{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:15:12Z","timestamp":1771481712619,"version":"3.50.1"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019349","name":"Universidad T\u00e9cnica Particular de Loja","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sexual and reproductive health (SRH) educational interventions in Ecuador show uneven effectiveness, particularly among adolescents and young people in socioculturally diverse settings. Although the \u201cRurankapak\u201d methodology has been implemented as a participatory SRH education strategy, its standardized application has limited cultural relevance, acceptability, and sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To collaboratively adapt the Rurankapak methodology for SRH education to diverse sociocultural contexts and to preliminarily assess its applicability and acceptability among adolescents and young people in Ecuador.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A mixed-methods quasi-experimental study was conducted in three phases. The qualitative phase included semi-structured interviews with key informants experienced in Rurankapak implementation, analyzed using thematic coding. Findings informed a participatory redesign process involving Obstetrics students trained as peer facilitators. The quantitative phase followed a before\u2013after design, applying the adapted intervention to four population groups and administering pre\u2013post knowledge assessments (Cronbach's\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u2009=\u20090.81) and satisfaction surveys.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Qualitative findings identified the need to strengthen pre-workshop planning, referral pathways, and the management of complex topics. An adapted version of Rurankapak was developed, structured into seven educational stations with culturally tailored materials. Quantitative results showed high acceptability among adolescents and young people, with lower acceptance among parents. Peer facilitators demonstrated strong pedagogical performance and reported improvements in communication skills, empathy, and intercultural competence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contextual adaptation and participatory redesign enhance the cultural relevance and feasibility of SRH educational strategies. The use of peer facilitators supports adolescent engagement and contributes to the comprehensive training of future SRH professionals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frph.2026.1783094","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:23:40Z","timestamp":1771478620000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the contextualized sexual and reproductive health educational strategy \u201cRurankapak\u201d: a mixed-methods quasi-experimental study among adolescents and young people in Ecuador"],"prefix":"10.3389","volume":"8","author":[{"given":"Jeny","family":"Valencia","sequence":"first","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jes\u00fas","family":"Endara-Mina","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias Jur\u00eddicas y Pol\u00edticas, Universidad T\u00e9cnica Particular de Loja (UTPL)","place":["Loja, Ecuador"]},{"name":"Coordinaci\u00f3n de Docencia e Investigaci\u00f3n, Hospital Provincial General Pablo Arturo Su\u00e1rez","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Morales","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Huertas","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenica","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johao","family":"Sinchiguano","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda-Jos\u00e9","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santiago","family":"Negrete","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yesenia","family":"Cacuango","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jefferson","family":"Ortega","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulina","family":"Rios-Quituizaca","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"B1","year":""},{"key":"B2","year":""},{"key":"B3","volume-title":"Global Accelerated Action for the Health of Adolescents (AA-HA!)","year":"2017"},{"key":"B4","year":""},{"key":"B5","year":""},{"key":"B6","year":""},{"key":"B7","doi-asserted-by":"publisher","first-page":"189","DOI":"10.11600\/rlcsnj.22.1.6254","article-title":"Experiences of adolescent mothers and fathers regarding sexual education in Ecuadorian schools","volume":"22","author":"Castillo-Nu\u00f1ez","year":"2024","journal-title":"Rev Latinoam Cienc Soc Ninez Juv"},{"key":"B8","doi-asserted-by":"publisher","first-page":"246","DOI":"10.15691\/0719-9112vol11n1a7","article-title":"Comprehensive sexuality education in Latin America and the Caribbean: where are we and where should we go?","volume":"11","author":"Ronconi","year":"2023","journal-title":"Lat Am Leg Stud"},{"key":"B9","author":"Medina Su\u00e1rez","year":"2024"},{"key":"B10","doi-asserted-by":"publisher","first-page":"129","DOI":"10.19136\/hs.a21n1.4025","article-title":"Effectiveness of sexual and reproductive health education programs in adolescents","volume":"21","author":"Jacinto-C\u00e1rdenas","year":"2022","journal-title":"Horiz Sanit"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.4067\/S0034-98872012001000003","article-title":"Changes in the epidemiological profile of maternal mortality in Chile and challenges to achieving millennium development goal 5","volume":"140","author":"Donoso","year":"2012","journal-title":"Rev Med Chile"},{"key":"B12","year":""},{"key":"B13","year":""},{"key":"B14","year":""},{"key":"B15","doi-asserted-by":"publisher","first-page":"333","DOI":"10.9745\/GHSP-D-15-00126","article-title":"What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices","volume":"3","author":"Chandra-Mouli","year":"","journal-title":"Glob Health Sci Pract"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.21723\/riaee.v15i3.12472","article-title":"Paulo freire and critical pedagogy: his legacy for a new pedagogy of the south","volume":"15","author":"Lima","year":"2020","journal-title":"Rev Iberoam Estud Educ"},{"key":"B17","author":"Kolb","year":"1984"},{"key":"B18","year":"2005"},{"key":"B19","doi-asserted-by":"publisher","first-page":"431","DOI":"10.35882\/ijahst.v2i6.191","article-title":"Peer education improve knowledge and attitude about sexual behavior in adolescents: a literature review","volume":"2","author":"Elisa","year":"2022","journal-title":"Int J Adv Health Sci Technol"},{"key":"B20","year":""},{"key":"B21","doi-asserted-by":"publisher","first-page":"189","DOI":"10.3390\/sexes3010015","article-title":"Participatory action research for adolescent sexual and reproductive health: a scoping review","volume":"3","author":"Lassi","year":"2022","journal-title":"Sexes"},{"key":"B22","doi-asserted-by":"publisher","first-page":"605","DOI":"10.22038\/jmrh.2016.6627","article-title":"Competence of healthcare workers in sexual health education for female adolescents at schools","volume":"4","author":"Javadnoori","year":"2016","journal-title":"J Midwifery Reprod Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"126","DOI":"10.55018\/janh.v3i2.25","article-title":"Midwives, counseling, and adolescent reproductive health rights during the COVID-19 pandemic","volume":"3","author":"Sumiari","year":"2021","journal-title":"J Appl Nurs Health"},{"key":"B24","first-page":"730","article-title":"Benefits of sexual education for adolescents guided by midwives","volume":"5","author":"Royo del R\u00edo","year":"2024","journal-title":"Rev Sanit Investig."},{"key":"B25","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1186\/s12913-024-10932-1","article-title":"Implementing digital sexual and reproductive health services in youth clinics: a qualitative study among midwives in Stockholm","volume":"24","author":"Zettergren","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"8","DOI":"10.65307\/bidana.v1i1.35","article-title":"Strengthening the role of midwives in adolescent reproductive health education","volume":"1","author":"Wantini","year":"2025","journal-title":"BIDANA J Ilmu Prakt Kebidanan"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e2025001","DOI":"10.53388\/IN2025014","article-title":"Peer education in adolescent sexual health education: a scoping review","volume":"9","author":"Yang","year":"2025","journal-title":"Nurs Commun"},{"key":"B28","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3390\/ijerph22020248","article-title":"Determinants of access to sexual and reproductive health for adolescent girls in vulnerable situations in Latin America","volume":"22","author":"D\u00e1vila","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1742-4755-12-11","article-title":"Improving adolescent sexual and reproductive health in Latin America: reflections from an international congress","volume":"12","author":"C\u00f3rdova Pozo","year":"2015","journal-title":"Reprod Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"35","DOI":"10.33554\/riv.17.1.1579","article-title":"Sexual education among adolescents in Latin America, 2012\u20132021: a systematic review","volume":"17","author":"C\u00f3rdova-Chaccha","year":"2023","journal-title":"Investig Valdizana"},{"key":"B31","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/S0968-8080(13)41693-2","article-title":"Beyond the clinic walls: empowering youth through peer provider programs in Ecuador and Nicaragua","volume":"21","author":"Tebbets","year":"2013","journal-title":"Reprod Health Matters"},{"key":"B32","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4067\/S0717-75262019000100028","article-title":"Impact of sexual education policies on adolescent sexual and reproductive health in southern Chile, 2010\u20132017","volume":"84","author":"Castro-Sandoval","year":"2019","journal-title":"Rev Chil Obstet Ginecol"},{"key":"B33","first-page":"161","article-title":"Educational strategy for promoting sexual and reproductive health among adolescents and university students","volume":"39","author":"Rodr\u00edguez Cabrera","year":"2013","journal-title":"Rev Cuba Salud Publica"},{"key":"B34","doi-asserted-by":"publisher","first-page":"18748","DOI":"10.3402\/gha.v5i0.18748","article-title":"Mechanisms for achieving adolescent-friendly services in Ecuador: a realist evaluation","volume":"5","author":"Goicolea","year":"2012","journal-title":"Glob Health Action"},{"key":"B35","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s12939-019-0951-0","article-title":"Social inequality in sexual and reproductive health in Ecuador: gaps by provincial poverty levels","volume":"18","author":"Guti\u00e9rrez","year":"2019","journal-title":"Int J Equity Health"},{"key":"B36","author":"Cevallos-Carrillo","year":"2025"},{"key":"B37","doi-asserted-by":"publisher","first-page":"540","DOI":"10.4067\/S0370-41062012000600003","article-title":"Urban adolescents\u2019 knowledge of sexual and reproductive health services","volume":"83","author":"Luengo-Charath","year":"2012","journal-title":"Rev Chil Pediatr"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15517\/revenf.v0i31.24755","article-title":"Pedagogical mediation in sexual and reproductive health and rights for adolescents","author":"Arguedas","year":"2016","journal-title":"Enferm Actual Costa Rica"},{"key":"B39","first-page":"358","article-title":"Importance of sexual education workshops for parents in a high-complexity hospital","volume":"26","author":"Bulgach","year":"2019","journal-title":"Med Infant"},{"key":"B40","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.socscimed.2019.01.011","article-title":"Adaptation of a school-based sexual health promotion program for youth in Colombia","volume":"222","author":"Morales","year":"2019","journal-title":"Soc Sci Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"57","DOI":"10.5334\/aogh.35","article-title":"Technology-based sexual health risk reduction among Ecuadorian adolescents","volume":"85","author":"Reynolds","year":"2019","journal-title":"Ann Glob Health"},{"key":"B42","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1177\/15404153221125171","article-title":"Using technology to improve youth sexual and reproductive health in Nicaragua: a randomized field study","volume":"21","author":"G\u00f3mez","year":"2023","journal-title":"Hisp Health Care Int"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.4067\/S0034-98872014001000005","article-title":"Parents of urban adolescents: perceptions of sexual and reproductive health services","volume":"142","author":"Luengo-Charath","year":"2014","journal-title":"Rev Med Chile"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1447016","DOI":"10.3389\/frph.2024.1447016","article-title":"Designing comprehensive sex education using intervention mapping","volume":"6","author":"Torres-Cort\u00e9s","year":"2024","journal-title":"Front Reprod Health"},{"key":"B45","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1186\/s12889-025-21629-3","article-title":"Drivers of adolescent SRH care-seeking behavior in Botswana","volume":"25","author":"Lawson","year":"2025","journal-title":"BMC Public Health"},{"key":"B46","doi-asserted-by":"publisher","first-page":"301","DOI":"10.56303\/jhnresearch.v4i1.349","article-title":"Role of adolescent health services in promoting sexual health in Indonesia","volume":"4","author":"Fitri","year":"2025","journal-title":"J Health Nutr Res"},{"key":"B47","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.evalprogplan.2016.06.007","article-title":"Lessons learned from the CERCA project in Latin America","volume":"58","author":"Ivanova","year":"2016","journal-title":"Eval Program Plann"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1080\/17441692.2015.1123752","article-title":"Sustaining adolescent-friendly health services in Ecuador and Peru","volume":"12","author":"Goicolea","year":"2017","journal-title":"Glob Public Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"CD006417","DOI":"10.1002\/14651858.CD006417.pub3","article-title":"School-based interventions for preventing HIV, STIs, and pregnancy","volume":"11","author":"Mason-Jones","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B50","author":"Rosas-Tejada","year":"2025"},{"key":"B51","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1080\/14681811.2021.1926961","article-title":"Training sexual education facilitators in Riobamba, Ecuador","volume":"22","author":"Kotkowski","year":"2022","journal-title":"Sex Educ"},{"key":"B52","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/j.jpag.2019.06.003","article-title":"Sexual and reproductive health literacy and adolescent pregnancy in Latin America","volume":"32","author":"Dongarwar","year":"2019","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1741495","DOI":"10.1080\/26410397.2020.1741495","article-title":"Global progress in adolescent sexual and reproductive health and rights","volume":"28","author":"Chandra-Mouli","year":"2020","journal-title":"Sex Reprod Health Matters"},{"key":"B54","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1016\/j.jadohealth.2019.09.011","article-title":"Political and programmatic responses to adolescent SRHR since ICPD","volume":"65","author":"Chandra-Mouli","year":"2019","journal-title":"J Adolesc Health"},{"key":"B55","doi-asserted-by":"publisher","first-page":"100967","DOI":"10.1016\/j.ehb.2020.100967","article-title":"Effects of abrupt SRH policy change on teen birth rates in Ecuador","volume":"41","author":"Gal\u00e1rraga","year":"2021","journal-title":"Econ Hum Biol"},{"key":"B56","author":"Cetina Galindo","year":"2021"},{"key":"B57","first-page":"79","article-title":"Parental influence on adolescent sexual education","volume":"12","author":"Caricote Agreda","year":"2008","journal-title":"Educere"},{"key":"B58","author":"Simba\u00f1a Garc\u00eda","year":"2025"}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1783094\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:23:42Z","timestamp":1771478622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2026.1783094\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":58,"alternative-id":["10.3389\/frph.2026.1783094"],"URL":"https:\/\/doi.org\/10.3389\/frph.2026.1783094","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]},"article-number":"1783094"}}