Sexual Health Education Programs Research Articles

Training programmes for practitioners in sexual health promotion: an integrative literature review of evaluations

ABSTRACT This paper reports on findings from an integrative literature review of evaluation studies undertaken into sexual health promotion preparation programmes aimed at professionals with a sexual health promotion remit. Using a pre-defined search strategy, inclusion criteria and PRISMA guidelines, databases were systematically searched. Studies were screened and those included were quality assessed. Twenty-seven relevant studies were identified. Thematic analysis showed programmes were diverse in terms of how they had been developed, the content included, approaches to evaluation and outcomes identified. Evaluations showed participation in a training programme encouraged participants to feel more comfortable and confident to discuss sexual health within their role and more likely to introduce sexual health into client discussions. The types of programmes and evaluation approaches were diverse making direct comparison between them challenging. There should be agreed core outcome impact measures for sexual health education programmes in the areas of knowledge, comfort, skills and changes to practice, to allow for more direct comparison in future evaluation studies.

Viewing Sexual Health Education through the Lens of Critical Pedagogy: A Case Study in Chicago Public Schools.

Comprehensive sexual health education (SHE) programs are being implemented in many state and local jurisdictions. Much research has focused on the strength and effectiveness of such programs. However, the experiences of teachers and students in their implementation is underexplored. A case study of the implementation of the SHE policy and curriculum in Chicago Public Schools sought to explore teachers’ and students’ experiences. Sixteen teachers were interviewed and five student focus groups, including 46 students, were conducted. Both teachers and students identified opportunities to improve upon the current program, including to (1) incorporate more student-centered learning opportunities and allow for tailoring to each specific group of students; (2) use discussion and dialogue to encourage students’ exploration of their own opinions and identities and development of a sense of agency over their own learning; (3) shift focus from risk reduction to a more holistic focus on healthy sexual wellbeing; and (4) directly discuss current health inequities, contributing factors, and intersectionality. These findings align with a critical pedagogical approach and underscore the need to understand SHE implementation within its sociopolitical context. Implications of the use of critical pedagogy as a framework for SHE in Chicago and beyond are discussed.

54. A Qualitative Analysis of Health Educators’ Perspectives on Use Of Blended In-Person And Digitally-Based Curriculum to Improve Reproductive Health of Youth in Fresno, CA

In the last decade, use of technology-based sexual health education programs to reduce sexually transmitted infections and undesired adolescent pregnancy has increased. Multiple studies have shown feasibility of technology-based interventions in improving youths’ sexual health outcomes (e.g. condom use, sexual health knowledge, safer sex norms, etc.), while a subset have also shown efficacy in these domains. Health educators play a vital role in the use of technology to augment sexual health curricula, so facilitating the implementation of technology for educators is necessary for maintaining technology as a viable resource for engaging with youth and improving sexual health outcomes. The purpose of this qualitative study is to examine the successes and challenges health educators faced in implementing "In the Know", a blended in-person and digitally-based curriculum, to youth in Fresno County, California. "In the Know" covers sexual and reproductive health, healthy relationships and life skills, and education and career success. The "In the Know" curriculum also includes access to the "In the Know" mobile application, which allows users to take the knowledge gained in the classroom to generate health and career goals, set reminders to keep them on track, browse curated content, and receive text messages reinforcing key messages. Participants can also locate clinics and other services on a map.

Comprehensive sexuality education in Hong Kong: study protocol for process and outcome evaluation

BackgroundHong Kong lacks comprehensive school-based sexuality education. Recent public health concerns have brought the inadequacies of sex education in Hong Kong to the forefront. The aim of the proposed study is to develop and evaluate the effectiveness of a comprehensive school-based sexuality education program in Hong Kong.MethodsThe proposed study is a prospective longitudinal study implemented in six secondary schools in Hong Kong over two academic years. The study adopts an ecological approach providing informational workshops for students, teachers and school management, social workers and guidance counsellors and parents. Study outcomes will be evaluated through pre- and post-tests.ResultsKey outcomes of interest among students include sexual health knowledge, awareness of values motivating healthy sexual decisions, understanding and efficacy of sexual communication and intention to use contraception. Among school employees and parents key outcomes include self-efficacy to engage in sexual health discussions with students/children, sexual health knowledge and awareness of Hong Kong community sexual health resources.ConclusionsThe proposed study will result in the development of a tested school-based culturally relevant comprehensive sexual health education program. Ultimately, this program aims to not only empower adolescents and their trusted adults in building a supportive environment for sexual health promotion but also construct a learning network to generate longitudinal evidence for the effectiveness of comprehensive sexuality education in improving sexual health outcomes. The program has the potential for expansion through widespread adoption in Hong Kong schools to benefit more adolescents and reduce the medical and societal burdens related to crisis pregnancy, sexually transmitted infections and sexual abuse.

‘We expected more about sex in the sex week’ - A qualitative study about students’ experiences with a sexual health education programme, from a health-promotion perspective

ABSTRACT Purpose The purpose of this study is to explore adolescents’ experiences with participation in a sexual health education programme named «Week 6», from a health-promotion perspective. Methods Six focus group interviews were conducted with adolescents aged 15–16 in Norway. Qualitative content analysis was used to analyse the data material. Results The results can be summed up by the main theme: “We like «Week 6» but … we expected more about sex in the sex week”. The main theme consisted of two main analysis-derived themes: “The students want a topical sexual health education, with realistic and relevant learning subjects and exercises”, and “The students want to contribute to the content and implementation, in order to improve the learning outcomes of «Week 6»”. Further, four categories were identified: organization and content, positive experiences, the potential for improvement, and learning outcome. «Week 6» is desirable, but students expect to learn more. Teaching should have a positive approach, and adolescents do not want their educators to get embarrassed. Conclusion Although the teaching methods with active participation are enjoyable, it is necessary with more time for discussions and questions. Student participation in planning and implementation of the programme seems crucial for promoting salutogenic teaching processes.

Internal and external sexual consent during events that involved alcohol, cannabis, or both.

For 28 days, 113 participants (MAge = 29.2 years, 57.5% women, 70.8% White) responded to three surveys per day on their personal devices. At time points when participants reported having engaged in partnered sexual activity, they were asked to report their alcohol use, cannabis use, internal consent feelings, and external consent communication. Across 1189 partnered sexual events, 31.5% involved alcohol, cannabis, or both. Sexual events that involved combined use were associated with diminished feelings of safety/comfort and feelings that the sexual act was consensual, compared with events that involved neither substance. Greater levels of alcohol consumption were descriptively associated with lower ratings of internal sexual consent. We found that combined use of alcohol and cannabis may lead to lower internal sexual consent than using either substance alone - potentially due to greater levels of impairment associated with polysubstance use. Sexual health education programs should consider more nuanced approaches to teaching people how to navigate substance use and sexual consent.

Exploring the Structure of a School-Based Sexual and Reproductive Health Education Program: A Qualitative Study.

ObjectiveTraining programs on sexual and reproductive health rank among the most effective strategies to empower individuals and engage in self-care in this field. This study aimed to explore the structure of a school-based sexual and reproductive health education program.MethodsA qualitative, inductive, content-analysis approach was used in this study. Participants were selected through a purposeful sampling method. Data were collected through individual in-depth interviews with 21 students; 7 key informants; and 3 focus group discussions with parents. Interviews were recorded and transcribed into text manually. Data analysis was carried out using the content analysis method and the MAXQDA11 software.ResultsThree categories of health services emerged from the analysis of participant experiences: 1) empowerment-based education model; 2) optimal educational characteristics; and 3) adolescent-friendly sexual and reproductive health services.ConclusionsThe study found that sexual and reproductive health education programs for adolescent girls should be based on empowerment, desirable educational characteristics, and adolescent-friendly mechanisms.

The effect of sexual health education program on sexual function and attitude in women at reproductive age in Iran.

BACKGROUND:Female sexual dysfunction is a common and often distressing public health problem. This study aimed to determine the effect of the sexual health program on female sexual function and attitude in reproductive age in the west of Iran.MATERIALS AND METHODS:This was a field trial study. A total of 103 women attending health centers were assigned into two groups; an experiment and a control group. Data collection tool involved sociodemographic characteristics questionnaire, sexual female attitude questionnaire, and the Female Sexual Function Index (FSFI), which was completed by participants before and after the implementation of a sexual health education program. Data were analyzed using SPSS software version 22.RESULTS:The results revealed that after the intervention, female sexual function in the experiment group based on the FSFI tool was significantly improved (P < 0.01) in the domains of desire, arousal, orgasm, satisfaction, pain, and the total score compared with the control group. Besides, there was no significant difference between posttest mean score of sexual attitude in the experiment group and control group (P > 0.05). However, a significant difference was found in the mean score of sexual attitudes in the experimental group before and after the intervention (P = 0.004).CONCLUSION:The findings showed that sexual health program was effective in improving women's sexual function and attitude in the experiment group. It is recommended that the effect of other training methods remain to be addressed on women's sexual function and attitude.

The Need for Nurse Interventions in Sex Education in Adolescents.

Background: Developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program and be accessible to all students. The registered school nurse is a valuable resource to parents and educators in this area and supports the implementation of evidence-based sexual health education programs that promote healthy sexual development for adolescents. Methods: The research group consisted of 438 adolescents aged 12 to 15 years in a selected region in Slovakia, 186 boys and 252 girls. Average age of the girls was 13.2 and the boys 13.3 years. A nurse—a specialist in community nursing—collected the data using a self-designed questionnaire. The questions evaluated by the five-point Likert scale focused on finding out the knowledge and attitudes of adolescents to the role of school nurses regarding sexuality and reproductive health. Results were analyzed using parametric comparison tests with significance value 0.05: Student t-test for independent samples. Results: The girls and the boys most often drew information on sexuality and reproductive health from their parents and friends. The evaluation of the adolescents’ views on who should be a competent professional in the field of sexual education at schools found statistically significant differences between the boys and girls. For the boys and girls, a sexologist received the most significant assessment of competence. The interest in a school nurse in a school environment would be statistically significantly more appreciated by the girls compared to the boys, not just for solving problems related to healthy lifestyle, but also regarding sexuality, parenting and marriage. The adolescents consider the education for marriage and parenthood as the least discussed issue at present. In evaluating topics the adolescents would discuss, there were statistically significant differences between the boys and girls. Conclusions: A community or school nurse would also be able to successfully perform sexual education at schools. In Slovakia, this applied nursing discipline is lacking.

Every School Healthy: An Urban School Case Study.

ABSTRACTBACKGROUNDIn this case study, multiple participants in a large urban school district used the Whole School, Whole Community, Whole Child (WSCC) model to guide development of a district wellness policy. The model's health education component is highlighted, focusing on concerns for special needs students and ones speaking English as a New Language (ENL).METHODSOrganizational structure was developed around the WSCC model and district wellness policy implementation through coordination, collaboration, and communication (3Cs) of programs, policies, and processes/practices (3Ps).RESULTSThe WSCC approach guided the creation of a district wellness policy that influenced programming for students with special needs and required Youth Risk Behavior Survey (YRBS) data collection. Using YRBS and School Health Index (SHI) data in planning sexual health education illustrated improvements over time. Formation of the School Health and Wellness Collaborative under WSCC improved family engagement in sexual health education programs and practices. Relationships were established with community partners to impact student's sexual risk behaviors. Finally, the district co‐created and implemented an evidenced‐based sexual health curriculum, modifying it for special education and ENL students.CONCLUSIONSThe WSCC approach is system changing. It takes time to develop the relationships vital to improve the 3Cs and 3Ps. Success is enhanced with a district wellness coordinator, the right people at the table, valid health data, and administrative and board support.

Cost – Benefit Analysis of Austin Public Health’s Peer to Peer Adolescent Sexual Health Education Program

Cost – Benefit Analysis of Austin Public Health’s Peer to Peer Adolescent Sexual Health Education Program

Targeted High-Risk Youth in Missouri PREP: Understanding Program Impacts on Youth Sexual Behavior Intentions.

Missouri Personal Responsibility Education Program (PREP) provides sexual health education programs to youth with goals of reducing unintended teen pregnancies. Theories of change provide that youth improve their sexual health knowledge, intentions, attitudes, and behaviors as a result of program implementation. Program evaluations are needed to assess the degree to which PREP programs are meeting their goals of improving youth outcomes. The purpose of this study is to examine youth sexual intentions to use a condom, engage in sexual behavior, and abstain from sex as a result of Missouri PREP program implementation. We evaluate the effectiveness of the Missouri program in modifying youth intentions toward healthier planned behaviors. All programs required youth to take pre- and post-program surveys. For this study, we evaluate a sample of 1,335 youth's pre- and post-survey intentions related to condom use, sex, and abstention. We utilize t-tests as well as a lagged logistic regression approach to account for youth's respective pre-intentions. Youth's scores on intentions, knowledge, and attitudes rise from pre- to post-survey. Knowledge gains are salient while attitudes remain relatively high and stable. Intentions to use condoms differ from those in intentions to have or abstain from sex. Program change in intentions to use a condom are highest among the three intention outcomes. Missouri PREP saw improvements in knowledge, attitudes, and intentions as a result of program implementation. Findings suggest that the Missouri PREP program is effective at positively influencing youth intentions to engage in risky or sexual behavior.

Sexual behaviours, condom use and other contraceptive methods among 15- to 24-year-olds in Canada.

Sexual and reproductive health are key issues for adolescents and young adults. Detailed national Canadian data about sexual behaviours, condom use and other contraceptive use by youth are lacking. Data from the 2015/2016 Canadian Community Health Survey were used to examine sexual behaviours, condom and other contraceptive use, and reasons for non-use by selected characteristics. In 2015/2016, 54.1% of 15- to 24-year-olds reported having had sexual intercourse in the past year. Among those who had intercourse in the previous year, the percentage of males (42.6%) who had multiple sexual partners was higher than the percentage of females (31.4%). Gay and bisexual males (67.4% and 72.5%, respectively) and bisexual females (47.5%) were more likely to report having had multiple partners than their heterosexual counterparts. Overall, 60.1% of youth reported using a condom the last time they had sex. This was more common at younger ages, among males and among those who reported having had sex with more than one partner in the previous year. When asked the reason for not using a condom, monogamy and use of another method, such as oral contraceptive pills, were each cited by nearly half of non-users. Some reasons for not using a condom also differed by age, sex and number of partners. For example, youth aged 20 to 24 were more likely to report not using a condom because they disliked them, whereas those aged 15 to 17 were more likely to report none were available. About one-fifth of 15- to 24-year-olds reported using neither a condom nor another method of contraception the last time they had sex. One in 10 currently sexually active females reported using emergency contraception in the past year. A substantial proportion of youth in Canada are at high risk for sexually transmitted infections and unplanned pregnancy, and the findings have implications for comprehensive sexual health education and related policies and programs.

Engaging parents in digital sexual and reproductive health education: evidence from the JACK trial

BackgroundResearch evidence and international policy highlight the central role that parents play in promoting positive sexual behaviour and outcomes in their children, however they can be difficult to engage in sexual and reproductive health (SRH) education programmes. Digital health promotion that uses online and mobile technologies (OMTs) to promote parent-child communication may offer an innovative solution to reach parents, however, few programmes have used OMTs to involve parents in SRH, and none have reported lessons learned in relation to optimising engagement. This study addresses this gap in the literature by reporting acceptability and feasibility of using OMTs to engage parents in SRH education. Findings will be relevant for those wishing to develop and implement digital SRH programmes with parents internationally.MethodsThe Jack Trial is a UK-wide cluster randomised controlled trial recruiting over 8000 adolescents from 66 socially and religiously diverse post-primary schools. An embedded mixed-methods process evaluation explored user engagement with parent components of the If I Were Jack SRH education programme, which include online animated films and a parent-teen homework exercise.ResultsA total of 109 adolescents, teachers, parents and SRH policy experts took part in semi-structured interviews and focus groups, 134 parents responded to an online survey, and 3179 adolescents completed a programme engagement and satisfaction questionnaire. Parents who accessed the materials were positive about them; 87% rated them as ‘good or excellent’ and 67% said they helped them have conversations with their child about SRH. Web analytics revealed that 27% of contacted parents accessed the digital materials, with 9% viewing the animated films. Only 38% of teachers implemented the homework exercise, mainly because they assumed that students would not complete it or it might result in backlash from parents.ConclusionsWhile digital parental materials show promise for engaging parents in SRH education, this study suggests that in order to optimise engagement, parental components that give parents the necessary skills to have conversations with their children about sex should be coupled with efforts to increase school and teacher confidence to communicate with parents on sensitive topics.Trial registrationISRCTN99459996.

Peer Teaching by Stanford Medical Students in a Sexual and Gender Minority Health Education Program.

Medical school curricula devote few instructional hours to LGBTQ-inclusive content. Innovative approaches are required to prepare students to care for sexual and gender minority patients. We describe a student-led program at Stanford School of Medicine in which peer educators are trained to teach about sexual and gender minority health issues.

Contraception practices among young unmarried women seeking abortion following unintended pregnancy in Ho Chi Minh City, Vietnam

The aim of this study was to explore and describe contraception practices among young unmarried Vietnamese women seeking abortion after an unintended pregnancy. A qualitative study was conducted with voluntary participation of 42 women at a hospital in Ho Chi Minh City. Interview data were subjected to content analysis from which five categories were identified: (1) attitudes towards sexuality and contraception, (2) knowledge about contraception, (3) use of contraceptive methods, (4) cultural and traditional issues concerning sexuality and contraception, and (5) abortion as a solution to unwanted pregnancy. Prior to their abortion, women had viewed premarital sex as a means of maintaining a relationship with their boyfriends. Misconceptions, misbeliefs, fear of side effects and limited knowledge were reasons for not using contraception and, in case of unintended pregnancy, abortion was the solution. Boyfriends played an important role in influencing the use (or non-use) of contraceptives. Sexual and reproductive health education including counselling for gender equality, safer sex practices and the prevention of unintended pregnancy should be provided to both women and men in ways which combine traditional and modern views of sexuality. Intervention research to develop sexual and reproductive health education programmes, including contraception counselling, should be carried out.

Socio-Ecological Factors Associated With Students' Perceived Impact of an Evidence-Based Sexual Health Education Curriculum.

Although schools often implement evidence-based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. Using student-reported perceived impact measures as a proxy for program effectiveness, we employed a socio-ecological approach to examine student, teacher, school, and district factors associated with greater perceived impact of It's Your Game (IYG), an evidence-based middle school sexual health education program. The student sample was 58.7% female, 51.8% Hispanic, mean age 13.2 years, from 73 middle schools. We assessed students' (N=4531) perceived impact of IYG on healthy decision-making (α=0.75) and sexual communication (α=0.71); satisfaction with IYG activities and teacher; and demographics. We assessed teachers' (N=56) self-efficacy to teach IYG, perceived administrative support, implementation barriers, and demographics. School and district data were abstracted from state records. We used multilevel logistic regression to estimate associations between independent variables and student-reported perceived impact. In final multivariate models, students' demographics (sex, β=0.06, SE=0.015), satisfaction with IYG (β=0.21, SE=0.012), and their IYG teacher (β=0.18, SE=0.013) (all p=.000) were significantly associated with perceived impact on healthy decision-making. Similar findings resulted for sexual communication. No other variables were significantly associated with perceived impact. Helping schools select age-appropriate, culturally relevant programs, and facilitate supportive learning environments may enhance the perceived impact of sexual health education programs.

Effectiveness of postpartum sexual health education programme structured according to Levine's conservation model: An interventional study.

This study aimed to determine the effects of a postpartum sexual health education programme structured according to Levine's conservation model on postpartum women. The interventional study was completed with 67 postpartum women. The intervention group was given the postpartum sexual health education programme structured according to Levine's conservation model. The control group received routine discharge training. The data were collected using a personal information form, The Index of Female Sexual Function, Arizona Sexual Experience Scale and Golombok-Rust Inventory of Sexual Satisfaction. It has been determined that the decrease in sexual arousal and desire is the first among postpartum sexual problems experienced by women. This study demonstrated that sexual function, sexual satisfaction and sexual response were higher in nonbreastfeeding women, women who had sexual intercourse one to three times a week and women who could talk to health care professionals on sexual matters. After the programme, the intervention group had more adequate sexual function, and they developed a strong, easy and satisfactory sexual response than the control group (p < 0.05). This programme was effective in increasing the sexual functions and satisfaction of the postpartum women. Models provide guidance to nurses for provision of care in a systematic manner.

Risk perceptions, misperceptions and sexual behaviours among young heterosexual people with gonorrhoea in Perth, Western Australia.

Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action. Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed. Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk. The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections.

Integrating Reproductive and Sexual Health Education and Services Into Opioid Use Disorder Treatment Programs: A Qualitative Study.

Women with opioid use disorder (OUD) in the USA are at risk for poor reproductive and sexual health (RSH) outcomes. The qualitative research presented here is part of a larger mixed methods study. The qualitative component used an implementation science framework to investigate provider and staff perspectives regarding the integration of RSH education and services for reproductive-age women in opioid treatment programs (OTPs) in North Carolina. Thirty-one semistructured interviews were conducted with providers and staff at 9 OTPs between November and December, 2017. The Consolidated Framework for Implementation Research (CFIR) was used to assess multilevel implementation contexts (eg, patient, provider, organizational) to identify barriers and facilitators that might influence effective intervention implementation. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. Deductive and inductive approaches were used. Barriers included transportation, childcare, and time constraints (patient-level), lack of communication between providers (provider-level), lack of political will, competing priorities, and shortages of available resources (organizational-level). Facilitators included a group education approach (patient-level), strong communication (provider-level), and a culture of collaboration (organizational-level). Assessing determinants of implementation is important to the development of RSH interventions. CFIR constructs were found to be important influences that could facilitate or hinder effective implementation. Integration of RSH education and services is a process, and, when addressed in stages, might be feasible. A broad range of RSH education and services has the potential to have a profound impact on the health of women with OUD and their children, their families, and their communities.