Integrating Behavioral Theory and Educational Innovation to Improve Adolescent Sexual and Reproductive Health: A Systematic Review

Abstract

Background: Educational interventions have become a cornerstone of adolescent SRH promotion, with increasing emphasis on theory-based approaches and innovative educational strategies. However, evidence regarding their comparative effectiveness across different SRH outcomes remains fragmented. This systematic review synthesized experimental evidence on the effectiveness of theory-based and innovative educational interventions for improving adolescent SRH outcomes and preventing risky sexual behaviors.
Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Six electronic databases (PubMed, Cochrane Library, ERIC, ScienceDirect, JSTOR, and Wiley Online Library) were searched for English-language studies published between January 2000 and December 2025. Randomized controlled trials (RCTs), cluster RCTs, and quasi-experimental studies evaluating educational interventions among adolescents aged 10–19 years were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools, while risk of bias was evaluated using RoB 2 for randomized studies and ROBINS-I for quasi-experimental studies. Due to methodological heterogeneity, findings were synthesized narratively.
Results: Forty studies met the eligibility criteria, comprising 28 randomized or cluster randomized controlled trials and 12 quasi-experimental studies. Educational interventions were categorized as theory-based, innovative, or combined approaches. Across the included studies, interventions consistently improved SRH knowledge, attitudes, self-efficacy, behavioral intentions, and communication skills. Evidence for behavioral outcomes including condom use, contraceptive behaviors, delayed sexual initiation, abstinence, and reductions in risky sexual behaviors was generally positive but less consistent. Combined approaches were promising, but heterogeneous indirect comparisons did not establish their superiority or sustained behavioral effectiveness.
Conclusions: Educational interventions can improve knowledge and selected psychosocial outcomes, while evidence for sustained behavioral change remains mixed. Cultural context, intervention dose and fidelity, service access, and methodological limitations should guide interpretation. Stronger comparative studies with longer behavioral follow-up are needed.