Hrev_master Healthcare in Low-resource Settings 2023; volume 11:11762 The relationship between knowledge and social support with sexual behavior in adolescents Puji Hastuti, Alesya Putri Jayanti, Astrida Budiarti, Iis Fatimawati Hang Tuah Surabaya College of Health Sciences, Surabaya, Indonesia Abstract Adolescents often undergo a tumultuous phase of sexual mat- uration, leading to increased dating activity due to a lack of ade- quate knowledge and support. This study aimed to investigate the relationship between knowledge, social support, and sexual behavior among adolescents. The research adopted a cross-sec- tional design with 100 respondents from Manukan Kulon. Simple random sampling was used to select the respondents. Knowledge and social support served as independent variables, assessed through questionnaires, while sexual behavior was the dependent variable, evaluated with a separate questionnaire. Ordinal data analysis, specifically the Spearman Rho test (ρ<0.05), was employed. Results indicated that 57% of adolescents in Manukan Kulon had low knowledge, 46% lacked social support, and 60% engaged in unsafe sexual behavior. The Spearman Rho test revealed significant relationships between knowledge and sexual behavior (ρ = 0.000) and between social support and sexual behavior (ρ = 0.000). In conclusion, improved knowledge can lead to safer sexual behavior among adolescents, while strong social support, particularly from parents and teachers, plays a vital role in providing information and promoting safe sexual behavior. Introduction Adolescents are individuals experiencing a transitional phase of sexual and biological maturation, which can lead to excessive dating behavior, including unhealthy reproductive behaviors like premarital sex.1 Premarital sexual behavior is sexual behavior car- ried out without going through an official marriage process according to the law or according to their respective religions and beliefs. One of the factors of sexual behavior is social support and lack of knowledge.2,3 Little knowledge of sex in adolescents makes adolescent behavior worrying, such as things that should not be done but in this day and age teenagers consider holding hands, hugging kissing with the opposite sex is common.4 This perception often stems from the absence of correct and compre- hensive sexual education1. In addition to insufficient knowledge, social support plays a significant role in adolescent sexual behav- ior. Parents, as a primary influence within the family environment, exert considerable impact by providing social support.5,6 Families, particularly parents, have a pivotal role in shaping adolescent sex- ual behavior by imparting knowledge and understanding of the consequences of premarital and free sex.7,8 However, adolescents tend not to disclose their premarital sexual activities to their par- ents or family.3 They often place more trust in their peers, believ- ing that friends can maintain confidentiality and offer solutions to their problems.9 According to data from the Adolescent Reproductive Health Survey (SKRR) in 2017, 45% of women and 44% of men started dating between the ages of 15 and 17. Regarding sexual behavior, Correspondence: Puji Hastuti, Hang Tuah Surabaya College of Health Sciences, Surabaya, Indonesia. E-mail: pujihastuti@stikeshangtuah-sby.ac.id Key words: knowledge; social support; sexual behavior; adolescent. Contributions: PH Conceptualization, Data Curation, Formal Analysis, Methodology, Validation, Visualization, Writing – Original Draft, Review & Editing; APJ Conceptualization, Investigation, Methodology, Validation, and Writing – Original Draft, Review & Editing; AB Conceptualization, Methodology, Formal Analysis, Validation, and Writing – Original Draft, Review & Editing; IF Visualization, Writing – Review & Editing. Conflict of interest: the authors declare no conflict of interest. Ethics approval and consent to participate: the research has received ethical approval from the Health Research Ethics Commission, Stikes Hnag Tuah Surabaya, based on ethical certificate PE/20/VI/2022/KEP/SHT. During the research, the researcher pays attention to the ethical principles of information to consent, respect for human rights, beneficence and non-maleficence. Research con- sent was obtained from adolescents and parents by signing their willingness to become research respondents. Patient consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Funding: this research did not receive external funding. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Acknowledgement: we would like to thankful to Head of RW 3 Manukan Kulon, for their valuable insights and contributions to this study. Received: 11 September 2023. Accepted: 3 October 2023. Early access: 16 October 2023. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11:11762 doi:10.4081/hls.2023.11762 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affili- ated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2023; 11:11762] [page 1] Non -co mmerc ial us e o nly most women and men reported activities such as holding hands (64% of women and 75% of men), hugging (17% of women and 33% of men), kissing on the lips (30% of women and 50% of men), and touching/groping (5% of women and 22% of men) while dat- ing. The survey also indicated that 8% of men and 2% of women reported engaging in premarital sexual intercourse. Reasons cited for engaging in premarital sex included love (47%), curiosity (30%), chance (16%), coercion (3%), and influence from friends (9%).10 In a preliminary study involving 10 adolescents from Manukan Kulon, findings revealed that 70% had limited sexual knowledge, while 30% possessed a higher level of knowledge. Regarding social support, 60% received support from peers, 20% from family, and 20% from special individuals like partners. In terms of sexual behavior, 70% had girlfriends, four held hands with the opposite sex, and three hugged individuals of the opposite sex. Furthermore, 30% did not have girlfriends, but two of them engaged in holding and hugging with the opposite sex, while one abstained from any such interactions. Notably, three teenage girls experienced unwant- ed pregnancies, highlighting the consequences of risky sexual behavior. Observations in Manukan Kulon indicated that adoles- cents lacked information about premarital sexual behavior and its consequences. Limited parental support, such as allowing late- night dating, pushed adolescents to rely on peers and special indi- viduals for emotional support during highs and lows. This combi- nation of insufficient knowledge and inadequate social support may contribute to high-risk sexual behavior among adolescents in Manukan Kulon. Adolescent knowledge about sex remains deficient, often influenced by incorrect sources of information, such as porno- graphic videos, pornographic websites on the internet, and other sources, which can lead to misconceptions and incorrect percep- tions about sex.11,12 These misconceptions can lead to inappropriate attitudes and subsequent sexual behaviors.13 Additionally, adoles- cents may believe that engaging in sex is a way to express love, leading them to engage in sexual activity before marriage.14 Lack of knowledge can result in sexual activity, and the worst conse- quences can include sexually transmitted diseases (STDs) like HIV/AIDS.15 Inadequate social support, including support from parents, peers, and special individuals, is another contributing factor to adolescent sexual behavior. Adolescents naturally seek indepen- dence from their parents and form bonds with peers, and peer asso- ciations significantly influence their sexual behavior, as they spend more time with friends.16,17 Adolescents often rely more on friends than their parents and develop strong emotional connections within their peer groups. This strong solidarity among peers can influence adolescents’ sexual behavior.18 The consequences of insufficient and incorrect social support can lead to sexual behaviors that result in unwanted pregnancies, abortions, STDs like HIV/AIDS, and psychological impacts such as anxiety, depression, shame, and fear.15 The support provided by families, peers, and special individ- uals is a crucial factor influencing premarital sexual behavior in adolescents. Insufficient social support can lead to limited knowl- edge, which is essential for preventing sexual behavior.15 Early sex education, provided by parents or teachers, is necessary to help adolescents make informed decisions about their behavior and avoid accepting incorrect information. Parents should maintain open communication with their children to explain what is accept- able and what is not. The primary objective of this research was to examine the relationship between knowledge, social support, and adolescent sexual behavior. Materials and Methods Research design This study employed a quantitative research approach with an observational analytical design using a cross-sectional approach. The research was conducted in a specific area of West Surabaya, namely Manukan Kulon. Study respondents The population for this study comprised adolescents residing in Manukan Kulon, with a total of 133 potential respondents. The sample size selected for this study consisted of 100 respondents. The sampling method involved collecting data from teenagers at a single location during a specific time frame, and those who were present during that time were included as research respondents. The inclusion criteria for this study included adolescents who were living in the area, willing to participate by completing the distribut- ed questionnaires, aged between 15 and 21 years, and not married. Exclusion criteria encompassed adolescents who did not attend the research site as respondents and adolescents with disabilities. Variable, instrument and data collection The independent variables in this study were knowledge and social support, while the dependent variable was sexual behavior. The questionnaire used to gather demographic data from respon- dents included initial name, gender, age, age at first menstruation (only for women), age at first wet dream (for men only), individu- als respected by the respondent, presence of close friends, number of close friends, presence of friends, the number of friends, sources of friendship, sources of information related to sexuality, existence of a romantic relationship, and parental restrictions on relation- ships. The knowledge measurement instrument employed in this study used a knowledge questionnaire comprising 15 Guttmann scale questions adapted from prior research,9 with two optional answers. Knowledge was categorized as low if the score was < 75% (true < 11) and high if the score was ≥ 75% (correct ≥ 11). The social support questionnaire in this study consisted of 12 Likert scale questions adapted from Lakey and Cohen,18 with four optional answers: Very suitable (4), suitable (3), not suitable (2), very inappropriate (1). Social support was categorized as low (12- 23), medium (24-35), and high (36-48). The sexual behavior ques- tionnaire in this study consisted of 15 Likert scale questions adapt- ed from Muflich’s research,19 with two optional answers: Never=0 and Ever=1. Sexual behavior was categorized as safe (if all answers were “Never”), less safe (if the respondent answered “Ever” for one of the indicators: Touching, Kissing, and Masturbation), and unsafe (if the respondent answered “Ever” for one of the indicators: Deep kissing, Oral sex, Petting, and Sexual intercourse). Validity and reliability tests were conducted on 30 respon- dents, and the results indicated that all the questions were valid. The Cronbach Alpha results for the knowledge questionnaire were 0.760, and for the sexual behavior questionnaire, they were 0.764, demonstrating the reliability of both questionnaires. Data analysis Statistical analysis was performed using Spearman’s rho (α<0.05). Mentioning data normality and characteristics is essential. Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions [page 2] [Healthcare in Low-resource Settings 2023; 11:11762] Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Non -co mmerc ial us e o nly Results The study’s respondents, as described in Table 1, primarily consisted of 58% males and 42% females. The majority fell into the 15-year-old age category (31%). Most females experienced menarche at age 12 (15%). Among males, wet dreams commonly occurred at ages 12 and 13 (15%). Regarding respected individu- als, 71% of respondents respected their parents. The majority had 1-5 close friends (66%), who primarily came from the home envi- ronment (38%) or school (34%). Information about sexuality was mainly obtained from multiple sources (33%). In terms of relation- ships with the opposite sex, 63% of respondents reported not hav- ing such relationships. Parental restrictions on relationships were mostly not imposed (62%). Table 2 illustrates that a significant majority of adolescents, specifically 60.0%, exhibit low knowledge and engage in unsafe sexual behavior. In contrast, a smaller percentage, 21.1%, display low knowledge but practice safe sexual behavior. Additionally, 40.0% of adolescents with high knowledge engage in unsafe sexu- al behavior, while 78.9% of those with high knowledge practice safe sexual behavior. Only 19.0% of adolescents with high knowl- edge engage in unsafe sexual behavior. The Spearman rho test results (ρ = 0.000) with a value of r = -0.378 indicate a significant negative relationship between adolescent knowledge and sexual behavior in RW 3 Manukan Kulon. This suggests that the hypoth- esis, which posits a low-nature relationship, is accepted, affirming the association between knowledge and sexual behavior among these adolescents. Table 3 provides insights into the relationship between adoles- cent social support and their sexual behavior in RW 3 Manukan Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable SolutionsTransforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Table 1. Demographic Data Characteristics of Youth in RW 3 Manukan Kulon 18-19 June 2022 (n=100). Characteristics Frequency (f) Percentage (%) Gender Male 58 58 Female 42 42 Age Middle adolescent (14-17year old) 56 56 Last adolescent (18-21 year old) 44 Age of puberty (menarche/wet dream) 8 year old 1 1 10 year old 6 6 11 year old 14 14 12 year old 30 30 13 year old 24 24 14 year old 12 12 15 year old 7 7 16 year old 6 6 Respected person Parent 71 71 Teacher 3 3 Parent and teacher 19 19 Special other 6 6 Nothing 1 1 Number of close friend Nothing 5 5 1-5 people 66 66 6-10 people 25 25 11-15 people 4 4 Neighborhood origins of close friends Household 38 38 School 34 34 Household and School 23 23 Nothing 5 5 Information about sexual behavior comes from Social media 25 25 School 27 27 Parent 1 1 Friend 14 14 Choose more 1 33 33 Relationship status (have boy/girlfriend) Yes 37 37 No 63 63 Parent limitation of relationship Yes 38 38 No 62 62 [Healthcare in Low-resource Settings 2023; 11:11762] [page 3] Non -co mmerc ial us e o nly Kulon. Notably, 48.3% of adolescents with low social support tend to engage in unsafe sexual behavior, while a smaller proportion (66.7%) with similarly low support also exhibit unsafe sexual behavior. However, a modest 15.8% of adolescents with low social support practice safe sexual behavior. On the other hand, 30.0% of adolescents with high social support engage in unsafe sexual behav- ior, while a significant majority (73.7%) with high support follow safe sexual practices. Moderate social support corresponds to diverse outcomes: 21.7% of adolescents with moderate support exhibit unsafe sexual behavior, while 9.5% with the same level of support engage in unsafe sexual practices. Additionally, 10.5% of adolescents with moderate social support opt for safe sexual behav- ior. The Spearman rho test results (ρ = 0.000) with a correlation coefficient (r) of -0.344 signify a significant negative relationship between adolescent social support and their sexual behavior in RW 3 Manukan Kulon. This supports the hypothesis of a low-nature relationship, underlining the meaningful connection between social support and adolescent sexual behavior in this context. Discussion Factors related to adolescent sexual behavior include knowl- edge and social support. Knowledge can shape a person’s attitudes and behavior. It also enables adolescents to have awareness and act in accordance with their knowledge. Behavior based on knowledge tends to be more enduring than behavior without a knowledge foundation. The results of this study are consistent with Kumalasari’s research19 which suggests that students with limited knowledge are more likely to engage in premarital sexual behavior. Conversely, adolescents with higher knowledge levels are less likely to engage in premarital sexual behavior.12,20,21 This study’s findings align with a survey conducted by Kumalasari19 in various countries, demonstrating that access to accurate information can reduce reproductive issues in adoles- cents.22,23Thus, it can be inferred that a higher level of knowledge among adolescents correlates with more responsible behavior. Cognitive knowledge is a vital domain for shaping an individual’s actions (i.e., behavior).24,25 Interestingly, there were 19% of respondents with high knowl- edge who engaged in unsafe sexual behavior. Researchers specu- late that these adolescents may have understood the definition and consequences of sexual behavior, leading them to take more risks. Access to abundant information on reproductive health through various media sources, such as websites, videos, television, books, and magazines, might influence this behavior.26,25,27 The results highlight that well-informed respondents can still engage in risky sexual behavior, possibly because the information they receive is not always accurate or complete, encouraging experimentation despite their knowledge.27,28 Low social support among adolescents was associated with less safe sexual behavior. Behavior can be influenced by the sup- port provided by individuals in one’s social circle, which encom- passes emotional support, information, rewards, and tools that enhance responsible behavior.29 Various factors, including predis- position, support, and driving factors, can shape an individual’s actions. Peer social support is a driving factor that should signifi- cantly influence behavior, as strong peer support can deter premar- ital sexual behavior. However, family support is another factor that may directly affect behavior.9,22,30 Interestingly, some respondents received high social support but still engaged in unsafe sexual behavior (23.8%). It’s possible that respondents perceived the support they received as granting them the freedom to do as they pleased, as the surrounding support allowed them to act without fear, including engaging in negative behaviors. This finding aligns with previous research31 which established a connection between parental support and adolescent risky sexual behavior. This support sometimes takes the form of permissive-indulgent parenting, where parents prioritize their chil- dren’s happiness, granting them more freedom and complying with their wishes. Consequently, this approach can lead to more aggres- sive, independent, and socially unaware adolescents who may engage in risky sexual behavior.7,28,30,32 One limitation of this study is that the measurement of social support does not provide detailed data on the sources of support received by adolescents. [page 4] [Healthcare in Low-resource Settings 2023; 11:11762] Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Table 2. The Relationship between Knowledge and Sexual Behavior in Adolescents in RW 3 Manukan Kulon on 18-19 June 2022 (n=100). Knowledge Sexual behavior Total Unsafe Less of safe Safe F % F % F % N % Low 17 81.0 36 60.0 4 21.1 57 57 High 4 19.0 24 40.0 15 78.9 43 43 Total 21 100 60 100 19 100 100 100 Result of Spearman’s Rho analysis (α = 0.05) > (ρ = 0.000) (r = -0.378). Table 3. The Relationship between Social Support and Sexual Behavior in Adolescents in RW 3 Manukan Kulon on 18-19 June 2022 (n=100)Knowledge Sexual Behavior Total Knowledge Sexual behavior Total Unsafe Less of safe Safe F % F % F % N % Low 14 66.7 29 48.3 3 15.8 46 46 Middle 2 9.5 13 21.7 2 10.5 17 17 High 5 23.8 18 30.0 14 73.7 37 37 Total 21 100 60 100 21 100 100 100 Result of Spearman’s Rho analysis (ρ = 0.000)<(α = 0.05) (r = -0.344) Non -co mmerc ial us e o nly Conclusions The knowledge and social support possessed by adolescents are related to their sexual behavior. Providing appropriate informa- tion that aligns with the needs of adolescents is one of the key fac- tors in helping them avoid risky sexual behavior. Efforts to prevent premarital sexual behavior should focus on increasing knowledge and social support, particularly from those who are closest to ado- lescents, including parents, teachers, and peers. This approach aims to create an environment conducive to the healthy develop- ment of adolescents as they navigate their developmental tasks. References 1. Wulandari S. Hubungan Pengetahuan dengan Perilaku Seksual Remaja pada Siswa/I di SMK N 1 Tandun Kabupaten Rokan Hulu. J Martenity Neonatal 2020;3:36-45. 2. Berliana SM, Utami ED, Efendi F, Kurniati A. Premarital Sex Initiation and the Time Interval to First Marriage Among Indonesians. Bull Indones Econ Stud 2018;54. 3. Berliana SM, Kristinadewi PAN, Rachmawati PD, Fauziningtyas R, Efendi F, Bushy A. Determinants of early marriage among female adolescent in Indonesia. Int J Adolesc Med Health 2021;33:1-6. 0 4. Ortiningsih R, Kasiati K, Handayani S. Premarital Counseling Affects Primigravidas’ Knowledge and Attitude on Reproductive and Sexual Health. J Ners 2021;16:49-53. 5. Zubaidah Z, Maria I, Rusdiana R. The Relationship between Parenting Style and Sexual Behavior before Marriage in Teenagers. J Ners 2020;15:553-6. 6. Panewaty DF, Indrawati ES. Hubungan Antara Dukungan Sosial Orangtua Dengan Penyesuaian Sosial Pada Siswa Dalam Asuhan Nenek Di Smp Negeri 1 Ngraho Kabupaten Bojonegoro. Empati 2018;7:145-54. 7. Krisnana I, Rachmawati PD, Kurnia ID, Rummy NSJ. Parental Interactions Associated with Adolescent Health Risk Behavior: Premarital Sexual and Aggressive Behavior. J Ners 2021;16:106-10. 8. Mohan SBVR, Dhanapal S, Govindasamy V, Pillay KSP. Psychological impact of parent-adolescent communication: A critical analysis. Int J Public Heal Sci 2022;11:1210-22. 9. Chasanah M. Hubungan antara Kontrol Diri dan Dukungan Sosial Teman Sebaya dengan Perilaku Seksual Pranikah pada Remaja Akhir. 2020. 10. BKKBN. Survei Demografi Dan Kesehatan : Kesehatan Reproduksi Remaja 2017. Badan Kependud dan Kel Berencana Nas 2017;1-606. 11. Tan ESS, Chin SAFX, Sathapan MSP, Dewi AD, Amini F, Bustami NA, et al. Mental Health and the COVID-19 Pandemic: Observational Evidence from Malaysia. Int J Environ Res Public Health 2023;20:4046. 12. Santoso S, Siswantara P. Adolescents’ knowledge and attitude before and after exposure to media of youth sexual behavior in Indonesia. Indian J Forensic Med Toxicol 2020;14:2338-42. 13. Fevriasanty FI, Suyanto B, Soedirham O, et al. Effects of social media exposure on adolescent sexual attitudes and behavior: A systematic review. Int J Public Heal Sci 2021;10:272-80. 14. Alfiyah N, Solehati T, Sutini T. Gambaran Faktor-Faktor yang Berhubungan dengan Perilaku Seksual Pranikah pada Remaja SMP. J Pendidik Keperawatan Indones 2018;4:131-9. 15. Hervina. Hubungan Dukungan Teman Sebaya Dan Religiusitas Dengan Perilaku Seks Pra Nikah. 2018; 16. Hartini N. Complete family and teenager’s well-being. J Adv Res Dyn Control Syst 2019;11:1302-7. 17. Suharmanto, Suyanto B, Purnomo W, Set al. Organized activ- ities in peer groups improve mental and social well-being in adolescents: A qualitative study. Indian J Public Heal Res Dev 2019;10:1239-44. 18. Santy E, Sari USC, Hikmah K. Assessing Factors Influencing Free Sexual Behavior Among Teenagers. J Vokasi Kesehat 2020;6:22-7. 19. Kumalasari D. Hubungan Pengetahuan dan Sikap dengan Perilaku Seksual Pada Siswa SMK. J Aisyah J Ilmu Kesehat 2017;1(1). 20. Susanti E. Women’s knowledge and the role of local female leaders in ending the practice of the early marriage of girls in rural communities of Indonesia. J Int Womens Stud 2019;20:13-28. 21. Muthmainnah M, Devi YP, Khoiriyah IE, et al. Determinants of Adolescent Sexual Behaviour in Indonesia during the COVID-19 Pandemic: A Scoping Review. Niger Postgrad Med J 2023;30:87-95. 22. Pradanie R, Yunitasari E, Wibawati AR, Abigail W. Analysis of factors related to behaviours to prevent sexual assault of teenage girls. J Pak Med Assoc 2023;73:S126-9. 23. Chotimah K, Suza DE, Efendi F, et al. Determinants of adoles- cent first births in Indonesia. Syst Rev Pharm 2020;11:241-5. 26294 24. Nurmala I, Ahiyanasari CE, Muthmainnah, et al. Emerging premarital sexual behavior among adolescent in indonesia: The impact of knowledge, experience, and media use to attitudes. Indian J Forensic Med Toxicol 2020;14:2864-70. 25. Kurnia ID, Krisnana I, Yulianti FN. Increasing Prevention Knowledge of Sexual Violence and Emotional Maturity on Children through the Mini-Movie Media. J Keperawatan Padjadjaran 2020;8:242-52. 26. Wahyuni PA, Winarti Y. Hubungan Pengetahuan dengan Perilaku Seksual Pranikah Berisiko Kehamilan Tidak Diinginkan (KTD) pada Mahasiswa Prodi S1 Kesehatan Masyarakat. Borneo Student Res 2020;2:383-9. 27. Hastutii P, Salsabila R, Budiarti A, Yunitasari E. The correla- tion between social media use, peer influence, and sexual behaviour among adolescents. J Pak Med Assoc 2023;73:S39- 41. 28. Permatasari E, Kuntoro, Devy SR, Hendriani W. Parental knowledge on the perpetrators and the impacts of child sexual abuse towards parental protection efforts to prevent children from being the victims of sexual abuse. Indian J Public Heal Res Dev 2019;10:1823-7. 29. Idawati I, Salim LA, Devy SR, et al. Literature review: the relationship between the role of parents as educators on the behavior of preventing early marriage in adolescents. J Public Health Africa 2023;14:2554. 30. Permatasari E, Kuntoro, Devy SR, Hendriani W. Parental responsiveness of mindest-based nursing on early sexual edu- cation to prevent child sexual abuse. Indian J Public Heal Res Dev. 2019;10:885-90. 31. Ungsianik T, Yuliati T. Pola Asuh Orang Tua Berhubungan dengan Perilaku Seksual Berisiko pada Remaja Binaan Rumah Singgah. J Keperawatan Indones 2017;20:168-75. 32. Kohno A, Dahlui M, Nik Farid ND, et al. Why girls get mar- ried early in Sarawak, Malaysia - An exploratory qualitative study. BMC Womens Health 2020;20:46. [Healthcare in Low-resource Settings 2023; 11:11762] [page 5] Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Non -co mmerc ial us e o nly