Sexual Health Education Programs Research Articles

Orienting Toward Possibility: Girls and Bisexuality at School.

While many more high school girls identify as bisexual than as lesbian, queer, or other marginalized sexual identities, girls who identify as bisexual remain peripheral to sexuality research and to many sexual health education programs. Nevertheless, research suggests that bisexuality is a distinct claim and experience for girls, marked by highly gendered discourses of sexuality and queerness. Based on the Beyond Bullying Project, a multimedia storytelling project that invited students, teachers, and community members in three U.S. high schools to enter a private booth and share stories of LGBTQ (lesbian, gay, bisexual, transgender and queer or questioning) sexuality and gender, this article explores the work the identity "bisexual" and the category "bisexuality" accomplish for girls when claimed for themselves or another or put into circulation at school. We consider the range of meanings and identifications mobilized by bisexuality and, drawing on insights of critical narrative intervention, explore how sexual health and sexuality educators might receive girls' narratives of bisexuality as capacious and contradictory-as claims to identity, as uncertain gestures toward desire, and as assertions of possibility and resistance. We show that in the assertion of bisexuality, girls align themselves with the surprise of desire and position themselves to resist the disciplining expectations of heteronormative schooling. Critical narrative intervention, with its focus on using stories to challenge the status quo, allows educators and researchers to recognize in girls' stories of bisexuality, the potential of new approaches to sexual health education and social belonging.

Bridging the Gap between Sexual Health Education and Clinical Services: Adolescent Perspectives and Recommendations.

Adolescents often lack access to accurate and appropriate sexual health information and services. Providing information about local clinical services during sexual health education classes is one strategy to increase awareness, yet many programs miss this opportunity. This study aims to learn about adolescents' experiences with sexual health education and their perceptions of barriers and facilitators to clinical care. Nine focus groups were conducted between April to July 2018 with 69 adolescents who had recently attended a comprehensive sexual health education program in California. Topics included information received about local clinics during class and barriers and facilitators to access care. Qualitative data were coded and analyzed for key themes and compared by sex and geographic location. The majority of participants (89%) were Latino and most reported receiving relevant information about clinical services and had positive impressions of local services. Several mentioned that this information increased the likelihood that they would access services if needed. Common barriers to clinic services included parental disapproval, stigma, embarrassment, and confidentiality concerns. Facilitators included peer and family support, confidentiality of services, awareness and education, and accessibility. Sexual health education programs can provide an important bridge to local clinic services and address adolescents' concerns.

Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review

ObjectivesTo critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education.DesignA systematic review and narrative...

Linking Families and Teens: Randomized Controlled Trial Study of a Family Communication and Sexual Health Education Program for Rural Youth and Their Parents

PurposeThis study describes the results of an impact evaluation of the Linking Families and Teens (LiFT) program, a 5-hour program for families in rural communities. LiFT’s goal is to reduce unplanned teen pregnancies by increasing family connectedness and youth’s self-efficacy, knowledge, and sexual health skills. MethodsLiFT was externally evaluated using a cluster randomized controlled trial. Families, consisting of one or more dyads of high school aged youth and their parenting adults, were randomly assigned to a study condition. The program was implemented 57 times in rural communities in 9 states. The analytic sample includes 786 youth (407 program and 379 control) with baseline, 3-month, and 12-month data. The analysis used an intent-to-treat framework using ordinary least squares regression to measure effects on each outcome. ResultsFewer LiFT participants experienced a pregnancy than control youth, which was significant at 3 months (net of baseline, 0 program vs. 4 control) and marginally significant at 12 months (net of baseline, 6 program vs. 14 control.) At both follow-up periods, the program had statistically significant effects on youth’s frequency of communication with their parenting adults about sexuality and pregnancy prevention and on their perceived competence to prevent pregnancy. ConclusionsLiFT achieved lasting effects on increasing parent-child communication and youth self-efficacy to prevent unwanted pregnancies a full year following the brief, family-focused workshop. LiFT’s impact on pregnancy was significant at 3 months and trended in the right direction at 12 months. A larger experimental study of this promising program is warranted to show the long-term effect on pregnancy.

Adapting Evidence-Based Sexuality Education to Meet the Needs of Refugee Youth in the USA

The sexual health of adolescents globally and in the USA remains a significant public health challenge. No evidence-based sexual health education programs exist that specifically target refugee adolescents. The purpose of this exploratory study was to describe the impact of an evidence-based sexual health education program previously demonstrated effectiveness in nonrefugee populations on refugee adolescents’ sexual health attitudes, beliefs, intentions and behaviors using minor adaptations to the curriculum. This analysis used a subsample of adolescents from refugee or immigrant backgrounds who participated in a community-based sexuality education program, Reach One Teach One-North Dakota (ROTO-ND). Previously validated scaled survey items were used to assess participants’ sexual health beliefs, self-efficacy, knowledge of sexual health resources, and behaviors. Summary statistics were calculated for sociodemographic characteristics categorized by length of time living in the USA. Bivariate unpaired comparisons demonstrated significant differences in the entire cohort on pre- to post-intervention scores on all outcome measures and scales while controlling for program attendance. Participant (n = 103) mean age was 16 and the majority were male (58%). The present study provides evidence that existing evidence-based interventions not intended to target refugee youth may contribute to meeting the unique sexual health education needs of refugee youth with minor adaptations.

The Effect of Children’s Sexual Health Education Program on Knowledge and Attitude of Primary School Health Care Providers

ABSTRACT School involvement is essential for providing Children’s Sexual Health (CSH), but Health Care Providers (HCPs) responsible for children’s health at schools are not sufficiently competent. This study aimed to determine the effect of the Children’s Sexual Health Education Program (CSHEP) on the knowledge and attitude of HCPs in elementary schools. Sixty HCPs were randomly assigned to two groups. The intervention was held in four 90-minute training sessions. Questionnaires were completed by the intervention and control groups in three stages (before, immediately after, and 4 weeks after the intervention). At the end of the intervention, a training session was held in the control group. CSHEP has been effective in improving the knowledge and attitude of HCPs about CSH. Given the important role of HCPs in CSH and their need for education, planning for continuing education courses to promote their knowledge and attitude seems essential.

Implementation and Adaptation Practices of 9th Grade Teachers Implementing the Chicago Public Schools’ Sexual Health Education Curriculum

For sexual health education implementation, program fidelity, defined as whether prescribed curricular components are delivered as prescribed, is critical. Whereas fidelity data is often collected quantitatively with little to no information about what changes were made and why, this mixed methods case study evaluation aimed to understand what kinds of adaptations are being made and why teachers are making them. This was done in order to better support teachers implementing sexual health education in Chicago Public Schools. Twenty-nine class-periods were observed in four high schools to assess curriculum fidelity. Twelve teachers were interviewed about their implementation practices. Teachers made numerous adaptations, primarily aimed to respond to students’ needs and interests. Teachers report needing more guidance on how to appropriately make adaptations that maintain fidelity to core content while allowing them to adjust to their own students’ needs and interests. Implications for sexual health education program implementation are discussed.

Evaluation of a Web-Based Sexual Health Education Program for Individuals with Visual Impairments

Evaluation of a Web-Based Sexual Health Education Program for Individuals with Visual Impairments

LGBTPQ Youth Negotiating Access to Sexual Health Education and Resources in a Rural South African University

ABSTRACT This article draws on sexual citizenship theory to analyze how some lesbian, gay, bisexual, transgender, pansexual and queer (LGBTPQ) youth in a low socio-economic rural South African context negotiate access to inclusive sexual health education programmes and resources. Participants are students aged 19 to 32 years old at a South African university. Using in-depth individual interviews, participants reflected on their experiences of sexual health education when they were still at school. The findings show the continuing silencing of sexual health issues concerning LGBTPQ youth in South African schools. Disadvantaged by the lack of sexual health education programmes in schools, findings show how the students sought LGBTPQ centered knowledge through self-study and other ways to empower themselves with information on sexual health matters. Participants also reflected on accessing the student health clinic at the university where they are students. Accessing condoms, lubricants, dental dams and HIV pre-exposure prophylaxis (PrEP) remains a challenge. Implications suggest ways of improving the provision of LGBTPQ inclusive sexual health education programmes and resources in poor rural contexts in South Africa.

Sexual and reproductive health education and learning among Indigenous youth of the Comarca Ngäbe-Buglé, Panama

ABSTRACT Indigenous adolescents and young people in Panama are at high-risk for sexually transmitted infections, due in part to limited access to condoms and comprehensive sexual and reproductive health (SRH) education. There is a paucity of evidence on how to develop sexual and reproductive health education programmes that incorporate different sources of learning. We used Bronfenbrenner’s Ecological Theory to understand two key sources of learning: noncaregivers (school or healthcare personnel) and caregivers (parents/grandparents/stepparents). Better understanding about sexual and reproductive health learning sources could provide a foundation for the development of targeted, culturally congruent interventions. This study included ethnographic observation in two Indigenous communities in Panama, followed by semi-structured interviews with young people and caregivers. Findings suggest non-caregiver sexual and reproductive health education was commonly provided by teachers, and increasingly through the Internet. Caregivers focused on topics of abstinence/delaying sexual debut, pregnancy, and STIs/HIV; condoms pregnancy, and STIs/HIV. Condoms and condom use were not mentioned. Traditional sexual and reproductive health teaching by same-gender caregivers took place through the rituals of mokän (girls at menarche) and grön (boys 13–14 years). To develop culturally congruent interventions, wesuggest programmes to improve sexual and reproductive health knowledge and access to condoms, which respect and build on social and traditional learning spaces.

\u2018Making of a Strong Woman\u2019: a constructivist grounded theory of the experiences of young women around menarche in Papua New Guinea

BackgroundMenarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This study explored post-menarcheal women’s understanding about body changes and menarche, preparation for menarche, and related cultural beliefs and practices at menarche.MethodsA constructivist grounded theory study was conducted with 98 female participants who originated from four PNG provinces: Eastern Highlands Province; East Sepik Province; Milne Bay Province; and National Capital District. The participants were purposively and theoretically sampled, with 10 focus group discussions and six individual interviews conducted using a semi-structured interview guide for data collection. Focus group discussions and interviews were voice recorded and transcribed. Data were inductively analyzed using initial, intermediate and advanced coding, memos and constant comparative methods to develop a theoretical model that explains women’s experiences at menarche. Interview participants also identified actions required to improve future experiences of girls at menarche in PNG.ResultsA grounded theory comprising the core category of ‘Making of a Strong Woman’ and four interconnecting categories (‘Having Baby Sense’; ‘Beginning of Learning’; ‘Intensifying Learning’; and ‘Achieving Womanhood’) was constructed. ‘Urban’ and ‘Rural’ represented both geographical and socio-cultural intervening conditions that influence the experiences of girls at menarche. Experiences of young women at menarche were rooted in socio-cultural beliefs and practices. Women reported being physically and emotionally distressed and unprepared at onset of menarche. Mothers were considered important support, however, their ability to adequately prepare their daughters is limited by shame and secrecy. Despite these limitations, cultural practices at menarche provided an opportunity for intensive preparation of girls for womanhood.ConclusionLimited pre-menarcheal awareness of the meaning of body changes and menarche of girls was linked to culture of shame and secrecy about open discussion on sexuality. However, traditional cultural practices provide an opportunity for collective support and focused learning for girls. Findings from this study have implications for broader sexual and reproductive health education programs in addressing menstrual health and hygiene in PNG, and the Pacific.

Gender Differences in Attitudes and Behaviors Toward Condoms and Birth Control Among Chicago Adolescents

Research shows that gender norms play a notable role in pregnancy prevention, often placing responsibility on females and allowing some males to pursue sexual encounters without considering the consequences of unprotected sex. This paper examines gender differences in attitudes and behaviors related to condom use and birth control among adolescents using survey, focus group, and interview data gathered from the evaluation of Chicago Healthy Adolescents and Teens (CHAT), a comprehensive sexual health education program implemented with adolescents in Chicago Public High Schools. Results indicate that safe sex attitudes and behaviors differ between male and female adolescents, specifically those related to condoms and birth control. Our findings suggest that (i) females have higher knowledge and presumed responsibility for pregnancy prevention, (ii) infrequent condom use among adolescents prioritizes male pleasure over female health needs, and (iii) social norms discourage females, but not males, from accessing and using birth control. We use the Theory of Gender and Power to show how our findings reflect gender dynamics within the United States and explain the potential health implications for adolescent sexual health.

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.