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Wang K, Xu SS, Liu Z, Wang W, Hee J, Tang K. A quasi-experimental study on the effectiveness of a standardized comprehensive sexuality education curriculum for primary school students. J Adolesc 2023; 95:1666-1677. [PMID: 37642372 DOI: 10.1002/jad.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Although the importance of sexuality education has been recognized, Chinese rural students have limited access to sexual and reproductive information. This study aims to evaluate the effectiveness of a standardized comprehensive sexuality education curriculum package featuring cartoon animation on sexuality-related knowledge and skills, attitudes, and practices of primary school students. METHODS This quasi-experimental study recruited 1725 students in grades 4-6 (aged 9-13) from eight primary schools sampled as school clusters in 2020 in China. Internet-based questionnaires from three intervention schools' participants were collected after trained schoolteachers had conducted six 45-min sexuality education sessions. We performed optimal full matching and treatment effects were estimated in the matched sample by outcome regression models that further adjusted the covariates. RESULTS Compared with the control group, intervention group students achieved significantly higher scores by 3.35 out of 38 and 2.02 out of 34 in knowledge- and skill-based tests and attitudinal tests, respectively. For the five self-reported practices on genital care, the experimental group showed significantly better performance than the control group in genital hygiene, by 6.92%, 22.45%, and 30.66% higher rates in the overall prevalence of three proper practices of genital hygiene, with effect sizes larger for boys than girls. CONCLUSIONS Our sexuality education package effectively improved primary school students' sexuality-related knowledge, skills, attitudes, and hygiene practices. Our study suggests that the standardized curriculum package could be a promising approach to improving the quality and accessibility of sexuality education in underdeveloped rural China.
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Affiliation(s)
- Kai Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Shebe Siwei Xu
- Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, China
| | - Zongchao Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wen Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jiayi Hee
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Evidence for a Comprehensive Sexuality Education Intervention that Enhances Chinese Adolescents’ Sexual Knowledge and Gender Awareness and Empowers Young Women. SEX ROLES 2021. [DOI: 10.1007/s11199-021-01223-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zizza A, Guido M, Recchia V, Grima P, Banchelli F, Tinelli A. Knowledge, Information Needs and Risk Perception about HIV and Sexually Transmitted Diseases after an Education Intervention on Italian High School and University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042069. [PMID: 33672540 PMCID: PMC7923805 DOI: 10.3390/ijerph18042069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
Sexually transmitted diseases (STDs) among adolescents and young people represent a significant public health problem that generates a pressing requirement of effective evidence-based education to promote primary and secondary prevention. The objective of the study is to evaluate how knowledge, information needs, and risk perception about HIV and STDs can change after targeted education interventions for students. A total of 436 subjects aged 15-24 attending high school (134 biomedical and 96 non-biomedical fields) and university courses (104 scientific and 102 non-scientific disciplines) were enrolled to respond to a questionnaire before and after the intervention. An improvement in knowledge was found in all groups, with statistically significant knowledge score differences between the four groups in 60% of the items. More than 94% of the students consider it useful to promote information on these issues. Receiving this information generated awareness and safety in more than 85% of high-school students and 93% of University students. Students widely perceived a great risk being infected with HIV/STDs, although pregnancy was seen as a more hazardous consequence of unprotected sex. This study shows that educational interventions are effective in improving knowledge, apart from findings about key knowledge topics, information needs, and risk perception, which provide significant insights to design future targeted education programs.
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Affiliation(s)
- Antonella Zizza
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy; (A.Z.); (V.R.)
| | - Marcello Guido
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy;
| | - Virginia Recchia
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy; (A.Z.); (V.R.)
| | - Pierfrancesco Grima
- Infectious Diseases Operative Unit, Vito Fazzi Hospital, 73100 Lecce, Italy;
| | - Federico Banchelli
- Department of Medical and Surgical Science, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, “Veris delli Ponti” Hospital, Scorrano, 73020 Lecce, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, 73100 Lecce, Italy
- Correspondence: ; Tel.: +39-339-2074078
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Sun WH, Miu HYH, Wong CKH, Tucker JD, Wong WCW. Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries. JOURNAL OF SEX RESEARCH 2018; 55:31-44. [PMID: 27898248 DOI: 10.1080/00224499.2016.1247779] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges' g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges' g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.
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Affiliation(s)
- Wai Han Sun
- a Department of Family Medicine and Primary Care , The University of Hong Kong
| | - Heidi Yin Hai Miu
- a Department of Family Medicine and Primary Care , The University of Hong Kong
| | - Carlos King Ho Wong
- a Department of Family Medicine and Primary Care , The University of Hong Kong
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Fonner VA, Armstrong KS, Kennedy CE, O'Reilly KR, Sweat MD. School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis. PLoS One 2014; 9:e89692. [PMID: 24594648 PMCID: PMC3942389 DOI: 10.1371/journal.pone.0089692] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/27/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. METHODS We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. RESULTS Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49-0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14-0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18-1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67-0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54-0.83, p<0.001). CONCLUSIONS The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors.
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Affiliation(s)
- Virginia A. Fonner
- Johns Hopkins Bloomberg School of Public Health, International Health Department, Baltimore, Maryland, United States of America
| | - Kevin S. Armstrong
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, United States of America
| | - Caitlin E. Kennedy
- Johns Hopkins Bloomberg School of Public Health, International Health Department, Baltimore, Maryland, United States of America
| | - Kevin R. O'Reilly
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, United States of America
| | - Michael D. Sweat
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, United States of America
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Xiao Z, Noar SM, Zeng L. Systematic review of HIV prevention interventions in China: a health communication perspective. Int J Public Health 2013; 59:123-42. [PMID: 23604051 DOI: 10.1007/s00038-013-0467-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 02/12/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To examine whether communication strategies and principles have been utilized in the HIV prevention intervention programs conducted in China. METHODS Comprehensive literature searches were conducted using PsycINFO, Medline, and Academic Search Complete with combinations of a number of keywords. Studies were included if they (1) were conducted in China and published prior to October 2011; (2) tested interventions promoting HIV/sexual risk reduction; and (3) reported empirical outcome evaluations on HIV knowledge, condom use and other condom-related variables. Data on 11 dimensions were extracted and analyzed, including formative research, theory, message targeting, messenger and channels, process evaluation, evaluation design, outcome measures. RESULTS The majority of the 45 intervention studies were not theory-based, did not report conducting formative research or process evaluation, used pretest-posttest control group designs, combined nonmedia channels, printed and visual materials, and employed HIV knowledge and condom use as outcome measures. CONCLUSIONS Many HIV prevention interventions in China have been successful in reducing HIV risk-related outcomes. This literature has its weaknesses; however, the current review illuminates gaps in the literature and points to important future directions for research.
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Affiliation(s)
- Zhiwen Xiao
- Valenti School of Communication, University of Houston, 101 Communication Bldg, Houston, TX, 77204-3002, USA,
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Cui Z, Shah S, Yan L, Pan Y, Gao A, Shi X, Wu Y, Dibley MJ. Effect of a school-based peer education intervention on physical activity and sedentary behaviour in Chinese adolescents: a pilot study. BMJ Open 2012; 2:bmjopen-2011-000721. [PMID: 22586284 PMCID: PMC3358620 DOI: 10.1136/bmjopen-2011-000721] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the effect on physical activity and sedentary behaviour of a pilot school-based peer education programme in urban Beijing, China. DESIGN 4 junior high schools were matched by school size and randomised to intervention (n=346) and control group (n=336). INTERVENTION Trained peer leaders from grade 7 by research staff delivered weekly 40-min lessons to their classmates over four consecutive weeks. Students in control schools received no intervention. OUTCOME MEASURES A validated 7-day youth physical activity questionnaire was used to evaluate physical activity and sedentary behaviours at baseline (September 2010), 3 months (December 2010) and 7 months (May 2011). Generalised linear mixed models were applied to evaluate the effect. RESULTS There was a significant decrease in time in sedentary behaviour on weekdays, 20 min/day at 7 months (p=0.020) reported by students in the intervention schools compared with control schools. This reduction was mainly due to a reduction of 14 min/day in computer usage on weekdays (p=0.0009). There were no significant differences in time on other sedentary behaviours, including television and DVD, video game, extracurricular reading, writing, drawing and listening to music, passive commuting and sitting to talk. There was also no significant difference in time in moderate-to-vigorous physical activity between intervention and control group. CONCLUSIONS Peer education appears to be a promising intervention in reducing sedentary behaviours in adolescents in China. These results need confirmation in a larger study. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12612000417886 at http://ANZCTR.org.au.
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Affiliation(s)
- Zhaohui Cui
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Smita Shah
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Primary Health Care Education and Research Unit, Primary Care and Community Health Network, Sydney West Local Health District, Sydney, Australia
| | - Lijing Yan
- The George Institute for Global Health, Beijing, China
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Yongping Pan
- Dongcheng District Institute for Student Healthcare, Beijing, China
| | - Aiyu Gao
- Dongcheng District Institute for Student Healthcare, Beijing, China
| | - Xiaoyan Shi
- Dongcheng District Institute for Student Healthcare, Beijing, China
| | - Yangfeng Wu
- The George Institute for Global Health, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Michael John Dibley
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Mens PF, Scheelbeek PF, Al Atabbi H, Enato EF. Peer education: the effects on knowledge of pregnancy related malaria and preventive practices in women of reproductive age in Edo State, Nigeria. BMC Public Health 2011; 11:610. [PMID: 21801460 PMCID: PMC3162527 DOI: 10.1186/1471-2458-11-610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/01/2011] [Indexed: 11/25/2022] Open
Abstract
Background There is limited uptake of measures to prevent malaria by pregnant women in Nigeria which is often related to the lack of knowledge on Malaria in Pregnancy (MIP) and its effects on mother and foetus. This study, explored peer to peer education as a tool in raising knowledge of MIP among women of child bearing age. Methods 1105 women of child bearing age were interviewed in their households using a structured questionnaire about their knowledge of malaria in general, MIP and use of preventive measures. Thereafter, a peer education campaign was launched to raise the level of knowledge in the community. The interviews were repeated after the campaign and the responses between the pre- and post-intervention were compared. Results In the pre-assessment women on average answered 64.8% of the question on malaria and its possibility to prevent malaria correctly. The peer education campaign had a significant impact in raising the level of knowledge among the women; after the campaign the respondents answered on average 73.8% of the questions correctly. Stratified analysis on pre and post assessment scores for malaria in general (68.8 & 72.9%) and MIP (61.7 & 76.3%) showed also significant increase. Uptake of bed nets was reported to be low: 11.6% Conclusion Peer education led to a significant increase in knowledge of malaria and its prevention but we could not asses its influence on the use of preventive measures.
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Affiliation(s)
- Petra F Mens
- Koninklijk Instituut voor de Tropen (KIT)/Royal Tropical Institute, KIT Biomedical Research, AZ Amsterdam, The Netherlands.
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Xiao Z, Mehrotra P, Zimmerman R. Sexual revolution in China: implications for Chinese women and society. AIDS Care 2011; 23 Suppl 1:105-12. [DOI: 10.1080/09540121.2010.532537] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zhiwen Xiao
- a School of Communication , University of Houston , Houston , MO , USA
| | - Purnima Mehrotra
- b Department of Social and Behavioral Health , Virginia Commonwealth University , Richmond , VA , USA
| | - Rick Zimmerman
- b Department of Social and Behavioral Health , Virginia Commonwealth University , Richmond , VA , USA
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Affiliation(s)
- Chi-Ting Horng
- Department of Ophthalmology, Kaohsiung Armed Forces General Hospital, Kaohsiung
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