Potential roles of nurses and school health personnel in strengthening adolescent sexual and reproductive health education in Bengkulu, Indonesia: a qualitative secondary analysis

Background Adolescent sexual and reproductive health (SRH) education extends beyond biological information and should also develop competencies related to relationships, bodily and digital boundaries, consent, protection from violence, and help-seeking. In Indonesia, School Health Units (Usaha Kesehatan Sekolah [UKS]) provide a potential platform for this work, particularly where UKS personnel have nursing backgrounds. However, their contribution to youth-friendly SRH promotion remains insufficiently understood. This study explored the current and potential roles of UKS personnel in adolescent SRH education and opportunities to strengthen school–primary health care (PHC) collaboration in Bengkulu, Indonesia. Methods A descriptive qualitative secondary analysis was conducted using data from a previously published study. The secondary dataset comprised 21 participants: six subject teachers, four guidance and counselling teachers, five community health centre staff, and six UKS personnel, five of whom had nursing backgrounds. The original data were collected through three focus group discussions and individual semi-structured interviews between April and July 2025. Transcripts were screened for accounts related to adolescent SRH education, UKS functions, early identification, counselling, referral, workforce capacity, and school–PHC collaboration. Eligible data were re-analysed using reflexive thematic analysis with a coding framework developed specifically for the secondary research question. Results Four interrelated themes were identified. First, fragmented SRH education created an unmet preventive role for UKS personnel. Second, UKS provided accessible physical care, informal listening, and opportunities for early identification, although its SRH role remained predominantly reactive and weakly institutionalised. Third, youth-friendly SRH promotion was constrained by ambiguous employment status, institutional underrecognition of nursing competence, uneven workloads and facilities, programme discontinuity, and the need for trusted, confidential, and appropriately trained responses to sensitive disclosures. Fourth, participants identified opportunities for UKS to support continuity through scheduled education, early identification, first-line support, referral, and follow-up linking schools with PHC services. Conclusions UKS has the potential to evolve from a predominantly reactive treatment setting into a school-based continuity point for adolescent SRH promotion. Realising this potential would require formal recognition of qualified UKS personnel, particularly nurses; competency-aligned roles; protected time; confidential and youth-friendly procedures; interdisciplinary training; and a functional school–PHC referral-and-feedback mechanism. The proposed pathway represents an interpretive practice opportunity rather than a validated service model and should therefore be co-designed with relevant stakeholders and feasibility-tested before formal implementation. Trial registration Not applicable.