Sexual Health

A COSMIN Systematic Review of Sexual Health Literacy Self-Report Measures for Adolescents.

TL;DR

Despite the availability of 68 different self-report outcome measurement instruments assessing sexual health literacy in adolescents, their quality and alignment with sexual health literacy dimensions are insufficient, with development quality generally rated as inadequate or doubtful.

Key Findings

The systematic search identified 83 studies examining 68 different self-report outcome measurement instruments (OMIs) assessing sexual health literacy in adolescents.

  • The search was conducted across 9 databases, covering studies published between 2002 and 18 April 2023.
  • A total of 18,637 records were initially identified before screening and inclusion.
  • Inclusion criteria focused on studies developing and validating OMIs for adolescents aged 10–19 years.
  • The review was preregistered in PROSPERO (ID: CRD42022303682).

The quality of OMI development was generally rated as inadequate or doubtful according to COSMIN criteria.

  • Quality evaluation was conducted using COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines.
  • Deficiencies were specifically noted in involvement of the target population during instrument development.
  • Deficiencies were also noted in piloting processes of the instruments.
  • These quality issues were described as characteristic across the body of identified OMIs.

OMIs varied in their coverage of sexual health literacy (SHL) dimensions, with appraisal and application of sexual health information being the most frequently addressed dimensions.

  • A narrative synthesis was used to assess the conceptual fit of identified instruments with SHL dimensions.
  • Not all SHL dimensions were equally represented across the 68 identified OMIs.
  • The WHO (2006) definition of sexual health served as the conceptual reference framework for SHL dimensions.
  • The study year 2002 was used as a lower boundary because it precedes the WHO's current definition of sexual health established in 2006.

There is a clear need for a comprehensive, standardized SHL measure for adolescents to enhance comparability across studies and interventions.

  • The authors note that measurement consistency aids in comparing studies and informing interventions.
  • Greater involvement of the target population (adolescents aged 10–19) in OMI development processes is recommended.
  • More rigorous piloting procedures are identified as a key area for improvement.
  • Developing a comprehensive SHL measure is described as necessary to 'enhance comparability and promote adolescent sexual health understanding and interventions.'

Despite the large number of available instruments, their alignment with the full construct of sexual health literacy as defined by the WHO is insufficient.

  • 68 different OMIs were identified, indicating substantial quantity but not quality or comprehensiveness.
  • The authors describe OMIs' quality and alignment with SHL as 'insufficient' despite availability.
  • The WHO 2006 definition of sexual health was used as the gold standard for conceptual alignment assessment.
  • The finding implies fragmentation in how SHL is operationalized across existing instruments.

What This Means

This research systematically reviewed all available self-report tools designed to measure sexual health literacy (the ability to find, understand, and use sexual health information) in young people aged 10–19. After searching nine scientific databases and screening over 18,000 records, the researchers identified 83 studies covering 68 different measurement tools. They then evaluated both what aspects of sexual health literacy each tool measured and how rigorously each tool was developed, using internationally recognized quality standards called COSMIN criteria. The findings reveal that while many tools exist, most fall short in two important ways. First, they do not fully cover all the dimensions of sexual health literacy as defined by the World Health Organization—the most commonly addressed skills were appraising and applying sexual health information, while other important dimensions were less frequently included. Second, the development quality of most tools was rated as inadequate or doubtful, largely because the young people these tools are meant to measure were not sufficiently involved in creating them, and the tools were not tested thoroughly enough before being used in research. This research suggests that the field lacks a single, well-designed, comprehensive tool for measuring sexual health literacy in adolescents. Without such a tool, it is difficult to compare results across different studies or to accurately evaluate whether sexual health education programs are working. The authors call for the development of new, more rigorous measurement instruments that actively involve adolescents in the design process and undergo thorough testing—steps that would ultimately lead to better understanding of, and support for, adolescent sexual health.

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Citation

Muehlmann M, Nieradt K, Tomczyk S. (2025). A COSMIN Systematic Review of Sexual Health Literacy Self-Report Measures for Adolescents.. Archives of sexual behavior. https://doi.org/10.1007/s10508-025-03142-1