Tabriz University of Medical Sciences Health Promotion Perspectives 2228-6497 12 2 2022 08 20 Sexual health literacy and preventive behaviors among middle-school students in a rural area during the COVID-19 situation: A mixed methods study 178 185 10.34172/hpp.2022.22 EN Mereerat Manwong https://orcid.org/0000-0003-1258-507X Saowanee Thongnopakun https://orcid.org/0000-0002-9075-2737 Yuvadee Rodjarkpai https://orcid.org/0000-0003-1191-1742 Aimutcha Wattanaburanon https://orcid.org/0000-0002-6961-4655 Sawitree Visanuyothin https://orcid.org/0000-0001-5165-1928 Journal Article 10.34172/hpp.2022.22 2022 02 10 2022 04 09 Background: This study explored the association between sexual health literacy (SHL) and preventive behaviors of pregnancies and sexually transmitted diseases (STDs) among middle-school students during the COVID-19 outbreak to aid in the development of an informative program. Methods: Mixed-method study with stratified two-stage cluster sampling was used to obtain 730 students from 20 middle schools in a rural province of Thailand. Online self-administered questionnaire was used to collect data from February 2020 to February 2021. Two brainstorming sessions were conducted with a purposeful sample of 25 stakeholders. Multiple linear regressions were used to assess the relationships. Results: The associated significant factors with the preventive behaviors were sex (b=2.06, 95% CI: 1.07, 3.05), nightlife (b=-2.33, 95% CI: -3.99, -0.67), drinking alcoholic beverages (b=2.24, 95% CI: -3.24, -1.23), sexual intercourse experience (b=-2.64, 95% CI: -4.56, -0.72), and SHL (b=0.12, 95% CI: 0.08, 0.16). The stakeholders recommended an edutainment online program via Facebook. Conclusion: This study investigated factors associated with SHL and preventive behaviors among middle school students. The most effective variable in this model was SHL. Therefore, a trial of an online program emphasizing SHL improvement should be examined for effectiveness among these students and seems appropriate, considering their rural area context and middle-school status.