From standard text to simplified learning: a conceptual framework for developing adolescent-friendly sexual and reproductive health resources in Ghana

Abstract

Background Adolescents in low-resource settings often lack access to sexual and reproductive health (SRH) materials that match their literacy levels. In Ghana, despite policy support for adolescent SRH education, implementation gaps persist due to the complexity of available texts. This paper presents a cyclical, theory-driven conceptual framework for developing adolescent-friendly SRH educational resources. It empirically assesses its application using evidence from a quasi-experimental study in Ghana.

Methods This framework was developed through an iterative process, including a baseline needs assessment, resource design, stakeholder validation, and evaluation of quasi-experimental methods. A review of existing materials and a literacy assessment identified major gaps in comprehension and vocabulary demands. Content was synthesized from six SRH themes and simplified into formats: a text-only version and a picture-enhanced version with static illustrations. Validation was conducted with educators, health officials, adolescents, and academic experts.

Results: The resources were piloted with 317 adolescents aged 11–15 over six weeks. A total of 249 participants completed the study. Compared to the control group, users of the simplified and picture-enhanced texts showed significant improvements in SRH decision-making skills (+ 11 points, p < 0.01) and print literacy scores (+ 13–14 points, p < 0.01). A 21% dropout rate, linked to stigma and sociocultural resistance, highlighted the need for greater community and parental engagement.

Conclusion: The framework offers a stepwise, theory-informed approach to developing adolescent-friendly SRH materials. By reducing cognitive load and improving readability, it supports equitable access to SRH education.