
ns
ist
ed
of
en
doge
nous
fact
or
s
t
hat
inclu
ded
norm
al
aff
ect
ive c
ondi
ti
on
s,
c
om
plete
sel
f
-
est
eem
, a
cadem
ic
achie
vem
ent, r
el
igiou
s v
al
ues,
a
nd
m
at
ur
it
y of
cogn
it
ive
dev
el
op
m
ent.
Ex
og
e
nous
fac
tors
inclu
de
d
academ
ic
achievem
ent,
wh
ol
e
fa
m
il
y,
par
e
ntal
su
pport
,
f
rien
d'
s
denu
nciat
ion
of
ris
ky
beh
a
vior,
reli
gious
act
ivit
y,
involvem
ent
in
sch
oo
l
act
iv
it
ie
s
and
aut
hor
it
arian
par
e
ntin
g.
Pre
ci
pitat
ion
fact
or
s
c
onsist
ed
of
peer
s
who
init
ia
te
risky
beh
a
vior,
soc
ia
l
pr
essu
re,
sch
oo
l
transiti
on, fam
i
ly
p
r
ob
le
m
s,
the u
se
of
dru
gs
, a
nd s
us
cepti
bil
it
y
[2
0].
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Hea
lt
h Pr
omot
ion
Mo
del
"
Ext
ra
c
ur
ric
ul
ar" Ap
pr
oac
h of R
epr
oductiv
e
He
alth…
(
Lidi
a Ha
st
uti
)
85
3.3.
Te
en
ag
e
Informa
tio
n
Needs a
b
out
Repr
od
uc
tive
H
ealt
h
Teena
ger
s
nee
ded
a
lot
of
tr
ue,
acc
ur
at
e
a
nd
openly
inf
orm
ation
ab
ou
t
the
cha
ng
es
i
n
their
sel
ves
wh
e
n
t
he
akhi
l
ba
li
q
.
T
he
stud
y
fou
nd
that
ad
olesce
nts
al
so
nee
ded
inf
or
m
at
ion
about
m
enstruat
io
n,
m
enstru
al
pro
cess,
wh
it
e
discharge
pro
bl
e
m
s
exp
e
rienc
ed,
sex
ually
transm
it
te
d
inf
ect
ion
,
body
sh
a
pe
changin
g
durin
g
pu
ber
ty
an
d
reprod
uctive
orga
n
ca
re
suc
h
as
m
a
le
ci
rcum
ci
sion
.
T
his
was
c
onveyed
by
the
fo
ll
owin
g
a
dole
scent
par
ti
ci
pa
nts:
"
.
.
White
disc
ha
r
ge
pr
oble
m
s
Ma’am
.
..,
.
.
Wh
at
the
menst
ru
atio
n
cycl
e
is,
why
it
can
be
irregul
ar
,
wha
t
s
uita
ble
ma
te
ri
al
for
unde
rwear
m
ade
from
an
d
the
name
an
d
the
il
lness
of
t
he
or
ga
n
.
.
"
(FG
D
with a
do
le
sce
nt
p
arti
ci
pa
nts)
"
.
..
Why
girls
have
menst
ruati
on, and w
hy b
oy
s have A
dam
'
s app
le
?"
(FG
D wit
h
te
ena
ge
p
a
rtic
ipants)
Adolesce
nts
ne
eded
in
form
a
ti
on
a
nd
c
ounse
li
ng
a
bout
r
epro
du
ct
ive
he
al
th
face
d.
I
nfor
m
at
ion
need
e
d
by
early
ado
le
sce
nts
wer
e
a
bout
m
enstru
al
pr
ob
le
m
s,
m
enstru
al
cy
cl
es,
wet
dream
s,
vag
i
nal
discha
rg
e
,
cau
ses
and
ef
fect
s
of
w
hite
disc
harge,
a
nato
m
y
and
ph
ysi
ology
of
re
producti
ve
or
ga
ns
,
a
nd
hygiene
m
ai
ntenan
ce
of
reprod
uctive
orga
ns
.
Be
sides
t
ha
t,
the
prob
le
m
of
te
enag
e
r
s’
so
ci
al
iz
at
ion
an
d
sex
ually
trans
m
itted
inf
ect
io
ns
wer
e
al
so
in
cl
ud
e
d.
I
n
a
ddit
ion
t
o
par
e
nts,
te
acher
s
play
ed
a
r
o
le
in
im
pr
ovin
g
ado
le
sce
nts’
re
pro
du
ct
ive
hea
lt
h.
Tee
ns
were
at
risk
f
or
r
epro
du
ct
ive
he
al
th
pro
blem
s
and
nee
de
d
se
rio
us
at
te
ntion
[1]
.
Healt
h
pro
blem
s
in
early
ado
le
sce
nce
(10
-
14
ye
ars
)
i
nclu
ded
pr
ob
l
e
m
s
wh
e
n
te
e
nag
e
rs
exp
e
rience
m
e
nar
c
he.
The
m
os
t react
i
on c
om
m
on
ly
r
eport
ed was
67
%
of
f
em
al
e ado
le
scent res
ponde
nt
s w
ere
sh
oc
ke
d, wee
pi
ng
a
nd a
fr
ai
d
of what
they
w
ere e
xp
e
rienci
ng
[19]
.
3.4.
S
ou
rces
of
In
fo
r
ma
tio
n
an
d
Frie
nds
for
Discussi
on
a
b
ou
t
R
e
prod
uctive
He
alth
Sour
ces
of
in
f
or
m
at
ion
an
d
f
rien
ds
f
or
d
isc
us
sio
n
a
bout
r
epro
du
ct
ive
he
al
th
wer
e
va
ry
ing
widely
.
Sour
ce
of
in
form
ation
a
bout
pube
rty
of
te
e
n
girls'
was
pa
ren
ts,
especial
l
y
m
oth
ers
a
nd
fr
ie
nd
s
,
wh
il
e
boys
pr
e
ferred
fr
ie
nds
as
fr
ie
nd
s
f
or
disc
us
si
on.
Pare
nts
cou
l
d
be
an
unfa
vor
able
source
of
infor
m
ation
if
not
su
pp
or
te
d
by
an
unde
rstan
di
ng
of
kn
ow
le
dg
e
a
bout
reprod
uctive
heal
th,
so
that
ad
olescents
di
d
no
t
get
accurate
in
for
m
at
ion
.
I
n
this
stud
y
f
ound
s
om
e
par
ti
ci
pant
s
of
the
fem
ale
gender
w
ho
hav
e
not
ex
peri
enced
akh
il
bali
q
ye
t
co
nv
ey
e
d
t
hat
the
s
ource
of
inf
or
m
at
ion
a
nd
f
rien
ds
f
or
discuss
i
on
pr
e
ferred
f
or
the
m
was
par
e
nts,
e
sp
eci
al
ly
m
oth
ers,
a
nd
ot
her
fam
ily
m
e
m
ber
s,
es
pecial
ly
te
enagers
who
ha
d
old
er
sibli
ngs
or
aun
ts
who
li
ved
in
one
hous
e
,
besi
des
with
pa
rent
s
the
oth
e
r
ch
oice
is
discussi
ng
with
te
ach
ers
an
d
fr
ie
nds
.
For
te
enag
e
rs
w
ho
had
e
xp
e
rience
d
ak
hil
bali
q
a
lso
pr
e
ferred
f
r
ie
nd
s
an
d
ot
he
r
f
am
i
ly
m
e
m
b
ers
li
ke
br
oth
e
r
a
nd
aun
t
t
o
as
s
our
ces
of
in
form
ation
oth
e
r
tha
n
m
oth
ers.
F
or
m
al
e
par
ti
ci
pation,
their
i
nform
at
ion
res
ourc
es
an
d
discuss
i
on
f
rie
nd
s
a
bout
re
pr
oductive
healt
h
wer
e
f
rien
ds
and
te
ache
rs,
a
lt
ho
ug
h
the
re
wer
e
al
so
pa
rtic
ipants
who
decla
red
t
he
source
of
i
nfor
m
at
ion
an
d
disc
us
sio
n
f
r
ie
nd
s
are
par
e
nts
an
d
fr
ie
nds
.
Audiovis
ual
m
edia
su
c
h
as
te
le
vision
we
re
al
s
o
ve
ry
po
pu
la
r
am
ong
t
ee
ns
t
o
fill
le
isure
ti
m
e
and
ente
rtai
nm
e
nt
facil
it
ie
s,
bu
t
not
necessa
rily
pro
vid
e
e
ve
nts
s
pe
ci
fical
ly
fo
r
re
pro
du
ct
ive
hea
lt
h
inf
or
m
at
ion
for
a
dole
scent
s.
A
nothe
r
s
ource
of
inf
or
m
at
ion
w
as
f
ro
m
m
ult
i
m
edia
m
ob
il
e
phones
a
nd
s
oc
ia
l
m
edia
tha
t
co
uld
be
acc
e
ssed
easi
ly
on
t
he
internet.
Like
the stat
em
ent o
f
one
of the
fo
ll
ow
i
ng teac
he
r partic
ipa
nts:
"
.
..
the
n
for
ki
ds
no
w
days
,
emmm
..
they
seem
to
know
mo
re,
m
ay
be
emm
..
bec
ause
there
are
facil
it
ie
s
li
ke
mo
bile
phone,
w
el
l,
it
’s
on
ly
a
pers
onal
thinki
ng,
internet
,
s
o
they
ar
e
ra
t
he
r
fre
e.
Th
ere
ar
e
also t
he sa
me pa
r
ents,
bu
t somet
imes
parents wi
ll
not e
xplain ..
.
“
(
F
G
D wit
h
te
ache
r partic
ipa
nts)
3.5.
M
od
el
of
School
-
b
as
e
d
Repr
od
uc
tive
Healt
h Pr
om
oti
on Pro
gr
am
So
m
e
of
the
reasons
for
the
prom
otion
of
r
epro
du
ct
ive
he
al
th
can
be
in
form
of
school
-
base
d
are
because
it
is
eff
ic
ie
nt
an
d
cos
t
-
eff
ect
ive
[19]
.
The
us
e
of
va
rio
us
te
achin
g
m
et
ho
ds
was
de
sign
e
d
to
inc
r
ease
act
ive
stud
e
nt
par
ti
ci
patio
n
a
nd
for
pe
rs
on
a
li
zat
ion
.
Progr
a
m
s
design
e
d
to
reduce
ris
ky
sexu
al
be
ha
vior,
so
the
cu
rr
ic
ulu
m
de
velo
ped
f
or
the
pro
gram
sh
ou
l
d
us
e
the
ory
and
resea
rch
on
the
factors
that
infl
uence
s
exua
l
beh
a
vior.
The
eff
ect
ive
ness
i
n
the
sex
ual
e
ducat
ion
im
ple
m
entat
ion
be
c
om
es
ver
y
im
p
or
ta
n
t
by
i
ncor
porati
ng
the
values
of
c
ultur
e
a
nd
reli
gion,
in
or
der
to
form
m
or
al
s
of
a
do
le
sce
nce
.
School
-
base
d
rep
r
oductive
healt
h
had
pro
ve
n
to
be
ver
y
ef
fec
ti
ve
in
im
pr
oving
knowle
dge
and
im
pr
ov
in
g
at
ti
tud
es
am
ong
a
do
le
s
ce
nt
s,
an
d
enab
li
ng
them
to
know
accu
ratel
y
in
identify
ing
si
gn
s
of
pube
rty
,
to
un
der
sta
nd
how
sex
ually
transm
itted
infecti
ons
wer
e
tran
sm
it
te
d.
Sexual
it
y
edu
cat
ion
did
not
encou
rag
e
te
ena
ger
s
to
en
ga
ge
in
fr
ee
sex
,
whil
e
pr
ov
i
ding
r
epro
du
ct
i
ve
healt
h
inf
o
rm
a
ti
on
pro
vid
e
d
te
ens
with
op
portu
n
it
ie
s
to
exp
l
or
e
thei
r
values
a
nd
at
ti
tud
es
wh
il
e
buil
ding
sk
il
ls
fo
r
m
aking
decisi
ons,
c
omm
un
ic
at
ing
with
ot
her
s
,
an
d
re
du
ci
ng
t
he
risk
of
healt
h
prob
le
m
s.
School
-
base
d
re
produ
ct
ive
healt
h
pr
om
otion
pro
gra
m
s
had
f
ull
su
pp
or
t
f
r
om
stud
e
nts,
par
e
nts
an
d
te
ache
rs.
All
par
e
nts
ag
reed
if
the
pr
ogra
m
was
i
m
ple
mented
in
sch
oo
l.
All
ado
le
sce
nts
a
gr
ee
d
if
the
sch
oo
l
car
ried
out
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
81
–
90
86
a
reprod
uctive
healt
h
prom
otion
pro
gram
.
Ther
e
is
difference
of
opinio
n
am
on
g
a
do
le
sce
nts
ab
out
th
e
i
m
p
lem
entat
io
n
of
t
he
progra
m
.
So
m
e
te
enag
ers
wa
nted
th
e
pro
gr
am
was
co
nducted
aft
er
sc
hool
hours
or
in
sp
eci
al
m
eeting
s.
So
m
e
oth
e
r
s
te
ena
ger
s
wa
nted
t
he
pro
gr
a
m
to
be
ca
rr
ie
d
out
du
rin
g
sc
hool
hours
a
nd
m
ade
into
one
in
de
pe
nd
e
nt
s
ubj
ect
.
Pro
vid
in
g
re
pro
duct
ive
healt
h
e
du
c
at
ion
in
sch
ools
was
an
e
ff
ect
ive
w
ay
to
reach
a
do
le
sce
nts.
Sc
hool
-
ba
sed
re
pro
du
ct
i
ve
healt
h
pro
m
ot
ion
poli
ci
es
are
rec
omm
e
nd
e
d
f
or
i
m
prov
em
ent
of r
e
pro
du
ct
ive
h
eal
th i
n
a
dole
scents.
Su
c
h su
pport
can
b
e
se
en
in
the
f
ollo
wing
par
ti
ci
pa
nt stat
em
ents:
"It is re
ally ne
eded M
a’am
…
we a
gr
ee.
"
(
F
GD w
it
h t
each
er
par
ti
ci
pa
nts)
1)
Extrac
urricular
Acti
viti
es o
f
R
epro
du
ct
ive
H
e
al
th
Im
ple
m
entation
of
re
pro
du
ct
i
ve
healt
h
prom
otion
pro
gr
am
s
in
sch
oo
ls
c
ou
ld
be
done
ei
th
er
thr
ough
form
al
cur
ricul
a
or
extrac
ur
ri
cular
act
ivit
ie
s
giv
en
in
early
ado
le
sce
nce.
The
rec
omm
end
ed
program
m
od
el
was
t
he
e
xtrac
urricular
pro
gr
a
m
as an
a
ddit
ion
al
sch
ool l
esson.
"
.
..
it
is
true,
in
ext
ra
c
ur
ric
ula
r
,
for
additi
onal,
theref
ore
it
need
s
an
ext
ra
ho
ur
,
w
el
l
it
need
s
ext
ra
cur
ric
ul
ar, c
an b
e
in
sc
hool
or ot
her place
"
(in
dep
t
h
i
nter
view wit
h key pa
rtic
ipant
s)
2)
Ma
nag
em
ent of P
a
rtic
ipants
Re
producti
ve
healt
h
prom
otion
pr
ogram
s
wer
e
ef
fecti
ve
w
hen
ai
m
ed
at
the
early
sta
ges
of
dev
el
op
m
ent,
especial
ly
fo
r
tho
se
w
ho
we
re
not
sexu
al
l
y
act
iv
e.
In
th
is
stud
y
the
program
was
aime
d
at
pr
im
ary
scho
ol
ado
le
sce
nts
aged
10
-
14
ye
a
rs
an
d
ha
d
not
exp
e
rience
d
ak
hil
ba
li
q
.
T
he
resu
lt
s
of
this
stud
y
fou
nd
that,
i
n
the
m
anag
e
m
e
nt
of
par
ti
ci
pa
nts,
s
om
e
par
ticipants
wa
nte
d
m
al
e
and
fem
al
e
stud
e
nts
w
ere
in
on
e
class
durin
g
the
lear
ning
act
ivit
ie
s,
as quo
te
d from
the stat
e
m
ent o
f o
ne of
the
fo
ll
owin
g partic
ipa
nts:
"
.
..
I
t
hin
k
it
s
houl
d
be
both
M
a’am,
c
ombi
ne
d
it
,
it
is
m
or
e
ef
fe
ct
iv
e,
do
no
t
ha
ve
to
be
se
pa
r
ate
d,
s
o
le
t
them
kno
w
.
It’s
ok
ay
fo
r
men
to
kn
ow
ab
out
wo
m
en
prob
le
ms,
and
inste
ad
“(
FG
D
with
par
ti
ci
pa
nts tea
cher)
In
fact,
gr
oupi
ng
par
ti
ci
pa
nts
accord
i
ng
t
o
t
he
sam
e
gen
de
r,
f
or
so
m
e
or
al
l
pr
ogram
s
had
pro
ven
it
s
eff
ect
ive
ness. M
anag
em
ent
of p
arti
ci
pa
nts
c
ou
l
d
be
done
s
epar
at
el
y
or
c
om
bin
ed
with
va
rio
us
c
onside
r
at
ion
s
.
Boys an
d girls
cou
l
d be c
om
bin
ed
i
n on
e
cla
ss w
it
h se
par
at
e seat
ing ar
rangem
ents b
et
we
en
girls a
nd bo
ys.
3)
Locati
on a
nd E
xecu
ti
on
T
im
e
The
re
su
lt
s
of
this
stud
y
f
ou
nd
a
nd
rec
omm
end
ed
seve
ra
l
locat
ion
s
f
or
the
i
m
ple
m
entat
ion
of
the
pro
gr
am
.
Sele
ct
ion
of
places
was
a
dju
ste
d
to
the
m
at
erial
nee
ds
an
d
obje
ct
ives
of
the
act
ivit
y.
Adolescents
sta
te
d
the
le
ng
th
of
ti
m
e
in
a
sin
gle
m
eet
i
ng
wa
s
a
rou
nd
tw
o
ho
ur
s
of
le
ss
on
once
a
wee
k.
Me
an
wh
il
e,
te
achers
a
rgue
d
that
the
ti
m
e
of
e
xec
utio
n
of
act
ivit
ie
s
duri
ng
a
sessio
n
w
as
two
t
o
th
ree
hours
us
in
g
va
rio
us
m
et
ho
ds an
d
m
edia s
o
as
not t
o be
borin
g.
"
.
..
I
t
hin
k
,
for
no
w
,
it
is
bet
te
r
for
tw
o
le
s
so
ns
ho
ur
s/me
et
ing
or
ab
ou
t
100
minute
s
"
(FGD
with
te
acher pa
rtic
ipants
)
The
res
ults
of
this
stu
dy
rec
om
m
end
ed
that
the
pro
gr
am
sh
ould
be
im
pl
e
m
ented
f
or
12
m
eet
ing
s,
includi
ng
pr
et
e
st
and
post
-
te
st
(1
m
eeting
pe
r
we
e
k)
in
ext
r
acurric
ular
for
m
.
The
tim
e
of
each
sessio
n
r
ang
e
was
from
on
e
to
two
hours
(
with
a
cal
culat
ion
of
50
m
inu
te
s
per
hour)
.
The
le
ngth
of
tim
e
each
sessi
on
was
adap
te
d
to
the
m
at
erial
s,
m
eth
ods
an
d
m
edia in the
lear
ning
process
.
4)
Me
thods a
nd
M
edia
The
e
ff
ect
ive
ne
ss
of
var
i
ous
le
arn
in
g
st
rategies
was
a
dju
s
te
d
to
t
he
nee
ds
an
d
ai
m
s
to
op
ti
m
iz
e
the
le
arn
in
g
pr
oce
ss,
so
that
the
obj
ect
ives
of
t
he
pro
gram
ca
n
be
ac
hieve
d.
Me
thods
an
d
m
edia
cho
se
n
are
base
d
on
a
ge
an
d
de
velo
pm
ent.
The
m
et
ho
ds
that
m
igh
t
b
e
us
e
d
inclu
de
le
ct
ur
es
,
disc
us
sio
ns
,
f
re
qu
e
ntly
aske
d
qu
e
sti
on
s
,
c
ompo
si
ng
pu
zzl
es
,
vie
wing
draw
ing
s
,
r
ole
play
s,
a
nd
assig
nm
ents.
The
use
of
le
ar
ning
m
e
thod
s
in
a
va
riet
y
of
le
arn
in
g
proc
ess,
co
uld
im
pr
ove
a
do
le
sce
nt
know
le
dg
e
a
bout
re
pro
du
ct
ive
healt
h
c
ould
al
so
m
ake
the
at
m
os
phe
re
m
or
e
enjoyable
le
arn
i
ng
process
.
So
m
e
al
te
rn
at
ive
m
e
tho
ds
li
ke
the
f
ollowi
ng
par
ti
ci
pa
nt stat
e
m
ent:
"
.
..
we
ll
, first
ly
they
ar
e intr
oduce
d
t
o
the
materi
al s
uch a
s
expla
na
ti
on
by
u
sin
g LCD
proje
ct
or
,
the
n
wi
th a
udiovis
ual. F
or
me
, it i
s m
ore
eff
ect
iv
e a
nd they
resu
lt
is a
lso more
appropri
ate ...
"
(F
G
D wit
h
te
acher pa
rtic
ipants
)
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Hea
lt
h Pr
omot
ion
Mo
del
"
Ext
ra
c
ur
ric
ul
ar" Ap
pr
oac
h of R
epr
oductiv
e
He
alth…
(
Lidi
a Ha
st
uti
)
87
"
.
..
T
he
meth
od
in
the
s
ugge
ste
d
pro
gr
am
is
by
play
in
g,
giving
t
heory
to
the
cl
as
s
.
It
is
also
a
combin
atio
n of theory
and
vi
de
o
im
pr
essi
ons
a
s wel
l
as
pictures
“(
FGD
with teac
he
r,
D
o 31 ye
ars
)
"
.
..
Usi
ng
pictu
res, let
the c
hil
dr
e
n be interes
te
d
an
d no
t
bor
ed
"
(FGD wit
h t
eacher
p
a
rtic
ipants
)
Ty
pes
of
m
e
dia
us
e
d
incl
ud
e
d
a
ud
i
ov
is
ual
an
d
vis
ua
l
fo
rm
of
i
nteresti
ng
pic
tures
a
nd
m
od
ules/
te
xtbooks,
m
et
ho
ds
of
gr
oup
dis
cussion,
ex
pe
r
i
m
entat
ion
/
de
m
on
strat
ion
,
r
ole
-
play
,
vis
ua
l
ai
ds
,
br
ai
ns
to
rm
ing
, s
toryte
ll
ing
,
a
nd
a
ud
i
ov
is
ual. P
re
vious
re
sea
rch
h
a
d
s
how
n
that
one o
f
t
he
m
os
t
eff
ect
ive w
ay
s
to
i
m
pr
ove
c
hild
an
d
pa
re
nt
com
m
un
ic
at
ion
about
se
xu
al
it
y
was
by
prov
i
di
ng
hom
ewo
r
k
w
he
n
the
st
uden
t
s
had
t
o
disc
us
s
sel
ect
ed
top
ic
s
with
pa
ren
ts
or
ot
her
tr
us
t
ed
ad
ults.
I
f
te
achers
a
nd
pa
ren
ts
s
upport
ed
each
oth
e
r
in
a
pp
ly
ing
str
uctu
red
t
eachin
g,
the
possibil
it
y
of
a
dole
scent
pe
rsonal
grow
t
h
te
nds
t
o
be
m
uch
bette
r.
Learn
i
ng
ob
j
ec
ti
ves
an
d
m
et
ho
ds
we
re
a
dju
s
te
d
to
th
e
stu
de
nt'
s
age
an
d
c
ultur
e
.
I
nter
ve
ntions
nee
de
d
to
be
dev
el
op
e
d
by
si
m
plifyi
ng
th
e
subj
ect
m
at
t
er,
int
rod
ucin
g
al
te
rn
at
ive
te
a
chin
g
m
et
ho
ds,
im
pr
ov
in
g
te
achers'
knowle
dge a
nd und
e
rstan
ding
[
21
]
.
5)
Ma
te
rial
The
re
c
omm
en
ded
m
at
erial
wer
e
su
c
h
as
pu
ber
ty
m
a
te
rial
for
m
en
and
w
om
en,
interco
urse
betw
een
the
op
po
sit
e
s
ex
afte
r
ak
hil
bali
q
,
reprod
uctive
orga
n
m
ai
ntenan
ce,
sel
f
-
c
on
tr
ol,
use
of
un
derwe
ar
an
d
conseq
ue
ntly
i
f
not
cl
ean,
a
nd
haza
rd
s
t
ha
t
m
ay
occu
r.
Like
the
s
ta
tem
ent
of
one
of
t
he
f
ollo
wing
par
ti
ci
pa
nts:
"
.
..
W
omen
ha
ve
enla
rg
e
d
he
r
br
e
as
ts,
t
he
n
sigh
e
d
by
me
ns
tru
atio
n,
w
hi
le
for
m
an,
th
ey
had
we
t
dr
e
am
....
Me
anin
g
y
ou
guys
in
rel
atio
n
t
o
t
he
opposit
e
se
x
shou
l
d
be
li
mite
d
and
c
are
ful,
nor
m
al
fe
el
ing
s
if
li
kes
the
op
posit
e
sex,
there
is
i
nt
erest
but
m
us
t
be
c
on
tr
ol
le
d
.
..
the
n
cl
e
an
li
ne
ss
an
d
th
e
dangers
als
o "
(F
G
D wit
h
te
a
cher pa
rtic
ipan
ts)
The
rec
omm
en
ded
m
at
erial
migh
t
be
in
sp
ire
d
by
w
ron
g
se
xu
al
beh
a
vior.
The
m
at
erial
w
as
giv
e
n
by
the tea
che
r
a
nd worke
d
wit
h
t
he
e
xp
e
rts, suc
h
as
the
fo
ll
ow
ing
pa
rtic
ipant
s:
".
..
T
he
m
aterial
can
be
li
ke
it
s
ad
verse
ef
fe
ct
s,
it
s
i
ll
nesses,
or
the
misu
se
of
this
re
pr
od
uctio
n"
(in
dep
t
h
inte
rvi
ew
with
k
ey
pa
rtic
ipants
)
Pr
ovisi
on
of
re
pro
du
ct
ive
hea
lt
h
inf
or
m
at
ion
shou
l
d
be
ad
justed
t
o
the
ag
e
an
d
sta
ges
of
ad
olescen
t
dev
el
op
m
ent
a
nd
pro
vid
e
d
grad
ually
.
S
ome
m
a
te
rial
s
cou
ld
im
pr
ove
a
do
le
sce
nt
c
ompete
nce
acc
ord
ing
t
o
WHO
reco
m
m
end
at
ions,
s
uch
as
a
do
le
s
cent
gro
wt
h
a
nd
de
velo
pm
e
nt,
a
do
le
sce
nt
body
c
ha
ng
e
s
towa
r
d
pube
rty
.
I
n
a
ddit
ion
,
se
xu
al
it
y
an
d
gende
r,
sex
ual
at
ti
tud
e
s
an
d
be
ha
vio
r
,
m
enstru
at
io
n,
m
enstru
al
hy
giene
,
and m
enstru
al
pro
blem
s,
includi
ng se
xu
al
ly
transm
itted infec
ti
on
s als
o
c
ould
be
c
hose
n
[
22
]
.
6)
Pr
og
ram
Resou
rces
The
e
xp
la
natio
ns
s
hould
be
gi
ven
by
ex
per
t
s
base
d
on
thei
r
sp
eci
ficat
ion
about
re
pro
du
c
ti
ve
healt
h.
As on
e
of
t
he f
ollow
i
ng p
a
rtic
ipants says:
"...
It
is
bette
r
if
the
stud
e
nts
ar
e
explai
ne
d
by
the
expe
r
ts
in
their
fi
e
l
d.
If
pare
nts
ma
y
no
t
kn
ow
mu
c
h
ab
ou
t
it
,
bu
t
if
tho
se
in
the
hea
lt
h
fi
el
d,
wh
o
take
c
are
of
repr
oduc
ti
ve
hea
lt
h
that
go
es
int
o
sch
oo
l
progra
ms,
wi
ll
b
e
mo
re cle
ar
"
(i
nd
e
pth
i
nter
view wit
h key pa
rtic
ipants)
The
open
ness
an
d
m
otivati
on
of
te
ac
hers
to
discu
ss
about
reprod
uc
ti
ve
healt
h
issues
i
n
t
he
cl
assroom
was
cru
ci
al
.
A
fem
al
e
te
acher
was
sp
eci
al
ly
trai
ned
.
Teac
her
tra
ining
was
the
ke
y
to
the
su
cce
ss
of
sch
oo
l
-
base
d
r
epro
du
ct
ive
he
al
th
e
du
cat
i
on
program
becau
se
it
cou
l
d
infl
uen
ce
know
le
dg
e,
at
ti
tu
de,
an
d
m
ot
ivati
on
to
te
ach.
Prov
isi
on
of
re
pro
duct
ive
healt
h
inf
or
m
at
ion
in
schools
co
uld
be
done
by
te
achers
,
especial
ly
reli
gious
a
nd
sci
ence.
Teac
he
r
s
shou
l
d
un
de
rstan
d
a
bout
reprod
uctive
hea
lt
h
prob
l
e
m
s
in
ado
le
sce
nts,
al
though
inte
rv
i
ews
an
d
obser
vational
fin
dings
f
ound
that
i
n
reali
ty
,
te
achers
ha
d
le
ss
con
t
ro
l
ov
e
r
re
product
ive
healt
h
pro
bl
e
m
s
in
dep
th
.
Stren
gth
e
n
te
acher'
s
knowle
dge
accor
di
ng
to
child
de
velo
pm
ent
ph
a
se
was req
ui
red
.
"
.
..
We
wa
nt
r
el
igiou
s
te
ac
he
rs
to
also
pa
rti
ci
pa
te
in
it
,
of
c
ou
rs
e
the
re
sho
uld
be
r
epr
oductiv
e
hea
lt
h
i
n
rel
ig
iou
s
le
ss
on
s
,
because
on
t
hat
ages,
they
ha
ve
alrea
dy
experience
d
tr
an
sit
io
n,
the
tran
sit
io
n
to
pube
rty
.
Wel
l
th
at
'
s
the
c
as
e
s
o
they
re
ally
have
t
o
be
true
-
righ
t
c
on
tr
olled,
we
ll
now
we
ha
ve
done
the
ef
fort,
and
we
ha
ve
told
to
all
rel
igiou
s
te
ach
e
rs.
We
ha
ve
alrea
dy
told
them
every
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
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:
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IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
81
–
90
88
ti
me,
since
lo
ng
ti
me,
s
o
it
’s
no
t
on
ly
t
his
year
.
..
bio
lo
gy
te
ach
ers
t
he
n
rel
igiou
s
te
ac
he
rs,
sci
ence
te
ach
er
“
(
i
nd
e
pth
i
nter
view wit
h key pa
rtic
ipants)
Pare
nts
al
so
a
rgue
d
that
i
n
beside
te
ache
r
s,
the
ot
her
ri
gh
t
res
ource
pe
rsons
i
n
t
his
pro
gr
am
are
healt
h
pract
it
ion
ers
or
people
who
are
e
xp
e
rt
s
in
their
fiel
d.
W
it
h
c
ollab
orat
ion
bet
ween
te
achers
a
nd
he
al
th
pr
act
it
io
ne
rs,
it
was
ex
pected
that
inform
at
io
n
on
re
pro
du
ct
i
on
healt
h
that
be
obta
ine
d
by
te
enag
er
s
was
m
or
e
com
pr
ehe
ns
ive
. T
he
sta
te
m
ent
w
as
quote
d by
the
par
ti
ci
pa
nts as follo
ws:
"
.
..
si
mu
lt
ane
ously
,
sim
ulta
ne
ou
sly
wi
th
t
he
collabor
atio
n
betwe
en
te
ac
hers
and
he
alt
h
worke
rs
"
(F
G
D wit
h pa
r
ent p
a
rtic
ipants
)
"
.
..
I
thi
nk
if
it
was
c
ollabor
at
ion
,
it
m
ea
ns
tha
t
there
are
experts
wh
o
c
an
expl
ain
t
he
n
there
ar
e
te
ach
ers
a
ls
o"
(F
G
D wit
h pa
r
ent p
a
rtic
ipant
)
Teacher
s
are
pa
rt
of
the
sc
ho
ol
str
uctur
e
,
know
n
a
nd
t
ru
st
ed
by
the
c
omm
un
it
y
and
est
ablish
good
relat
ion
s
hip
s
w
it
h
stu
den
ts.
T
eachers
can
int
egr
at
e
t
he
m
es
sage
of
re
pro
duct
ive
healt
h
a
nd
sex
ualit
y
in
to
the
su
bject
s.
Ba
se
d
on
the
fi
nd
i
ngs
of
this
qual
it
at
ive
stud
y
an
d
t
he
e
vid
e
nce
base
or
previ
ous
st
ud
ie
s
,
t
his
stu
dy
r
ecom
m
end
ed t
hat r
es
ource
pe
rsons
i
n
the
pr
ogram
i
m
ple
mentat
ion
a
re
fro
m
r
epr
oductive
h
eal
th
pr
act
it
ion
e
rs
and trai
ne
d
te
a
cher
s
.
3.6.
Rec
omm
endatio
n
of
School
-
b
as
e
d
Reproducti
ve
Health
Pr
om
ot
io
n
w
ith
"Ext
r
acurri
cular"
Ap
pr
oach
of
Repr
od
uc
tive
Healt
h
on
E
ar
ly Adolesce
nt
s
in
Sch
ool
Sex
e
du
cat
io
n
did
no
t
e
ncou
rag
e
a
dole
scen
ts
to
en
gag
e
i
n
f
ree
se
x,
whil
e
pr
ovidi
ng
r
epro
du
ct
iv
e
healt
h
in
form
a
ti
on
an
d
pro
vid
ed
te
e
ns
with
opport
un
it
ie
s
to
ex
plore
thei
r
val
ues
an
d
at
ti
tud
es
w
hile
buil
ding
sk
il
ls
to
m
ake
decisi
ons,
co
m
m
un
ic
at
e
with
oth
e
rs,
a
nd
reduce
the
ri
sk
of
healt
h
pro
blem
s
[22
]
,
[
19]
.
School
-
base
d
r
epro
du
ct
io
n
he
al
th
prom
otion
had
pro
ven
t
o
be
ve
ry
eff
ect
ive
in
im
pr
ov
i
ng
knowle
dge
and
i
m
pr
ovin
g
at
ti
tud
es
am
o
ng
ado
le
sce
nts.
L
et
them
kn
ow
accu
ratel
y
to
identify
si
gn
s
of
pube
rty
,
an
d
unde
rstan
d
ho
w
sex
ually
transm
itted
diseases
sp
rea
d
[23]
.
Schools
we
r
e
sel
ect
ed
as
a
sit
e
fo
r
inter
ve
ntions
relat
ed
to
sex
ua
li
ty
and
re
pro
du
ct
ive
healt
h
[10].
Sc
hool
-
ba
sed
reprod
uct
ive
healt
h
pr
om
ot
ion
po
li
ci
es
we
re
reco
m
m
end
ed
for
i
m
pr
ovem
e
nt
of
reprod
uc
ti
ve
healt
h
in
ado
le
sce
nts
[
19]
.
Sexual
an
d
rep
r
oducti
ve
healt
h
edu
cat
io
n
in
a
do
le
sce
nts
c
ou
ld
be
prov
i
de
d
th
r
ough
for
m
al
or
i
nfor
m
al
cha
nn
el
s
ba
sed
on
the
goal
of
equ
i
pp
i
ng
know
le
dg
e
,
sk
il
ls
and
a
sen
se
of
res
ponsi
bili
ty
f
or
hum
an
rep
r
oduc
ti
ve
functi
on
[9]
.
T
he
im
ple
m
entat
ion
of
reprodu
ct
ive
healt
h
prom
otion
program
s
in
scho
ols
c
ou
l
d
be
done
ei
ther
th
rou
gh
form
al
cur
ricul
um
or
extrac
urricular
act
ivit
ie
s
giv
e
n
in
ea
r
ly
ado
le
scence
[9
]
,
[
19]
.
A
n
eff
ect
ive
c
urri
culum
was
str
uct
ur
e
d or m
od
ifie
d
t
o i
nclud
e
all
the
top
ic
s
nee
ded
by teena
ger
s
, t
eachers
and
he
al
th worker
s
[8]
.
The
re
pro
du
ct
i
ve
healt
h
pr
om
ot
ion
pro
gr
a
m
was
eff
ect
ive
if
it
was
aim
ed
at
an
ea
rly
sta
ge
of
dev
el
op
m
ent,
especial
ly
fo
r
tho
se
w
ho
were
no
t
sex
ually
act
ive
[24]
.
I
n
the
i
m
ple
m
e
ntati
on
of
the
eff
ect
s
pro
gr
am
was
pro
ven
to
be
be
tt
er
and
m
or
e
eff
ect
ive
if
th
e
program
ta
rg
et
s
wer
e
early
ado
le
sce
nt
or
early
ado
le
sce
nts
[
10]
.
Pro
vid
in
g
edu
cat
io
n
a
bout
re
pro
duct
ive
healt
h
c
ou
ld
ed
ucate
ch
il
dr
en
a
bout
healt
hy
sex
ualit
y
and
a
ver
y
im
po
rtant
way
to
protect
them
from
ph
ysi
cal
and
se
xual
abu
s
e,
pre
ven
t
sexu
al
har
as
sm
ent an
d
to
inc
rease t
he
li
kelihoo
d of
repor
ti
ng i
n
t
he
ev
e
nt of se
xu
al
v
iolen
ce
[11
]
,
[
19]
.
The
the
or
y
use
d
f
or
pro
gr
a
m
plann
in
g
w
as
interve
ntio
n
m
app
in
g.
T
he
re
we
re
6
ba
sic
ste
ps
that
cou
l
d
be
s
pelle
d
out
as
f
ollows:
first
perf
or
m
an
assessm
ent
or
needs
anal
ysi
s,
second,
c
reate
a
m
at
rix
bas
e
d
on
determ
inan
ts
of
be
hav
i
or
and
en
vir
onm
ental
conditi
on
s
.
T
hir
d,
c
hoose
the
the
o
ry
-
base
d
inter
ve
ntion
m
et
ho
d
an
d
pract
ic
al
strat
egy.
Fo
urt
h,
tra
ns
la
te
the
m
eth
ods
an
d
strat
e
gies
into
an
orga
nized
pro
gr
am
.
Fifth,
plan
a
n
adoptio
n,
im
plem
entat
ion
,
and
su
sta
ina
bi
li
ty
of
the
pr
ogram
and
th
e
sixth,
pro
duce
an
evaluati
on
pla
n.
Th
e
ado
le
sc
en
t
reprod
uctiv
e
healt
h
extrac
urricular
progr
a
m
was
dev
el
oped
us
in
g
a
m
app
i
ng
interve
ntio
n
appr
oach
as
a
r
efere
nce
to
th
e
dev
el
opm
ent
of
theo
ries
on
sch
oo
l
-
ba
se
d
repr
oductive
healt
h
prom
otion
pro
gr
am
s
[25]
.
Qu
al
it
at
ive
re
s
earch
co
nduct
ed,
ai
m
ed
to
fin
d
the
m
od
el
or
patte
r
n
of
pro
gr
am
s
to
be
a
pp
li
e
d.
Ex
planati
on
a
bout
i
nter
ven
ti
on
m
app
in
g
ste
ps
i
n
this
stu
dy
wer
e:
first
st
age
inte
rv
e
ntio
n
m
app
in
g
wa
s
ab
out
the
obj
ect
ive
of
the
pro
gr
a
m
,
wh
ic
h
was
to
exp
l
or
e
a
nd
cl
arify
feeli
ng
s
a
nd
est
abl
ish
posit
ive
va
lues
an
d
at
ti
tud
es
an
d
in
form
ation
needs
on
re
pro
du
ct
i
ve
he
al
th
to
prom
ote
and
m
ain
ta
in
beh
a
vior
that
was
possib
le
to
reduce
ris
ky
be
hav
i
or
in
reprod
uctive
heal
th.
The
sec
on
d
inter
ven
ti
on
m
app
in
g
was
by
m
aking
a
m
at
rix
base
d
on
det
erm
inants
of
beh
a
vior
a
nd
en
vir
on
m
ental
conditi
ons.
Re
searche
rs
i
den
ti
fie
d
fact
or
s
that
influ
e
nce
d
earl
y
ado
le
sce
nt
be
hav
i
or
on
reprod
uctive
healt
h
a
nd
al
te
r
nati
ve
s
olu
ti
ons
t
o
ad
dr
ess
the
prob
le
m
.
Fu
rt
her
m
or
e,
t
he
thir
d
sta
ge
of
inte
rv
e
ntio
n
m
app
in
g
was
about
the
f
oundat
ion
of
t
heor
y
and
strat
egy.
At
this
sta
ge,
resea
rchers
id
entifi
ed
i
t
theo
reti
cal
ly
and
e
vid
e
nce
-
base
d
inte
rv
e
nt
ion
s
t
hat
had
been
ef
fecti
ve.
The
interve
ntio
n
w
as
co
nducte
d
i
n
t
he
form
of
re
pro
du
ct
ive
healt
h
prom
otion
pr
ogram
s
that
wer
e
pac
ke
d
i
n
extrac
urricular
form
of
re
p
r
oductive
healt
h.
T
he
fou
rth
sta
ge
of
t
he
interve
ntio
n
m
app
i
ng
was
pr
ogram
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IJPHS
IS
S
N: 22
52
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8806
Hea
lt
h Pr
omot
ion
Mo
del
"
Ext
ra
c
ur
ric
ul
ar" Ap
pr
oac
h of R
epr
oductiv
e
He
alth…
(
Lidi
a Ha
st
uti
)
89
desig
n,
sta
rted
with
a
qu
al
it
at
ive
stu
dy
to
e
xp
l
or
e
the
m
od
el
of
t
he
pro
gram
to
be
de
ve
lop
e
d.
I
n
a
dd
i
ti
on
t
o
the
fin
dings
of
qu
al
it
at
ive
research
that
ha
d
been
done,
in
t
he
de
velo
pm
e
nt
of
the
pr
ogr
a
m
research
er
s
al
so
ref
e
rr
e
d
to
the
theo
ries
an
d
e
vid
e
nce
ba
se
of
previ
ous
rese
arch.
The
fifth
ph
a
se
of
inter
ve
ntion
m
app
i
ng
wa
s
about
pla
nn
i
ng
the
ad
op
ti
on
a
nd
im
ple
m
entat
ion
pr
ogram
.
Im
ple
m
enting
or
de
velo
ping
th
e
pro
gr
am
require
d
colla
bo
rati
on
betwee
n
re
sea
rch
e
rs,
sch
ool
te
achers
,
parents
an
d
a
dol
escents
in
pr
ogram
dev
el
opm
ent.
The
de
velo
pme
nt
of
a
healt
h
prom
otion
pro
gr
am
was
based
on
the
theo
ry
and
evi
den
ce
base
an
d
the
strat
eg
y
adopted
.
The
researc
her
de
ve
lop
e
d
a
pro
gra
m
m
od
el
consi
sti
ng
of:
1)
form
ulati
ng
the
com
petence
to
be
m
ast
ered
in
t
he
i
m
ple
m
entat
i
on
of
th
e
re
pro
du
ct
io
n
healt
h
prom
otion
pro
gr
am
on
the
ea
rly
ad
olescents
(a
ge
10
-
14
ye
ars
)
in
pr
im
ary
school
stu
den
ts
,
2)
de
sig
ning,
com
pili
ng
the
sta
nd
a
rd
of
rep
r
oduc
ti
ve
healt
h
extrac
urricular
com
petence
as
well
as
de
velop
i
ng
t
he
m
od
el
and
pr
i
nting
program
m
od
ules
f
or
st
ud
e
nt
s
a
nd
facil
it
at
or
s;
3)
desig
ning
a
nd
pr
e
par
i
ng
the
m
edia
us
e
d
ac
cordin
g
t
o
rec
om
m
end
at
ion
s
ob
ta
ine
d
from
the
first
sta
ge
of
resear
ch,
e
vid
e
nce
ba
se
an
d
the
ori
es.
T
he
pr
e
par
e
d
m
edia
include
:
stud
e
nt
le
ar
ning
m
od
ule,
te
ach
e
r
m
od
ule,
pro
j
ec
tor
sli
de,
pro
ps,
ro
le
play
pro
per
ty
,
vi
de
o,
c
a
m
era,
puzzl
e
of
reprod
uctio
n
orga
n
im
age
and,
4)
dev
el
op
i
ng
le
arn
i
ng
st
rateg
y
in
the
f
orm
of
interact
ive
m
et
ho
ds
.
The
m
et
ho
ds
us
e
d
are:
l
ect
ur
in
g,
br
ai
ns
to
rm
ing
,
sm
a
ll
gr
oup
discuss
i
ons,
quest
io
ning,
fill
ing
qu
iz
zes
in
wor
ks
heets
,
r
ole
-
play
,
ta
ke
ho
m
e
assignm
ent
tha
t
involvin
g
pa
ren
ts,
an
d
dem
on
st
rati
ons/sim
ulati
on
s
.
I
n
th
e
6th
sta
ge
int
erv
e
ntio
n
m
app
in
g:
Evaluati
on
of
dev
el
op
e
d
outc
om
es
was
m
ea
su
re
d
by
the
re
su
lt
ed
pre
-
te
st
and
po
st
-
te
st
and
the
ef
fects
of
the
i
m
ple
m
ented
pr
ogram
.
In
ad
di
ti
on
,
in
m
od
el
ing
the
inter
ve
ntion,
it
ref
erre
d
to
the
Tem
plate
fo
r
In
te
r
ve
ntio
n
Descr
i
ption
a
nd
Re
plica
ti
on
(
TIDI
e
R)
C
hec
klist
.
TI
DI
e
R
pro
vid
e
d
inf
or
m
at
ion
relat
ed
to
the
desc
rip
ti
on
of
the
inter
ve
ntio
n.
TI
DI
e
R
incl
ud
e
d
t
he
var
i
ous
c
om
po
ne
nts
that
would
be
accom
m
od
at
ed
in
the
inter
ve
ntion
m
od
el
.
This
st
ud
y
re
com
m
end
ed
a
pro
gr
am
cal
le
d
e
xtrac
urricular
repr
oduct
ive
healt
h
with
the
slo
ga
n
"gr
eet
in
g
ad
ole
scence
with
he
al
thy
and
obe
di
ent".
This
sc
hool
-
base
d
program
was
aim
ed
at
early
ado
le
scents
(10
-
14
ye
ars
ol
d),
who
ha
d
no
t
exp
erie
nced
akh
il
bali
q
an
d
stud
ie
d
at
pr
i
m
ary
scho
ol.
T
he
pro
gr
am
aime
d
to
i
m
pr
ove
knowle
dg
e
,
s
ha
pe
at
ti
tud
es
a
nd
posit
ive
be
ha
vio
r
of
a
do
le
sce
nts
t
ow
a
r
ds
reprod
uctive
healt
h
with
a
reli
gious
a
ppr
oach.
T
he
res
earche
r
de
vel
oped
t
he
basic
com
petencies
that
m
us
t
be
possesse
d
by
early
ado
le
sce
nts
(
10
-
14
ye
ars)
a
nd
bei
ng
de
velo
ped
i
n
a
sta
nd
ard
of
c
om
petence
that
desc
ribe
d
the
knowle
dge,
aff
ect
ive
a
nd
s
kill
that
m
us
t
be
posse
ssed
ba
sed
on
t
he
re
su
lt
s
of
resea
r
ch
an
d
t
heorie
s.
The
incre
asi
ng
of
knowle
dge
an
d
un
der
sta
nd
i
ng
of
ad
olesc
ent
a
bout
repr
oductive
healt
h
du
rin
g
pre
-
pube
rty
would
equi
p
ado
le
sce
nt
to
con
ti
nue
t
o
th
e
de
velo
pm
ent
process
with
fu
ll
of
res
po
ns
ibil
it
y.
Partic
ipants
w
ou
l
d
ha
ve
po
sit
ive
v
al
ues
an
d
at
ti
tud
es
a
nd b
e
ha
viors
on
reprod
uctive
healt
h.
The
re
pro
duct
ive
healt
h
extra
curricula
r
pro
gram
was
giv
e
n
12
sessio
ns
in
cl
ud
in
g
pr
e
-
te
st
and
post
-
te
st,
with
durati
on
100
m
inu
te
s
at
each
ses
s
ion
.
The
le
arn
i
ng
pro
gram
was
arr
a
nged
in
a
syl
la
bu
s,
i
nvolv
i
ng
resou
rce
pe
rs
ons
f
r
om
healt
h
pr
act
it
ion
e
r,
t
eachers
an
d
pa
ren
ts
in
orde
r
to
im
pr
ov
e
th
e
com
m
un
ic
at
i
on
of
par
ti
ci
pa
nts
an
d
pa
re
nts.
I
n
t
his
pro
gram
,
tr
ai
nin
g
on
te
ac
her
s
i
nvolv
e
d
i
n
re
pro
du
ct
ive
healt
h
pr
ogra
m
s
was
cond
ucted
befor
e
.
Be
sides
th
at
,
par
e
nts
we
r
e
involve
d
in
helping
st
ud
e
nt
s
to
do
hom
e
work
pro
vid
e
d
by
th
e
facil
it
at
or
at
hom
e.
Teacher
t
rainin
g
was
ve
ry
i
m
po
rta
nt;
al
l
te
achers
m
us
t
hav
e
kn
ow
le
dg
e
,
s
kill
s,
cha
racte
r
and
qual
it
y.
Com
po
ne
nts
tha
t
po
s
sibly
us
e
d
in
the
de
velop
m
ent
of
re
pro
duct
ive
healt
h
prom
otion
we
r
e
curriculum
,
especial
ly
cogniti
ve,
af
fecti
ve
a
nd
b
e
hav
i
or
al
d
o
m
ai
ns
.
A
n
e
ff
ect
ive
c
urric
ulu
m
was
struc
ture
d
to
include
all
the
top
ic
s
nee
ded
by teena
ger
s
, t
eachers
, a
nd h
e
al
th worker
s
[8]
.
Pr
og
ram
was
design
e
d
wit
h
m
et
ho
ds
a
nd
le
arn
i
ng
m
edia
that
was
f
un
f
or
te
ena
ger
s
,
so
they
did
not
feel
bore
d
dur
ing
t
he
pro
gr
a
m
.
T
o
i
m
pr
ov
e
the
qu
al
it
y
of
le
a
rn
i
ng,
e
ver
y
a
dole
scent
was
eq
ui
pped
wit
h
trai
ning
m
od
ul
e
as
well
as
f
aci
li
ta
tor
and
r
eso
ur
ce
perso
n.
Me
thods
i
n
the
pr
ogram
wer
e
le
ct
ur
i
ng,
gro
up
discuss
i
ons,
brai
ns
torm
ing
,
a
nd
r
ole
-
play
,
s
tory
-
te
ll
ing,
au
diovisual
a
nd
pro
vid
i
ng
ho
m
ewor
k
to
st
ud
ents.
Me
dia
in
the
pro
gr
am
wer
e
m
od
ules
for
stud
e
nts,
te
ache
r
s,
pro
j
ect
or
sli
de,
vi
deo,
cam
era,
pro
pe
rty
fo
r
r
ole
play
,
pictu
re
puzzl
e
of
repr
oductive
or
gan
s
,
an
d
pro
per
ty
ab
ou
t
se
xual
and
re
pro
du
ct
i
ve
healt
h
m
essages.
Pr
og
ram
m
ater
ia
l
i
nclud
e
d
akh
il
bali
q
,
m
enstru
at
io
n,
an
d
m
ai
nt
enan
ce
of
re
pro
du
ct
ive
organs
.
The
im
ple
m
entat
ion
of
act
ivi
ti
es
was
c
ondu
ct
ed
after
sc
hool,
by
ch
oosin
g
places
that
wer
e
co
nduci
ve
.
Ma
le
and fem
al
e stud
ents
w
e
re m
a
de
int
o on
e
cla
ss, bu
t
with
se
par
at
e
d
seat
s
w
hen
the
pro
gr
a
m
w
as i
m
ple
m
ented
4.
CONCL
US
I
O
N
This
stu
dy
rec
omm
end
s
a
pr
ogram
abo
ut
“
Extrac
urricular
School
ba
sed
of
reprod
uctiv
e
healt
h
f
or
early
ad
olesce
nts
w
ho
e
xperi
ence
befor
e
Ak
hil
Baliq
.
T
his
stu
dy
al
so
de
velo
p
basic
of
com
petension
wh
ic
h
m
us
t
be
owne
d
in
t
he
healt
h
c
om
petency
sta
nd
a
r
d
of
re
pro
du
ct
ive
h
eal
th f
or
ea
rly
ad
ole
scents
in
sc
ho
ol
ag
ed
10
-
14
ye
ars
ol
d.
Com
petence
dev
el
op
m
ent
include
s
know
le
dg
e,
a
ff
ect
iv
e
and
s
kill
s
in
reprod
uctive
healt
h.
The pr
ogram
is don
e
outsi
de o
f
sc
hool
by in
volvin
g
te
ac
h
ers
, p
a
ren
ts
and
he
al
th worker
s. For i
nc
rease
qual
it
y
of
stu
dy,
this
researc
h
us
e
d
a
m
e
tho
d
noti
ce
ado
le
sce
nts
gro
wth
a
nd
de
velo
pm
ent.
Ever
y
ad
ole
scents,
facil
it
at
or
, a
nd
keyn
ote s
peak
e
rs
i
n
this
stu
dy g
ive
n
a
traini
ng m
od
ul.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
81
–
90
90
ACKN
OWLE
DGE
MENTS
We
tha
nk
t
o
Edu
cat
i
on
s
auth
or
it
ie
s
of
Kub
u
Ra
ya
district
,
UPTD
Ra
sau
Ja
ya
su
b
-
district
,
Partic
ipants
of
this stu
dy, a
nd
In
sti
tutt
e of
N
ursin
g
Mu
ham
m
adiy
ah
P
onti
an
ak
as
resea
rch
fun
der
s
.
REFERE
NCE
S
[1]
Hindin,
Mich
el
l
e,
J.
,
Sigurdson,
C.
C.
,
Jan
e
F.
B.
,
“
Settin
g
rese
arc
h
prio
rit
ie
s
for
adol
e
sce
nt
sexua
l
an
d
rep
roduc
t
ive
h
ealth
in
low
and
m
iddl
e
-
inc
om
e
count
ri
es
”
,
Bul
l
et
in
o
f
th
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ah,
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ce
of
ea
rl
y
rep
rodu
ct
iv
e
he
al
th
educat
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l
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”,
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enter
for
G
ende
r
Studi
es
of
Univer
sita
s Isl
a
m
Indone
sia
-
Kubu Ra
y
a
Indone
s
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n
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amic
Univ
ersity
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rch
and
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ion
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l
opm
ent
Center
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oduc
t
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ea
l
th
surve
y
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r
ado
le
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2007
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resul
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”,
htt
p
s://
digilib.
bkkb
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go.
id
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ndex
.
php
?
p
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&i
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ac
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essed
Desem
ber
2012
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2007
[4]
Resea
rch
and
P
opula
ti
on
Deve
l
opm
ent
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-
BKK
BN.
"The
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e
assess
m
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nt
of
th
e
ado
le
s
ce
nt
popu
latio
n
(10
-
24
y
ears
),
th
ere
wi
th te
en
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".
Serie
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No.
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du
-
BKK
B
N/Dec
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r
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[5]
BP
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BKK
B
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Depa
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Hea
lt
h
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Mac
ro
I
nte
rna
ti
ona
l
Inc
.
"Reproduc
ti
ve
hea
l
th
of
Indone
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n
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Jak
art
a
,
2008
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[6]
UN
ICEF,
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Indone
sia annua
l
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ort”
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UN
IC
EF
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sia
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[7]
Ministr
y
of
He
al
th
Rese
arc
h
and
Deve
lopme
nt
RI.
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at
ion
al
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on
Basic
Hea
l
th
Resea
rch
2010”
.
(
htt
p://ww
w.di
skes.ba
l
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le
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ai
n
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skes/Januar
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a
cc
essed
Ma
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[8]
UN
FPA,
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rds
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lizing
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full
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ent
i
al
of
adol
esc
ent
s
a
nd
y
outh
;
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FP
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strat
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y
on
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esc
ent
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an
d
y
outh
”. (
htt
p
:/
/w
ww
.
un.
org/Doc
s/journa
l
/a
sp/ws
.
a
sp
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