Beyond the Textbook: An HBM and SCT Analysis of Adolescent Reproductive Health Education in Rural Bangladesh

The effective delivery of adolescent and reproductive health (ARH) education in rural Bangladeshi schools is influenced by factors extending beyond curriculum content, including teacher preparedness, classroom interactions, gender norms, and the broader social environment. This qualitative study examined how teachers and students experienced the delivery and discussion of ARH topics in rural secondary schools, drawing on the Health Belief Model (HBM) and Social Cognitive Theory (SCT) as interpretive frameworks. Data were collected through 18 in-depth interviews with teachers and nine focus group discussions involving 54 students from six secondary schools across three rural districts. Thematic analysis identified substantial variation in teachers' confidence and instructional practices, with training and administrative support associated with greater willingness to discuss sensitive topics and use participatory teaching approaches. Students' engagement was shaped by gendered classroom dynamics, perceived approachability of teachers, and concerns about embarrassment. When students perceived communication with teachers as difficult, they frequently sought information from peers and online sources, despite uncertainty about the reliability of such information. Teachers also described adapting their instructional practices to navigate cultural sensitivities, whereas parental concerns, community expectations, curriculum limitations, and inconsistent school-level support continued to constrain classroom discussion. Viewed through HBM and SCT, these findings illustrate how perceived barriers, self-efficacy, social reinforcement, modeling, and institutional conditions interact in shaping ARH education. Strengthening teacher training, school leadership support, student-centered communication, and community engagement may improve the delivery of ARH education in rural Bangladeshi schools.