The study design was cross-sectional as it did not fulfill the criteria of a true experimental research design. Moreover, the data collection was carried out only once among the respondents. No intervention programs were provided during the conduction of the study among the respondents.

Study Area

The study was conducted in Tokha Municipality, Kathmandu. Adolescents in this municipality have socio-economically diverse characteristics. This municipality consists of 24 higher secondary schools. This data shows that the adolescent population in this municipality is huge.

Study Population 

The population consisted of students aged 15–19 years from higher secondary schools in Tokha municipality. As compared to other groups, adolescents are more prone to SRH issues, and they have the desire to keep trying new things that make them vulnerable to SRH issues.  

The total sample size for this study was 228.

The required sample size was determined by using the following formula.

n=z2pq/d2

Where,

Degree of confidence (CI) = 95%, Z value at 95% of CI (z) = 1.96

Prevalence (p) = 0.16 

q = 1-p = 0.84

Allowable error (d) = 5% = 0.05

Now, 

Sample size (n) = z2pq/d2 

                       = (1.96)2*0.16*0.84/(0.05)2 

                       = 3.8416*0.16*0.84 / 0.0025

                       = 206.5~207

Adding a 10% non-responsive rate (207+10% of 207), the actual sample size for the study was 227.7~228. However, we were able to collect only 212 samples. The remaining 16 respondents refused to participate in the study.

The study area of Tokha municipality, Kathmandu, was selected by using the simple random sampling technique. For the study, the study area was divided into north, south, east, and west directions. A list of schools located in each direction was made. Then one school from each direction was selected for the research study by lottery method. On the day of data collection, the roll numbers (student ID numbers) of the present students were listed from which an equal proportion of students were chosen from each section of grades 11 and 12 for the research study through the lottery method from the respective college.

There were four phases to the data collection tool. Part I: It comprises socio-demographic variables in which respondents answered a questionnaire aimed to collect information on the adolescent's details (age, sex, grade, ethnicity, and religion), parental factors (Mother's Educational Status, Father's Educational Status, Father's Occupation, and Mother’s Occupation), and living arrangement of respondents. Part II: Use of Divya and Manikandan designed the parenting style questionnaire (2013). It has 30 items, and for each, respondents selected one of five options: strongly agree, agree, neither agree nor disagree, disagree and strongly disagree. 5,4,3,2 and 1 were used to score the various items. Part III: The questionnaire's knowledge-related questions, which were designed to assess adolescents' understanding of the principal sexual and reproductive health topics, were answered by the respondents. Part IV: Adolescent parent communication on a variety of topics was evaluated using the Weighted Topics Measure of Family Sexual Communication. It comprises 11 questions on a scale of 0 to 44 to measure the level of communication between the parent and adolescent regarding various aspects of sexual and reproductive health. For the data collection, the self-administered technique was used.

Each question was coded by labeling, compiling, and organizing by using numbers to represent response categories. The questionnaires were examined by examining all the answers to one question or variable at a time or by examining all the responses given to all questions by one respondent at a time. After examining the questionnaires, the collected data was entered and cleaned in Epidata v4.6 and then exported to SPSS v26 software for analysis. Descriptive statistics were used for the quantitative data, and the final result of the study was presented in the form of numbers and tables. The Chi-square test was used to test the association between the independent and dependent variables.

Validity was maintained by searching for relevant literature. The validity of the instruments was maintained through reviewing different literature related to the topic. An intensive review of the literature was carried out. Consultation with faculties as well as the research supervisor was conducted to maintain the validity. Pretesting of the instrument at 10% of the sample population from similar schools and similar respondents was done. The consistency and accuracy of the collected data were checked on the same day to avoid missing information or incomplete information. Additionally, the content validity ratio (CVR=0.89) and content validity index (CVI=0.78) indicated the confirmation of content validity.

Adolescents aged 15–19 years from selected schools or colleges in Tokha Municipality who are interested and willing to participate in the study were considered to meet the inclusive criteria.

Ethical approval was obtained from the Institutional Review Committee of the Nepal Institute of Health Sciences (Ref no. 13/078) before the initiation of the study. Before conducting the study, informed consent was taken from the respondents. Consent from the parents of the respondents who are below 18 years was taken by informing and providing the consent form to the respondents beforehand to pass the information regarding the data collection. An approval letter was taken from the respective schools/colleges and the health and education section of Tokha municipality. The purpose and objectives of the study were explained in detail to the respondents. Finally, the confidentiality of the respondents was maintained, no identity was revealed, and the collected data was used only for the study purpose.

The study was conducted from 14th November 2021 to 7th July 2022.

Among 212 respondents, sixty percent (60%) were 15-17 years forty percent (40 %) were 18-19 years respectively. The female respondents were more than the male respondents. More than half of the respondents, nearly fifty-seven percent (56.6%), were female, and forty-three percent (43.4%) were male, respectively. Regarding ethnicity, most of the respondents (43.4%) were from Brahmin/Chhetri ethnic backgrounds, followed by Dalits (5.7%), Newars 13.7%, Janajati 35.4%, and Muslims 1.9%, respectively. Most of the respondents (76.4%) followed the Hindu religion, followed by Buddhists (12.3%), Muslims (1.4%), and Christians (9%), respectively.

Similarly, the study found that the majority of the parents (93.9%) were together, while 3.8% were separated, and 2.4% were divorced. Regarding education, the majority of respondents' mothers (73.1%) were literate, and nearly twenty-seven percent (26.9%) were illiterate. Among mothers in the literate group, 18.9% were able to read and write, while 19.8% received primary-level education. Likewise, 10.8% were lower secondary level, 17% were secondary level, 4.2 % were higher secondary level, and 2.4% received bachelors and above-level education, respectively. Similarly, the majority of respondents’ fathers (84%) were literate, while 16% were illiterate. Among fathers in the literate group, 11.8% were able to read and write, while 19.3% received primary-level education. Likewise, 16.5% were lower secondary level, 21.7% were secondary level, 9.4% were higher secondary level, and 5.2% received bachelors and above-level education, respectively. Most of the respondents' fathers (93.9%) were employed and engaged in different sectors. For example, 30.7% were in agriculture, 10.8% were in government/civil service, 5.2% were in private service/NGO/INGO, 20.8 % were engaged in business, 10.4% were in labor, and 16% were foreign employers. Similarly, the majority of mothers, 26.9%, were housemakers while 4.2% were engaged in government/civil service, 5.2% were in private service/NGO/INGO, 12.7 % had engaged in business, 2.4 percent were labor, and 4.2% were foreign employers. (Table 1).

Upon assessing the living arrangements of the respondents, the study revealed that the majority of respondents (64.6%) were living with their both parents (father and mother), followed by living with their mother only (1.4%), living with their father only (3.3%), living with siblings (1.4%), living with friends (1.9%), living with relatives (21.7%) and living alone (5.7%) respectively. Upon assessing the parenting styles of the respondents, the study found that more than half of the respondents (57.08%) perceived an authoritative parenting style, followed by an authoritarian style (32.54%) and a permissive style (10.38%), respectively.

Among 212 respondents, the majority of responses were recorded for pubertal changes (93.9%), menstruation (92.9%), child or forced marriage (91%), pregnancy (93.4%), abortion (57.5%), STI (80.2%), sexual violence (87.3%), and contraceptive devices (82.1) respectively. Upon assessing the level of knowledge, out of 212 respondents, half had an adequate level of knowledge, whereas 50% had an inadequate level.

The study revealed that most respondents, nearly seventy-six percent (75.9%), communicated on SRH topics with their parents, whereas twenty-four percent (24.1%) never communicated results with their parents on SRH topics. The study reveals that, out of 161 respondents, the majority of respondents (47.2%) rarely communicated on SRH topics, followed by sometimes (23.6%) and often (5.2%), respectively (See table 2). The responses illustrated that more than half of the respondents (56.1%) communicated about choosing a life partner. A fair share of respondents (27.4%) sometimes talked, and a small handful of responses (6.1%) had recorded as often. Communication on using birth control was never done by the majority of the respondents (61.3%), while 15.6% of responders rarely talked, a fair share of respondents (15.6%) sometimes talked, and a small handful of responses (6.1%) had recorded as often. Communication about menstruation (50.1%), communication about physical and psychological changes (55.2%), and physical growth of reproductive organs and development (50.5%) had significantly discussed by the respondents with their parents. Topics such as communication on when to start having sex (86.6%), pregnancy (69.3%), how to handle sexual pressure from a partner (85.8%), STI and HIV/AIDs (72.2%), communication about condoms (78.8%) and abortion (82.5%) had never discussed. (See table 3).

WTM: Weighted Topics Measure of Family Sexual Communication

AIDS: Acquired Immune Deficiency Syndrome

HIV: Human Immune Deficiency Virus

STI: Sexually Transmitted Infection

SRH: Sexual and Reproductive Health

DF: Degrees of freedom

CI: Confidence Interval

SPSS: Statistical Package for the Social Sciences

PSS: Perceived Stress Scale

NGO/INGO: Non-governmental organization/ International non-governmental organization

This study was approved by the Institutional Review Committee (IRC) of the Nepal Institute of Health Sciences (Ref no. 13/078). Written informed consent was obtained from the participants. Consent from the parents of the respondents aged less than 18 years was taken by informing them and providing the consent form to the respondents beforehand to pass the information for the data collection. An approval letter was also taken from the respective schools, colleges, and the health and education section of Tokha municipality.

Not Applicable

Datasets used in the current study are available from the corresponding author on reasonable request.

This research did not receive any funding from any agency in the public, commercial, or not-for-profit sectors.

AG made substantial contributions to the concept and design of the research, collected the data, acquired, analyzed, or interpreted the data, and drafted the article. KS made a central contribution in drafting the research article, revised it critically for important intellectual content, acquired, analyzed, or interpreted data, and approved the version to be published. SD and SD conceived and helped to design the research, contributed data collection and analysis tools, and supervised throughout the study. AC drafted the article and revised it critically for important intellectual content. All authors read and approved the final manuscript. 

We would heartily extend our sincere gratitude to the Nepal Institute of Health Sciences, Purbanchal University, Kathmandu, Nepal. Furthermore, we would like to thank Mr. Pawan Neupane, Ms. Anita Shakya, Mr. Sudeep Okheda, Mr. Paban Prakash Oli, and Ms. Sabina Sapkota for helping us throughout our research journey.