Methodologies of sexual health education intervention for high school students' knowledge and attitudes: A systematic review
,
Abstract
Background & Aim: Providing adolescents with information to understand their sexual health is critical to promote healthy sexual development, reducing the negative consequences of risky sexual behaviors, and creating a foundation for healthy adulthood. This study aimed to identify the recent empirical evidence on new methodologies for improved sexual health outcomes among adolescents.
Methods & Materials: A systematic review of randomized controlled trials guided the PICO question, "What knowledge and attitudes do high school students obtain when confronted with new methodologies for teaching sexuality compared to traditional teaching?" regardless of geographic location, race/ethnicity, or gender criteria, concerning adolescents, was conducted. The databases CINAHL, MEDLINE, PsycINFO, SCOPUS, and Cochrane Central Register of Controlled Trials, were searched in December 2022. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews were used to assess methodological quality. Data were synthesized across studies and presented narratively.
Results: Thirteen articles were included for review, involving 11.262 participants. The duration of the interventions with new methodologies ranged from a few hours to three months. New methodologies on sexual health education to improve high school student's knowledge and attitudes were divided into four types: digital and Internet-based intervention, curriculum-based intervention, training-based intervention, and peer group bonding-based intervention.
Conclusion: These results provide healthcare professionals with additional strategies that may be integrated into school health programs regarding sex education.
1. United Nations Population Fund. Adolescent sexual and reproductive health toolkit for humanitarian settings. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_ASRHtoolkit_english.pdf. 2009.
2. Do L, Boonmongkon P, Paek S, Guadamuz T. ‘Hu Hong’ (bad thing): Parental perceptions of teenagers’ sexuality in urban Vietnam. BMC Public Health. 2017;17:226–36.
3. United Nations Population Fund. Education on sexual and reproductive health, building partnerships with and for youth. Available from: https://www.un.org/esa/socdev/unyin/documents/UNFPASexualReproductiveHealth.pdf. 2012.
4. Future of Sex Education Initiative. National Sex Education Standards: Core Content and Skills, K-12 [Internet]. 2020 [cited 2022 Oct 16]. Available from: https://advocatesforyouth.org/wp-content/uploads/2020/03/NSES-2020-web.pdf
5. Guttmacher Institute. US Adolescents’ Receipt of Formal Sex Education. 2022.
6. European Commission DG for ESA and I and NP. Sexuality education across the European Union: An overview. 2021.
7. Kirby D. Sex and HIV education in schools. BMJ. 1994;311(4):349–64.
8. Patton G, Sawyer S, Santelli J, Ross D, Afifi R, Allen N, et al. Our future: A Lancet commission on adolescent health and wellbeing. The Lancet. 2016 Jun;387(10036):2423–78.
9. Greene K, Eitle D, Eitle T. Developmental Assets and Risky Sexual Behaviors Among American Indian Youth. J Early Adolesc. 2018 Jan 30;38(1):50–73.
10. Steiner R, Michael S, Hall J, Barrios L, Robin L. Youth Violence and Connectedness in Adolescence: What Are the Implications for Later Sexually Transmitted Infections? Journal of Adolescent Health. 2014 Mar;54(3):312-318.e1.
11. Lauritsen J. Explaining Race and Gender Differences in Adolescent Sexual Behavior. Social Forces. 1994 Mar;72(3):859.
12. Henderson M, Butcher I, Wight D, Williamson L, Raab G. What explains between-school differences in rates of sexual experience? BMC Public Health. 2008 Dec 8;8(1):53.
13. McNeely C, Falci C. School Connectedness and the Transition Into and Out of Health-Risk Behavior Among Adolescents: A Comparison of Social Belonging and Teacher Support. Journal of School Health. 2004 Sep;74(7):284–92.
14. Kim J. School Socioeconomic Composition and Adolescent Sexual Initiation in Malawi. Stud Fam Plann. 2015 Sep;46(3):263–79.
15. White C, Warner L. Influence of Family and School-Level Factors on Age of Sexual Initiation. Journal of Adolescent Health. 2015 Feb;56(2):231–7.
16. Resnick M. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA: The Journal of the American Medical Association. 1997 Sep 10;278(10):823-32.
17. Bonell C, Parry W, Wells H, Jamal F, Fletcher A, Harden A, et al. The effects of the school environment on student health: A systematic review of multi-level studies. Health Place. 2013 May;21:180–91.
18. Tobler A, Komro K, Dabroski A, Aveyard P, Markham W. Preventing the Link Between SES and High-Risk Behaviors: “Value-Added” Education, Drug Use and Delinquency in High-Risk, Urban Schools. Prevention Science. 2011 Jun 1;12(2):211–21.
19. Widman L, Kamke K, Evans R, Stewart J, Choukas-Bradley S, Golin C. Feasibility, Acceptability, and Preliminary Efficacy of a Brief Online Sexual Health Program for Adolescents. The Journal of Sex Research. 2020 Feb 12;57(2):145–54.
20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery. 2021 Apr 1;88:105906.
21. Higgins J, Thomas J. Cochrane Handbook for Systematic Reviews of Interventions. 2021.
22. Richardson W, Wilson M, Nishikawa J, Hayward R. The well-built clinical question: A key to evidence-based decisions. ACP J Club. 1995;123:A-12-A-13.
23. The Joanna Briggs Institute. Checklist for Systematic Reviews and Research Syntheses. 2017.
24. Chong A, Gonzalez-Navarro M, Karlan D, Valdivia M. Do Information Technologies Improve Teenagers’ Sexual Education? Evidence from a Randomized Evaluation in Colombia. World Bank Econ Rev. 2020 Jun 1;34(2):371–92.
25. Coyle K, Anderson P, Laris B, Barrett M, Unti T, Baumler E. A Group Randomized Trial Evaluating High School FLASH, a Comprehensive Sexual Health Curriculum. Journal of Adolescent Health. 2021 Apr;68(4):686–95.
26. Darabi F, Kaveh M, Farahani F, Yaseri M, Majlessi F, Davoud Shojaeizadeh D. The Effect of a Theory of Planned Behavior-based Educational Intervention on Sexual and Reproductive Health in Iranian Adolescent Girls: A Randomized Controlled Trial. Journal of Research in Health Sciences. 2017;17(4):400.
27. Haruna H, Hu X, Chu SK, Mellecker RR, Gabriel G, Ndekao PS. Improving sexual health education programs for adolescent students through game-based learning and gamification. International journal of environmental research and public health. 2018 Sep;15(9):2027.
28. Manaseri H, Roberts K, Barker L, Tom T. Pono Choices: Lessons for School Leaders From the Evaluation of a Teen Pregnancy Prevention Program. Journal of School Health. 2019 Apr;89(4):246–56.
29. Morales A, Carratalá E, Orgilés M, Espada JP. A preliminary study of the effectiveness of a program to promote sexual health among adolescents with divorced parents. Salud y drogas. 2017;17(1):37-44.
30. Scull T, Malik C, Morrison A, Keefe E. Promoting sexual health in high school: A feasibility study of a web-based media literacy education program. Journal of Health Communication. 2021 Mar 4;26(3):147-60.
31. Scull TM, Dodson CV, Geller JG, Reeder LC, Stump KN. A media literacy education approach to high school sexual health education: immediate effects of media aware on adolescents’ media, sexual health, and communication outcomes. Journal of Youth and Adolescence. 2022 Apr;51(4):708-23.
32. Scull TM, Kupersmidt JB, Malik CV, Morgan-Lopez AA. Using media literacy education for adolescent sexual health promotion in middle school: Randomized control trial of Media Aware. Journal of Health Communication. 2018 Dec 2;23(12):1051-63.
33. Walsh S, Jenner E, Qaragholi N, Henley C, Demby H, Leger R, Burgess K. The Impact of a High School‐Based Positive Youth Development Program on Sexual Health Outcomes: Results from a Randomized Controlled Trial. Journal of School Health. 2022 Dec;92(12):1155-64.
34. Widman L, Golin C, Kamke K, Burnette J, Prinstein M. Sexual Assertiveness Skills and Sexual Decision-Making in Adolescent Girls: Randomized Controlled Trial of an Online Program. American Journal of Public Health. 2018 Jan;108(1):96–102.
35. Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad M, Yidana A. Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial. Reprod Health. 2019 Dec 15;16(1):124.
36. Widman L, Kamke K, Evans R, Stewart J, Choukas-Bradley S, Golin C. Feasibility, Acceptability, and Preliminary Efficacy of a Brief Online Sexual Health Program for Adolescents. The Journal of Sex Research. 2020 Feb 12;57(2):145–54.
37. Lameiras-Fernández M, Martínez-Román R, Carrera-Fernández M, Rodríguez-Castro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. Int J Environ Res Public Health. 2021 Mar 4;18(5):2555.
38. Chinelli A, Salfa M, Cellini A, Ceccarelli L, Farinella M, Rancilio L, et al. Sexuality education in Italy 2016-2020: a national survey investigating coverage, content and evaluation of school-based educational activities. Sex Education. 2022 Oct 25;1–13.
39. Haruna H, Okoye K, Zainuddin Z, Hu X, Chu S, Hosseini S. Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study. JMIR Serious Games. 2021 Oct 12;9(4):e19614.
40. McGregor A, Chin E, Rojek M, Digre K, Lopez A, Jenkins K, et al. Sex and Gender Health Education Summit: Advancing Curricula Through a Multidisciplinary Lens. Journal of Womens Health. 2019 Dec 1;28(12):1728–36.
41. Pichon M, Howard‐Merrill L, Wamoyi J, Buller AM, Kyegombe N. A qualitative study exploring parent–daughter approaches for communicating about sex and transactional sex in Central Uganda: Implications for comprehensive sexuality education interventions. Journal of Adolescence. 2022 Aug;94(6):880-91.
42. Meherali S, Rahim KA, Campbell S, Lassi ZS. Does digital literacy empower adolescent girls in low-and middle-income countries: a systematic review. Frontiers in Public Health. 2021:2053.
43. Zanatta ET, Wanderley GP, Branco IK, Pereira D, Kato LH, Maluf EM. Fake news: The impact of the internet on population health. Revista da Associação Médica Brasileira. 2021 Oct 22;67:926-30.
44. Freeman JL, Caldwell PH, Bennett PA, Scott KM. How adolescents search for and appraise online health information: A systematic review. The Journal of Pediatrics. 2018 Apr 1;195:244-55.
45. Cleland J, Ingham R, Stone N. Topics for in-depth interviews and focus group discussions: partner selection, sexual behaviour and risk-taking [Internet]. 2014 [cited 2023 May 12]. Available from: https://www.who.int/news/item/08-05-2014-asking-young-people-about-sexual-and-reproductive-behaviours
2. Do L, Boonmongkon P, Paek S, Guadamuz T. ‘Hu Hong’ (bad thing): Parental perceptions of teenagers’ sexuality in urban Vietnam. BMC Public Health. 2017;17:226–36.
3. United Nations Population Fund. Education on sexual and reproductive health, building partnerships with and for youth. Available from: https://www.un.org/esa/socdev/unyin/documents/UNFPASexualReproductiveHealth.pdf. 2012.
4. Future of Sex Education Initiative. National Sex Education Standards: Core Content and Skills, K-12 [Internet]. 2020 [cited 2022 Oct 16]. Available from: https://advocatesforyouth.org/wp-content/uploads/2020/03/NSES-2020-web.pdf
5. Guttmacher Institute. US Adolescents’ Receipt of Formal Sex Education. 2022.
6. European Commission DG for ESA and I and NP. Sexuality education across the European Union: An overview. 2021.
7. Kirby D. Sex and HIV education in schools. BMJ. 1994;311(4):349–64.
8. Patton G, Sawyer S, Santelli J, Ross D, Afifi R, Allen N, et al. Our future: A Lancet commission on adolescent health and wellbeing. The Lancet. 2016 Jun;387(10036):2423–78.
9. Greene K, Eitle D, Eitle T. Developmental Assets and Risky Sexual Behaviors Among American Indian Youth. J Early Adolesc. 2018 Jan 30;38(1):50–73.
10. Steiner R, Michael S, Hall J, Barrios L, Robin L. Youth Violence and Connectedness in Adolescence: What Are the Implications for Later Sexually Transmitted Infections? Journal of Adolescent Health. 2014 Mar;54(3):312-318.e1.
11. Lauritsen J. Explaining Race and Gender Differences in Adolescent Sexual Behavior. Social Forces. 1994 Mar;72(3):859.
12. Henderson M, Butcher I, Wight D, Williamson L, Raab G. What explains between-school differences in rates of sexual experience? BMC Public Health. 2008 Dec 8;8(1):53.
13. McNeely C, Falci C. School Connectedness and the Transition Into and Out of Health-Risk Behavior Among Adolescents: A Comparison of Social Belonging and Teacher Support. Journal of School Health. 2004 Sep;74(7):284–92.
14. Kim J. School Socioeconomic Composition and Adolescent Sexual Initiation in Malawi. Stud Fam Plann. 2015 Sep;46(3):263–79.
15. White C, Warner L. Influence of Family and School-Level Factors on Age of Sexual Initiation. Journal of Adolescent Health. 2015 Feb;56(2):231–7.
16. Resnick M. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA: The Journal of the American Medical Association. 1997 Sep 10;278(10):823-32.
17. Bonell C, Parry W, Wells H, Jamal F, Fletcher A, Harden A, et al. The effects of the school environment on student health: A systematic review of multi-level studies. Health Place. 2013 May;21:180–91.
18. Tobler A, Komro K, Dabroski A, Aveyard P, Markham W. Preventing the Link Between SES and High-Risk Behaviors: “Value-Added” Education, Drug Use and Delinquency in High-Risk, Urban Schools. Prevention Science. 2011 Jun 1;12(2):211–21.
19. Widman L, Kamke K, Evans R, Stewart J, Choukas-Bradley S, Golin C. Feasibility, Acceptability, and Preliminary Efficacy of a Brief Online Sexual Health Program for Adolescents. The Journal of Sex Research. 2020 Feb 12;57(2):145–54.
20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International Journal of Surgery. 2021 Apr 1;88:105906.
21. Higgins J, Thomas J. Cochrane Handbook for Systematic Reviews of Interventions. 2021.
22. Richardson W, Wilson M, Nishikawa J, Hayward R. The well-built clinical question: A key to evidence-based decisions. ACP J Club. 1995;123:A-12-A-13.
23. The Joanna Briggs Institute. Checklist for Systematic Reviews and Research Syntheses. 2017.
24. Chong A, Gonzalez-Navarro M, Karlan D, Valdivia M. Do Information Technologies Improve Teenagers’ Sexual Education? Evidence from a Randomized Evaluation in Colombia. World Bank Econ Rev. 2020 Jun 1;34(2):371–92.
25. Coyle K, Anderson P, Laris B, Barrett M, Unti T, Baumler E. A Group Randomized Trial Evaluating High School FLASH, a Comprehensive Sexual Health Curriculum. Journal of Adolescent Health. 2021 Apr;68(4):686–95.
26. Darabi F, Kaveh M, Farahani F, Yaseri M, Majlessi F, Davoud Shojaeizadeh D. The Effect of a Theory of Planned Behavior-based Educational Intervention on Sexual and Reproductive Health in Iranian Adolescent Girls: A Randomized Controlled Trial. Journal of Research in Health Sciences. 2017;17(4):400.
27. Haruna H, Hu X, Chu SK, Mellecker RR, Gabriel G, Ndekao PS. Improving sexual health education programs for adolescent students through game-based learning and gamification. International journal of environmental research and public health. 2018 Sep;15(9):2027.
28. Manaseri H, Roberts K, Barker L, Tom T. Pono Choices: Lessons for School Leaders From the Evaluation of a Teen Pregnancy Prevention Program. Journal of School Health. 2019 Apr;89(4):246–56.
29. Morales A, Carratalá E, Orgilés M, Espada JP. A preliminary study of the effectiveness of a program to promote sexual health among adolescents with divorced parents. Salud y drogas. 2017;17(1):37-44.
30. Scull T, Malik C, Morrison A, Keefe E. Promoting sexual health in high school: A feasibility study of a web-based media literacy education program. Journal of Health Communication. 2021 Mar 4;26(3):147-60.
31. Scull TM, Dodson CV, Geller JG, Reeder LC, Stump KN. A media literacy education approach to high school sexual health education: immediate effects of media aware on adolescents’ media, sexual health, and communication outcomes. Journal of Youth and Adolescence. 2022 Apr;51(4):708-23.
32. Scull TM, Kupersmidt JB, Malik CV, Morgan-Lopez AA. Using media literacy education for adolescent sexual health promotion in middle school: Randomized control trial of Media Aware. Journal of Health Communication. 2018 Dec 2;23(12):1051-63.
33. Walsh S, Jenner E, Qaragholi N, Henley C, Demby H, Leger R, Burgess K. The Impact of a High School‐Based Positive Youth Development Program on Sexual Health Outcomes: Results from a Randomized Controlled Trial. Journal of School Health. 2022 Dec;92(12):1155-64.
34. Widman L, Golin C, Kamke K, Burnette J, Prinstein M. Sexual Assertiveness Skills and Sexual Decision-Making in Adolescent Girls: Randomized Controlled Trial of an Online Program. American Journal of Public Health. 2018 Jan;108(1):96–102.
35. Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad M, Yidana A. Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial. Reprod Health. 2019 Dec 15;16(1):124.
36. Widman L, Kamke K, Evans R, Stewart J, Choukas-Bradley S, Golin C. Feasibility, Acceptability, and Preliminary Efficacy of a Brief Online Sexual Health Program for Adolescents. The Journal of Sex Research. 2020 Feb 12;57(2):145–54.
37. Lameiras-Fernández M, Martínez-Román R, Carrera-Fernández M, Rodríguez-Castro Y. Sex Education in the Spotlight: What Is Working? Systematic Review. Int J Environ Res Public Health. 2021 Mar 4;18(5):2555.
38. Chinelli A, Salfa M, Cellini A, Ceccarelli L, Farinella M, Rancilio L, et al. Sexuality education in Italy 2016-2020: a national survey investigating coverage, content and evaluation of school-based educational activities. Sex Education. 2022 Oct 25;1–13.
39. Haruna H, Okoye K, Zainuddin Z, Hu X, Chu S, Hosseini S. Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study. JMIR Serious Games. 2021 Oct 12;9(4):e19614.
40. McGregor A, Chin E, Rojek M, Digre K, Lopez A, Jenkins K, et al. Sex and Gender Health Education Summit: Advancing Curricula Through a Multidisciplinary Lens. Journal of Womens Health. 2019 Dec 1;28(12):1728–36.
41. Pichon M, Howard‐Merrill L, Wamoyi J, Buller AM, Kyegombe N. A qualitative study exploring parent–daughter approaches for communicating about sex and transactional sex in Central Uganda: Implications for comprehensive sexuality education interventions. Journal of Adolescence. 2022 Aug;94(6):880-91.
42. Meherali S, Rahim KA, Campbell S, Lassi ZS. Does digital literacy empower adolescent girls in low-and middle-income countries: a systematic review. Frontiers in Public Health. 2021:2053.
43. Zanatta ET, Wanderley GP, Branco IK, Pereira D, Kato LH, Maluf EM. Fake news: The impact of the internet on population health. Revista da Associação Médica Brasileira. 2021 Oct 22;67:926-30.
44. Freeman JL, Caldwell PH, Bennett PA, Scott KM. How adolescents search for and appraise online health information: A systematic review. The Journal of Pediatrics. 2018 Apr 1;195:244-55.
45. Cleland J, Ingham R, Stone N. Topics for in-depth interviews and focus group discussions: partner selection, sexual behaviour and risk-taking [Internet]. 2014 [cited 2023 May 12]. Available from: https://www.who.int/news/item/08-05-2014-asking-young-people-about-sexual-and-reproductive-behaviours
| Files | ||
| Issue | Vol 10 No 2 (2023): Spring | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/npt.v10i2.12830 | |
| Keywords | ||
| sexual health; sex education; adolescent; knowledge; attitudes | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Couto G, Oliveira I, Fernandes C, Mark K. Methodologies of sexual health education intervention for high school students’ knowledge and attitudes: A systematic review. NPT. 2023;10(2):86-98.
