Background There is relatively limited research in China on the current status and influencing factors of adolescents’ sexual health literacy, and the findings are inconsistent. Quantitative studies struggle to provide an in-depth portrayal of the actual state of adolescents’ sexual health literacy and are unable to thoroughly explore the primary factors influencing it. However, qualitative research offers unique advantages in this regard. Objectives Drawing on the socio-ecological model, this study employs semi-structured interviews to provide an in-depth interpretation and contextual understanding of quantitative research findings within the cultural context of China. It further explores influencing factors across five levels—individual, interpersonal, organizational, community, and policy—with the aim of providing a foundation for developing a multi-level intervention framework to promote sexual health among adolescents. Methods This study employed a descriptive qualitative research methodology, conducting semi-structured interviews with 16 adolescents using purposive sampling, and applying directed content analysis to identify themes. Results Following repeated analysis and organization of interview data from 16 adolescents, five main categories and 12 subcategories were identified. Conclusions Qualitative research has revealed that adolescents generally have low levels of holistic health literacy, which needs to be improved. Factors influencing adolescents’ sexual health literacy include: sexual knowledge; proactive personality traits; the state of parent-child communication; family structure; peer influence; the content and format of school-based sex education; a lack of teacher training; ambiguous teaching methods and awkward teacher-student interactions; the absence of adolescent-friendly service providers and inadequate facilities; insufficient service promotion leading to information gaps; the attitude of service staff and lack of privacy protection during medical visits; and weak policy enforcement—specifically, the marginalization of sex education.

Adolescents, Sexual Health Literacy, Factors Influencing, Qualitative Study