Parents' and teachers' views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study

Knowledge and attitudes regarding contraceptive methods and sex education in students and parents of eight Colombian schools 2020-2021: a mixed methods study

Background

In Colombia, the average age of first sexual intercourse is between 14 and 15, and it has one of the highest fertility rates among adolescents in Latin America, which reflects poor access to health services and a lack of knowledge about contraception. Some laws support comprehensive sex education as a learning process that families and schools should provide. The objective of this work was to assess the frequency of adequate knowledge and attitudes of acceptance towards contraception in students, their associated factors, sexual behaviours in sexually active students, and experiences with sex education.

Methods

Mixed methods study consisting of an analytical cross-sectional study and a qualitative hermeneutic phenomenological study. The former included students who completed a questionnaire with sociodemographic variables, surveys on knowledge and attitudes toward contraception, and questions about sexual behaviour. Focus groups were used in the qualitative study to evaluate students' and parents' sex education experiences.

Findings

827 students were surveyed, of whom 52.3% had adequate knowledge about contraceptives and 80.1% had attitudes of acceptance. Talking with parents about sex education, receiving sex education, and being in the eleventh grade increased the likelihood of having adequate knowledge. Each year of age, being male, being a victim of forced displacement, and studying in a public school were associated with lower possibilities of attitudes of acceptance. Using condoms, compared to other contraceptives, was associated with less adequate knowledge and attitudes of acceptance (p < 0.05). Experiences with sex education, contraception, and sexual and reproductive rights were three emerging categories in the focus groups.

Interpretation

In a group of Colombian high school students, half of them had adequate knowledge, eight out of 10 had attitudes of acceptance about contraception, and both were associated with having received sex education. Nevertheless, different types of barriers to sexual education were identified at home and in schools. The results will allow the generation of educational policies that modify the educational model as well as new strategies by health professionals to raise awareness about responsible sexuality.

Funding

This project was financed by internal research of the Fundación Universitaria de Ciencias de la Salud-FUCS (DI-I-0392-20).

Adolescents' Perceptions of Sexuality: A Qualitative Study

Adolescents have a greater risk of acquiring sexually transmitted infections (STIs), which is a serious public health problem. Education is an effective strategy to improve adolescent sexual health outcomes. However, Spanish adolescents have a lack of sex education. The aim of this study was to explore the perceptions and opinions of a sample of adolescents regarding sexually transmitted infections (STIs). Photovoice is a research method that uses the search for images of everyday events with the intention of bringing about social change. An exploratory, descriptive design was used with a qualitative approach based on the Photovoice methodology. The sample consisted of 26 high school and baccalaureate students of Almería (Spain) selected through a convenience sample. The age of the participants ranged from 14 to 17 years, with a mean age of 15.31 years. Two main categories were extracted from the data analysis: 'Towards a culture of preventing STIs and promoting healthy sexual practices' and 'Adolescents' needs from their perspective'. In conclusion, numerous changes take place at the biopsychosocial level during adolescence that imply a need to explore their sexuality in depth. A lack of knowledge and a carefree attitude during sexual initiation can increase the risk of developing STIs. The study's adolescents stated that they do not have adequate sex education to acquire sufficient knowledge about sexuality and sexual health, and therefore, request that the traditional format be modified in order to achieve better results.

Public Awareness About Sexually Transmitted Diseases in Taif, Saudi Arabia

INTRODUCTION

Islamic culture does not tolerate homosexuality and extramarital sex. This may result in ignorance of safe sex practices and a lack of proper public health education by the authorities and parents; this includes knowledge and awareness about sexually transmitted diseases (STDs), modes of transmission, protection methods, and sources of information about STDs.

METHODS

This is a cross-sectional study, a Quick Response (QR)-code-based survey. A standard web-based questionnaire was electronically delivered to our enlisted sample. The statistical analysis started by transferring data from the Excel spreadsheet (Microsoft Corporation, Redmond, Washington, United States) to the SPSS software program. We used one-way ANOVA to compare mean scores between the various groups. And we used the Pearson correlation coefficient to assess the association of age with the score. Significance was established at a p-value of 0.05 or less with a 95% confidence interval. All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States).

RESULTS

The study analysed the sociodemographic characteristics and STD knowledge of 608 participants. Findings revealed a balanced gender distribution, 52.8% male and 47.2% female, the majority being single (72.0%) and with a university education (72.0%). Knowledge gaps were identified, such as confusion between genital herpes and HIV, limited understanding of chlamydia transmission, and misconceptions about human papillomavirus (HPV) and HIV. No significant differences were found based on sex, age, marital status, or father's education. However, higher education of mother correlated with significantly higher knowledge scores (p < 0.0001).

CONCLUSION

This study shed light on the limited knowledge and misconceptions surrounding STDs in Taif city. The findings highlighted knowledge gaps, including confusion between different STDs and misconceptions about transmission modes. The results revealed a positive correlation between higher maternal education and increased knowledge scores. These findings underscore the urgency for health authorities to develop awareness campaigns and educational initiatives to promote accurate information and foster healthier attitudes toward sexual activity in these regions.

Effect of a board game on imprisoned women's knowledge about sexually transmitted infections: a quasi-experimental study

INTRODUCTION

Board games can be used as a playful educational practice in the teaching and learning process, as they constitute an educational technology that can be a source of health knowledge and an aid in decision-making. The objective of this research was to assess the effect of a board game on imprisoned women's knowledge about STIs.

METHODS

A quasi-experimental study was conducted in 2022 with 64 imprisoned women who were students at a school located in a prison unit from the city of Recife, state of Pernambuco, Brazil. A 32-item instrument was used to assess knowledge about sexually transmitted infections before, immediately after the intervention and at 15 days. The intervention consisted in applying the Previna board game in a classroom. All the analyses were performed in the Stata software, version 16.0, with a 5% significance level.

RESULTS

The knowledge mean in the pre-test was 23.62 (± 3.23) points, whereas it rose to 27.93 (± 2,28) in the immediate post-test, dropping to 27.34 (± 2.37) (p < 0.001) in post-test 2, which was performed 15 days after the intervention. There was a statistically significant difference in the means obtained between the pre-test and the immediate post-test (p < 0.001), with a difference of 4.241 points, as well as between the pre-test and post-test 2 (p < 0.001), a difference of 3.846 spots.

CONCLUSIONS

The Previna board game significantly increased its players' knowledge about STIs, and such increase in knowledge remained significant during the follow-up period.

Adolescent Girls and Young Women in Kenya Demonstrate Rapid STI Incidence Following First Sex: Data From a Longitudinal Cohort

PURPOSE

Adolescent girls and young women (AGYW) are disproportionately affected by STIs. Observation of life course events can describe behavioral and biological factors associated with STI risk.

METHODS

Sexually inexperienced AGYW aged 16-20 years in Kenya were followed for five years. Quarterly visits assessed for C. trachomatis (CT), N. gonorrhea (GC), and T. vaginalis (TV), bacterial vaginosis (BV), HSV-2, and HIV. Sexual activity was self-reported but amended if incongruent with results from STI, pregnancy, or any other testing. Cox regression and Generalized Estimating Equation models were used to determine hazard ratios (HRs) and relative risks (RRs) of STI.

RESULTS

During follow-up, 293 of 400 participants reported sex, 163 AGYW experienced an STI, and 72 participants had multiple STIs. Among 163 participants that experienced an STI, there were a total of 259 visits where STIs were detected, 78% (n = 201) of which included CT. Cox regression found participants with BV had over two-fold higher risk of first STI acquisition (adjusted hazard ratio (aHR): 2.35; 95% confidence interval (CI) 1.43-3.88; p = .001). Increased risk for first STI episode was associated with a new partner (aHR: 3.16; 95% CI 1.59-6.28; p = .001). AGYW who did not disclose sexual activity had the highest risk (aHR: 3.60; 95% CI 1.93-6.70; p < .001). Condom use was low, with 21% reporting condom use with sex. GEE analysis of all STIs including incident, prevalent, and recurrent, confirmed these risk factors.

DISCUSSION

During the critical years after first sex, AGYW with BV, new sexual partners, and those who did not disclose sexual activity were at highest risk for STI events, especially CT.

Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014-2016

Background

Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear.

Objectives

To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania.

Methods

Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014–2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15–19 years, compared to mothers aged 20–29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival.

Results

About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20–29 years-old-mothers, HR 1.80 (95% CI 1.22–2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62–10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers.

Conclusion

Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents’ obstetric care conducted by only skilled personnel should be introduced and implemented.

Adolescents’ World: Know One Tell One against Unsafe Sexual Behaviours, Teenage Pregnancies and Sexually Transmitted Infections Including Chlamydia

Addressing adolescents’ sexual and reproductive health (SRH) matters using multidisciplinary pedagogical innovations may assure the proper development and well-being of adolescents so that they reach the adulthood stage healthy and strong enough to produce for their future investment. This is in response to sustainable development goal number 3, target 3.7, and SDG4, target 4.7 in particular emphasizes the universal availability and accessibility of sexual information and education among people and knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030, respectively. Yet, the innovative strategies may respond to a call stated by SGD5 (gender equality), target 5.3 which advocates the elimination of child, early, and forced marriages, and target 5.6 which focuses on ensuring universal access to SRH and rights to all by 2030.

Advancing sexual and reproductive health outcomes in rural schools with the use of a sexuality education enhancement model: learners' perspectives

Despite evidence-based proof that sexuality education enhances school-going adolescents' sexual and reproductive health, the high number of teenage pregnancies and sexually transmitted infections, including HIV, among young people in the rural areas of South Africa suggests that the school-based sexuality education programme in the rural areas might have less influence on learners due to various contextual factors in these settings. This phenomenological study used nine focus group interviews to explore the experiences of 84 school-going adolescents regarding sexuality education offered in their schools, located in the rural areas of the King Cetshwayo District, in Kwazulu-Natal, South Africa. The participants were purposively sampled and the transcribed data from the interviews were thematically analysed. The study revealed that the sexuality information provided to learners did not improve their motivation or encourage behaviour to act on the information provided. Additionally, the results highlighted environmental factors in the research setting that influenced the effectiveness of the sexuality education programme. To enhance its effectiveness, a sexuality education enhancement model was developed using elements of the systems theory and modified information-motivation-behavioural skills model. The model identifies the input resources needed to address issues of information, motivation and skills as well as the influencing environmental factors.

The perception of parents of high school students about adolescent sexual and reproductive needs in Nigeria: A qualitative study

Objectives

Despite the fact that quality and effective services are provided to meet adolescents’ needs, the perceptions of parents regarding the delivery of these services must be taken into consideration. This aim of this study was to explore the perceptions of parents of High school students on the sexual and reproductive needs of adolescents.

Study design

The study employed an exploratory research design using a qualitative approach.

Methods

Participants were selected using purposive sampling technique and a total number of 30 participants were recruited in two States in Nigeria. Data collection was done by means of audio-recorded, semi-structured interviews and data were analyzed using content analysis approach. Descriptive statistics were used to generate participants’ demographic profiles.

Results

Almost all (28 of 30) of the participants had a basic understanding of the sexual and reproductive health needs of adolescents. Majority (90%) stated that parents have a major role to play in counseling and educating their children on sexual and reproductive health issues and others felt is a joint responsibility of teachers and parents. Furthermore, majority (20 of 30) of the participants are not aware of youth friendly services in their communities. However, most of the parents preferred sex education and counseling services for the adolescents above other youth friendly services, as only a few of the participants were in support of distribution of condoms and contraceptives in schools.

Conclusion

The participants reported that youth friendly health care services are very effective in improving young people’s health, thus they are in support of their implementation.

Parent-adolescent communication on adolescent sexual and reproductive health in sub-Saharan Africa: a qualitative review and thematic synthesis

Background

Improving adolescent sexual and reproductive health continues to be a global public health need. Effective parent–adolescent communication on sexual health issues has been cited as a factor that could influence adolescents towards adopting safer sexual behaviour. The current review synthesises qualitative literature to understand the nature and relevance of parent–adolescent sexual and reproductive health communication and the barriers to effective communication in sub-Saharan Africa.

Methods

We systematically searched and synthesised qualitative literature published between 1st January 1990 to December 2019 and searched from CINAHL, PsycINFO, MEDLINE, Global Health, EMBASE, PubMed, and Google Scholar. We assessed the methodological quality of included studies using the Critical Appraisal Skills Programme (CASP) checklist. We thematically analysed qualitative data from the included primary studies.

Results

Fifteen studies were included. Social and physiological events act as triggers for initiating discussions. Fear of personal, social, and economic consequences of high-risk sexual behaviours act as drivers for communication but also carry a negative framing which hinders open discussion. Lack of parental self-efficacy and cultural and religious norms create an uncomfortable environment leaving peers, media, teachers, and siblings as important and sometimes preferred sources of sexual health information.

Conclusions

While mothers recognise their own role in adolescent sexual and reproductive health and school-based interventions can act as useful prompts for initiating discussion, fathers are mainly absent from home-based dialogue. Fear dominates the narrative, and the needs of adolescents remain unarticulated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01246-0.

Improving adolescent sexual and reproductive health remains an important public health need globally. Effective communication on sexual health issues between adolescents and their parents has been recognised to influence safer sexual behaviour among adolescents. This review combined qualitative evidence to understand the nature of, and barriers to communication about sex between parents and adolescents in sub-Saharan Africa.

We searched academic databases for relevant articles published between January 1990 and December 2019 and found 15 studies of appropriate quality. Data on parents and adolescents’ experiences of sex communication in these studies was synthesised. Drivers for sex communication including fear of personal and economic consequences were highlighted. Results also identified barriers to communication such as cultural and religious norms and lack of parental knowledge and skills.

Findings showed that adolescents sometimes prefer other sources of sexual health information like peers, media, and siblings. Mothers are recognised to be more involved with home-based interactions on sexual health with adolescents compared to fathers. The results of this review point to the necessity for adolescents’ needs to be understood and articulated towards influencing policy and programmes.

Adolescents in sub-Saharan Africa remain at high risk for sexually transmitted infections, female genital mutilation, and early pregnancy.

Adolescents mostly view sex-related discussions with parents as uncomfortable, and interactions are driven by fear of personal, social, and economic consequences of sexual risk-taking behaviour.

Parents recognise their lack of capacity to engage with adolescents and are influenced by cultural norms and religious beliefs.

Future research needs to address the current imbalance of adult versus adolescent voices in published work and also ensure a creation of space for conversations about sexuality with sexual and gender minority youth in the Lesbian, Gay, Bi-sexual, Transgender, Queer, Intersex, and Asexual communities.

Addressing Learner-Centred Barriers to Sexuality Education in Rural Areas of South Africa: Learners' Perspectives on Promoting Sexual Health Outcomes

INTRODUCTION

The school-based sexuality education programmes in South Africa aim to improve the sexual and reproductive health of school-going adolescents. However, the high rate of unplanned pregnancy and sexually transmitted infections among learners in some schools in rural areas of King Cetshwayo district suggests that the programmes in these schools might not be effective due to certain learner-centred factors.

METHOD

This qualitative study explored lived experiences of 84 learners from nine public schools in 2020 through focus group interviews. Data was analysed using Interpretative Phenomenological Analysis.

RESULTS

Learner-centred barriers to effective school-based sexuality education identified in this study were attitudes, age disparity, psychological status, peer pressure, socio-economic status, the exploratory attitude of learners, media, lack of role models, previous experiences, socio-economic status, and lack of parental love. These factors could reduce good sexual health. Learner-targeted interventions such as campaigns, using guest professionals, condom distribution, videos, on-site family planning, formal demonstrations, and on-site counselling could address these barriers.

CONCLUSIONS

Addressing these barriers and implementing the proposed interventions will enhance school-based sexuality education and consequently improve adolescents' sexual health.

POLICY IMPLICATIONS

The findings could guide programming, implementation, and delivery of school-based sexuality education leading to improved adolescents' sexual and reproductive health.

What do service providers in Southern Ethiopia say about barriers to using youth-friendly sexual and reproductive health services for adolescents?: Qualitative study

Background

In Ethiopia, the utilization coverage of adolescent-friendly health services (AFSRHs) ranged only from 9 to 55% and it was the lowest of all Sub-Saharan African countries in 2016. Little is known why adolescents were not accessing the existing services to the side of healthcare providers.

Objective

The aim of this study is to explore contextual perceived and actual barriers to accessing AFSRHs by adolescents in Southern Ethiopia.

Methods

Phenomenological study design supplemented with observation was used to explore perceived and actual barriers to accessing AFSRHs in 2020. Criterion sampling was used to select study participants. In-depth interviews with healthcare providers and non-specialist sexual and reproductive healthcare providers were conducted. Transcribed interviews and observations were imported to Open Code 4.02 for coding, categorizing, and creating themes. Finally, barriers to accessing existing services were explained using thematic analysis.

Results

The study explores contextual barriers to accessing sexual and reproductive health services in five emergent themes. According to providers’ points of view, the barriers include ranging from providers (e.g. poor providers’ competency), health facilities (e.g. supply constraints and unsupportive environment), adolescents (e.g. perceived lack of information and attitude towards SRHs), community (e.g. lack of parental and social support), and broader health system (e.g. poor implementation and multi-sectorial engagement).

Conclusion

As to providers, adolescents face multiple barriers to accessing youth friendly sexual and reproductive health services. Healthcare facilities and all levels of the healthcare system should implement varieties of approaches to increase access to the services for adolescents. Given the lack of progress in utilization of adolescents- youth friendly sexual and reproductive services, the existing strategy should be re-evaluated and new interventions at all levels of the healthcare system are needed. Moreover, implementation research is required at system level factors.

Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: a qualitative study

Background

Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya.

Methods

Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and postpartum) as well as male adult community members. A thematic content analytic approach was used.

Results

There were a total of 47 FGD respondents, including 15 (32%) females with a median (interquartile, IQR) age of 38 (27–55) years and 6 (3–8) children. Majority (40%) reported attaining secondary-level education. All IDI respondents were female with a median (IQR) age of 27 (24–35) years and 4 (2–5) children. Majority (80%) had attained primary-level education. We found that religious and socio-cultural norms as well as gender stereotypes were important influences on the uptake and utilization of maternal health services, including facility-based delivery and contraception. Key amongst this was the unspoken deference to the counsel of a prominent matriarchal figure in the decision-making process.

Conclusions

Among the Digo community of coastal Kenya, a unique social-cultural context comprising of a religious and gendered value belief system influences women’s reproductive health and rights. These findings highlight the important role of demand-side factors in influencing maternal health outcomes. In addition to addressing supply-side factors, programs in such settings should aim to address factors that leverage inherent social capital to drive demand for maternal health services ensuring that they are not only effective, but also responsive to the local context.

The role of trust and health literacy in nurse-delivered point-of-care STI testing for pregnant women living with HIV, Tshwane District, South Africa

Background

Sexually transmitted infections (STIs) during pregnancy result in neonatal morbidity and mortality, and may increase mother-to-child-transmission of HIV. Yet the World Health Organization’s current syndromic management guidelines for STIs leaves most pregnant women undiagnosed and untreated. Point-of-care (POC) diagnostic tests for STIs can drastically improve detection and treatment. Though acceptable and feasible, poor medication adherence and re-infection due to lack of partner treatment threaten the programmatic effectiveness of POC diagnostic programmes.

Methods

To engender patient-provider trust, and improve medication adherence and disclosure of STI status to sexual partners, we trained study nurses in compassionate care, good clinical practices and motivational interviewing. Using qualitative methods, we explored the role patient-provider communications may play in supporting treatment adherence and STI disclosure to sexual partners. Nurses were provided training in motivational interviewing, compassionate care and good clinical practices. Participants were interviewed using a semi-structured protocol, with domains including STI testing experience, patient-provider communication, and HIV and STI disclosure. Interviews were audio-recorded, transcribed and analyzed using a constant comparison approach.

Results

Twenty-eight participants treated for Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and/or Neisseria gonorrhea (NG) were interviewed. Participants described strong communications and trusting relationships with nurses trained in patient-centered care training and implementing POC STI diagnostic testing. However, women described a delayed trust in treatment until their symptoms resolved. Women expressed a limited recall of their exact diagnosis, which impacted their ability to fully disclose their STI status to sexual partners.

Conclusions

We recommend implementing patient health literacy programmes as part of POC services to support women in remembering and disclosing their specific STI diagnosis to sexual partners, which may facilitate partner treatment uptake and thus decrease the risk of re-infection.

Factors influencing access of HIV and sexual and reproductive health services among adolescent key populations in Kenya

OBJECTIVES

The objective of this study is to identify enablers and barriers in access of HIV and sexual reproductive health (SRH) services among adolescent key populations (KP) in Kenya.

METHODS

A cross-sectional study using qualitative methods was conducted between October 2015 and April 2016. A total of 9 focus group discussions and 18 in-depth interviews were conducted with 108 adolescent KPs in Mombasa, Kisumu and Nairobi Counties of Kenya. Data were recorded digitally, translated, transcribed and coded in NVivo10 prior to analysis.

RESULTS

Adolescent KPs preferred to access services in private health due to increased confidentiality, limited stigma and discrimination, access to adequate amount of condoms, friendly and fast-tracked services. Negative health provider attitudes made adolescent KPs dislike accessing health care in public health facilities. There was a lack of adolescent key population's policies and guidelines on HIV and SRH.

CONCLUSIONS

The study has demonstrated existing enablers and barriers to provision of HIV/SRH services for an at-risk population for which limited data exist. The results provide a basis for program redesign involving the adolescent KPs to minimize barriers for access to HIV/SRH services.

Perceptions and intervention preferences of Moroccan adolescents, parents, and teachers regarding risks and protective factors for risky sexual behaviors leading to sexually transmitted infections in adolescents: qualitative findings

BACKGROUND

Sexual choices and practices of adolescents living in conservative societies, including Morocco, can be influenced either positively or negatively by the prevailing contextual and social norms. These norms not only limit the access to reproductive health information and services but also lead to abstinence among devout adolescents. Thus, identifying contextual risks and protective factors of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents, as well as exploring perceptions of adolescents, parents and teachers regarding effective intervention preferences could improve the sexual health of adolescents.

METHODS

We conducted a qualitative study using focus group discussions (FGDs) based on the socio-ecological model as a theoretical framework. Sample groups of adolescents, parents, and teachers were selected from two public middle schools (disadvantaged and advantaged according to socio-economic level) in Taza city, Morocco, from May to July 2016. Participants were polled on protective factors and perceived facilitators of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents as well on their perception of intervention preferences to reduce the risks. Three sets of data were initially formed, coded, and analyzed using thematic analysis.

RESULTS

Seventeen FGDs were conducted, including 8 groups of adolescents (28 boys and 28 girls, 14-16 years old), 5 groups of parents (21 males and 5 females), and 4 groups of teachers (13 males and 5 females). Five overall themes seemed to influence risky sexual behaviors in adolescents: (1) risky sexual practices and STIs; (2) the adolescent's social domain; (3) the role of school; (4) media, including internet and social media; and (5) socio-cultural norms. Participants also suggested a number of possible interventions to improve the sexual health of adolescents and to reduce the risk of STIs, which could be applied at multiple levels.

CONCLUSIONS

Successful intervention programs should target the multifaceted factors affecting the adolescent's sexual behaviors, from the individual to the societal level. Allowing parents, teachers, and adolescents to work together could help reduce the socio-cultural and personal barriers that prevent effective communication about sexuality. Furthermore, schools can play a vital role in reducing risky sexual behaviors and STI acquisition rates in adolescents by promoting sex education in school curriculum and encouraging adolescents to engage in extracurricular activities and awareness campaigns.

Factors related to healthy sexual and contraceptive behaviors in undergraduate students at university of Seville: a cross- sectional study

Background

Young people are a group of population with sexual risk-taking behaviors. Despite efforts to inform them it is common for them to adopt risk conducts during their stay at University. The aim of this research was to assess knowledge, attitudes and experiences on sexual health and contraceptives and factors related to risk behaviors in university students.

Methods

A cross- sectional analytical study was carried out from February to April 2014 among undergraduate students at University of Seville. A self-administered questionnaire was filled in by participants. Data analysis was performed using SPSS V22. Descriptive statistics were used to show data. A P-value of 5% (two-tailed) was considered statistically significant.

Results

A total of 566 students responded to the questionnaire. 47.3% (267) were male and 52.6% (297) female. About sexual behavior: 93.3% of participants were sexually active last year. 58.3% had had sex under alcohol effect and 18% under drugs effect. About contraceptive behavior: 86.9% used a contraceptive method during their first sexual relation, the male condom being the most used (90.6%). Currently, the most used contraceptives are the male condom, and hormonal pills. The participants’ answers about their knowledge on contraceptives and STIs (sexual transmission infections) showed weaknesses. Participants who had received sexual and contraceptive education showed more knowledge (p < 0.001). We did not find differences about knowledge on contraceptives and STIs by age (p = 0.056). Level of knowledge is less in young people who use coitus interruptus or none as a contraceptive method (p < 0.001). We observed differences by frequency of sex since young people who had sex more frequently showed more knowledge about contraceptives and STI (p < 0.001). There are more women that had a partner than men (p = 0.003) and their attitudes and experiences on sex are healthier. Females showed more knowledge about management of hormonal contraceptives and medical controls (p < 0.001).

Conclusion

Factors that contribute to having a healthier behavior on sexuality and contraception are age, gender and background in health issues, showing greater knowledge and less risky behavior. Programing reproductive health programs at university should be continued.