Development and Pilot Evaluation of "Cut Nyak": A Comic-Based Reproductive Health Education Medium for Adolescents in Aceh, Indonesia

Background: Adolescent reproductive health remains a pressing public health concern in Indonesia, particularly in educational settings where access to accurate, culturally appropriate, and engaging information may be constrained. These challenges underscore the need for innovative health communication approaches that can address sensitive reproductive health issues in ways that are accessible and contextually relevant to adolescents, including those in Islamic boarding schools (pesantren/dayah).Objective: This study aimed to develop and preliminarily evaluate the acceptability of Cut Nyak, a comic-based reproductive health education medium designed for adolescents in Aceh Province, Indonesia, using a Research and Development (R&D) approach.Methods: The development process involved two focus group discussions (FGDs) with stakeholders comprising lecturers, midwives, health office personnel, reproductive health facilitators, an Islamic boarding school representative, educators, and visual communication design specialists. The FGDs informed the comic’s conceptual framework, characters, narrative structure, visual language, and priority health content. Ten candidate topics were integrated into a coherent narrative and subsequently developed into a 56-page A5 comic entitled Sepatu Sebelah Kiri (One Left Shoe). The comic uses a contemporary anime- and manhwa-influenced visual style, featuring modestly dressed, hijab-wearing characters and a boarding-school setting. Rather than presenting health information through explicit didactic instruction, reproductive health messages are embedded within the storyline and conveyed through characters’ experiences, interpersonal relationships, and problem-solving processes. A preliminary acceptability assessment was conducted among 30 female adolescents, comprising 15 students from a non-boarding Islamic junior high school and 15 students from a boarding pesantren. Acceptability was assessed descriptively using positive and negative response categories.Results: Participatory development resulted in a culturally contextualized comic centred on Cut Putri Ashtanti, a boarding-school student navigating identity-related conflict, family tension, and social stigma, with support from peers. The narrative incorporated ten priority topics, including puberty, bullying, LGBT-related stigma, sexual harassment, premarital sexual behaviour, personal hygiene, substance use, adolescent nutrition, mental health, and violence against children. The resulting 56-page comic was accompanied by intellectual property outputs, including a patent-related application and a copyright certificate. Overall acceptability was favourable across both educational settings. Positive responses ranged from 67% to 93% among adolescents in the non-boarding school and from 80% to 87% among those in the boarding pesantren. Boarding-school adolescents showed higher positive responses to LGBT-related stigma content (87% vs. 73%), whereas non-boarding adolescents showed higher positive responses to mental health content (93% vs. 80%). Responses to violence-related content were identical in both groups (80%).Conclusion: The findings indicate that participatory, entertainment-education-informed comic development is feasible for creating culturally responsive reproductive health communication media for adolescents in Islamic educational settings. The generally favourable preliminary acceptability supports further refinement and larger-scale evaluation. However, the findings should be interpreted as exploratory because of the small, non-probability pilot sample and the absence of controlled measures of educational effectiveness. Future studies should assess whether the intervention improves reproductive health knowledge, attitudes, self-efficacy, stigma-related perceptions, and health-related behaviours using validated instruments and controlled pre-test/post-test designs.