Exploring sexual awareness and Decision-making among adolescent girls and boys in rural Nicaragua: A socio-ecological approach

•Girls turned to parents on topics of sexuality while boys turned to peers.•Social stigma hinder adolescent’ access to sexual and reproductive health services.•Social media appears to influence how adolescents develop sexual awareness.•Sexual education represented a reliable source of information about sex.•Adolescents challenged social and cultural norms by developing sexual agency. To explore how individual, relational, and social contexts influence adolescents' sexual awareness and decision-making in rural Nicaragua. Eighteen semi-structured interviews were conducted with adolescent boys and girls aged 15 to 19 years. Thematic analysis identified patterns of meaning applying a socio-ecological approach. A thematic map illustrates how the themes are organized according to the socio-ecological model and suggests their interactions. Six main themes emerged as (1) Adolescence - a period of life changes, (2) Fears as a pathway to awareness and decision-making, (3) Awareness about protective measures, (4) Relational influences on adolescents’ sexual health, (5) Service provision and institutional influences on awareness and decision-making and (6) Sociocultural determinants on adolescent sexual health. Informants of both genders expressed concern in several issues of their sexuality. They identified fear of pregnancy, STIs, and their impact on future goals, family communication, and school-based sexual education as protective factors for their sexual decision-making. Adolescents of both genders are challenging social and cultural norms by developing sexual agency. These findings imply that personal and societal factors in rural Nicaragua produce a multi-dimensional effect on adolescent sexual self-efficacy. Our study is relevant for a wider discussion about sexual awareness to promote positive development and health outcomes particularly among adolescents’ girls and boys living in rural settings.