Sexual wellbeing in early adolescence: a cross-sectional assessment among girls and boys in urban Indonesia

Risk and Protective Factors for the Sexual and Reproductive Health of Young Adolescents: Lessons Learnt in the Past Decade and Research Priorities Moving Forward

PURPOSE

To review the published literature on what has been reported on risk and protective factors for early adolescent sexual and reproductive health (SRH) in the recent decade.

METHODS

A scoping review of English language, peer-reviewed literature on risk and protective factors for early adolescent (aged 10-14 years) SRH published between January 2010 and January 2023 using Medline, Web of Science, PsycInfo, CINAHL, and Google Scholar. Articles reporting only on nonmodifiable demographic factors, or on the effect of interventions, were beyond the scope of this review.

RESULTS

Of 11,956 screened records, 118 were included of which half (49.2%) were published since 2018. Most articles (44.9%) presented research conducted in North America, followed by sub-Saharan Africa (20.3%) and East Asia and Pacific (16.1%). Five percent were based on multicountry studies or reported on pooled global data. Two-thirds (61.0%) reported on quantitative cross-sectional research designs, and 78.8% included both females and males. The most common SRH outcomes were sexual behaviors (34.7%); sexual and dating violence (28.8%); and sexual attitudes, beliefs, and intentions (19.5%). Most (83.0%) articles reported on risk/protective factors at the individual level, followed by interpersonal (family 58.5%, peers 33.0%, partners 11.9%), school (21.2%), and community (15.2%) factors. None of the included articles reported on macro/structural-level factors.

DISCUSSION

While there has been growing attention to risk/protective factors for early adolescent SRH, gaps remain with regards to study contexts (mainly North America), focus (mostly individual factors), and conceptualizations (generally risk-oriented). We offer recommendations for research priorities over the coming decade.

Using the behaviour change wheel to examine facilitators and barriers to assertive contraception-use conversations for Indonesian women

Contraception-use communication between sexual partners is important to reduce unwanted pregnancies and protect sexual and reproductive health. There is a dearth of research focused on developing countries where sexual and reproductive health conversations are often considered taboo. Using the Behaviour Change Wheel, this qualitative study examines the facilitators and barriers to having assertive contraception-use conversations with a male partner for Indonesian women and then identifies behaviour change techniques as potential intervention strategies. Semi-structured interviews were conducted with ten Indonesian women aged 18 to 29 years who had been sexually active and were currently in a committed dating relationship with a male partner. Using thematic analysis, 13 themes were identified. Facilitators of assertive contraception-use communication include knowledge about sexual and reproductive health and contraception, communication skills, closeness of the relationship with one's partner, other people's experiences of sex and contraception, and social media norms concerning the open discussion of sex and contraception. Fear of initiating the conversation about contraception was a barrier. Partner's attitude towards having contraception-use conversations and the taboos surrounding contraception in Indonesian culture acted as both facilitators and barriers. Suggested strategies to promote contraception-use communication include using social media to break the stigma surrounding sexual and reproductive health matters, normalising assertive conversations about contraceptive use with sexual partners, empowering women to be more assertive about their preferences for contraception, and teaching strategies to promote assertive contraception-use communication among young women and men in Indonesia.

Effect evaluation of a comprehensive sexuality education intervention based on socio-emotional learning among adolescents in Jakarta, Indonesia

Introduction

The field of comprehensive sexuality education (CSE) has switched from a focus on adolescents’ health to a more holistic approach, embracing the concept of sexual development with the aim of improving adolescents’ sexual well-being. The growing interest in the link between CSE and socio-emotional learning (SEL) competencies led to the development of the Journey4Life (J4L), a comprehensive sexuality education curriculum based on socio-emotional learning. In the current research, we evaluate the effectiveness of this program on perceived behavioral control, gender equality attitudes, norms, and intentions related to sexual and reproductive health and rights.

Methods

To this end, we conducted a Cluster Randomized Trial among 14 senior secondary schools in Jakarta, Indonesia. A questionnaire was administered before and after implementation of the J4L program among 16–17 year old pupils; n = 906 completed baseline measurement, n = 771 completed endline measurement. With a final matched sample of N = 466 (65.5% girls) we conducted a mixed model repeated measures ANOVA.

Results

Unfortunately, only limited and inconsistent results were found. We found that at endline, girls had stronger positive gender equality attitudes than boys; that overall attitudes towards reporting sexual violence were stronger for girls than for boys. However, contrary to our expectations, respondents had more positive attitudes toward child marriage at baseline than at endline.

Discussion

Inconsistency and non-statistical significance of results limit our ability to draw firm conclusions about the effectiveness of the Journey4Life. We discuss how complex comprehensive sexuality education interventions could best be evaluated, since our study highlights the need for better conceptualization, operationalization and measurement of the interconnection between comprehensive sexuality education and socio-emotional learning.

Promoting sexual health in schools: a systematic review of the European evidence

Introduction

Sexual ill-health is an urgent public health issue with subsequent social and economic costs. There is, therefore, a need for more effective sexual health promotion interventions in an early stage of life. Previous research has focused on preventive sexual health interventions applying a risk perspective, and the limited and scattered evidence concerning school-based sexual health promotion interventions employing a health-resource perspective has not been compiled and synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in schools in Europe.

Method

A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and included information on study characteristics, intervention content, methods, and outcomes relevant to the current review. A narrative synthesis of the included studies was performed, highlighting the collective results.

Result

Seventeen records were included in the review, reporting on 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All three studies with a qualitative research design described positive effects experienced by the participants. Six of thirteen quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. The outcomes of interest were grouped into five areas, and most studies focused on the area of attitudes toward sexual health.

Conclusion

The findings indicate promising evidence of effect for interventions with a health promotion approach, highlighting the importance of strengthening sexual health resources related to respect, communication skills, attitudes, and other positive psycho-social aspects of sexual health. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas a comprehensive focus on the multi-dimensional sexual health literacy concept is less common and can be recommended to be included in future intervention research.

Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study

PURPOSE

To evaluate the effects of a comprehensive sexuality education (CSE) intervention on short-term psychosocial outcomes related to healthy sexuality among very young adolescents in urban Indonesia.

METHODS

A quasi-experimental study was conducted between 2018 and 2021 with students aged 10-14 years at 18 schools in Indonesia (Lampung, Denpasar, Semarang). Three schools per site were purposefully selected to receive the SEmangaT duniA RemajA intervention, a two-year, rights-based teacher-led CSE intervention delivered in classrooms (or online after the 2020 COVID-19 outbreak); and matched with three control schools. Surveys were completed by 3,825 students at pre- and posttest (82% retention). The final analytical sample included 1852 intervention and 1483 control students (N = 3,335). Difference-in-difference analysis was conducted to examine the intervention effect on healthy sexuality competencies (knowledge, skills, and attitudes) and personal sexual well-being.

RESULTS

Baseline characteristics for intervention and control groups were similar in terms of sex (57% female) and age (mean 12 years). Students receiving SEmangaT duniA RemajA demonstrated significantly greater increase in competencies, including greater pregnancy knowledge, more gender equal attitudes, and communication about sexual and reproductive health and rights, compared to controls. There was no intervention effect on personal sexual well-being, except for self-efficacy to prevent pregnancy. Subgroup analysis indicated more significant effects among females and students in Semarang and Denpasar, than males or students in Lampung.

DISCUSSION

While findings demonstrate the potential for CSE programs to improve healthy sexuality competencies in early adolescence, the effect appears to be highly contextualized which may be due to varying levels of implementation quality, especially since the COVID-19 outbreak.

"Such conversations are not had in the families": a qualitative study of the determinants of young adolescents' access to sexual and reproductive health and rights information in Rwanda

Background

Access to sexual and reproductive health and rights (SRHR) information during adolescence has become a global concern. This study explored factors that enable or prevent young adolescents from accessing to SRHR information from the perspective of the key informants in Rwanda.

Methods

We conducted a qualitative study using semi-structured interviews with 16 purposively selected key informants from public and private institutions in Rwanda. This selection was based on their positions and expertise in delivering SRHR information to adolescents. The interview guide questions were designed based on the social-ecological theoretical framework of adolescent health. The interview transcripts were recorded, transcribed, translated and thematically analysed in Nvivo 11.

Results

The study reflected that multiple enablers and barriers at the individual, relationship, community and societal levels determined young adolescents’ access to SRHR information. These determinants include information-seeking behaviour and age of starting sexuality education at the individual level; and parents’ limited communication with young adolescents due to taboos, lack of skills, limited parental availability, beliefs, lack of appropriate language and peer norms at the relationships level. Enablers and barriers at the community level were the diversity of SRHR sources, the scope of sexuality education programmes, and cultural and religious beliefs. Finally, the perceived enablers and barriers at the societal level consisted of inadequate resources, inappropriate SRHR policy-making processes and unfriendly SRHR laws.

Conclusion

Enabling access to SRHR information requires addressing multiple factors within the social-ecological environment of young adolescents. Addressing these factors may facilitate improved access to SRHR information for this age group.

Healthy sexuality development in adolescence: proposing a competency-based framework to inform programmes and research

Positive aspects of sexuality remain understudied among young people globally, and consensus is lacking on how to conceptualise different aspects of healthy adolescent sexuality development in order to guide programmes, research, and policy. We propose a conceptual framework that draws on theories and literature related to positive youth development, empowerment, human rights, gender, social-ecological and life-course perspectives. The framework highlights six key competencies for healthy adolescent sexuality development: (1) sexual literacy, (2) gender-equal attitudes, (3) respect for human rights and understanding consent, (4) critical reflection skills, (5) coping skills, and (6) interpersonal skills. These competencies have the potential to strengthen or impede adolescents’ sense of sexual wellbeing in relation to both themselves (e.g. body image, self-efficacy) and others (e.g. mutually respectful relationships). Whether adolescents are able to translate competencies into desired actions and achieve a sense of sexual wellbeing depends on the resources available to them, their agency, and on the influence of social-ecological opportunity structures. The framework can provide concrete direction for sexual and reproductive health practitioners and researchers by providing a platform for recognising and operationalising indicators of healthy sexuality development, and serve as a Theory of Change for programmes aiming to improve adolescent sexual and reproductive health and wellbeing. Our assets-based, life-course approach can also be used to make the case to donors and policymakers for why early investments and positive approaches to adolescent sexuality are needed to achieve sexual wellbeing over time.

Promoting gender equity in very young adolescents: targeting a window of opportunity for social emotional learning and identity development

Background

The transition from childhood to adolescence is a uniquely sensitive period for social and emotional learning in the trajectory of human development. This transition is characterized by rapid physical growth, sexual maturation, cognitive and behavioral changes and dynamic changes in social relationships. This pivotal transition provides a window of opportunity for social emotional learning that can shape early adolescent identity formation and gender norms, beliefs and behaviors. The objective of this study is to evaluate the potential of a social emotional learning intervention for very young adolescents (VYAs) to improve social emotional mindsets and skills.

Methods

Discover Learning is a social emotional learning intervention designed for VYAs (10-11 years of age) to support development of social emotional mindsets and skills from four primary schools in Dar es Salaam, Tanzania. The intervention delivered three different packages of learning experiences to three arms of the study. 528 VYAs were randomized to each of the three study arms (A-Content learning, B-Content learning and reflection, and C-Content learning, reflection and experiential practice). A quantitative survey was administered to all participants before and after the intervention to capture changes in social emotional mindsets and skills. A discrete choice experiment measured changes in gender norms, beliefs and behaviors.

Results

528 VYAs were included in the analysis. Participants in all three arms of the study demonstrated significant improvements in social emotional mindsets and skills outcomes (generosity, curiosity, growth mindset, persistence, purpose and teamwork). However, Group C (who received experiential social learning opportunities in small, mixed-gender groups and a parent and community learning components demonstrated larger treatment effects on key outcomes in comparison to Groups A and B. Results indicate Group C participants had greater change in gender equity outcomes (OR = 1.69, p = <0.001) compared to Group A (OR = 1.30, p = <0.001) and Group B (OR = 1.23, p = 0.004).

Conclusion

These findings provide evidence that social emotional learning interventions targeting VYAs can improve social emotional mindsets and skills and gender equity outcomes. The findings indicate the importance of experiential learning activities in mixed-gender groups during the unique developmental window of early adolescence. The study also provides support for the inclusion of parental/caregiver and community engagement in programs designed for VYAs.

Trial registration

Retrospectively registered on July 7^th, 2020. NCT0445807

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12278-3.