{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T17:28:30Z","timestamp":1787074110481,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Prior studies have reported that street adolescents engaging in high-risk behaviors are at a substantially higher risk of human immunodeficiency virus (HIV) infection. This study examines the impact of engaging caregivers on enhancing knowledge, attitudes, and preventive skills against pregnancy, sexually transmitted infections (STIs), and HIV among street adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>A quasi-experimental non-randomized pretest\u2013posttest design with a control group was conducted in Central Java, Indonesia. A total of 200 street adolescents were recruited using purposive sampling, with 100 assigned to the intervention group (Semarang City) and 100 to the control group (Pekalongan and Batang Regencies). The intervention consisted of a six-month comprehensive sexuality education (CSE) program delivered by 20 trained caregivers following a five-day preparatory training. Outcomes included changes in knowledge, attitudes, and sexual risk behavior measured using structured questionnaires. Data were analyzed using Chi-square tests, independent and paired t-tests, and Linear Mixed Models to adjust for baseline differences and repeated measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>This study showed the average score for both knowledge and attitudes was increased by 7.09 and 2.80 points, respectively, after six-month interventions in the intervention group. While sexual risk behavior was decreased from 0.48 to 0.35 (0.7 points). The effectiveness of a six-month comprehensive sexual education intervention by engaging caregivers was revealed by a 56% increase in knowledge and a 21% improvement in attitudes, though positive sexual behavior changes moderately increased by only 16%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>It is recommended that future interventions targeting street adolescents continue to prioritize caregiver engagement as central to these efforts, because their involvement amplifies the intervention\u2019s effectiveness and sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jehp.jehp_117_26","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:02:21Z","timestamp":1785484941000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Engaging caregivers in providing comprehensive sexual education to prevent pregnancy, sexually transmitted infections, and human immunodeficiency virus among street adolescents in central Java: A quasi-experimental design"],"prefix":"10.4103","volume":"15","author":[{"given":"Zahroh","family":"Shaluhiyah","sequence":"first","affiliation":[{"name":"Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Diponegoro University, Central Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bagoes","family":"Widjanarko","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Diponegoro University, Central Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Budiyono","family":"Budiyono","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Faculty of Public Health, Diponegoro University, Central Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabrina Arifia","family":"Qatrannada","sequence":"additional","affiliation":[{"name":"Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Diponegoro University, Central Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Educational Sciences, Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Rani","sequence":"additional","affiliation":[{"name":"Department of Health Care and Hospital Management, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Parish-Sprowl","sequence":"additional","affiliation":[{"name":"Department of Communication Studies, Global Health Communication Center, Indiana University Indianapolis, Indianapolis, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"key":"R1-20260818","doi-asserted-by":"crossref","first-page":"e0265601","DOI":"10.1371\/journal.pone.0265601","article-title":"Health status of street children and reasons for being forced to live on the streets in Harar, Eastern Ethiopia. Using mixed methods","volume":"17","author":"Abate","year":"2022","journal-title":"PLoS One"},{"key":"R2-20260818","article-title":"Statistical Yearbook of Indonesia 2022","year":"2022"},{"key":"R3-20260818","doi-asserted-by":"crossref","DOI":"10.1016\/j.nwh.2025.09.004","article-title":"Scoping review of health care-seeking behavior and antenatal care visits among pregnant adolescents in low- and middle-income countries","author":"Khuzaiyah","year":"2026","journal-title":"Nurs Womens Health"},{"key":"R4-20260818","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/jehp.jehp_318_25","article-title":"Knowledge, awareness, support networks, and service utilization of sexual and reproductive health and rights among Indonesian adolescents","volume":"15","author":"Harjana","year":"2026","journal-title":"J Educ Health Promot"},{"key":"R5-20260818","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.jadohealth.2025.06.021","article-title":"Pathways to adolescent pregnancy in Southeast Asia: Qualitative evidence from lived experiences of girls in four countries","volume":"77","author":"Habito","year":"2025","journal-title":"J Adolesc Health"},{"key":"R6-20260818","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s10900-021-01010-2","article-title":"Risky sexual behavior among street children, adolescents, and young people living on the street in southern Brazil","volume":"46","author":"Hartmann","year":"2021","journal-title":"J Community Health"},{"key":"R7-20260818","doi-asserted-by":"crossref","first-page":"113168","DOI":"10.1016\/j.socscimed.2020.113168","article-title":"Pathways to sexual health communication between adolescent girls and their female caregivers participating in a structured HIV prevention intervention in South Africa","volume":"260","author":"Thurman","year":"2020","journal-title":"Soc Sci Med"},{"key":"R8-20260818","doi-asserted-by":"crossref","first-page":"100055","DOI":"10.1016\/j.hctj.2024.100055","article-title":"An exploration of anxiety and depressive symptoms among sexual and gender minority young adults visiting a drop-in center for youth experiencing homelessness","volume":"2","author":"Misedah-Robinson","year":"2024","journal-title":"Health Care Transit"},{"key":"R9-20260818","doi-asserted-by":"crossref","first-page":"e70029","DOI":"10.1111\/jora.70029","article-title":"Socio\u2010ecological domains and adolescent mental health: An application of the dual\u2010factor model","volume":"35","author":"Rose","year":"2025","journal-title":"J Res Adolesc"},{"key":"R10-20260818","doi-asserted-by":"crossref","first-page":"912751","DOI":"10.3389\/fmed.2022.912751","article-title":"Applications of social theories of learning in health professions education programs: A scoping review","volume":"9","author":"Mukhalalati","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"R11-20260818","doi-asserted-by":"crossref","first-page":"1023994","DOI":"10.3389\/fpsyg.2022.1023994","article-title":"The perspectives of social cognitive career theory approach in current times","volume":"13","author":"Wang","year":"2022","journal-title":"Front Psychol"},{"key":"R12-20260818","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1007\/s10461-022-03574-z","article-title":"Effects of a sexual risk-reduction intervention for teenagers: A cluster-randomized control trial","volume":"26","author":"G\u00f3mez-Lugo","year":"2022","journal-title":"AIDS Behav"},{"key":"R13-20260818","doi-asserted-by":"crossref","first-page":"1655371","DOI":"10.3389\/fpsyg.2025.1655371","article-title":"Self-esteem and peer pressure susceptibility mediating the link between maternal behavior and adolescent risk behaviors","volume":"16","author":"Mili\u0107","year":"2025","journal-title":"Front Psychol"},{"key":"R14-20260818","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s44217-025-01039-8","article-title":"The SSES-A: Development and validation of a tool for adolescent self-efficacy in 21st-century skills","volume":"4","author":"Morello","year":"2025","journal-title":"Discov Educ"},{"key":"R15-20260818","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.pedn.2023.11.024","article-title":"\u201cThey\u2019re scared that somebody\u2019s gonna judge them\u201d: Female African American youth in foster care\u2019s perspectives on sexual and reproductive health communication with caregivers","volume":"75","author":"Ross","year":"2024","journal-title":"J Pediatr Nurs"},{"key":"R16-20260818","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s11469-020-00238-8","article-title":"A qualitative study of caregiver\u2019s perceptions and needs around adolescent substance use and other risk behaviours","volume":"19","author":"Carney","year":"2021","journal-title":"Int J Ment Health Addict"},{"key":"R17-20260818","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/MOP.0000000000001359","article-title":"Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care","volume":"36","author":"Calihan","year":"2024","journal-title":"Curr Opin Pediatr"},{"key":"R18-20260818","doi-asserted-by":"crossref","first-page":"e0003569","DOI":"10.1371\/journal.pgph.0003569","article-title":"Adolescent choices and caregiver roles: Understanding individual and interpersonal influences on sexual decision-making in South Africa","volume":"4","author":"Makkan","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"R19-20260818","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1007\/s13178-024-00995-4","article-title":"A qualitative analysis about sexual health of foster teenagers: What concerns do their caregivers have?","volume":"22","author":"Gil-Llario","year":"2025","journal-title":"Sex Res Soc Policy"},{"key":"R20-20260818","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/hpja.14","article-title":"Yarning quiet ways: Aboriginal carers\u2019 views on talking to youth about sexuality and relationships","volume":"29","author":"Vujcich","year":"2018","journal-title":"Health Promotion J Aust"},{"key":"R21-20260818","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1017\/cts.2024.180","article-title":"189 designing a parent-adolescent-provider intervention to support adolescent girls\u2019 use of dual prevention strategies: Results from the teen and parent survey","volume":"8","author":"Narasimhan","year":"2024","journal-title":"J Clin Transl Sci"},{"key":"R22-20260818","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1080\/10810730.2024.2352535","article-title":"Media influence on bystander intervention for health protective norms: The integrative model of behavioral prediction perspective","volume":"29","author":"Ju","year":"2024","journal-title":"J Health Commun"},{"key":"R23-20260818","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1177\/10901981241236415","article-title":"Effects of an animation-based comprehensive sexuality education package: A 2-year repeated intervention study","volume":"51","author":"Zhou","year":"2024","journal-title":"Health Educ Behav"},{"key":"R24-20260818","doi-asserted-by":"crossref","first-page":"e70212","DOI":"10.1002\/hsr2.70212","article-title":"Efficacy of digital health interventions used for adolescent\u2019s sexual health: An umbrella review","volume":"7","author":"Borji-Navan","year":"2024","journal-title":"Health Sci Rep"},{"key":"R25-20260818","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12939-021-01395-5","article-title":"Adolescent, caregiver and community experiences with a gender transformative, social emotional learning intervention","volume":"20","author":"Cherewick","year":"2021","journal-title":"Int J Equity Health"}],"container-title":["Journal of Education and Health Promotion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jehp.jehp_117_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T17:00:37Z","timestamp":1787072437000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jehp.jehp_117_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jehp.jehp_117_26","relation":{},"ISSN":["2277-9531","2319-6440"],"issn-type":[{"value":"2277-9531","type":"print"},{"value":"2319-6440","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-01-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}