The Temporal Evolution of Digital Learning: A Longitudinal Quasi-Experimental Study of Web-Based Versus Conventional...

Adolescents in rural indigenous communities often lack culturally appropriate sexual and reproductive health (SRH) education. This study compared the short-term effectiveness of a web-based SRH intervention versus conventional face-to-face education among 260 rural Bidayuh adolescents aged 16-19 in Sarawak.

Using a non-randomized, two-district quasi-experimental design (one district assigned to each arm to minimize contamination), knowledge was assessed via a validated questionnaire at baseline, 1 month, and 3 months. All 260 enrolled participants were analyzed under an intention-to-treat approach using a repeated-measures ANCOVA (arm × gender × time); 15 participants (5.8%) were lost to follow-up by 3 months.

Knowledge scores did not differ between arms at baseline or 1 month, but diverged significantly by 3 months, favoring the web-based arm (68.12% vs. 59.13%; adjusted difference = -8.67 percentage points, 95% CI = [-12.61 to -4.74] (conventional minus web-based; the web-based arm scored higher), p < 0.001), reflected in a significant Arm × Time interaction, F(2, 747) = 7.47, p = 0.001. This advantage was numerically larger among females (Δ = -11.48, p < 0.001) than males (Δ = -5.87, p = 0.050), though the three-way interaction did not reach conventional significance (p = 0.053). Sensitivity analyses (per-protocol; multiple imputation) produced consistent estimates.

Knowledge retention over 3 months was better in the web-based arm, with a numerically larger effect among females. These findings may be associated with digital SRH education promoting longer-lasting knowledge among rural indigenous adolescents, but should be interpreted cautiously given the non-randomized, two-cluster design, which cannot fully separate intervention effects from district-level differences.

Self-regulated digital platforms may be a promising addition to school- and community-based SRH programs in conservative rural settings, alongside strategies to promote engagement and reinforcement, pending confirmation in a randomized, multi-site trial.