Abstract
This study examined how the complexity and format of sexual and reproductive health (SRH) education materials influence adolescents' functional SRH literacy and its implications for literacy-sensitive SRH education. Quasi-experimental study design. This school-based quasi-experimental study was conducted among 317 adolescents aged 11-15 years (grades 7-8) in the Effutu Municipality. Schools were cluster-assigned to standard text, simplified text, picture-enhanced text, or comparison conditions. Participants engaged in six weekly guided reading and facilitated discussion sessions. Data were analyzed using SPSS 26.0 and STATA 17.0, applying regression-based difference-in-differences (DiD) and fixed-effects models. Of the 317 adolescents assessed at baseline, 249 completed the intervention. The DiD results showed significant improvements in functional SRH literacy for simplified text (12.28 points; 95% CI: 6.79-17.77; p = 0.001) and picture-enhanced text (10.26 points; 95% CI: 4.37-16.14; p = 0.001), while the standard text showed no significant change. The fixed-effects estimates confirmed similar gains for the simplified (13.87 points; 95% CI: 7.33-20.42; p = 0.001) and picture-enhanced materials (13.06 points; 95% CI: 6.94-19.17; p = 0.001). Although pictorial supports improved textual comprehension, their contribution to numeracy-related literacy was limited and, in some school contexts, elicited sociocultural resistance. The findings illustrate the pedagogical value of simplifying SRH educational materials and support literacy-sensitive school-based health promotion strategies. They also emphasize the need to consider sociocultural context when designing and implementing age-appropriate SRH education, particularly in underserved settings.