Sexual Health Literacy and Knowledge Gained Through Podcast Education by University Students in Türkiye

Abstract

Background:

In countries such as Türkiye, university and college students often have limited access to structured forms of sexual health education, which may lead to inadequate knowledge and literacy regarding sex and sexuality. Digital tools such as podcasts offer a flexible and engaging platform that may improve sexual health outcomes.

Aims:

This study aimed to evaluate the effects of podcast-based education on sexual health knowledge and functional sexual health literacy among university students.

Setting:

The study was conducted at a state university in Istanbul and involved on-campus participant recruitment and intervention together with follow-up study using WhatsApp.

Methods:

A quasi-experimental pretest–posttest control group study was conducted between October and December 2024. Students from non-health sciences faculties were assigned to Podcast (G1: n = 40), Brochure (G2: n = 41), and Control (G3: n = 44) groups. G1 received four podcast sessions, G2 received brochures with the same content, and G3 received no intervention. Data were collected via a Student Information Form, a Sexual Health Knowledge Test (SHKT), and Sexual Health Literacy Scale (SHLS) at baseline, and at 4 and 8 weeks post-intervention.

Results:

For SHLS, significant time, group, and time × group effects were observed, with a significant increase over time occurring only in G1. Intergroup comparisons showed that G1 scored significantly higher than G2 and G3 at the first measurement and higher than G3 at the second measurement. For SHKT, the main effect of time was not significant, whereas significant group and time × group effects were found. Intergroup comparisons indicated that G1 had significantly higher SHKT scores than G3 at the first measurement and higher scores than both G2 and G3 at the second measurement. No significant within-group changes over time were observed on the SHKT.

Conclusion:

Podcast-based education was associated with short-term improvements in sexual health knowledge and functional sexual health literacy among university students. Incorporating interactive and regularly updated digital programmes may further enhance the efficacy and accessibility of sexual health education.

Keywords

Health education podcast broadcasts sexual health knowledge sexual health literacy university students

Introduction

Sexual health, an essential dimension of health, refers to “emotional, mental, and social well-being related to sexuality and an important element of quality of life” (World Health Organization (WHO), 2022). Sexual health problems, including unwanted pregnancy and sexually transmitted infections (STIs) among young people (approximately 20 million new cases of STIs each year) (Centers for Disease Control and Prevention (CDC), 2022), and sexual violence and abuse (13%–50%), are quite common (Alix et al., 2020).

Sexual and reproductive health indicators in Türkiye highlight some of the ongoing public health challenges facing young people. Between 1985 and November 2025, a total of 54,472 cases of HIV and 2,629 cases of AIDS were reported in Türkiye, with the majority occurring among men and individuals aged 25–34 years. Sexual transmission accounted for fully 94.5% of cases with a known transmission route (Republic of Turkey Ministry of Health, General Directorate of Public Health, 2025). In addition, data from the 2018 Türkiye Demographic and Health Survey indicate that while most births or ongoing pregnancies were intended, a proportion were reported as mistimed or unwanted, pointing to unintended pregnancy as an important reproductive health issue (Hacettepe University Institute of Population Studies, 2019).

The sexual and reproductive health of young people is not only an individual concern; it is also seen as important by parents and society more generally. Engaging with the sexual and reproductive health needs of young people as a part of a process of normal growth and development is vitally important (Değer and Balcı, 2018). Rapid socio-cultural change and lack of education about sex and sexuality make university-aged young people a risk-prone group in terms of sexual/reproductive health (SRH). Collectively, young people in Türkiye constitute a group that benefits least from sexual and reproductive health service provision, but which makes up a large proportion in the population (Sons and Eckhardt, 2023).

Sexual health literacy is key to maintaining sexual health and preventing sexually transmitted diseases. Individuals need and have the right to information to be aware of sexual health problems, diagnose and treat sexual health problems early, and enhance the quality of their sexual lives (Logie, 2023). Sexual health literacy involves not only access to accurate information but being able to apply this information correctly (Cegolon et al., 2022).

Health literacy more generally has been conceptualised as a multidimensional construct, and embraces functional, interactive, and critical forms, as described by Nutbeam’s framework (Nutbeam and Lloyd, 2021). In this study, sexual health literacy is addressed primarily at the functional level, focusing on knowledge acquisition and perceived understanding. The educational interventions used aimed to improve functional sexual health literacy through access to engaging health education materials: one of which took the form of podcasts. The popularity of podcasts has increased significantly in recent years, especially among adolescents and young adults. As a result, podcasts are increasingly used as tools for health communication (Kurt, 2023). According to Institut Public de Sondage d’Opinion Secteur (IPSOS) data, 53% of the listeners to podcasts in Türkiye are under the age of 25, and 43% listen to podcasts to learn about something or to master a topic (IPSOS, 2021).

Research on sexual health knowledge among university students in Türkiye reports disparate but worrying findings. A study conducted among nursing students at a public university in Türkiye found that 90% of participants reported having only some level of sexual health knowledge (Dissiz et al., 2020). In a study by İldan Çalım et al. (2021), students studying in a university social work department were found to have inadequate sexual health knowledge, and a study by Aydın (2019) conducted among undergraduate students from various universities in Istanbul found that students had only moderate levels of sexual health knowledge. Together, this evidence indicates that university students’ knowledge and awareness levels regarding sexual health is open to improvement.

To increase functional sexual health literacy among university students, it is important to provide this information through channels that young people can access and which are seen as credible. Because podcasts provide settings in which young people can obtain information safely, this study set out to examine how sexual health education can be provided using this tool. Since levels of sexual health knowledge may be lower among students studying in non-health sciences faculties, this study sought to assess the effects of podcast education through podcasts on knowledge and functional sexual health literacy among university students in this setting.

Materials and methods

This research took place using a non-randomised pretest–posttest control group quasi-experimental investigation. We report on it using the Transparent Reporting of Evaluations with Non-randomised Designs (TREND) reporting guidelines (Des Jarlais et al., 2004).

The study population comprised students studying between October and December 2024 at a university in Istanbul. Students studying at the Faculty of Health Sciences were not included to prevent confounding factors. It was assumed that students in the field of health sciences will acquire certain knowledge and skills concerning sexual and reproductive health as part of their educational programmes, which would affect the results of a study involving members of this group.

The sample size was calculated using G*Power (3.1.9.2) with a 5% margin of error and 90% power. Assuming a medium effect size (d = 0.5), it was determined that each group should include at least 41 individuals. Since there were repeated measurements and interventions in the study, the study power was kept high to minimise possible sample losses (Mohammadi et al., 2025).

Sampling and sample

Students from the Faculties of Engineering, Veterinary Medicine, and Education were invited to join the study, as these faculties do not include formal undergraduate coursework on sexual and reproductive health or sexual health literacy in their curricula. Thus, the “absence of prior education” in this study refers to the lack of structured university-level instruction rather than general or informal knowledge.

A total of 168 students with Internet access were enrolled at baseline, with 56 participants being initially allocated to each group. The study was completed with 40 students in the Podcast group (G1 = 40), 41 students in the Brochure group (G2 = 41), and 44 students in the Control group (G3 = 44). Participant attrition occurred due to non-adherence to the intervention protocol (e.g. not listening to the podcast recordings within the specified time frame), incomplete data collection, inability to be reached during follow-up, or voluntary withdrawal.

The number of participants excluded for each reason and at each measurement point is presented in Figure 1. Comparisons of baseline characteristics between completers and non-completers revealed no statistically significant differences, suggesting that attrition was not systematic and was unlikely to have biased the study findings.

Data collection tools

A Student Information Form (SIF), prepared by the researchers in line with the literature, and a Sexual Health Literacy Scale (SHLS) and a Sexual Health Knowledge Test (SHKT), whose validity and reliability have been studied, were used to collect data. These are detailed below.

Student Information Form

This form was developed to examine and ensure equivalence between the experimental and control groups. Informed by the literature (Dissiz et al., 2020), the form sought to elicit socio-demographic data from participants such as age, gender, faculty of study, and romantic relationship status that was predicted to be associated with students’ sexual health literacy and knowledge.

Sexual Health Knowledge Test

Reliability and validity studies of this test, developed by Evcili and Gölbası (2017), have been conducted. The test, which consists of 40 multiple-choice questions, captures 12 sub-dimensions. Questions 1 and 2 assess knowledge of shared values related to sexuality; questions 3, 4, 5, and 10 assess understanding of sexual identity development; questions 6, 7, and 14 assess knowledge of sexual orientation; questions 8, 9, and 11 assess knowledge of sex and gender roles; questions 12, 13, and 20 assess knowledge of reproductive system anatomy; questions 15, 16, 17, and 21 assess knowledge of sexual intercourse and sexual satisfaction; questions 18, 19, and 22 assess knowledge of the physiology of reproduction; questions 23, 24, 25, 26, 27, and 28 assess knowledge of contraceptive methods; questions 29, 30, 31, 32, 33, 34, and 35 assess knowledge of STIs; questions 36, 37, and 38 assess knowledge about sexual violence, and questions 39 and 40 assess knowledge of safe sexual behaviours.

During the implementation of the test, participants were asked to read and answer each question. Each question answered correctly received “1” point, while each question answered incorrectly or left blank received “0” points. The lowest score that could be received from the test is 0, and the highest is 40. Cronbach’s alpha reliability coefficient for the scale was reported to be .88, when the scale was first developed (Evcili and Gölbası, 2017). In the current study, Cronbach’s alpha coefficients were .70, .88, and .91, respectively, in the groups at first measurement, .68, .84, and .90 at second measurement, and .77, .88, and .89 at third measurement. The test was administered prior to the education, in the fourth week, and in the eighth week.

Sexual Health Literacy Scale

The scale, for which reliability and validity studies were conducted by Üstgörül (2022), assessed the sexual health literacy status of individuals. The scale comprises 17 items. A 5-point Likert-type rating, from strongly disagree (1) to strongly agree (5), is used in the scale, with the last five questions being scored in reverse. The scale has a two-factor structure and assessed sexual knowledge and sexual attitudes. The sexual knowledge factor has 12 items; the lowest score is 12, and the highest is 60. The sexual attitude factor comprises five items. The lowest score that can be obtained from this section is 5, and the highest is 25. A high score on the SHLS indicates high sexual health literacy. Cronbach’s alpha coefficient for the scale was originally determined to be .88 (Üstgörül, 2022). In the present study, Cronbach’s alpha coefficients were .88, .88, and .90, respectively, in the groups at first measurement, .92, .91, and .92 at second measurement, and .84, .83, and .83 at third measurement. The scale was applied prior to the education, in the fourth week, and in the eighth week.

Educational content

The educational content presented in the current work was structured around four main topics relevant to functional sexual health literacy and knowledge among university students: Functional Sexual Health Literacy, Anatomy and Physiology, Family Planning (FP) and Pregnancy, Infectious Diseases, LGBTQ+, and Violence.

The education was provided in two formats with podcasts and brochures, and both contents were delivered to students synchronously. In the first week, sexual health and functional sexual health literacy were defined, and the importance of having accurate information about these subjects was stressed. In the second week, the anatomy and physiology of the reproductive system and the structure and functions of female and male reproductive organs were discussed. In the third week, family planning, pregnancy, contraceptive methods, and safe birth control were focused on, alongside symptoms of pregnancy and relevant factors in the first trimester. In the last week, STIs, topics related to sex, sexual orientation and gender diversity (including LGBTQ+ issues), sexual health and rights, and sexual violence and its prevention were addressed (Figure 2).

Procedure

Method and process of the study

Following agreement to participate in the study, the study’s purpose and process were explained individually during face-to-face interviews in a quiet environment on campus, and written and verbal consent was received from participants. Subsequently, participants were assigned to study groups using stratified sampling based on faculty, ensuring proportional distribution of students from each faculty across the groups, and pre-test measurements were conducted. Participants were added to WhatsApp groups: a total of three groups were created, and a separate WhatsApp channel was opened for each group.

Content development and expert opinion

Two academics interested in sexual health issues and two healthcare professionals working in the field of sexual health examined and approved the educational programme contents used in the podcasts and brochures. In addition, the first author of this paper has received training in sexuality education in interpersonal relationship psychotherapy. When preparing the educational content, experts evaluated the content for accuracy, validity, and suitability for the needs of the target audience. The content was prepared in a way that would potentially increase the participants’ functional sexual health literacy.

Providing information through podcasts and brochures

In November 2024, the content was presented to participants in the form of podcast broadcasts and brochures for 4 weeks according to the groups they were assigned to.

Podcast group: Participants received weekly podcast episodes of approximately 20 minutes covering the designated sexual health topics. The podcasts were delivered according to the weekly schedule, and participants accessed the content through the designated communication channels.

Brochure group: Participants received weekly brochures prepared using Canva, which included visually supported information consistent with the content presented in the podcasts. The brochures summarised key points (“bite-sized” information) related to the weekly topics.

Control group: No intervention was provided to the control group. Students in this group were enrolled in faculties outside the health sciences and were not exposed to sexual health–related content within their coursework. In addition, the researchers did not deliver any educational materials or educational interventions to this group during the study period. Podcasts and brochures were delivered synchronously each week in line with the scheduled topics.

Data collection

Data were collected at three time points.

Baseline measurement (pre-test): The first measurement was conducted in October 2024, prior to the intervention. Baseline data on sexual health knowledge and literacy were collected from all participants.

Second measurement (post-test): Following the 4-week intervention implemented in November 2024, post-test data were collected at the end of that month to assess immediate changes in sexual health knowledge and literacy.

Third measurement (follow-up): Follow-up measurement was conducted 4 weeks after the completion of the intervention (December 2024) to assess the long-term effects of the education provided.

Participants in the podcast and brochure groups participated in all three measurements. The control group completed the same measurements but did not receive any educational intervention. All measurements and interventions were carried out on pre-determined dates and times, and communication with participants was maintained via WhatsApp throughout the study to support participation. The data collection process, which began in October 2024, was completed in December 2024 (Figure 3).

Ethics

Prior to the start of the study, ethical approval was received from the Istanbul University-Cerrahpasa Non-Interventional Clinical Research Ethics Committee (Reference: E-74555795-050.04-902913) and the Istanbul University-Cerrahpasa Rectorate (Reference: E-60350273-300-878578).

The study was conducted in accordance with the ethical principles of the World Medical Association Declaration of Helsinki, ensuring that participants’ rights, dignity, and well-being were prioritised throughout the research process. Ethical guidelines were strictly followed. Required permissions for the use of the measurement tools were obtained. To protect confidentiality, participant information was coded and no identifying data were included in the analysis or in reports. All data were stored securely and were accessible only to the research team. During data collection, participants completed the forms independently and were informed that they could contact the researchers if they had any questions. To reduce potential bias, the dataset provided to the statistician was fully anonymised, and group allocations were coded so that the statistician was blinded to which groups represented the intervention or control conditions during the analysis. After the completion of the study, educational materials were shared across groups to ensure equitable access to information and to address ethical considerations related to withholding potentially beneficial educational content. Accordingly, members of the control group received both the podcast recordings and brochures; participants in the podcast group were provided with the brochures; and participants in the brochure group were given access to the podcast recordings.

Data analysis

Data analysis was conducted using R software. Continuous variables were summarised as means, standard deviations, and minimum and maximum values, while categorical variables were presented as frequencies and percentages. Group comparisons for continuous variables (e.g. age and number of siblings) were undertaken using one-way analysis of variance (ANOVA) to determine whether there were significant differences in mean values between the three groups. Categorical variables were compared using the Chi-Squared test.

The study involved three groups and three measurement time points (pre-test, first measurement, second measurement). Due to dropouts in the groups during follow-up, linear mixed models (LMMs) were used to evaluate changes over time and differences between groups. To examine the change in SHLS and SHKT scores over time between groups, time (pre-test, first measurement, second measurement), group (G1, G2, G3), and the time × group interaction were included in the model as fixed effects. To account for the clustering of repeated measurements within individuals, a random intercept was specified for participants. Since pre-test scores and the variables of age and gender were related to the outcome variables, age, gender, and the pre-test score of the relevant scale were added to the model as covariates in both models.

The models were estimated using the maximum likelihood (ML) method. F statistics, degrees of freedom, and p-values are reported for the model results. When the time × group interaction was significant, between-group and within-group comparisons were made using multiple comparisons based on estimated marginal means. Model fit and explained variance were assessed using marginal R² and conditional R² values. The level of statistical significance was two-tailed and set at p < .05.

Results

A total of 125 students completed all stages of the study (G1: n = 40; G2: n = 41; G3: n = 44). Table 1 presents the baseline demographic characteristics.

Gender: A significant difference was observed across groups (χ² = 6.95, p = .031), with the highest proportion of young women in the control group (75.0%).

Age: Mean ages differed significantly between groups (F = 8.18, p = .001), with G1: 20.12 ± 1.67, G2: 18.75 ± 1.01, and G3: 19.64 ± 2.48. Post hoc analysis revealed no significant difference between G1 and G3.

Other variables: No significant differences were observed for faculty type, residence status, relationship status, or number of siblings (p > .05).

Table 1.

Students’ socio-demographic characteristics.

Characteristics	G1 (n = 56)		G2 (n = 56)		G3 (n = 56)		χ²/f
Characteristics	n	%	n	%	n	%	p
Gender
Female	38	67.86	29	39.73	42	75.00	χ² = 6.95* p = .031
Male	18	32.14	27	36.99	14	25.00	χ² = 6.95* p = .031
Faculty they studied at
Faculty of Education	21	37.50	19	33.93	22	39.29	χ² = 0.60* p = .963
Faculty of Veterinary Medicine	17	30.36	20	35.71	18	32.14
Faculty of Engineering	18	32.14	17	30.36	16	28.57
The longest place lived
Metropolitan city	42	75.00	42	75.00	48	85.71	χ² = 2.98* p = .561
Village	1	1.79	2	3.57	1	1.79
Town/district/small city	13	23.21	12	21.43	7	12.50
Current place of residence
Family home	27	48.21	28	50.00	33	58.93	χ² = 5.74* p = .220
Dormitory	23	41.07	26	46.43	22	39.29
Student house	6	10.71	2	3.57	1	1.79
Status of having a romantic relationship
Yes	19	33.93	15	26.79	15	26.79	χ² = 0.92* p = .631
No	37	66.07	41	73.21	41	73.21	χ² = 0.92* p = .631
Age Mean ± SD (Min.-Max.)	20.12 ± 1.67^a (18-25)		18.75 ± 1.01^b (18-22)		19.64 ± 2.48^{a b} (18-32)		F = 8.18** p = .001
Number of siblings Mean ± SD (Min.-Max.)	1.98 ± 1.18(0-5)		1.98 ± 1.33(0-6)		2.18 ± 1.60(0-8)		F = 0.38** p = .686

a,b

There is no difference between values that have the same letter.

Pearson chi-square.

One-way ANOVA.

Note: Bold values represent statistically significant differences (p < 0.05).

Overall, the groups were largely comparable in socio-demographic terms, except for gender and age. Adjusted linear mixed-effects models were conducted for SHLS and SHKT scores, controlling for age, gender, and pre-test values (Tables 2 to 4). For SHLS, significant main effects were observed for time (F (2,302) = 6.69, p = .001) and group (F (2,173) = 8.11, p < .001), as well as a significant time × group interaction (F (4,302) = 4.08, p = .003). Pre-test scores were a significant covariate (F (1,173) = 352.79, p < .001), whereas age and gender were not significant. There were no baseline differences between groups. At the first measurement, G1 had significantly higher SHLS scores than G2 and G3 (p < .01), and at the second measurement, this difference remained significant between G1 and G3 (p = .007). The model demonstrated substantial explanatory power (Marginal R² = .56; Conditional R² = .62), and model comparison indicated good fit (χ² (11) = 211.8, p < .001). For the SHKT, the main effect of time was not significant (F (2,305) = 0.29, p = .747); however, significant effects were found for group (F (2,182) = 8.19, p < .001) and the time × group interaction (F (4,305) = 5.85, p < .001), indicating differential change across groups. Pre-test scores (F (1,185) = 315.78, p < .001) and gender (F (1,185) = 4.45, p = .036) were significant covariates, while age was not. No baseline group differences were detected. At the first measurement, G1 scored significantly higher than G3 (p < .001), whereas at the second measurement, G1 scored higher than both G2 and G3 (p < .01). The model explained a considerable proportion of variance (Marginal R² = .57; Conditional R² = .67) and showed good overall fit (χ² (11) = 204.2, p < .001).

Table 2.

Distribution of SHLS and SHKT scores by group and time linear mixed model (adjusted models).

Scale	Time measurement	G1 (Mean ± SD)	G2 (Mean ± SD)	G3 (Mean ± SD)
SHLS	Pre-test	46.9 ± 0.77	46.6 ± 0.85	46.8 ± 0.81
	1st measurement	50.4 ± 0.82*	47.1 ± 0.87	46.1 ± 0.84†
	2nd measurement	49.9 ± 0.84‡	48.3 ± 0.91	47.0 ± 0.85
SHKT	Pre-test	27.9 ± 0.80	28.0 ± 0.90	27.9 ± 0.84
	1st measurement	30.3 ± 0.84*	28.4 ± 0.92	26.1 ± 0.87†
	2nd measurement	30.6 ± 0.86‡	27.1 ± 0.95	26.9 ± 0.88

Averages were adjusted for age, gender, and pre-test scores.

SHLS for *: G1 > G2, G3 (p < .01). †: G1 > G3 (p < .001). ‡: G1 > G3 (p = .007).

SHKT for *: G1 > G3 (p < .001). †: G2 > G3 (p = .032). ‡: G1 > G2, G3 (p < .01).

Note: Bold values represent statistically significant differences (p < 0.05).

Table 3.

Linear mixed model results for SHLS and SHKT scores (adjusted models).

Effect	SHLS – F (df)	p	SHKT – F (df)	p
Time	F(2.302) = 6.69	.001	F(2.305) = 0.29	.747
Group	F(2.173) = 8.11	<.001	F(2.182) = 8.19	<.001
Time×Group	F(4.302) = 4.08	.003	F(4.305) = 5.85	<.001
Age	F(9.155) = 0.90	.529	F(9.164) = 1.54	.137
Gender	F(1.176) = 0.17	.684	F(1.185) = 4.45	.036
Pre-test	F(1.173) = 352.79	<.001	F(1.185) = 315.78	<.001

Table 4.

Model fit and effect size.

Scale	Marginal R²	Conditional R²	Model comparison
SHLS	.56	.62	χ²(11) = 211.8, p < .001
SHKT	.57	.67	χ²(11) = 204.2, p < .001

Discussion

This study evaluated the effectiveness of podcast broadcasts in improving functional sexual health literacy and sexual health knowledge among university students. Our results show that the podcast group demonstrated significantly higher SHLS and SHKT scores over time compared to the other groups. After controlling for age, gender, and baseline scores, G1 scored significantly higher than G2 and G3 on both follow-up measures for SHLS and SHKT; no similar improvement was observed in the brochure or control groups. These findings suggest that podcast-based education can have at least positive short-term effects on knowledge acquisition and functional literacy development.

Our findings support previous studies indicating that sexual health knowledge among young adults may be insufficient or prone to misconceptions (Lirios et al., 2024). The strong effect observed in G1, contrasted with the absence of change in the brochure and control groups, reinforces evidence suggesting that audio-based, narrative-driven, and easily accessible content facilitates learning. The use of digital and asynchronous educational tools has increased substantially in the post-COVID-19 period, with rising engagement in blog and podcast content (Boreskie et al., 2022; Robins et al., 2024). Although the evidence base for podcast use in health education is expanding, studies focusing specifically on sexual health education remain limited compared to other health domains (Porter et al., 2022). Our study therefore contributes valuable insights both to the literature on the practical use of digital education tools in the post-pandemic era and to sexual health education specifically.

Several studies have similarly reported that podcasts can improve knowledge levels among healthcare professionals (Ramchandani et al., 2024), can enhance fertility awareness in young men (Larsen et al., 2023), and have demonstrated educational validity for adolescents (Leite et al., 2022). Robins et al. (2024), in their scoping review of podcasts used to promote health-related behaviours and outcomes, highlighted that podcasts featuring personal experiences, narrative elements, and reliable information can support listener engagement and knowledge gains.

There are several factors that may explain the effectiveness of the podcast format. Accessibility and flexibility allow students to listen whenever convenient and to replay content as needed. Privacy and anonymity may make podcast learning more acceptable than face-to-face discussion, especially on sensitive or potentially embarrassing topics. Narrative and contextual elements—such as personal stories, case examples, and conversational styles—may enhance knowledge retention. In addition, sensory diversity through auditory and contextual presentation may promote greater attention and emotional engagement compared with static written materials (Bouchey et al., 2021). The observed gains in the podcast group in our study may be partially explained by one or more of these mechanisms; however, qualitative research or systematic measurement of interaction metrics (e.g. listening duration, repeated access) is needed to clarify the underlying processes. Future studies might incorporate measures of interactive and critical sexual health literacy to examine whether podcast-based interventions also influence higher-level health literacy competencies and related health behaviours.

Our findings also revealed no significant changes in either knowledge or literacy scores in the brochure group, suggesting that providing information alone may be insufficient. Written materials may have limited reach, engagement, and attention compared with audio and narrative-based content. Nevertheless, this does not imply that brochures are ineffective under all circumstances. Strategies such as embedding QR codes linking to interactive digital content, integrating short online quizzes or discussion groups, or adopting hybrid approaches may enhance their effectiveness. Design, language, and visual layout may also influence the impact of written materials (Bester et al., 2016).

Limitations

Despite its strengths, this study has several limitations that should be considered when interpreting the findings. First, the sample was drawn from a single university, limiting the generalisability of the findings to other universities, regions, or cultural contexts. In addition, participants were allocated to groups by faculty rather than through individual randomisation, which may have contributed to baseline imbalances and selection bias. To address this, age, gender, and baseline scores were included as covariates in the analyses; however, residual confounding factors cannot be completely ruled out. Second, the relatively short follow-up period prevented conclusions being drawn regarding long-term retention, sustainability of effects, or downstream behaviour change. Therefore, the observed improvements should be interpreted as short-term outcomes rather than evidence of enduring educational impact. Third, significant differences in age and gender distribution between groups may have acted as potential confounding factors that could have influenced the response to the intervention; however, these variables were statistically controlled for. Fourth, the study focused on functional sexual health literacy and knowledge outcomes and did not assess interactive or critical dimensions of sexual health literacy, nor did it directly measure behavioural or clinical endpoints (e.g. STI testing, contraceptive use). As a result, the findings reflect gains in knowledge and perceived understanding rather than changes in higher-level literacy skills or health-related behaviours. Fifth, awareness of intervention allocation by participants may have introduced expectation or performance bias, particularly in the podcast group, potentially inflating self-reported outcomes. In addition, interpretation of the findings should consider the measurement scope of the instruments used. The SHLS assesses functional aspects of sexual health literacy, such as accessing and understanding information, while the SHKT evaluates domain-specific factual knowledge. Therefore, the results should be interpreted within the context of the constructs measured by these instruments.

Conclusion

Podcasts are important as tools for education and raising awareness. This study highlights the growing role of digital media in health education by examining the effects of podcast-based education on functional sexual health literacy among a group of university students. Podcasts offer broad accessibility, particularly for young people, and enable flexible learning independent of time and place. Compared to traditional educational materials, audio-based content can capture attention more effectively and facilitate information retention. Importantly, podcasts provide a relatively private and non-judgemental learning environment that can be advantageous for sensitive topics such as sexual health. Feelings of embarrassment or discomfort often prevent participation in face-to-face sexual health education. Digital tools, including podcasts, can help reduce these barriers by providing anonymous access to information and encouraging more open and informed participation.

It is important that podcast content related to sexual health is based on accurate, evidence-based, and ethically sound information. Previous studies have shown that misinformation or inadequate education can not only increase knowledge levels but also increase sexual risk behaviours. Therefore, content developers and educators bear a critical responsibility to ensure scientific accuracy and ethical integrity in this field. Future studies should use more heterogeneous, multicentre samples, include longer follow-up periods, and include behavioural and clinical outcomes to better assess the broader impact of podcast-based interventions. While randomised designs with adjusted statistical models strengthen causal inference, mixed-methods approaches can clarify which podcast features (e.g. narrative elements, expert interviews, or interaction) are most efficacious. The evaluation of hybrid interventions combining podcasts with tests, forums, or short videos, along with the collection of systematic participation metrics and cost-effectiveness analyses, will further advance this research area.

Footnotes

Acknowledgements

We thank the students who participated in the study.

ORCID iDs

Betul Uncu

Yasemin Karabulut

Merve Kaya

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this study was funded by The Scientific and Technological Research Council of Türkiye (TUBITAK-2209; Grant Number 1919B012325397). The funders had no role in study design, data collection and analysis, manuscript preparation, and publication decisions.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Data to support the findings of this study may be made available by the corresponding author upon reasonable request. Due to ethical and confidentiality considerations, the data are not publicly shared.

Use of AI

ChatGPT (OpenAI, San Francisco, CA) was used only for linguistic editing and to enhance the clarity and readability of the manuscript text. No data analysis, data interpretation, conceptual development, or scientific conclusions were generated or influenced by AI tools. The authors take full responsibility for the accuracy, originality, and integrity of the content of the manuscript.

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