Factors influencing sexual and reproductive health perceptions among mountainous adolescents in Vietnam

ABSTRACT

This cross-sectional study aimed to assess the knowledge and perceptions of sexual and reproductive health (SRH) and factors influencing perceptions among adolescents living in Son La, a mountainous region in Vietnam. A total of 382 adolescents participated in the study, with 59.7% girls and 40.3% boys. Findings revealed that the level of knowledge of SRH among adolescents in Son La is markedly different among girls and boys, where girls exhibited higher knowledge compared to boys in all aspects surveyed. The average SRH perception score was moderate (21.7 ± 8.05; maximum score = 33). Adolescents’ understanding of sexual intercourse, misconceptions related to first-time sexual experiences, and awareness of contraceptive methods were significantly associated with SRH perception scores. These findings underscore the need for targeted health education interventions in mountainous areas, emphasizing the importance of enhancing SRH knowledge and awareness among all adolescents, with gender-specific needs. Such efforts can contribute to improved SRH outcomes among adolescents in these regions.

KEYWORDS:

• Adolescents
• reproductive health
• sexual health
• knowledge
• perceptions
• mountainous regions

Introduction

Adolescence, defined as ‘the unique phase of life between childhood and adulthood, from ages 10 to 19’ by the World Health Organization, represents a pivotal period marked by profound biological, psychological, and emotional changes (WHO, 2022b). Despite being deemed a foundational stage of life, this phase also exposes adolescents to health risks that have not been adequately addressed. In developing regions, around 770,000 girls under 15 years of age give birth annually, contributing to complications during pregnancy and childbirth, which is one of the primary causes of mortality among girls aged 15–19 globally (WHO, 2022a). Adolescent girls and young women comprise one-third of 357 million curable cases of Sexually Transmitted Infections (STIs) reported globally annually which warrant significant attention owing to the enduring reproductive health implications associated with fertility, pregnancy outcomes, and cervical cancer (Mehta & Seeley, 2020).

In Vietnam, merely 17.4% of adolescents know when a woman can get pregnant, and only 25.9% understand how to use condoms, and only 25.9% are familiar with correct usage of condoms during sexual intercourse (VietnamPlus, 2020). A study on female adolescents in A Luoi Mountainous district, Thua Thien Hue Province highlighted a notable limitation in fundamental understanding of pregnancy and reproductive hygiene, only 14.1% of adolescents demonstrate good overall knowledge, and 27.1% follow good practices (Trang, 2021). Unintended pregnancies are prevalent among Vietnamese unmarried young women, raising concerns due to their association with risky behaviours and adverse health outcomes including drug addiction, unsafe sexual practices leading to sexually transmitted diseases, and child development challenges (T. Ngo et al., 2012; T. D. Ngo et al., 2014).

Addressing these challenges requires an emphasis on providing knowledge and raising awareness about sexual and reproductive health (SRH) during adolescence to mitigate the risks of unintended pregnancy, unsafe abortions, and sexually transmitted diseases such as HIV/AIDS. Among unmarried single women in Lebanon, only 8.8% demonstrated sufficient knowledge, with the lowest regarding contraception (13.5%). This insufficient level of understanding poses potential adverse social impacts, including school dropout, violence, and suicide, imposing substantial physical, psychological, and economic strains on individuals, families, and communities (Hamdanieh et al., 2021). Among adolescents from low and middle-income countries, a systematic review revealed that the limited access to contraception and safe abortion services was due to insufficient knowledge about SRH (Munakampe et al., 2018). A quantitative study in Nepal pointed out that the lack of basic knowledge about SRH contributed to a higher risk of sexual health-related issues among adolescents in remote areas (Sah et al., 2012). A qualitative study in Southeast Asia have highlighted cognitive and psychological barriers to SRH access, rooted in a dearth of fundamental knowledge and feelings of embarrassment among young people (Thongmixay et al., 2019). The United Nations Population Fund’s report on Vietnam in 2017 has disclosed that approximately 20% of students are sexually active, yet less than 0.5% possess knowledge of contraceptives (Vietnam, 2017). Particularly, 36% of youth face the risk of experiencing discrimination against individuals living with HIV, while 7% are at a high risk of contracting HIV themselves due to their lack of awareness (Hoang et al., 2019; Vietnam, 2016). Lack of access to education on SRH and rights contributes to early and child marriages, unintended pregnancies, and elevated rates of gender-based violence. These consequences have significant negative impacts on healthy and sustainable development.

Many socio-demographic factors affect the knowledge and perceptions of sexual and reproductive health, such as age (Finlay et al., 2020), gender (Berhe et al., 2022), education, living conditions, and parental education (Shiferaw et al., 2014). Protective and risk factors influencing adolescent sexual behaviour have been identified including relationship with parents and teacher or having spiritual beliefs (WHO, 2006). Other factors to consider are marital status, gender norms, whether sexual relations have begun, whether young people are in or out of school, whether they have already had a child or an abortion, their economic status, whether they live in a rural or urban setting, peer pressure, and political and cultural (FHI, 2003). In the neighbouring Lao PDR, differences in SRH knowledge were noted among adolescents residing in rural and urban districts (Phongluxa et al., 2020). Similarly, in Vietnam, the collaboration between the United Nations Population Fund (UNFPA), Vietnam General Statistics Office (GSO), and the United Nations International Children’s Emergency Fund (UNICEF) in 2021 demonstrated higher adolescent pregnancy rates in the Northern Midlands and Mountains (particularly the Northwest) and the Central Highlands compared to other regions (General Statistics Office and UNICEF, 2021). This ratio is specifically high in the Northern Mountains, accounting for 19.9% (General Statistics Office and UNICEF, 2021). The study also reveals substantial disparities in adolescent birth rates between ethnic groups, with Mong ethnic women aged 15–19 experiencing a birth rate of 210 live births per 1,000 women compared to 28 births per 1,000 women among the Kinh/Hoa ethnic groups (General Statistics Office and UNICEF, 2021). These disparities are often exacerbated in population groups with lower living standards, ethnic minority backgrounds, and those residing in mountainous and rural areas (Nguyen et al., 2016).

However, there is a dearth of reports on sexual and reproductive health among mountainous adolescents in Vietnam, particularly in Son La, a mountainous province in the Northwest region. Son La is home to isolated communities that often face lengthy and hazardous journeys to access essential health services.

Several intervention programmes have been implemented both internationally and locally to improve SRH outcomes and gender equity among very young adolescents, young first-time parents, and the important adults in their lives (Childrens).In Vietnam, these programmes include school-based programmes and activities, as well as community-based programmes and activities since 1988. Despite these, young people still lack knowledge and skills, which is one of the operational barriers to SRH.

These findings underscore the complexity of SRH issues among adolescents and the need for multifaceted interventions. As a result, understanding SRH knowledge and perception is paramount in designing context-specific and comprehensive sexual education programmes for adolescents, especially in mountainous area.

This study aims to assess the knowledge and perceptions of sexual and reproductive health (SRH) and factors influencing perceptions among adolescents living in Son La. Two primary questions guide our inquiry:

1. What are the levels of SRH knowledge and perceptions among adolescents in Son La?

2. What factors influence the SRH perceptions of adolescents in this mountainous region?

Method

Research design

A cross-sectional study design was used to address the study’s aim and research questions.

Research procedure

The study was conducted at three junior high schools and three high schools in Son La province. Inclusion criteria included students (1) who aged between 12 and 18 years, (2) currently residing in Son La province, (3) able to communicate in Vietnamese, (4) agree to participate in study. Data collection took place over a period of 3 weeks, from 3 March 2022, to 26 March 2022.

The convenience sampling method was applied, and adolescents who met the selection criteria were invited to participate in the study. Data was collected by data collectors residing and living in Son La province including teachers in selected schools of this study. Data collectors had been introduced to the research objectives and data collection procedures. Then, they underwent testing to ensure the ability to collect data. The data collection was collected at classroom setting. Vietnamese was used in the data collection. A total of 382 participants were recruited during the 3 weeks of data collection.

Research instruments

Data were measured by a self-administrated questionnaire. The instruments were self-developed by the research team based on the literature. Three experts in the field of reproductive health reviewed the instruments to validate information. Then, the questionnaire was tested by 5% of eligible participants to determine that participants understood the questions accurately. These participants did not participate in the main survey.

The questionnaire comprised socio-demographic information and items related to knowledge and perceptions. Knowledge about SRH was assessed using a structured questionnaire consisting of 12 multiple-choice questions, covering:

1. General knowledge about SRH (3 questions),

2. Knowledge about teenage sexual activities (4 questions),

3. Methods of contraception (4 questions), and

4. Impact of early pregnancy and childbirth (1 question)

Details of the questionnaire used for data collection can be found in Appendix A. Participants were asked to choose their answers, in which those who selected all the correct items for each multiple-choice question will be considered to have adequate and correct knowledge about that aspect.

Perceptions towards SRH on two dimensions (teenage sexual activities and contraception methods) were assessed using a Likert questionnaire consisting of 11 items. Each item was rated on a range from 0 – Unknown, to 3 – Very agree. The total perception score towards SRH ranged between 0 and 33 points, with the highest score indicating more accurate SRH perceptions. The scale demonstrated a relatively high internal consistency with Cronbach’s alpha = 0.83 (listed in Table 1).

Table 1. Internal consistency of the perception’s scale and subscale.

Variables	Cronbach’s Alpha	Number of items
Overall	0.83	11
Subscales
Sex during adolescence	0.63	5
Contraceptive methods	0.82	6

Ethical considerations

The research team got the approval of school boards of six schools in this project before conducting the survey. Given that the participants were underage, prior to data collection, informed consent was obtained from both the participating adolescents and their parents or legal guardians. A detailed information sheet explaining the study’s purpose, procedures, potential risks and benefits, confidentiality measures, and the voluntary nature of participation was provided to both the adolescents and their parents or guardians. In addition to obtaining parental consent, adolescents aged 12–18 were also asked to provide their verbal agreement to participate in the study. This process was conducted in a child-friendly manner, with age-appropriate explanations to ensure that adolescents understood their involvement and voluntarily agreed to participate.

Data analysis

The data were analysed by SPSS 26.0. Descriptive statistics, namely frequency, percentage, mean, and standard deviation, were used to describe socio-demographic information, knowledge, and perceptions towards sexual reproductive health. The knowledge-related items were compared and performed by gender, and the Wilcoxon Rank Sum test has been used to test if the difference between boys and girls is statistically significant. Mann–Whitney U test was used to analyse the correlation between SRH knowledge and perceptions. To determine the relationship between perceptions and other demographic variables, a series of binary correlations were conducted between each demographic variable and perceptions. Variables that did not show significant correlations were excluded from further analysis. Multiple linear regression was then employed to examine the relationship between perceptions and the remaining demographic variables. A p-value of < .05 was considered statistically significant.

Results

Participants’ characteristics

A total of 382 participants took part in the survey. Table 2 presents the demographic characteristics of the participants. The mean age of the adolescents participating in this study was 15.2 years (SD = 1.47). The majority of adolescents ranged from 12 to 15 years old. Among 382 participants, 59.7% were girls, and 40.3% were boys. Most of the participants lived with their parents (93.7%). Most parents lived together (88.5%), and a significant number of fathers (56.8%) and mothers (61.3%) worked as farmers.

Table 2. Socio-demographic characteristics of mountainous adolescents.

Variables	Category	Frequency	Percent (%)
Age	Mean±SD	15.17 ± 1.47
Age in years	12–15	234	61.3
	16–18	148	38.7
Gender	Boy	154	40.3
	Girl	228	59.7
Ethnic groups	Kinh	110	28.8
	Thai	215	56.3
	Others	57	14.9
Class	Grade 6	21	5.5
	Grade 8	145	38.0
	Grade 9	70	18.3
	Grade 10	45	11.8
	Grade 11	101	26.4
Living arrangements	Parents	358	93.7
	Relatives	9	2.4
	Friends	9	2.4
	Others	6	1.6
Parent’s status	Living together	338	88.5
	Apart for work	12	3.1
	Divorced/separate	23	6.0
	Others	9	2.4
Fathers’ occupation	Officials and employees	95	24.9
	Trade	43	11.3
	Farmers	217	56.8
	Retired	8	2.1
	Unknown	19	5.0
Mothers’ occupation	Officials and employees	91	23.8
	Trade	47	12.3
	Farmers	234	61.3
	Retired	1	0.3
	Unknown	9	2.4

Knowledge and perceptions of SRH among mountainous adolescents

Figure 1 depicts three general questions about sexual reproductive health. In this study, the proportion of adequate basic understanding of sexual reproductive health among girls was higher. When participants were asked for signs of puberty, 76.0% of girls had adequate knowledge for female’s puberty, while that of boys were 71.0% for the knowledge of male’s puberty. For the question ‘When can the girl get pregnant,’ 83.3% of girls had adequate knowledge; however, only 55.2% of boys had a correct answer. The difference in this aspect between boys and girls was statistically significant (Z=-6.000, p < 0.01).

Figure 1. The general knowledge of mountainous adolescents about sexual and reproductive health.

Figure 2 reveals that girls had more knowledge about teenage sexual activities than boys. The adequate knowledge proportion of girls related to these questions was relatively high, ranging from 91.7% to 93.4%. Among boys, this proportion fluctuates between 81.8% and 83.8%. However, for the statement ‘first-time sex can cause pregnancy,’ the percentage of boys and girls who had the correct answer was only 53.9% and 64.0%, respectively, and the difference was not statistically significant (Z=-0.317, p = 0,75). In response to the question ‘How can a boy and a girl have sexual intercourse?’, up to 91.7% of girls had a correct answer, while that for boys were accounted for only 83.8%. These differences in the number of correct answers between boys and girls were found to be statistically significant (Z = 2.369, p = 0.018).

Figure 2. The knowledge of mountainous adolescents about sex during adolescence.

This study found that more than half of the participants had heard about contraceptive methods. However, their knowledge about each contraceptive method appeared to be insufficient. Of note, only 18.9% of girls and 16.2% of boys know how to use a condom properly, with nearly half of participants know that only condoms can prevent pregnancy and sexually transmitted infections. Nonetheless, the differences between boys and girls related to both of the questions were not statistically significant (p > 0,05). Regarding the question ‘When to use emergency contraception pill,’ only 49.1% of girls and just 31.2% of boys provided the correct answer. The difference in the percentage of boys and girls having correct answer for this question was found to be statistically significant (Z=-3.484, p < 0,01). Detail information is illustrated in the Figure 3.

Figure 3. The knowledge of mountainous adolescents about contraceptive methods.

The mean perception score was 21.7 (SD = 8.05) for 11 questions related to perceptions about sexual reproductive health, with a possible range of 0–33. The mean scores for the perception of teenage sexual activities were 10.4 (SD = 3.69) on a scale with a possible range of 0–15 (higher scores indicating a more positive perception). Similarly, the mean scores for the perception of contraceptive methods were 11.3 (SD = 5.33) on a scale with a possible range of 0–18 (higher scores indicating a more positive perception).

Factors associated to perception of SRH

Table 3 reveals the correlation between the perception of SRH with other variables. As demonstrated, the perception of SRH had a significantly strong positive correlation with understanding sexual intercourse, whether first-time sex can get a girl pregnant, and understanding of contraceptive methods (p < 0.01).

Table 3. Correlation between knowledge-related items with mountainous adolescents’ perception overall score.

		Median (Q1; Q3)	U	Z	P value^1
Understanding of sexual intercourse	Inadequate	17 (10.125; 23.875)	3823	−5.251	<0.01
	Adequate	24 (19; 29)
Misconception about first-time sex cannot get pregnant	Inadequate	18 (11.25; 24.75)	8078	−8.938	<0.01
	Adequate	26 (22.5; 29.5)
Awareness of the contraceptive methods	Inadequate	16 (9; 23)	5984	8.209	<0.01
	Adequate	26 (21.5; 30.5)

¹p value < 0.01 is significant..

The multiple linear regression model was used to determine predictors of adolescents’ perceptions after controlling for the influence of age and gender. Preliminary analyses confirmed that no assumptions of normality, linearity, multicollinearity, and homoscedasticity were violated. Table 4 shows the final model of the significant predictors of the perceptions of mountainous adolescents. Before the model was developed, Mann–Whitney U test was conducted to examine the relations between the continuous variables entered in regression analysis.

Table 4. The final model of the significant predictors of the perceptions of mountainous adolescents.

Block	Variable	Category	Mean ± SD	B	SE	β	95% CI	t	p
1	Age			1.201	0.268	0.219	0.67–1.73	4.481	<0.01
	Gender			3.352	0.802	0.205	1.78–4.93	4.179	<0.01
			R^2 = 0.096; Adjusted R^2 = 0.092; F = 20.225; p < 0.01
2	Age		15.17 ± 1.47	0.14	0.25	0.026	−0.35–0.63	0.561	0.575
	Gender	Boy*	19.59 ± 8.84	Ref	Ref	Ref	Ref	Ref	Ref
		Girl	23.20 ± 7.13	1.958	0.696	0.119	0.59–3.33	2.815	0.005
	Understanding sexual intercourse	Inadequate*	15.39 ± 8.80	Ref	Ref	Ref	Ref	Ref	Ref
		Adequate	22.57 ± 7.58	3.197	1.116	0.127	1.00–5.39	2.866	0.004
	Misconception about first-time sex cannot get pregnant	Inadequate*	17.11 ± 8.53	Ref	Ref	Ref	Ref	Ref	Ref
		Adequate	24.84 ± 5.98	5.642	0.727	0.344	4.21–7.07	7.758	<0.01
	Aware of the contraceptive methods	Inadequate*	15.55 ± 8.53	Ref	Ref	Ref	Ref	Ref	Ref
		Adequate	23.80 ± 6.74	4.992	0.883	0.268	3.26–6.73	5.654	<0.01
			R^2 = 0.35; Adjusted R^2 = 0.341; F = 40.454; p < 0.01

*Reference group; VIF max: 1.304; Durbin – Watson index: 1.581.

In the final model (Table 4), age and gender were entered in Step 1, explaining 9.2% of the variance in perceptions. After the entry of the knowledge variable in Step 2, the total variance explained by the model as a whole was 34.1%, F_{(df = 5, n = 376)} = 40.45, p < 0.01. Four variables were statistically significant in the final model, with the highest beta value associated with awareness that first-time intercourse can result in pregnancy (β = 0.344, p < 0.01). This finding suggests that participants who were aware that first-time sex could lead to pregnancy had 5.642 times higher in the overall perception score compared to that of those were unaware of this fact. Additionally, the results indicate that participants who were aware about contraceptive methods had 4.992 times higher in overall perception score compared to that of those were unaware, participants who understood sexual intercourse had 3.197 times higher in overall perception score compared to that of those misunderstood.

Discussion

Integrating reproductive health into national strategies and programmes to enhance the accessibility of sexual and reproductive healthcare services is one of the targets established by the United Nations (United Nations, 2018). However, some literature states that adolescents are less likely to receive comprehensive sexual education before they become sexually active, which is also reflected in our study (Kohler et al., 2008).

Knowledge and perceptions of SRH among adolescents in Son La province

The rate of correct knowledge among adolescents in Son La regarding sexual and reproductive health is notably low. Comparing these statistics to other countries reveals similar challenges. In Southern Ethiopia, a study found that only 35.0% of adolescents had communicated with their parents about SRH issues, indicating a significant communication gap (Kusheta et al., 2019). In Malaysia, among secondary school students, knowledge about SRH was also lacking, with substantial misconceptions, such as the belief that washing the vagina after sexual intercourse prevents pregnancy (17.0%) or that one cannot get pregnant after a single act of sexual intercourse (30.4%) (Rahman et al., 2011). These findings highlight that insufficient knowledge about SRH is not unique to Son La but is a global concern. More specific, knowledge gaps in Son La can be attributed to several interconnected factors. The mountainous terrain of the region presents logistical challenges, making it difficult for adolescents to access comprehensive SRH education and services. Limited access to accurate SRH information exacerbates the problem, as adolescents may rely on informal sources, such as peers, for information (Ha & Fisher, 2011; Klingberg-Allvin et al., 2008). Additionally, deeply rooted cultural taboos surrounding SRH topics may deter open discussions and contribute to the lack of awareness and understanding among adolescents in this region (Hong Hai Nguyen et al., 2014; Kennedy et al., 2013; Zakaria et al., 2020).

In our study, the gender analysis reveals that girls exhibited higher knowledge levels than boys concerning basic aspects of SRH, teenage sexual activities, and contraceptive methods. This finding is consistent with the result of Susan among adolescents in a college (Sutan, 2014). This could be explained that girls might tend to seek information and knowledge more than boys (Godia et al., 2014; Martinez et al., 2010). However, it is important to note that when assessing their knowledge, both boys and girls scored on average above the moderate-to-high range based on the scoring for each item. These gender disparities, while statistically significant, should not be interpreted as a justification for exclusive intervention targeting. Instead, they underscore the need for comprehensive SRH education for all adolescents, with a particular emphasis on addressing the unique needs and knowledge gaps of each gender.

Our results indicated that mountainous adolescents perceived about SRH are relatively low in Son La region. Regarding basic knowledge about SRH as the sign of puberty, our findings among boys aligned with the previous study among adolescent boys in Malaysia (Upadhyay-Dhungel et al., 2013). The fewest correct answer is when a boy can make a girl get pregnant. This can lead to accidental pregnancy after experimenting with sexuality between boys and girls. For teenage sexual activities, the easiest sentence to get wrong is the statement about ‘after the first-time sex, girls cannot get pregnant’ for both boys and girls. This finding aligned with the result of a previous study, in which nearly one-third of ever-pregnant 15–24 years old in El Salvador (29%), Guatemala (33%), and Honduras (28%) thought that they unable to get pregnant after the first-time intercourse (Remez et al., 2008). For the contraceptive methods, our finding indicated that the proportions of knowing at least one contraception were relatively high (81,6% of girls and 65,6% of boys); however, it does not necessarily mean that they can apply contraceptive method(s) properly. Our study highlighted that the proportion of using a condom properly or knowing the method could prevent STI and pregnancy was very low. This result is lower than the study in four nations in Sub-Saharan Africa. According to this study, the percentage of girls 15–19 years old who know condom use correctly in Malawi, Ghana, Uganda, and Burkina Faso was 26%, 40%, 43%, and 50%, respectively, and it was higher among the boy counterparts (Bankole et al., 2007). This difference can be explained by the summary measure of knowledge of condom correct use. In our study, the proper use of a condom means the participants must choose all of the correct statements, including ‘Packaging must be intact, not expired,’ ‘Each condom can only be used once,’ and ‘Use when having sex with strangers.’

Factors influencing perceptions

The current study also revealed a statistically significant relationship between gender and adolescents’ perception. This result was comparable with a study among poor Myanmar youths (Thin Zaw et al., 2013), which means more positive perceptions among girls than boys. Our results also exhibited a significant relationship between adolescents’ perceptions and their understanding of sexual intercourse. The positive perceptions increased as adolescents were equipped with adequate knowledge about sexual intercourse. Similarly, the perceptions of SRH decreased if adolescents did not know that first-time sex can get pregnant. This result was aligned with a qualitative study conducted in South Africa which explored that ignorance about the physiological aspects of conception led them to misunderstand first-time sex (Richter & Mlambo, 2005). This phenomenon may stem from a deficiency in sex education during adolescence, which is exacerbated by the limited accessibility of reproductive health programmes. Furthermore, adolescents who possess knowledge about contraception tend to harbour more positive and accurate perceptions compared to their peers who lack this information. This outcome mirrors findings from a study conducted across four Sub-Saharan African countries (Remez et al., 2008), perhaps because of the cultural and personal embarrassment when communicate about sexual activities.

Practical implications and future research

To address the multifaceted challenges revealed by our study, interventions should be thoughtfully designed, taking into account the specific needs of both boys and girls. Comprehensive SRH education programmes should aim to bridge knowledge gaps and promote positive perceptions among all adolescents, regardless of gender. Moreover, future interventions should prioritize providing detailed information about contraceptive methods to improve adolescents’ contraceptive literacy and, ultimately, their knowledge of correct condom use.

Furthermore, additional research is warranted to delve deeper into the underlying factors contributing to the observed disparities in SRH knowledge and perceptions among mountainous adolescents. Such research can provide valuable insights for the development of more effective interventions aimed at raising awareness and promoting healthy SRH behaviours in this population.

Strengths and limitations

To our knowledge, this is the first study that examine the knowledge and perceptions of young people in the Son La province regarding sexual and reproductive health. The data were collected both in the urban area of Son La city and its rural remoted area – Thuan Chau district, so our results by some means reflect the current situation of Son La province. Despite the strengths, our study has some limitations. First, the study design is cross-sectional, meaning causal reference could not be determined. Second, even though the key collectors were extensively trained, taboos and socially desirable answers could have appeared due to the sensitive nature of SRH. Third, the questionnaire was self-developed based on literature reviews and was not tested in other populations; however, a high Cronbach’s alpha indicated good internal consistency and reliability.

Conclusion

Girls outperformed boys in their knowledge of sexual and reproductive health (SRH), covering basics, teenage sexual activities, and contraceptive methods. Key knowledge factors, including understanding sexual intercourse, addressing misconceptions about first-time sex, and increasing awareness of contraceptive methods, significantly influenced adolescents’ SRH perceptions. To enhance SRH outcomes, future interventions should prioritize improving contraceptive knowledge and raising awareness for both boys and girls with more focus on boy groups. By addressing these knowledge gaps and fostering awareness, we can empower mountainous adolescents in Vietnam to make informed choices about their SRH, ultimately contributing to healthier and more fulfilling lives.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work is the result from a baseline survey from the project which was funded by the Global Affair Canada (GAC) and implemented by HealthBridge Foundation of Canada, Vietnam Office.

Appendix A

Questionnaire

Table

No		Question	Answer	Move
A. Personal Information
		1. When you were born? (Specify, example: 1999)	Year of birth:
		2. What is your gender?	1. Male 2. Female 98. Other: … … … .
		3. What ethnicity are you? (specify, ex: Tày people)	Ethnicity:
		4. What grade are you?	1. Grade 6 2. Grade 7 3. Grade 8	4. Grade 9 5. Grade 10 6. Grade 11
		5. Who do you currently live with? (select one answer)	1. Family (with parents) 2. Relatives 3. Friends	4. Alone 98. Other (specify)…….
		6. Can you tell us about your parents’ marital status? (select one answer)	1. Living together 2. Living apart for work 3. Divorced/separate 4. Widow 98. Other (specify) … … …
		7. Tell us about your parents education level? (the highest level of education of your parents)	Father Mother 1. Primary 2. Secondary 3. High school 4. Intermediate 5. College or higher 98. 98.Don’t remember/Don’t know
		8. What is the main occupation of your parent? (select one answer)	Father 1. 2. 3. 4. 98	Mother Officials and employees Trade Farmers (farming) Retired 98. Other (specify)
B. Knowledge About Reproductive Health
No		Question	Answer	Move
	9. What are the signs of female puberty? (can select more than one answer)		Breasts grow bigger Start to grow armpit and pubic hair Development of sex organs Hips expand, slimmer form Rapid increase in height and weight Menstruation appears The appearance of eggs Sleep disturbance Memory loss Other answers (specify): … … . 98. Don’t know
	10. What are the signs of male puberty? (can select more than one answer)		1. Testicles and penis enlarge. 2. Broken voice, exposed pharynx 3. Rapid increase in height and weight 4. Muscles in shoulders, chest, arms… get bigger 5. Appears pubic hair, moustache 6. Have a dream (ejaculate while sleeping) 7. The appearance of eggs 8. Sleep disturbance 9. Memory loss 10. Other answers (specify): … … … … 99. Don’t know
	11. In your opinion, since when can a male friend make a female friend pregnant? (select one answer)		1. Since the appearance of ejaculation 2. Since growing pubic hair 3. Since growing armpit hair 4. Since the genitals develop 5. Other: … … … … … … … … 99. Don’t know
	12. From when do you think a female friend can get pregnant? (select 1 answer)		1. Since menstruating 2. Since growing pubic hair 3. Since growing armpit hair 4. Since the genitals develop 5. Other: … … … … … … … … . 99. Don’t know
	13. How is connection between a boy and a girl to get pregnant?		1. Hold hands, hug and kiss 2. Touching each other’s private parts 3. Sleeping in the same bed 4. Unsafe sex (with intercourse) 99. Don’t know
	14. Can a female friend get pregnant in the first time she has sex?		1. Yes 2. No 99. Don’t know
	15. What are the consequences of having unprotected sex? (can choose more than one answer)		1. Unintended pregnancy 2. Having a sexually transmitted disease 3. HIV/AIDS infection 4. Get married early 5. Unsafe abortion 6. There are no consequences 7. Other (specify) 99. Don’t know
	16. Have you ever heard, read, or learned about contraceptives?		1. Yes 2. Not yet 99. Don’t know/Don’t remember
	17. Choose two (02) contraceptive methods that both prevent pregnancy and prevent sexually transmitted diseases?		IUD (intrauterine device) Male condom Female condom Daily oral contraceptives Emergency Contraceptive Pill Injectable Pills	Contraceptive Implants Contraceptive patch Vaginal diaphragm Cervical cap Male/Female sterilization Other (specify)…
	18. In your opinion, how to use condoms properly? (you can choose more than one answer)		1. Packaging must be intact, not expired 2. Only wear a sungay condom before ejaculating 3. Each condom can only be used once 4. Use when having sex with strangers 5. It’s safer to use two condoms at the same time 6. Any size of condom is suitable 7. Straighten the condom and put it on the penis 99. Don’t know
	19. When do you think emergency contraception is used? (Select only one answer)		Before having sex Daily use Within 72 hours immediately after having sex Anytime after sex Don’t know how to use emergency contraception Never heard of emergency contraception
	20. In your opinion, how does pregnancy and childbirth before the age of 18 affect the mother and baby? (you can choose more than one answer)		1. The child is not healthy 2. The child is not properly nurtured 3. The mother can die in childbirth 4. Impact on mother’s education 5. Impact on mother’s health 6. No harm to mother and child 98. Other (specify) … … … … … … … … . 99. Don’t know
C. Attitudes on Reproductive Health
	21. According to you, having sex before marriage while still a student in middle school or high school is? (select one answer)		Very agree Agree Disagree 99. Unknown
	22. According to you, a person who is a student or high school is pregnant? (select 1 answer)		Very agree Agree Disagree 99. Unknown
	23. Some say love must have sex, without sex it is not love. (select 1 answer)		Very agree Agree Disagree 99. Unknown
	24. A girlfriend can refuse to have sex with her boyfriend when she doesn’t want to. (select 1 answer)		Very agree Agree Disagree 99. Unknown
	25. Unmarried people who have sex should use contraception. (select one answer)		Very agree Agree Disagree 99. Unknown
	26. You feel ashamed and apprehensive about seeking birth control?		Very agree Agree Disagree 99. Unknown
	27. It is acceptable to talk and discuss contraceptive methods between two lovers. (select one answer)		Very agree Agree Disagree 99. Unknown
	28. Using a condom is a sign that you don’t trust your lover’s loyalty. (select 1 answer)		Very agree Agree Disagree 99. Unknown
	29. When a girlfriend asks her boyfriend to use a condom, the boyfriend will not respect her anymore. (select one answer)		Very agree Agree Disagree 99. Unknown
	30. If a person has a condom in his pocket, it means he or she is sexually immodest (select one answer)		Very agree Agree Disagree 99. Unknown
	31. If a girlfriend says she doesn’t agree to have sex, she doesn’t really think so (select one answer)		Very agree Agree Disagree 99. Unknown