Effectiveness of Puppetry-Based Sexual Health Promotion and Education Interventions: A Scoping Review

Advancing Sexual and Reproductive Health Education—Pursuing the Long Arc of Justice

Introduction Young people (16–24-year-olds) experience the highest diagnosis rates of STIs. Lack of engagement, public awareness, lack of training, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of interventions such as sexual health education and other services. Whilst relationship and sexual health education (RSE) has been part of many school curriculums for generations, young people’s experiences of RSE can vary widely. Objective This research aims to provide insight into the experiences of sexual health education, sexual health behaviours and recommendations to improve engagement and sexual health outcomes amongst adolescents. Methods An online quantitative survey was conducted between June and July 2021 (n=5,457). 855 respondents were recruited from a market research panel (answering a 20-minute survey) and a further 4,602 respondents were recruited via public links (answering a cut-down survey). All respondents were living in the UK and aged 18+. Data were analysed using descriptive statistics and adjusted to reflect the sample size of LGBTQ+ and heterosexual respondents. Results 90% of respondents received formal sex education, however, only 12% agreed sex education had a positive long-lasting effect on their sexual life. Reproductive biology, pregnancy, safe sex, and avoiding STIs were the core pillars of sex education, whilst different sexualities, pleasurable intimate relations, gender identity and trans-specific topics were covered less than 13% of the time. Although 90% of respondents declared they have a good understanding of sexual health risks, sexual health outcomes in this group were sub-optimal; safe sex was only consistently practiced by 43% of respondents and regular testing only carried out by 25% of respondents. Conclusions Whilst most participants reported receiving sexual health education, their experiences varied. Despite a high self-reported understanding of sexual health risks, sexual health outcomes were sub-optimal. This research highlights the potential beneficial effects of an exhaustive sexual health education on attitude, knowledge, and behaviours among adolescents to improve the long-term sexual health outcomes. Recommendations include designing programmes based on young people’s experiences of sexual education, reviewing current guidance and practices adding on key topics outside the main pillars of sexual education, increasing guidance and training for educational institutions and supporting RSE provisions in alliance with external educators and services. Disclosure Yes, this is sponsored by industry/sponsor: Reckitt. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Reckitt.

IntroductionAs educators and health professionals, school nurses are in an optimal position to improve and advocate for adolescent reproductive and sexual health. This report outlines a protocol for a systematic...

BackgroundMany community college students experience poor sexual and relationship health outcomes. Young adults consume a plethora of media content, much of which depicts unhealthy sexual and romantic relationships, and research has shown that media exposure can negatively impact health outcomes. Asynchronous, web-based media literacy education (MLE) programs have been shown to improve short-term sexual and relationship health outcomes. However, there is a dearth of research on the mechanisms by which MLE programs impact health outcomes and the long-term effects of MLE programs on sexual and relationship health outcomes among community college students.MethodsThis study will (1) evaluate the unique effects of MLE on primary and secondary sexual and relationship health outcomes; (2) compare the mechanisms underlying the effects of an asynchronous, web-based MLE sexual health program (Media Aware) to the mechanisms underlying the effects of an active control program on health outcomes; and (3) evaluate the long-term efficacy of Media Aware on media literacy skills and sexual and relationship health outcomes compared to active control and delayed intervention control groups. To address these aims, a three-arm randomized controlled trial with young adults attending community college will be conducted. It is expected that around 30 campuses will participate and approximately 67 students from each campus will be enrolled in the study (estimated n = 2010). Campuses will be randomized to either the (1) intervention group (Media Aware); (2) active control group (sexual health education from Media Aware without MLE content or methods); or (3) delayed intervention control group. Students will complete online questionnaires at pretest, posttest, 6-month, and 12-month follow-ups.DiscussionThis project has the potential to advance theory about the potential mechanisms through which MLE has an impact on sexual and relationship health outcomes by directly testing the impact of interventions using a randomized design. Additionally, this study is expected to establish strong evidence for the effectiveness of Media Aware for use with young adults and to help identify strategies to optimize the longer-term impact of the program on health. Students’ satisfaction with programming will be discussed to inform future implementation efforts.

Objective Sexual health education is crucial for promoting healthy sexual behaviors among people of all ages. Interventions involving cartoons, comics, and animations have emerged as effective tools due to their engaging and accessible nature. This scoping review explores the effectiveness of these interventions across different time frames and age groups. Methods Using the PICOS framework and PRISMA guidelines for scoping reviews, a review was conducted across 14 databases to include relevant studies published between 2000 and 31 May 2024. Results Analyzing 51 intervention studies meeting the inclusion/exclusion criteria revealed varied outcomes in interventions that highlight a significant shift in focus from developing educational tools and empowering youth in the earlier period (2000–2010) to implementing advanced technology-based cartoons, comics, and animations interventions and addressing diverse populations in the later period (2011–2024). The results of these studies were predominantly positive, with many reporting significant improvements in knowledge, behaviors, and engagement. Conclusion While many studies report positive outcomes, further investigation is needed into the long-term impact of digital-based cartoons, comics, and animation interventions on behavior change and health outcomes. Research should also explore the effectiveness of these tools in different cultural and socioeconomic contexts to ensure their broad applicability. Ongoing research and iterative development are warranted to ensure that these interventions continue to evolve and meet the changing needs of users in an increasingly digital world across diverse populations

Sexual health in the United States is poor, yet most physicians do not address the topic. Sexual health education (SHE) guidelines are available but not used. The lack of SHE in undergraduate medical education (UME) impacts sexual and general health outcomes, as SHE in UME increases physicians' awareness of and ability to address sexual health, which is bidirectionally correlated with other health. To design and assess the need, feasibility, and outcomes of an educational recommendation for increased incorporation of SHE in UME. Comprehensive literature review was used to assess current and future needs of SHE in UME and humanism and professionalism education (HPE). Qualitative analysis was used to assess a potential solution. The main outcome measure was an educational recommendation based on qualitative analysis of (1) the benefits of SHE and HPE in UME, (2) the SHE and HPE overlap, and (3) the potential effect of a formally combined delivery on UME and patient and practitioner outcomes. Available literature on medical SHE supports increased SHE is necessary and should be incorporated into existing HPE whenever possible, secondary to numerous intersections. Qualitative analysis supports HPE could be enhanced when consistently exemplified through SHE, and this approach could be beneficial for (1) increased understanding, retention, application, and advocacy of both topics; (2) long-term improvement of sexual and general health at the patient and population levels; and (3) increased practice of humanism and professionalism, potentially resulting in better patient outcomes and professional satisfaction for physicians. Cross-disciplinary qualitative analysis supports using SHE as the primary topic to teach HPE is a viable method to increase SHE and potentially creates physicians who address sexual health and practice with increased humanism and professionalism, leading to population-level sexual and general health improvements. Gordon EG. A Medical Education Recommendation for Improving Sexual Health and Humanism and Professionalism. Sex Med Rev 2021;9:23-35.

Implementation of digital interventions for sexual health for young people

Adolescents’ knowledge on sexual ity and reproductive health is still limited, although there have been initiatives to provide sexual and reproductive health education as indicated by previous studies. This paper examines reproductive health and sexuality education for adolescents that has been conducted by government and non-government at the high school level. This paper is based on a research using mixed methods of quantitative methods that are supported by qualitative. Quantitative methods are surveys conducted to 918 students and 128 high school teachers and supported by focus group discussions and in-depth interviews in eight cities in Indonesia. Focus group discussions conducted to civil society organizations, teacher forums, and youth groups, while in-depth interviews conducted to local government, parents, school committees, and religious/community leaders. The results show that the reproductive and sexual health education does not match the reality of sexual behavior and sexual risk faced by teenagers because: (1) reproductive health and sexuality education that is given to the high school level is more focused on the biological aspects alone, (2) There is still a notion that sexuality is a taboo to be given at school, (3) the sexuality education tends to emphasize the dangers of premarital sex from the moral and religious point of view, (4) the sexuality education has not looked at the importance of aspects of gender relations and rights of adolescents in adolescent reproductive and sexual health. The construction of adolescent sexuality and the discourse on sexuality education contribute to the content and methods of sexual ity and reproductive health education for adolescents. Normal 0 false false false EN-US X-NONE X-NONE

A Call for Comprehensive, Disability- and LGBTQ-Inclusive Sexual and Reproductive Health Education

This study investigates how the sexual health outcomes of a representative sample of students aged 15-16 in Wales vary according to the person delivering Sex and Relationships Education (SRE) in schools, students' access to on-site sexual health services and access to free condoms. Cross-sectional, self-report survey data were collected from students who participated in the 2015/16 School Health Research Network questionnaire in Wales. Data were analyzed from 59 schools, totalling 3781 students aged 15-16 (M = 15.7; SD = 0.3) who responded to questions about ever having had sex; age of sexual initiation and condom use at last intercourse. School level data were also collected, examining who delivers school SRE, provision of on-site, school 'drop-in' sexual health services and provision of free condoms for students. Binary and linear multi-level analyses explored the relationship between school level predictors and sexual health outcomes. Compared to teachers, other modes of SRE delivery were associated with better sexual health outcomes, including remaining sexually inactive, later age of first intercourse and condom use. Providing on-site sexual health services did not significantly reduce the odds of having ever had sex or delaying first intercourse; but was associated with increased condom use. On-site condom provision was associated with lower condom use. SRE delivery by educators other than teachers is optimum to young people's sexual health outcomes. Further funding and coordination of on-site sexual health advice services are required. Longitudinal research is needed to identify the temporal sequence of sexual health practices and outcomes.

Background: Sexual health interventions against sexual contraction and transmission of HIV in most developing countries such as Zambia, are often biased towards heterosexual sexual health interventions. This act tends to exclude minority sexual groups such as men who have sex with men whose existence could affect the transmission and spread of the virus. This paper therefore sought to present an analysis of the exclusion of sexual minorities in sexual health education interventions in Zambia. Methods: This paper employed a desk-based-research study and relied mainly on the review of secondary data in form of Ministry of Health (MOH) and National Aids Council (NAC) strategic documents and scholarly journals, articles and research papers relevant to the topic. Results: A knowledge gap on sexual health education exists amongst the sexual minority groups in the few studies assessed. This can be attributed to the fact that the Zambian society is believed to be heterosexual with most interventions adopting a heterosexual stance towards sexual health education. Limited thought to the sexual health concerns of men who have sex with men in Zambia can be attributed to criminal laws against acts of homosexuality, societal disdain for acts of a non-heterosexual nature, and religious teachings against acts of a non-heterosexual nature. Lack of consideration of sexual minorities and their sexual activities may have serious effects on their sexual health knowledge levels and sexual practices. Conclusion: Legal, societal and religious opposition must be addressed to enable open public discussion and debates on the design of more representative sexual health education.

Background Sexual ill-health causes a high health burden. There is, therefore, a need for more effective sexual health promotion interventions. Previous research has focused on preventive sexual health interventions and the limited evidence concerning school-based sexual health promotion interventions has not been synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in European schools. Methods A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and a narrative synthesis of the included studies was performed, highlighting the collective results. Results The review included 17 records, reporting 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All qualitative studies described positive effects as experienced by the participants, and ten of the quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. Conclusions The findings indicate good evidence for the effectiveness of interventions with a health promotion approach, underscoring the importance of sexual health resources such as respect, communication skills, and attitudes. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas, e.g., sexual health literacy is less studied and can be recommended to be included in future research. Key messages • The synthesized evidence sheds light on the lack of evaluated interventions employing holistic and positive, resource-focused sexual health promotion interventions targeting European adolescents. • The included school-based sexual health promotion studies, although limited in number, show evidence of promising effects on sexual health outcomes among participants.

The USA has a high rate of adolescent pregnancy, with non-Hispanic (NH) Black and Hispanic women disproportionately affected. We sought to investigate the presence of racial/ethnic disparities in the receipt of sexual health (SRH) care and education and whether such disparities contribute to differences in sexual health outcomes for youth. We conducted a cross-sectional study of females aged 15-21 years who participated in the National Survey of Family Growth from 2008 to 2015. Multivariable logistic regression was used to measure the association between race/ethnicity and SRH outcomes after adjustment for potential confounders. Models were developed to measure whether receipt of SRH care and education served as an effect modifier on SRH outcomes. The sample included 4316 participants, representing 33.5 million females. Almost half (47.2%) received birth control services in the last 12 months; NH-Blacks (aOR 0.7 [0.5, 0.9]) and Hispanics (aOR 0.6 [0.5, 0.8]) were less likely to have obtained birth control services than NH-whites. Hispanics (aOR 1.5 [1.2, 1.9]) had a higher likelihood of receipt of condom education than NH-whites. We found that disparities in SRH outcomes were slightly mitigated after adjustment for access to SRH care and education. We identified racial/ethnic disparities in sexual health outcomes and in SRH and education; however, SRH care and education can mitigate some of these differences in sexual behaviors and outcomes. Racial/ethnic differences in sexual health outcomes may be at least partially related to the differential receipt of sexual health care and education and deserve further investigation.

“If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine?”: The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida

A history of colonisation and corresponding traumas has resulted in disparate rates of violence and sexual health inequities among many Native American populations. As a result, Native American adolescents and young adults specifically, experience higher rates of STIs, HIV and unintended pregnancy relative to their non-Hispanic White counterparts. To address these inequities, sexual health education programmes should reflect Native American cultural values and traditional teachings to align with community assets and protective factors. The objective of this study was to describe sexual and reproductive health professionals’ perspectives on how trauma collectively affects the sexual health of older adolescents and young adult Native American women between the ages of 15–25 years. We purposively sampled sexual and reproductive health professionals who worked with members of this priority population. Individual in-depth interviews were conducted, recorded, and transcribed. Transcripts were analysed using thematic analysis. The themes identified in the interviews include the impact of trauma and colonisation on sexual health, strategies for combatting trauma, promoting sexual health, and supporting the development of culturally congruent sexual health education curricula. Findings point to the need for culturally relevant, trauma-informed sexual health education interventions to help promote sexual and reproductive health equity for Native American adolescent and young adult women.