Improving Sexual Health Education Programs for Adolescent Students through Game-Based Learning and Gamification

Acceptability of 'Humpr': An Online Tool to Educate Adolescent Sexual Minority Males About Sexual Networking Applications

We examined the acceptability of Humpr - an interactive, online tool developed to educate adolescent sexual minority males (ASMM) about how to safely navigate sexual networking applications (SNA). We developed Humpr as part of a larger HIV intervention trial in the U.S. In Humpr, 218 ASMM aged 14-20 (Mage = 17.18) created a mock dating profile, explored simulated user profiles, learned health-related information (e.g. slang indicating HIV/STI risks and/or drug use intentions), and then gave feedback regarding acceptability of the tool. Results showed that Humpr was very well-received, with 94% overall approval rates. Reasons for liking Humpr were evenly split between liking it for educational and entertaining reasons. Participants praised Humpr for its realistic design and interactive interface that allowed them to engage and connect with the tool. The majority (61%) had used SNAs in the past, but many still reported learning something new from Humpr. Participants also appreciated the acknowledgment of SNA use in ASMM and how the education was implemented in an open and judgment-free way. Topics learned from Humpr included how to be safe on SNAs and warning signs for HIV/STI risks. Suggested areas of improvement included having an opt-out option for those who do not wish to participate for any reason (e.g. discomfort) and additional educational content (e.g. consequences of being a minor on SNAs). Taken together, the findings offer preliminary evidence for the potential educational benefits of digital tools like Humpr for ASMM with and without prior SNA exposure.

Effect of a digital school-based intervention on adolescent family planning and reproductive health in Rwanda: a cluster-randomized trial

We conducted a cluster-randomized hybrid effectiveness-implementation study of CyberRwanda, a digital family planning and reproductive health intervention for Rwandan adolescents. Sixty schools were randomized 1:1:1 to control or to one of two implementation models-self-service (self-guided access on tablets) or facilitated (peer-led clubs plus tablet access) with no masking. Eligible participants were aged 12-19 years, in secondary school levels 1 or 2, and willing to provide consent or assent/parental consent and contact information for follow-up. In 2021, 6,078 randomly selected adolescents were enrolled. At 24 months, 91.3% of participants were retained and included in the primary intention-to-treat analyses (control, n = 1,845; self-service, n = 1,849 and facilitated, n = 1,858). There were no adverse events related to the study. CyberRwanda did not affect the primary outcomes of modern contraceptive use (prevalence ratio (PR) = 1.04; 95% confidence interval (CI) = 0.76, 1.42), childbearing (PR = 1.33; 95% CI = 0.71, 2.50) and HIV testing (PR = 1.00; 95% CI = 0.91, 1.11) in the full sample. Significantly higher modern contraceptive use observed in the CyberRwanda facilitated arm in a prespecified analysis of sexually active participants suggests that longer-term evaluation is needed to examine effects as more of the study population becomes sexually active and has increased demand for contraception. ClinicalTrials.gov registration: NCT04198272 .

Effectiveness of digital interventions to reduce school-age adolescent sexual risks: A systematic review

INTRODUCTION

The increase in risky sexual behaviors among adolescent students has sparked alarm and has become an area of research interest. As adolescents prioritize confidentiality and accessibility, digital interventions are becoming increasingly relevant in sex education. We therefore posed the following research question: Are digital application interventions effective to prevent risky sexual behaviors in school adolescents?

DESIGN

A systematic peer review was conducted between January and December 2023 in five databases (PubMed, Web of Science, Scopus, EMBASE, and PsycINFO) without restricting for language or year of publication.

METHOD

We included randomized control trials or quasi-experimental studies that measured the effectiveness of interventions targeting young people aged 10-19 years or their parents and developed in a school setting. Interventions aimed at young people with intellectual disabilities, learning difficulties, or any disease requiring a specific intervention were excluded.

RESULTS

The search ultimately yielded 27 studies covering a total of 18 digital interventions that demonstrated positive effects, not maintained over time, on knowledge, attitudes, and behaviors, although the latter to a lesser extent.

DISCUSSION

We have found very interesting digital interventions with effects, among others, on knowledge, attitudes, and contraceptive use in adolescents. In general, digital interventions have positive effects on knowledge and attitudes, but it is more difficult to modify behaviors with strictly digital interventions or combined with complementary face-to-face sessions or group class activities.

CONCLUSION

We thus believe that digital interventions are adequate to reduce adolescent sexual risk behaviors, and our systematic review facilitates the implementation of these interventions by sharing existing digital interventions that have had positive effects, as well as the main characteristics a digital intervention should possess to reduce sexually risky behaviors in adolescents.

CLINICAL RELEVANCE

Digital interventions with adolescents improve sexual behaviors and can be a valuable resource in education on this topic due to their accessibility and confidentiality, two key points for young people.

Development and validation of Adolescent Sexual and Reproductive Health - Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ)

OBJECTIVES

The tools to measure knowledge, attitudes, and self-efficacy related to adolescent sexual and reproductive health have been developed, but with adolescent subjects over 15 years old and with specific topics. The needs and focus of SRH education in adolescents are different from those of young adults. This study aimed to develop a valid and reliable tool to measure adolescents' knowledge, attitude, and self-efficacy regarding SRH.

METHODS

A total of 100 items were developed based on a literature search, focus group discussion, and expert panel encompassing three domains: knowledge, attitude, and self-efficacy. The Adolescent Sexual and Reproductive Health - Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ) then underwent a validation process that included content validity, face validity, and internal consistency reliability. This study was conducted on adolescents aged 12-15 years in secondary school in Yogyakarta, Indonesia. All statistical methods were analyzed using STATA software.

RESULTS

The average content validity (S-CVI/Ave) and face validity (S-FVI/Ave) for knowledge, attitude, and self-efficacy demonstrated good validity with scores of 0.93 and 0.94, 0.92 and 0.96, and 0.95 and 0.96, respectively. The internal consistency reliability using Cronbach's alpha for the knowledge, attitude, and self-efficacy domains exceeded 0.6, with results of 0.7, 0.81, and 0.89, which were considered acceptable.

CONCLUSIONS

The final set of ASRH-KASeQ consisted of 100 items measuring knowledge (40 items), attitude (30 items), and self-efficacy (30 items) of adolescents SRH. ASRH-KASeQ was shown to be a reliable and valid tool for Indonesian adolescents, especially those aged 12-15 years.

Teaching methods for critical thinking in health education of children up to high school: A scoping review

According to the World Health Organization, the improvement of people's health literacy is one of the fundamental public health challenges in the 21st century. The key issue in teaching health literacy is to develop critical thinking skills. As health literacy and critical thinking should be developed at school age, we reviewed teaching methods or educational interventions used in empirical studies focused on the development of critical thinking regarding health and implemented by teachers in preschools, primary schools, or secondary schools. We searched seven databases (Medline, Embase, Web of Science, ERIC, ProqQuest, PsycArticles, and CINAHL) from inception to 20 September 2023 for any type of empirical studies. Due to the heterogeneity in interventions and inadequate reporting of results, a descriptive synthesis of studies was performed in addition to quantitative analysis. Of the 15919 initial records, 115 studies were included in the review. Most of the educational interventions focused on lifestyle-related health issues such as substance use, sexual and reproductive health, and nutrition. The popularity of health issues changed over time and depended on the geographical context. Six dimensions that differentiated the teaching methods were identified: central teaching component, central educator, pupils' activity level, teaching context, educational materials, and significance of critical thinking. Many educational interventions did not address the development of critical thinking skills in a comprehensive manner, and the significance of critical thinking varied greatly. Interventions in which critical thinking had high and very high significance applied mainly problem-solving methods and involved pupils' activity. The evidence on the effectiveness of the teaching methods that develop critical thinking is limited because most articles failed to provide detailed information on the teaching methods or did not examine their effects. We recommend that a checklist is developed to facilitate a detailed description of health educational interventions and thus promoting their replicability. Study registration: The protocol of the review was registered in the OSF Registries on 13 January 2022 (doi: https://doi.org/10.17605/OSF.IO/46TEZ).

Understanding the contents and gaps in sexual and reproductive health toolkits designed for adolescence and young adults: a scoping review

INTRODUCTION

Adolescence is a crucial stage of physical and sexual maturation and development and a period in which understanding sexual and reproductive health (SRH) is important. SRH interventions and toolkits provide a range of valuable resources and information to young people, educators, and members of the community on numerous topics, including contraception and puberty.

OBJECTIVES

The usefulness and reliability of these available toolkits have not been previously studied, thus limiting our understanding of their appropriateness and contents. Hence, this scoping review aimed to synthesize the available toolkits aimed at the SRH of adolescents and young adults to understand the contents, design, and information gaps.

METHODS

A systematic search was conducted of 6 medical databases and 12 gray literature sites. Sixteen toolkits published globally before May 2023 were included in our review.

RESULTS

The majority of toolkits (n = 12) contained information related to general SRH knowledge and contraception, whereas only 3 contained information on teenage pregnancy. We found that aiming the toolkits toward educators and health care workers was a favorable design over targeting adolescents and young adults directly and that vulnerable youth-including LGBTQI+ (lesbian, gay, bisexual, transgender, queer or questioning, asexual or allied, intersex, and additional identities) and youth from humanitarian settings-were not well represented.

CONCLUSION

We identified key gaps in the inclusion of information in a range of SRH topics, such as LGBTQI+ sexuality, teenage pregnancy, and safe abortion, in the currently available SRH toolkits and their lack of applicability in a global context. Furthermore, we provide recommendations for areas of improvement to encourage adolescents' agency in their SRH education.

CyberRwanda's Pathway to Impact: Results From a Cluster-Randomized Trial of Adolescent Family Planning Knowledge, Beliefs, Self-Efficacy, and Behavior

PURPOSE

CyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda.

METHODS

Sixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models-self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)-or to control. Students aged 12-19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models.

RESULTS

There were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05-0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01-0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01-0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02-0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02-0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03-0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed.

DISCUSSION

CyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing.

Students' Knowledge about HIV and their attitudes towards people living with HIV/AIDS in the Czech Republic: analysis of the school environment and recommendations for prevention

OBJECTIVES

The main objective of the questionnaire survey conducted by the National Institute of Public Health in Prague was to determine the level of knowledge and attitudes and to identify changes since the previous survey in 2015. A secondary objective was to gather more detailed information on how HIV/AIDS topics are taught in schools, as reported by school prevention coordinators.

METHODS

The questionnaire was distributed to 48 randomly selected educational institutions and the humanitarian organization MRIYA UA z.s. between October 2022 and January 2023. Data on 21 questions focusing on HIV/AIDS issues were collected anonymously from Czech and Ukrainian students. The survey included a representative sample of students from the 7th, 8th, and 9th grades in primary schools and multi-year grammar schools. Each institution received a questionnaire for the prevention coordinator, who answered 12 questions.

RESULTS

A total of 3,011 students completed the questionnaire. The average score for HIV/AIDS knowledge was 13.5 points out of a maximum of 22 points. Students' knowledge gradually increased with higher grades: students from multi-year grammar schools scored an average of 15.9 points, while primary school students scored an average of 13.2 points. Czech students scored an average of 13.6 points, whereas Ukrainian students scored an average of 12.4 points; the 1.2-point difference was statistically significant (p = 0.004). Compared to the 2015 survey, there was a slight overall decline in adolescents' knowledge levels. Students' attitudes towards people living with HIV/AIDS positively correlated with their knowledge about HIV/AIDS: the better their knowledge, the more favourable their attitudes toward people living with HIV/AIDS. Students' main sources of information about HIV/AIDS were school (37.1%) and the Internet (36.6%). According to school prevention coordinators, 95.7% of the surveyed schools address the topic of HIV/AIDS, most commonly in biology or health education classes, dedicating an average of 8.7 instructional hours to the subject. The most frequent teaching method is video lessons, used by 87.2% of the surveyed schools. Schools expressed a preference for improving the quality of education by utilizing presentations with professionally approved content, with 74.5% of schools supporting this option.

CONCLUSIONS

The survey highlighted a gradual increase in HIV/AIDS knowledge with advancing school grades, a significant disparity in knowledge between Czech and Ukrainian students, and a slight overall decline in knowledge compared to 2015. The Internet and schools were the main information sources, though the role of schools declined significantly. It also underscored the need for enhanced educational programmes and continuous professional development for educators to improve health literacy and HIV/AIDS prevention among adolescents.

"I am still human and worth a life:" a qualitative study of the impacts of a community based, peer-led, treatment support model for young adults living with HIV in Zimbabwe

Background

A persistent treatment gap remains between children and adults living with HIV. The Zvandiri program, developed by Africaid, is one of the few models of differentiated service delivery for children, adolescents, and youth that has been shown to improve outcomes along the HIV care continuum, employing Community Adolescent Treatment Supporters (CATS) to offer peer counseling and patient navigation. Our qualitative study provides an in-depth analysis of the feelings and experiences Zimbabwean youth had following an HIV diagnosis, and the ways that CATS facilitated linkage and retention in care.

Methods

We conducted in-depth interviews in Shona with adolescents and young adults who were recently diagnosed with HIV in Zimbabwe. Interviews were audio-recorded, transcribed, and then translated to English. Interviews were coded in Dedoose using a structured a priori codebook. We wrote semi-structured summary memos for each interview. We co-conducted thematic analysis, guided by interpretive phenomenology with a team of Zimbabwean and American experienced qualitative researchers and community partners. We co-developed memos to elaborate and understand key themes across interviews.

Results

Most of our interview participants recounted an immediate sense of loss upon testing HIV positive and a fear that "there was no hope for the future." CATS played a pivotal role for youth, providing emotional, educational, and logistical support to facilitate treatment initiation, adherence, and persistence in care. The CATS program supported youth through multiple approaches: group sessions, individual meetings, and via text or phone. While CATS offered counseling and comfort to participants, they emphasized the long-term importance of identifying at least one other person in participants' lives who could know their status and support them around HIV.

Conclusion

Our findings delineate some of the key concerns that face youth after receiving an HIV diagnosis and the ways that a community-based adherence peer navigation program supported participants to navigate both their feelings and the health care system. Results can inform practice at community-based agencies that are implementing or considering peer youth navigation programs and garner support for policy to fund interventions for youth.

Training nurses in an international emergency medical team using a serious role-playing game: a retrospective comparative analysis

BACKGROUND

Although game-based applications have been used in disaster medicine education, no serious computer games have been designed specifically for training these nurses in an IEMT setting. To address this need, we developed a serious computer game called the IEMTtraining game. In this game, players assume the roles of IEMT nurses, assess patient injuries in a virtual environment, and provide suitable treatment options.

METHODS

The design of this study is a retrospective comparative analysis. The research was conducted with 209 nurses in a hospital. The data collection process of this study was conducted at the 2019-2020 academic year. A retrospective comparative analysis was conducted on the pre-, post-, and final test scores of nurses in the IEMT. Additionally, a survey questionnaire was distributed to trainees to gather insights into teaching methods that were subsequently analyzed.

RESULTS

There was a significant difference in the overall test scores between the two groups, with the game group demonstrating superior performance compared to the control group (odds ratio = 1.363, p value = 0.010). The survey results indicated that the game group exhibited higher learning motivation scores and lower cognitive load compared with the lecture group.

CONCLUSIONS

The IEMT training game developed by the instructor team is a promising and effective method for training nurses in disaster rescue within IEMTs. The game equips the trainees with the necessary skills and knowledge to respond effectively to emergencies. It is easily comprehended, enhances knowledge retention and motivation to learn, and reduces cognitive load.

Revision and Psychometric Testing of the Intercultural Competence Scale

Background and Purpose: Given the broad availability of instruments developed to assess cultural competence, there is a need to develop psychometric properties of existing instruments so they might be adapted accordingly. The purpose of this study was to conduct a psychometric evaluation of the Intercultural Competence Scale (ICS) to ensure its validity and reliability of measurement. Methods: The psychometric evaluation included scale selection and construction, psychometric testing, and instrument validation. Data analysis methods included item analysis, internal consistency reliability, and exploratory factor analysis. Results: Participants in this longitudinal study included 215 nursing students from a selected university. The ICS adopted three instruments modified into a 21-item tool. Conclusion: This study provides a foundation for future research to develop a modified instrument for measuring cultural competence.

Sexual health and safety of adolescents with intellectual disability: Challenges and concerns among special educators in India

Sexual health education among adolescents with intellectual disabilities is an area of concern among parents and educators. Special educators play a vital role in teaching sexual health and safety to their students with disabilities. The present study explores special educators' concerns in teaching sexual health among adolescents with intellectual disabilities. The participants included 35 special educators working with adolescents with intellectual disabilities in India. Summative content analysis of the data collected using a semi-structured interview schedule highlights the neglect of the issues related to sexual health among adolescents with disabilities. Special educators reported the challenges in providing sexual health education. Teachers lacked skills in imparting sexual health education. Developmentally and culturally appropriate sexual health education can help adolescents with a disability learn healthy life skills. The paper emphasizes the need for professional support and training among special educators on sexual health education.

Promoting Physical and Mental Health among Children and Adolescents via Gamification-A Conceptual Systematic Review

The rapid growth in digital technology usage among children and adolescents has highlighted the need for novel approaches to promote their physical and mental health. This paper investigates the viability of gamification-the application of game mechanics to non-gaming contexts-as a potent instrument for health promotion and mental health support. This conceptual systematic review seeks to examine the various published articles promoting children and adolescents' physical and mental health through gamified techniques. These interventions can provide an interactive and engaging platform for encouraging physical activity, promoting healthy nutrition, enhancing emotional regulation, and promoting mental health. The significance of this topic stems from the pervasive use of electronic games, beginning at a young age, which makes them popular educational tools. For the review to be systematic and reproducible, the PsycINFO, Scopus, PubMed, and Elsevier databases were searched and the PRISMA method was utilized for the analysis. After analyzing the research data, empirical studies assessing the use of gamification in promoting adolescents' physical and mental health are discussed. In conclusion, gamification has demonstrated promise for promoting children's and adolescents' physical and mental health. It improves motivation, commitment, and adherence to healthy behaviors. However, additional research is required to evaluate gamification interventions' long-term effectiveness and sustainability in promoting health behaviors among this population.

Gamified Educational Learning Path on HIV/AIDS Stigma and Discrimination (REDXIR): Design, Development and Pilot Study

Background

HIV/AIDS-related stigma and discrimination are among the main barriers to controlling the HIV epidemic. Discriminatory behavior in healthcare settings deprives people of accessing high-quality health services.

Methods

This study presents the design, development, and pilot study of a novel web-based application ("REDXIR"), which is designed based on behavioral and gamification principles and aims to eliminate HIV/AIDS-related discriminatory behavior among health professions students. REDXIR storyline is set in an imaginary world where the students' journey is like a 10-level game, in which each level consists of several missions with a certain amount of score. The participants have to accomplish the mission to reach the minimum amount of score to pass each level. Finally, each becomes an individual who has not only the knowledge but also the competency to educate and advocate appropriately in the field.

Results

The pilot was done in six medical sciences universities in Tehran, Iran. The feasibility of the instructional design, specifically gamification strategies in the field of HIV education, and the executive functions to run the program on a bigger scale were evaluated. In total, 241 students were included and performed 1952 missions. The program evaluation showed a mean satisfaction score of 4.16 (from 1, the lowest, to 5, the highest) and participants considered their learning practical and gamification method appropriate for HIV education.

Conclusion

A meaningful gamification design for an online medical education program could be a suitable, functional, and applicable learning model to reduce HIV/AIDS stigma and discrimination among health professions students.

The effect of gamification-based training on the knowledge, attitudes, and academic achievement of male adolescents in preventing substance and internet addiction

BACKGROUND

Preventing addiction through training takes precedence over treatment and plays a crucial role in enhancing the well-being of adolescents. Utilizing inclusive and participatory methods can significantly enhance the effectiveness of education. Numerous studies have demonstrated that gamification, as an interactive and comprehensive approach, has the potential to boost teenagers' motivation to engage in learning and contributes to better comprehension.

AIM

This study aimed to assess the impact of gamification-based training to prevent substance and internet addiction on the knowledge and attitudes of male adolescents. Additionally, the study examined this educational program's effects on male adolescents' academic achievement.

METHODS

This study employed a quasi-experimental design with a control group. One hundred fourteen male adolescents were randomly assigned to the intervention or control groups. They completed a pre-intervention questionnaire assessing addiction-related knowledge, attitudes, and academic achievement. Subsequently, the intervention group received the gamification-based drug and internet addiction prevention training. Post-tests were conducted immediately after the training and again one month later for both groups.

RESULTS

Before the intervention, there were no significant differences in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement between the intervention and control groups (P > 0.05). However, after the intervention, the intervention group demonstrated significantly higher scores in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement compared to the control group (P < 0.001).

CONCLUSION

The current study highlights the positive impact of gamification-based training on enhancing male adolescents' knowledge, attitudes, and academic achievement.

Effectiveness of curriculum-based sexual and reproductive health education on healthy sexual behaviors among year one students at Arba Minch University: A quasi-experimental study

INTRODUCTION

Curriculum-based sexual and reproductive health education (CBSRHE) is one of the preventive strategies targeting youth in higher institutions to protect them from sexual and reproductive health problems, despite never assessing the effect in Ethiopia. Therefore, this study aimed to assess the effect of CBSRHE on knowledge and attitude about SRH services to have safer sexual behaviors among first-year students of Arba Minch University.

METHOD

We conducted a quasi-experimental study among purposively selected campuses. The campuses were allocated to (i) an intervention arm consisting of curriculum-based sexual and reproductive health, or (ii) a control arm for those who were free from intervention. Data was collected, at baseline and immediately after the intervention ended by using a structured self-administered questionnaire. To compare differences in the change from baseline to post-intervention between the two arms we use the chi-square test and independent-samples t-test. To see the effect of the CBSRHE by controlling the effect confounding inverse probability-weighted analysis was conducted.

RESULT

A total of 832 and 820 students participated in a baseline and post-test respectively. The proportion of youth who practice receptive penetrative sex decreases from 40.9% to 28.3% in the intervention arm compared to 37.6% to 37.3% in the non-intervention arm between baseline and end line, with statistically significant differences between groups. However, there are statistically significant differences between the intervention and control groups in terms of changes in contraception utilization (X2 = 1.21; P>0.05). Furthermore, there were significant improvements in knowledge and attitude among the intervention arm a comprehensive knowledge of HIV/AIDS (ATE = 0.22,95% CI, 0.14 to 0.29; p < 0.01), an average change of attitude toward HIV/AIDS(ATE = 1.32, 95% CI, 1.18 to 1.47; p < 0.01), comprehensive condom knowledge score (ATE = 0.23, 95% CI, 0.13 to 0.33; p < 0.01) and the average change of attitude toward condom score (ATE = 1.83, 95% CI, 1.19 to 2.77; p < 0.01).

CONCLUSION AND RECOMMENDATION

It was found that there was a significant difference in knowledge and attitude toward a disk sexual behaviors among r one student. This implies that the educational authority o the country can gain through the adoption of courses to all universities across the country, besides doing further comparative studies to determine the long-term effect of the course supported with models and/or theories like the theory of change.

Scaling up delivery of HIV services in Africa through harnessing trends across global emerging innovations

Globally, innovations for HIV response present exciting opportunities to enhance the impact and cost-effectiveness of any HIV program. However, countries especially in the African region are not on equal footing to effectively harness some of the existing innovations to accelerate impact on HIV services delivery. This paper aims to add to the discourse on innovative solutions to support countries to make informed decisions related to technologies that can be adapted in different contexts to strengthen HIV programs. A scoping review which involved a search of innovations that can be used in response to the HIV epidemic was carried out between June 2021 and December 2022. The results showed that a high level of technological advancement occurred in the area of digital technologies and devices. Out of the 202 innovations, 90% were digital technologies, of which 34% were data collection and analytics, 45% were mobile based applications, and 12% were social media interventions. Only 10% fell into the category of devices, of which 67% were rapid diagnostic tools (RDTs) and 19% were drone-based technologies among other innovative tools. The study noted that most of the innovations that scaled relied on a strong ICT infrastructure backbone. The scoping review presents an opportunity to assess trends, offer evidence, and outline gaps to drive the adoption and adaptation of such technologies in Africa.

The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review

BACKGROUND

AIDS, which is caused by HIV, has long been one of the most significant global public health issues. Since the beginning of the HIV epidemic, various types of nonelectronic communication tools have been commonly used in HIV/AIDS prevention and care, but studies that apply the potential of electronic games are still limited.

OBJECTIVE

We aimed to identify, compare, and describe serious games and gamified systems currently used in HIV/AIDS prevention and care that were studied over a specific period of time.

METHODS

A scoping review was conducted into serious games and gamified systems used in HIV prevention and care in various well-known digital libraries from January 2010 to July 2021.

RESULTS

After identifying research papers and completing the article selection process, 49 of the 496 publications met the inclusion criteria and were examined. A total of 32 articles described 22 different serious games, while 17 articles described 13 gamified systems for HIV prevention and care.

CONCLUSIONS

Most of the studies described in the publications were conducted in the United States, while only a few studies were performed in sub-Saharan African countries, which have the highest global HIV/AIDS infection rates. Regarding the development platform, the vast majority of HIV/AIDS gaming systems were typically deployed on mobile devices. This study demonstrates the effectiveness of using serious games and gamified systems. Both can improve the efficacy of HIV/AIDS prevention strategies, particularly those that encourage behavior change.

Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study

BACKGROUND

Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies.

OBJECTIVE

We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults.

METHODS

This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening-eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented.

RESULTS

A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91%) and White (18/23, 78%), and 83% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20).

CONCLUSIONS

Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app's ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial.

Unlock digital health promotion in LMICs to benefit the youth

As digital technologies such as smartphones and fitness bands become more ubiquitous, individuals can engage in self-monitoring and self-care, gaining greater control over their health trajectories along the life-course. These technologies appeal particularly to young people, who are more familiar with digital devices. How this digital transformation facilitates health promotion is therefore a topic of animated debate. However, most research to date focuses on the promise and peril of digital health promotion (DHP) in high-income settings, while DHP in low- and middle-income countries (LMICs) remain largely unexplored. This narrative review aims to fill this gap by critically examining key ethical challenges of implementing DHP in LMICs, with a focus on young people. In the existing literature, we identified potential impediments as well as enabling conditions. Aspects to consider in unlocking the potential of DHP include (1) addressing the digital divide and structural injustice in data-related practices; (2) engaging the target population and responding to their specific needs given their economic, cultural, and social contexts; (3) monitoring the quality and impact of DHP over time; and (4) improving responsible technology governance and its implementation. Addressing these concerns could result in meaningful health benefits for populations lacking access to more conventional healthcare resources.

A Review of Serious Gaming as an Intervention for HIV Prevention

PURPOSEOF REVIEW

Young people face the highest number of new HIV infections globally. With today's increasing access to smartphones, serious games have been viewed as an effective means of improving knowledge and behavioral outcomes. This systematic review describes current HIV prevention serious games and their relationship with HIV-related knowledge and behavioral outcomes.

RECENT FINDINGS

A search of HIV prevention serious games was conducted using PubMed, CINAL, IEEE, Web of Science, and Google Scholar. A total of 31 papers were identified, which consist of 20 studies and 11 protocols. Results for knowledge, attitudes, intentions, and behaviors were mixed. Two interventions reported improvement in PrEP usage and optimal dosing. Gaming appears to be a viable and engaging method to improve knowledge, attitudes, and behavioral outcomes to promote HIV prevention among diverse groups of adolescents and young adults globally. However, additional research is needed to understand how to implement this modality effectively.

Digital booklet on sustainable practices for promoting adolescent health

This methodological study aimed to describe the elaboration and validation of a digital booklet focused on sustainable practices toward adolescent health-promoting actions. It was conducted according to the following stages: preparation of the educational booklet; appearance and content validation with 21 judges and validation with a target audience of 53 adolescents. The drafting, elaboration, and assembly of the material's layout were performed through data retrieved from the integrative review and interviews. The digital booklet was entitled "Uncomplicating Environmental Health", with 29 pages in the A5 half-page format (14.8 cm width and 21.0 cm height), configured in landscape layout mode, made available for free, and accessible via mobile and fixed devices. The booklet was validated regarding appearance and content, with an overall Content Validity Index of 0.95, and judges' validation through the Suitability Assessment of Materials tool was considered "superior". The booklet achieved the target audience's positive agreement for validation. It was considered valid to be used in health education for adolescents.

Trends and Challenges in Comprehensive Sex Education (CSE) Research in Sub-Saharan Africa: a Narrative Review

Purpose of the Review

Adolescent sexual and reproductive health remains a major public health challenge in Sub-Saharan Africa (SSA). Comprehensive sex education (CSE) has been hailed as a key strategy to inform young people about sexual health and wellbeing and prevent negative health outcomes. This paper presents an overview of the trends and challenges around sex education in SSA and puts forth key recommendations for future research and policy initiatives.

Recent Findings

This review employed a narrative approach to synthesize evidence on the implementation of comprehensive sex education in SSA. The literature review elicited four key themes: (i) comprehensiveness of CSE curricula, (ii) gender norms in CSE, (iii) prominence of 'fear' narratives in CSE implementation, and (iv) CSE delivery methods. Additionally, the authors propose a fifth theme-'Future-proofing CSE programs', based on their learnings from implementing sex education interventions during the COVID-19 pandemic. These five themes are presented through a narrative description of current research accompanied by reflections from the authors on the implementation of a parent-focused sex education program in Uganda.

Summary

Based on the insights from the literature review and the authors' reflections, three recommendations are put forward to guide the design of further CSE initiatives: (i) stakeholder engagement in determining CSE priorities and strategies, (ii) diverse delivery pathways for CSE programs, and (iii) active engagement of both boys and girls to challenge gender norms in CSE.

Perceptions, Experiences, and Needs of Adolescents About School-Based Sexual Health Education: Qualitative Systematic Review

Adolescents are particularly vulnerable to poor sexual health outcomes such as sexually transmitted diseases, sexually transmitted infections, human immunodeficiency virus, and unintended pregnancy. While school-based sexual health education (SBSHE) can address adolescents' needs, they are often insufficient. Hence, their perception of SBSHE should be explored to improve current education. This review aims to consolidate the available evidence on perceptions, experiences, and needs of adolescents about SBSHE. Six electronic databases were searched from their inception date till June 2022. The included studies were assessed using the method of the Critical Appraisal Skills Program tool, and findings were meta-synthesized using Sandelowski and Barroso (2007). This review was registered via the International Prospective Register of Systematic Reviews. Overall, 51 studies were included, and three themes were identified: (1) teachings of SBSHE and its impact, (2) adolescents' preferred approach to SBSHE, and (3) importance of engaging and safe SBSHE. In conclusion, adolescents had mixed reactions toward SBSHE. They expressed the need for inclusivity (gender identity and racial, ethnic, and cultural groups). Having a "safe space," well-trained educators, and interactive approaches were important and hence should also be considered. More qualitative studies from different geographical regions are needed. Diverse topics (e.g., mutual consent, sexual abuse, and violence) should also be discussed. The use of multiple educators (e.g., schoolteachers, specialist teachers, and peers) should also be deliberated in future SBSHE research. Findings from this review should be triangulated by evaluating the perceptions of various stakeholders (e.g., educators, adolescents, and SBSHE administrators).

Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs)

Background

Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design.

Objectives

The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research.

Methods

This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added.

Selection Criteria

To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes.

Results

This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied.

Conclusion

This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.

The effectiveness of digital sexual health interventions for young adults: a systematic literature review (2010-2020)

There has been a proliferation of digital sexual health interventions targeting adolescents; however, limited evaluative reviews have compared the effectiveness of multiple digital tools for sexual health literacy and behaviour change. This study conducted a systematic literature review, screened 9881 records and analysed 61 studies. Findings suggest that websites and mobile phones dominate digital sexual health interventions, with a majority effectively delivering cognitive (e.g. awareness and attitudes about sexual and reproductive health) and behavioural outcomes (e.g. abstinence and use of contraception). The most popular sexual health promotion mechanisms were interactive websites, text messaging and phone calls, and online education programmes, followed by mobile applications-fewer studies in this review utilized social media, games and multimedia. Previous reviews focused on single outcome measures (e.g. sexually transmitted infection testing) to assess interventions' effectiveness. The current review moves beyond single outcome measures to cover a wider range of behavioural and non-behavioural sexual health issues and contexts covered in the literature. Four main categories were analysed as outcomes: cognitive perceptions, promoting sexual health-related behaviours, promoting sexual health-related products and services, and impact (viral load). Seventy-nine per cent of interventions focused on preventive sexual health behaviours and products (e.g. condoms) and services (e.g. HIV testing). Overall, 75% of studies effectively changed sexual health behaviour and cognitive perceptions. However, the digital-only tools did not vary from the blended formats, in influence outcomes, even after categorizing them into behavioural or non-behavioural outcomes. Compared to previous systematic reviews, more studies from the last decade used rigorous research design in the form of randomized controlled trials, non-randomized control trials, and quasi-experiments and lasted longer.

Effect of Conventional and "Dental Truth or Dare" Board Game on Oral Hygiene Knowledge and Oral Hygiene Status of Preschool Children

Aim: To compare the benefits of didactic versus board game-based oral health instruction on oral health knowledge (OHK) and oral hygiene of preschool students. Materials and Methods: Participants were selected through computer-assisted randomization. (Eighty students were selected in both the 3- to 4-year-old and 5- to 6-year-old age groups, respectively, for a total of 160 participants). Forty participants of each age group were assigned randomly to Group A (PowerPoint^® presentation) and 40 to Group B ("Dental Truth or Dare" board game-based instruction). OHK and debris index-simplified (DI-S) were assessed at preintervention, and at 1-week, 1-month, and 3-month postintervention timepoints. Results: OHK scores increased significantly in the 3- to 4-year-old subset of Group A at the 1-week postintervention timepoint but declined and approximated the baseline value at the 3-month timepoint. In contrast, compared to baseline, significantly improved OHK scores were observed at all 3 timepoints in both age groups in Group B, and were especially pronounced in the 5- to 6-year-old subset. Although the 3-month scores were slightly lower than the 1-week scores, they were well above baseline values. Pre- and postintervention DI-S scores did not change significantly in the 3- to 4-year-old subset of Group A. However, significant increases in good DI-S scores and decreases in fair and poor scores were observed between baseline and 3-month timepoints in the 5- to 6-year-old subset of Group A and in both age subsets of Group B (P ≤ 0.05). OHK and DI-S scores were significantly higher among 5-6-year-olds than among the 3-4-year olds in both Groups A and B (P ≤ 0.05). Age and board game intervention were the main determinants of higher OHK and lower DI-S scores. The impact of intervention mode (board game) was greater than that of age. Conclusion: Board game-based oral hygiene education conferred significant short-term retention, enhanced OHK, and reduced DI-S. We conclude that gaming is an easily implemented and cost-effective educational tool for the improvement of oral hygiene in preschool children.

Design and evaluation of two educational media in the form of animation and games to promote the cutaneous leishmaniasis prevention behaviors in adolescent female

BACKGROUND

Cutaneous leishmaniasis (CL) has social and psychological effects on different groups, especially adolescents and young girls in 98 countries of the world, in addition to the economic burden. Therefore, it is necessary to apply effective methods for CL prevention. In this study, educational messages were designed based on Extended Parallel Process Model in both forms of animation and game, whose effect on the cutaneous leishmaniasis prevention behaviors was evaluated in adolescent female students.  METHODS: This experimental study was carried out from January to September 2021 on 275 adolescent female students in Isfahan province, Iran. Cluster sampling method was used, and then the students were randomly divided into three groups, namely animation education, game education, and control groups. The educational intervention was performed with two new media in the form of animation and games. The data collected before and two months after the education through a valid and reliable researcher-made questionnaire were analyzed in SPSS24 software using statistical tests of ANOVA, Chi-square, paired t and analysis of covariance (ANCOVA).

RESULTS

The mean age of the participants was 14.07 ± 0.94. The mean scores of behavior in the animation group (60.60 ± 23.00), the game group (61.70 ± 22.05), and the control group (66.13 ± 24.62) were not significantly different prior to the education. However, after the education, there was a significant difference between the animation (80.66 ± 17.62) and game groups (82.58 ± 19.07) and the control group (69.79 ± 23.29) (P < 0.001). The mean scores of model constructs following the intervention (susceptibility, severity, response efficacy, and perceived self-efficacy) significantly increased in the animation and game groups compared to that in the control group (P < 0.05).

CONCLUSION

The results showed that if educational programs contain a combination of threat and efficiency messages, CL-preventive behaviors in adolescents increase. Providing similar educational content with both game and animation methods indicated that both methods had an almost same effect. Although animation production is more costly, it has the advantage of being used in periods and for other adolescents.

Do family values and reproductive health knowledge influence reproductive health-promoting behaviors in married women? A cross-sectional survey

PURPOSE

Based on the World Health Organization framework on reproductive health, this descriptive correlational study investigated the factors affecting reproductive health-promoting behaviors ofmarried women, with a focus on family values and reproductive health knowledge.

METHODS

A cross-sectional survey was conducted on 170 married women between the ages of 25and 49 years living in Daegu, Korea. The general and reproductive health characteristics, family values, and reproductive health knowledge of married women were identified, as well as factors affecting reproductive health-promoting behaviors. A questionnaire survey was administered to investigate the impact of various factors on reproductive health-promoting behaviors.

RESULTS

Positive correlations were shown for family values (r=.78, p<.001) and reproductive healthknowledge (r=.55, p<.001). Family values (β=.35, p<.001) and reproductive health knowledge(β=.24, p<.001) were identified as factors influencing reproductive health-promoting behaviors. According to the regression model, the explanatory power of factors affecting reproductive health-promoting behaviors among married women was 51.2%.

CONCLUSION

A history of reproductive diseases, family values, and reproductive health knowledgewere identified as factors influencing reproductive health-promoting behaviors. These results willprovide basic data for the development of a reproductive health-promoting program, including apositive approach to reproductive health among married women, and will serve as a basis for furtherresearch on intervention strategies.

The effect of educational intervention based on theory of planned behavior on mothers’ skills in sexual care of children

Background

The parent’s and especially the mothers’ skills play a major role in the the education of healthy sexual behaviors in children. This study investigates the effect of educational intervention based on the Theory of Planned Behavior (TPB) on mothers’ skills in the sexual care of children in Fasa city, Fars province, Iran in 2019.

Methods

This study was a quasi-experimental intervention with a control group. 200 mothers of children aged 5 to 6 years in Fasa preschool were selected using a multi-stage random sampling method and were divided into two groups of intervention (100) and control (100). After providing a pre-test to both groups, only the experimental group received training on sexual care of children's abilities based on the Theory of Planned Behavior constructs. The educational intervention consisted of seven 55–60-minute sessions in which the presenter gave a presentation, asked and answered questions, and used posters, brochures, films, animations, and PowerPoints. Both groups completed the questionnaire three months following the intervention. A questionnaire and Theory of planned behavior constructs were used to collect information. The data was analyzed with SPSS22 software using paired t-tests, Chi-square tests, and independent t-tests, with a significance level of 0.05.

Results

Before the intervention, there was no significant difference in the constructs of theTheory of planned behavior between the two groups (p>0.05), but after the intervention, knowledge scores from 8.33±2.97 to 20.67±2.84, attitude scores from 29.80±4.27 to 62.22±4.34, subjective norms from 20.12±4.55 to 42.28±4.20, perceived behavioral control from 20.24±4.36 to 42.88±4.52, behavioral intention from 3.24±1.60 to 7.44±1.59 and behavior from 2.98±1.13 to 8.14±1.08 in the intervention group (p< 0.001).

Conclusion

This study showed TPB constructs’ Effectiveness in adopting the level of mothers’ skills in the sexual care of children. Hence, this model can act as a framework for designing and implementing educational interventions for the sexual care of children.

Health education and global health: Practices, applications, and future research

Health education is a crucial consideration in the healthcare system and has the potential to improve global health. Recently, researchers have expressed interest in streamlining health education, utilizing digital tools and flexible curriculums to make it more accessible, and expanding beyond disease and substance abuse prevention. They have also expressed interest in promoting global health through health and safety promotion programs. Amidst the COVID-19 pandemic, climate change, the refugee crisis, and overpopulation, healthcare crises are erupting all over the world. A lack of health education has and will continue to have a profound impact on community healthcare indicators, particularly in low-income nations. Current priorities within the health education sector include digitization, equity, and infectious disease prevention. Studies and data from university journals and other academic databases were analyzed in a literature review. Health education programs have a significant positive impact on attitudes and behaviors regarding global health. Improving upon these programs by digitizing them and expanding upon the scope of health education will help ensure that such interventions and programs make a significant difference.

Structural Equation Model Analysis of HIV/AIDS Knowledge, Attitude, and Sex Education Among Freshmen in Jiangsu, China

Background

The study of acquired immunodeficiency syndrome (AIDS) related knowledge, attitude, and sex education status of Jiangsu freshmen was conducted, which can provide data support directionally for the prevention work of HIV/AIDS among this population.

Methods

Male students (4,006) and female students (4,279) were selected from 20 universities or colleges in the Jiangsu province. The knowledge, attitudes, and sex education of freshmen were conducted with an online questionnaire. The log-binomial regression model was used to analyze the influencing factors of HIV/AIDS knowledge. In addition, a structural equation model was used to analyze students' health needs that affect knowledge awareness and knowledge mastery.

Results

The overall awareness rate of AIDS knowledge was 87.4%. The students in undergraduate colleges (OR = 2.523, 95% CI=2.223~2.864) and independent colleges (OR = 1.389, 95%CI = 1.172~1.646) were more likely to have a higher awareness compared with the students in junior colleges. In this study, 2,011 freshmen approved of premarital behavior, 4,921 freshmen insisted on using condoms when having sex, and 8,138 freshmen were willing to take HIV antibody test when they suspected they were infected. In total, 4,703 freshmen believed that sexual health education was necessary for colleges and universities, and most of them (57.2%) hoped that sex education in schools should be improved. The direct effect of sex education on knowledge awareness and attitude is 0.15 and 0.58. The mediation effect test found that the pass ability knowledge path of sex education indirectly affected sexual attitudes (0.05).

Conclusion

The awareness rate of HIV/AIDS among Jiangsu freshmen has not reached the national standard. Health education has a significant positive effect on knowledge awareness and attitude; however, students' needs in terms of time, place, and degree of sex education have not been met in time. It is necessary to strengthen the HIV/AIDS health education of college students in multiple ways.

HIV/AIDS-Related Knowledge and Attitudes Among Chinese College Students and Associated Factors: A Cross-Sectional Study

In recent years, adolescent has become one of the high-risk groups for HIV. Meanwhile, good HIV awareness and positive attitude are essential for HIV prevention. This study aims to evaluate the extent to which college students understand HIV and their attitudes toward HIV-infected patients, as well as the correlative factors. The data used in this study came from a cross-sectional survey. An anonymous online questionnaire was used to investigate the demographic characteristics, HIV/AIDS-related knowledge, and attitudes toward HIV-infected patients of 17,678 students from a university in Henan. Descriptive statistics, Chi-square test and logistic regression were used to analyze differences and connections between variables in SPSS version 25.0. Participants' HIV/AIDS-related knowledge awareness rate was 80.8%. Levels of students' HIV/AIDS-related knowledge correlated with their gender, nationality, marital status, and their grade (p < 0.01). Female students [OR = 0.757, 95% CI (0.699-0.820)] and minority students (OR = 0.717, 95% CI (0.619-0.832)] had insufficient HIV health education knowledge. Meanwhile, male students (OR = 0.845, 95% CI (0.773-0.924)], and students with good HIV knowledge (OR unaware-ness/awareness = 2.385, 95% CI (2.111-2.694)] were more likely to hold a positive attitude toward HIV-infected patients. The relevant education departments should strengthen and promote the education of AIDS transmission and prevention. Many college students still hold negative attitude toward HIV-infected patients. The government should further make efforts to eliminate social discrimination in HIV-infected patients and lead people to approach HIV-infected patients fairly.

Experiences of teachers, educators, and school counselors about the sexual and reproductive health of educable intellectually disabled adolescent girls: a qualitative study

Background

Adolescents with intellectual disabilities are probably twice as many people without intellectual disabilities to be sexually abused by family members, caregivers, close relatives, and others in the community. Sex education and training are essential components of children's and teenagers' education and human rights, as well as a source of worry for parents and society. While the parents are thought to be the most accessible choice as sexual educators, they often do not fulfill this role. Therefore, professional teachers and trainers who have undergone sex education courses for mentally retarded adolescents are more reliable sources to provide the sexual information in terms of their educational role. This study aimed to determine the experiences of teachers, educators, and school counselor parents regarding the sexual and reproductive health of educable intellectually disabled adolescent girls.

Methods

This was a qualitative content analysis study. 35 participants were selected via purposive sampling with maximum variation, and data were collected through in-depth individual interviews, focus group discussions and field notes, and analyzed using the conventional qualitative content analysis method simultaneously.

Results

Three subcategories have emerged: “knowledge and professional experience of teachers, educators, and school counselors with how to educate and care for adolescent sexual health”, “proficiency of teachers, educators, and school counselors in guiding families in solving their child's sexual problems”, “attitude of teachers, educators, and school counselors towards sexual behaviors and sexual education of adolescents” which formed the main category of “teachers, educators, and school counselors’ inefficiency in maintaining ID adolescent girls’ sexual and reproductive health”.

Conclusions

Teachers, educators, and school counselors encounter a variety of issues related to the sexual and reproductive health of intellectually impaired teenage females, as a consequence of the findings. As a result, efforts should be made to enhance knowledge and skill development, as well as the evolution of negative attitudes. Therefore, the teaching of sexual guidelines for teenagers with mental impairments should be included in the agenda of the country's educational policies. Teachers and educators should be taught by health experts via the holding of in-service training courses.

Achieving sexual health is a key task to develop health for all people including adolescents. Adolescents with intellectual disabilities are probably twice as many as people without intellectual disabilities to be sexually abused by family members, caregivers, close relatives, and others in the community. The role of schools and educators to manage children's sexual behaviors and provide appropriate training in this field was accepted by most societies. This research aimed to ascertain instructors', educators', and school counselors' perceptions on teenage females with educable ID's sexual health. Participants in the present study were mothers, teachers, educators, and school counselors who were selected via purposive sampling in Isfahan from July 2017 to April 2018. Data were collected from via semi‑structured interviews, focus group discussions, and field notes, and analyzed using conventional content analysis. The results showed that teachers, educators, and school counselors face different challenges about the sexual and reproductive health of intellectually disabled adolescent girls. Therefore, it should be attempted to promote knowledge and skill and eliminate negative attitudes and make them aware of the sexual rights of intellectually disabled adolescent girls to protect themselves in different situations.

Pilot implementation of a user-driven, web-based application designed to improve sexual health knowledge and communication among young Zambians: a mixed method study (Preprint)

Background

Digital health interventions show promise in improving the uptake of HIV services among adolescents and young people aged 15 to 24 years in sub-Saharan Africa.

Objective

This study aimed to pilot-test a theory-based, empirically grounded web-based application designed to increase condom-related knowledge, sexual and reproductive health (SRH) communication, and healthier choices among young Zambians.

Methods

We conducted a pre-post quasi-experimental evaluation of the user-driven Be in the Know Zambia (BITKZ) web application using web-based surveys and in-depth interviews (IDIs) on the phone. We enrolled participants using social media advertisements. Our final analysis set comprised 46.04% (749/1627) of participants in the intervention group (which received the BITKZ link) and 53.96% (878/1627) of participants in the comparison group (no intervention). We collected survey data at study enrollment (baseline) and 5 weeks after the first enrollment in each group. Approximately 85% (637/749) of BITKZ users completed a user survey, of whom 9.3% (59/637) participated in IDIs. We calculated the time interfacing with BITKZ using the application log files. We conducted descriptive analyses to describe baseline characteristics and the user experience. At the endline, we assessed association using a t test and adjusted logistic regression for binary outcomes and ordinal regression for ordered outcomes, conditioning on age, sex, marital status, and employment status. We used adjusted average treatment effects (aATE) to assess the effects of BITKZ intervention. We conducted rapid matrix analyses of IDI transcripts in Microsoft Excel, sorting the data by theme, gender, and experience rating.

Results

Users rated BITKZ highly (excellent: 352/609, 57.8%; good: 218/609, 35.8%). At the endline, the intervention group had a higher level of knowledge related to condoms (adjusted odds ratio [aOR]: 1.35, 95% CI 1.06-1.69) and on wearing condoms correctly (aOR: 1.23, 95% CI 1.02-1.49). Those who had full-time employment had increased odds of knowing how to wear condoms correctly (aOR: 1.67, 95% CI 1.06-2.63) compared with those who reported being unemployed, as did men when compared with women (aOR: 1.92, 95% CI 1.59-2.31). Those in the intervention group were more likely to score higher for intention to test for sexually transmitted infections (STIs; aATE 0.21; P=.01) and HIV (aATE 0.32; P=.05), as well as for resisting peer pressure (aATE 2.64; P=.02). IDIs corroborated increased knowledge on correct condom use among men and female condoms among women, awareness of STIs and testing, and resistance to peer pressure. Interviewees provided examples of more open SRH communication with partners and peers and of considering, adopting, and influencing others to adopt healthier behaviors.

Conclusions

Despite the high baseline awareness of SRH among Zambian adolescents and young people with internet access, BITKZ provided modest gains in condom-related knowledge, resistance to peer pressure, and intention to test for STIs and HIV.

Effectiveness of eHealth Interventions for HIV Prevention and Management in Sub-Saharan Africa: Systematic Review and Meta-analyses

HIV is still the leading cause of death in Sub-Saharan Africa (SSA), despite medical advances. eHealth interventions are effective for HIV prevention and management, but it is unclear whether this can be generalised to resource-poor settings. This systematic review aimed to establish the effectiveness of eHealth interventions in SSA. Six electronic databases were screened to identify randomised controlled trials (RCTs) published between 2000 and 2020. Meta-analyses were performed, following Cochrane methodology, to assess the impact of eHealth interventions on HIV-related behaviours and biological outcomes. 25 RCTs were included in the review. Meta-analyses show that eHealth interventions significantly improved HIV management behaviours (OR 1.21; 95% CI 1.05-1.40; Z = 2.67; p = 0.008), but not HIV prevention behaviours (OR 1.02; 95% CI 0.78-1.34; Z = 0.17; p = 0.86) or biological outcomes (OR 1.17; 95% CI 0.89-1.54; Z = 1.10; p = 0.27) compared with minimal intervention control groups. It is a hugely important finding that eHealth interventions can improve HIV management behaviours as this is a low-cost way of improving HIV outcomes and reducing the spread of HIV in SSA. PROSPERO registration number: CRD42020186025.

Digital Escape Rooms as Game-Based Learning Environments: A Study in Sex Education

Game-based learning is becoming increasingly popular in education. The playful experience especially promises a high degree of students’ motivation. In this research, we examine the influence of sequential scaffolding within a digital educational escape room game. Escape rooms are usually games where players have to escape from a room within a given time limit by completing different tasks and quests. Therefore, we developed an educational virtual escape room for biology classes, focusing on the topic of sex education. In an experiment, we modified this learning environment and developed two different conditions: in one escape room, scaffolding was implemented using sequential learning aids; in the other escape room, which was assigned to the control group, no additional learner support was provided. The main objective of this quantitative research is to measure the escape room’s impact on learning and cognitive load. In addition, motivation, flow experience and experience of immersion are analyzed. A comparison between the two escape rooms shows that additional scaffolding does not significantly increase cognitive load or have any effect on learning. Results show that motivation and knowledge acquisition can be successfully supported by using game-based learning with escape rooms.

Evaluation of an AIDS educational mobile game (AIDS Fighter · Health Defense) for young students to improve AIDS-related knowledge, stigma and attitude of high-risk behaviors in China: A Randomized Controlled Trial

BACKGROUND

The AIDS epidemic among young students is serious, and effective preventive interventions are urgently needed. Game-based intervention has become an innovative way to change healthy behaviors, and we have developed an AIDS educational game called AIDS Fighter · Health Defense. In this study we tested the effect of an AIDS Fighter · Health Defense for young students to improve AIDS-related knowledge, stigma and attitude of high-risk behaviors in Southwest China.

OBJECTIVE

To test the effect of an AIDS educational game (AIDS Fighter · Health Defense) for young students to improve AIDS-related knowledge, stigma and attitude of high-risk behaviors in Southwest China.

METHODS

A randomized controlled trial was conducted from September 14 to September 27, 2020. Ninety-six students from two classes in a middle school were selected by stratified cluster sampling in Luzhou City, China. The two classes were randomly divided into the intervention group (n=50) and the control group (n=46). The intervention group received AIDS educational game (AIDS Fighter · Health Defense); the control group learned AIDS-related knowledge through independent learning on the QQ chat group. The AIDS-related knowledge questionnaire, the stigma scale, the attitude questionnaire on AIDS-related high-risk behaviors were used to measure the effect of an AIDS educational game by face-to-face. The user's experience of the game was assessed by the Educational Game User Experience Evaluation Scale. The difference was statistically significant with P≤0.05.

RESULTS

After the intervention, the AIDS knowledge awareness rate (±S, ％) of the intervention group and the control group were 70.09±11.58 and 57.49±16.58（t=4.282, P<0.001）. The stigma scores of the two groups were 2.44±0.57 and 2.48±0.47（t=0.373, P =0.710）, The positive rate (±S, ％) of attitudes of high-risk AIDS behaviors of the two groups were 82.00±23.44 and 79.62±17.94（t=0.555, P =0.580. The mean percentage of the game evaluation as excellent was 54.73%, and 31.45% of good, 13.09% of medium, 0.73% of poor.

CONCLUSIONS

AIDS Fighter · Health Defense could increase the AIDS-related knowledge among young students, but the effect of the game in reducing AIDS-related stigma and improving the attitudes of high-risk AIDS behaviors has not appeared. Long-term effects and large-scale studies are needed to assess the efficacy of game-based intervention.

CLINICALTRIAL

Chinese Clinical Trial Registry: ChiCTR2000038230. Registered 14 September 2020.

Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study

BACKGROUND

Sexual education has become increasingly important as unhealthy sexual practices and subsequent health risks become more prevalent during adolescence. Traditional sex education teaching methodologies are limiting for digital natives exposed to various digital technologies. Harnessing the power of technology applications attractive to the younger generation may be a useful approach for teaching sex education.

OBJECTIVE

The aim of this study was to improve sexual health knowledge and understanding of the problems associated with unhealthy sexual practices and address sexual and reproductive health challenges experienced in a low-tech setting.

METHODS

A participatory design approach was used to develop the digital gamified methodology. A sample of 120 secondary school students aged 11-15 were randomly assigned to either experimental or control group for each of the 3 teaching approaches: (1) gamified instruction (actual serious games [SG] in teaching); (2) gamification (GM; making nongames, such as game-like learning); and (3) traditional teaching (TT) methods.

RESULTS

The SG and GM approaches were more effective than TT methods in teaching sexual health education. Specifically, the average scores across groups demonstrated an increase of mean scores from the pre- to posttest (25.10 [SD 5.50] versus 75.86 [SD 13.16]; t₁₁₉=41.252; P<.001 [2 tailed]). Analysis of variance indicated no significant differences across groups for pretest scores (F_2,117=1.048, P=.35). Significant differences across groups were evident in the posttest scores. Students in the SG and GM groups had higher average scores than the TT group (F_2,117=83.98; P<.001). Students reported increased learning motivation, attitude, know-how, and participation in learning (P<.001) when using SG and GM approaches.

CONCLUSIONS

Digital health technologies (particularly teaching and learning through gamified instruction and other novel approaches) may improve sexual health education. These findings may also be applied by practitioners in health care settings and by researchers wishing to further the development of sex education.

Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis

Currently, one of the main public health problems among children and adolescents is poor adherence to healthy habits, leading to increasingly high rates of obesity and the comorbidities that accompany obesity. Early interventions are necessary, and among them, the use of gamification can be an effective method. The objective was to analyse the effect of game-based interventions (gamification) for improving nutritional habits, knowledge, and changes in body composition. A systematic review and meta-analysis were performed in CINAHL, EMBASE, LILACS, MEDLINE, SciELO, and Scopus databases, following the PRISMA recommendations. There was no restriction by year of publication or language. Only randomized controlled trials were included. Twenty-three articles were found. After the intervention, the consumption of fruit and vegetables increased, as well as the knowledge on healthy food groups. The means difference showed a higher nutritional knowledge score in the intervention group 95% CI 0.88 (0.05–1.75). No significant effect of gamification was found for body mass index z-score. Gamification could be an effective method to improve nutritional knowledge about healthier nutritional habits. Promoting the development of effective educational tools to support learning related to nutrition is necessary in order to avoid and prevent chronic diseases.

A Digital Gaming Intervention to Improve HIV Testing for Adolescents and Young Adults: Protocol for Development and a Pilot Randomized Controlled Trial

Background

Two strategies of the US Ending the HIV Epidemic initiative are early diagnosis of infections via widespread testing and prevention of new infections using pre-exposure prophylaxis (PrEP). These strategies are particularly important for adolescents and young adults (AYAs) who are disproportionately affected by HIV, particularly if they identify as Black and/or lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+). This study will develop and test an interactive life-simulation game in which players can enact real-life behaviors and receive their HIV risk profile to improve HIV testing and PrEP access among AYAs aged 13-24 years in Washington, DC.

Objective

This mixed methods study aims to determine the acceptability of an interactive, enhanced life-simulation game prototype among AYAs, conduct a pilot test of the gaming intervention among a small cohort of AYAs to ensure game usability and acceptability, and evaluate the efficacy of the game in a randomized controlled study with AYAs at risk for HIV in Washington, DC.

Methods

This research protocol will be conducted in 3 phases. A formative phase will involve surveys and focus groups (n=64) with AYAs living in the DC area. These focus groups will allow researchers to understand youth preferences for game enhancement. The second phase will consist of a pilot test (n=10) of the gaming intervention. This pilot test will allow researchers to modify the game based on formative results and test the planned recruitment and data collection strategy with intended end users. The third phase will consist of a randomized controlled study among 300 AYAs to examine the efficacy of the life-simulation game compared with app-based HIV educational materials on HIV and PrEP in changing HIV testing, knowledge, risk behaviors, and PrEP access. Participants will have unlimited access to either the life-simulation game or the educational app for 3 months from the time of enrollment. Study assessments will occur at enrollment and at 1, 3, and 6 months post enrollment via e-surveys. At 6 months, a subset of intervention participants (n=25) will participate in in-depth exit interviews regarding their experience being in the study.

Results

Institutional review board approval was received on February 5, 2020. This project is currently recruiting participants for the formative phase.

Conclusions

This interactive life-simulation intervention aims to increase HIV testing and PrEP access among AYAs in the DC area. In this intervention, players can enact real-life behaviors and receive their HIV risk profile to promote HIV testing and PrEP seeking. Such an intervention has great potential to improve knowledge of HIV and PrEP among AYAs, increase motivation and self-efficacy related to HIV testing and PrEP use, and decrease individual and structural barriers that often preclude engagement in HIV prevention services.

Trial Registration

ClinicalTrials.gov NCT04917575; https://clinicaltrials.gov/ct2/show/NCT04917575

International Registered Report Identifier (IRRID)

PRR1-10.2196/29792

Education of Adolescents in the Prevention of HIV/AIDS in the Czech Republic

The number of HIV-positive people in the Czech Republic has trebled over the last decade. An educational programme aimed at the prevention of HIV and STDs in adolescents between 13 and 19 years of age is underway in the Moravian-Silesian Region in the Czech Republic. All schools in the region have been offered the chance to participate in the programme (on a voluntary basis). The programme consists of an educational lecture and a game with interactive elements; the students perform various tasks in groups. An anonymous paired questionnaire (input/output) was used to assess the efficacy of the programme. In order to evaluate the programme efficacy, descriptive statistics, non-parametric Wilcoxon paired test at the level of significance of 5%, and a model of logistic regression for a dichotomous variable were used. A total of 1210 students took part in the programme. The students’ knowledge improved, on average, by 15.5%. The highest efficacy was observed in the age group of 13–14-year-olds, where the improvement reached 17.9%. The educational programme was effective in raising awareness about STDs. Due to the observed increase in knowledge especially among the youngest participants (13–14 years old), we recommend aiming further interventions at the youngest age groups.

Gamification and transmedia in interdisciplinary contexts: A didactic intervention for the primary school classroom

Previous research has established the lack of motivation by primary education students vis-à-vis the acquisition of the necessary key competencies compulsory in the Spanish school curriculum and this is closely linked to poor academic performance on the part of the aforesaid students. Based on this current educational reality, we present a quantitative study regarding the perception of students after the implementation of a new gamified experience in the classroom such that it integrates, for the first time and jointly, the benefits of gamification (Deterding et al., 2011a; Deterding & Zagal, 2018) with interdisciplinary methodologies (Candel, 2018; Cruz-Pichardo & Cabero-Almenara, 2020; Flores-Aguilar, 2019) and technology-enhanced transmedia narratives (Scolari 2018a, 2018b; Jenkins, 2003; Scolari 2018a, 2018b). This integrative and innovative proposal was implemented in a primary school in Valencia (Spain) between October 2019 and February 2020. The research is designed based on survey-type studies, employing an experimental cross-sectional quantitative methodology with pretest and posttest, in addition to experimental and control groups. Regarding the cross-sectional approach, descriptive analyses (means and standard deviation) have been conducted, together with histograms of each of the items in the questionnaire, as well as the Student's t test and an analysis of variance, which is of significant value when working with independent samples from a normal distribution, as in our case. The instrument utilised in the present study confirms the existence of a high and adequate internal consistency (Alpha = .873). The results obtained, as presented herein, confirm that the incorporation of the gamified proposals in primary school classes, unprecedentedly intertwined with the benefits provided by interdisciplinary work and transmedia narratives, notably improves the students' training process and their motivation, while also contributing to the better acquisition of compulsory curricular contents and enhanced academic performance.

Promoting Sexual Health Knowledge through a Social Workers' Mentorship Programme: A Study of Gay Young Adults

Mentorship of counselling for men who have sex with other men and gay youths is understudied. The purpose of this study was to explore the effectiveness of how the Mentor Modelling Programme may increase the sexual health knowledge and practices of gay youths. As an expansion of a previous study with the application of the conceptual framework, this study mapped a sexual health promotion plan and the six-month-long Mentor Modelling Programme with the coordination of eight health and social care professionals and 40 gay youths. The researcher found positive and supportive feedback of how the Mentor Modelling Programme could increase sexual health knowledge, promote long-term relationships, and encourage referral of other vulnerable people. The results indicated two directions. The first solicited the perspectives of health and social care professionals and gay youths on how they would describe the relationship, application to, and experience of the Mentor Modelling Programme and second, assessed how this Mentor Modelling Programme influenced and changed the ideas and senses about counselling services and mentorship. This study reflected the current limited sexual promotion between traditional and inclusive sexual health materials. It further indicated the necessary concerns and areas of attention needed to upgrade the materials and host inclusive sexual health materials for both youths and adults in the communities.

AIDS fighter health defense: protocol for a randomized controlled trial to test a game-based intervention to improve adolescents' AIDS prevention ability

Background

Although great progress has been made in the prevention and treatment of AIDS, there are still a considerable number of new infections annually, especially in adolescents. With the advance of technology, game-based education has gradually become an important tool for changing healthy behaviors among youth.

Methods

A protocol for conducting a randomized controlled trial to evaluate the “AIDS Fighter · Health Defense”, a game-based AIDS education project aimed at improving the ability of adolescents to prevent AIDS. During the four-week intervention, participants will receive: 1) A virus combat game; 2) Goal setting to eliminate HIV; 3) Questions to be answered to be resurrected in the game; 4) Points ranking; 5) Recognition and Rewards. The primary outcomes include changes in participants’ knowledge, stigma attitude, and risk behaviors attitude related to AIDS after four weeks of intervention. The secondary outcomes are the participants’ AIDS-related risk behaviors three and six months after the intervention.

Discussion

AIDS Fighter· Health Defense may be an innovative approach to help adolescents improve AIDS prevention capabilities, fill the gap in game-based AIDS prevention education in China, and gain experience of AIDS management.

Trial registration

Chinese Clinical Trial Registry: ChiCTR2000040195. Registered 25 November 2020.

Evidence map on serious games in preventing sexually transmitted infections among adolescents: Systematic review about outcome categories investigated in primary studies (Preprint)

Background

Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs.

Objective

The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents.

Methods

A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience.

Results

Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction.

Conclusions

This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior.

Stakeholders' perspectives of comprehensive sexuality education in Iranian male adolescences

Background

A coherent sexuality education program for adolescents is part of their sexual and reproductive rights and can help them have a healthier future. Therefore, the aim of this study was to explore the perspectives and intervention preferences of Iranian stakeholders regarding comprehensive sexuality education (CSE) in male adolescents based on the IMB model (information, motivation, behavioral skills).

Methods

This study was a qualitative study that was analyzed through a directed content analysis approach. Individual interviews and focused group discussions (FGDs) were used for data collection. The data were collected through in-depth semi-structured interviews with stakeholders in two schools and the Education Department in Sari and the Ministry of Health and Ministry of Education in Tehran from March 2019 to August 2019. Data saturation was achieved after 28 interviews and 1 FGDs with 9 participants. Finally, two sets of data were coded and analyzed using directed content analysis.

Results

In this study, five themes emerged as (1) role of institutions; (2) role of organizations; (3) need for stakeholder’s partnership; (4) need for adolescent sexuality socialization management; and (5) need for enhancing the teachers’ professional competence, which seemed to influence the implementation of CSE in male adolescents. Participants also expressed a number of intervention preferences for CSE. The most important of these was the change in macro policies, helping to create a culture against all forms of violence and breaking the taboo of sexuality education for children and adolescents.

Conclusions

The results of this study revealed the need for a CSE program for adolescents' sexuality socialization. The finding showed that teachers required training to enhance their professional competence about sexuality issues. Therefore, it is necessary to design and implement culture-appropriate skill based programs to enhance the teachers’ professional competence regarding the adolescents’ sexual health.

Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review

INTRODUCTION

Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research.

METHODS

We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement.

RESULTS

We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement.

CONCLUSIONS

We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.

Delivery strategies for optimizing uptake of contraceptives among adolescents aged 15-19 years in Nsanje District, Malawi

Background

Despite documented benefits of contraceptives, uptake among young people aged 20–24 years is high compared to adolescents aged 15–19 years in Malawi. As the world’s population of 15–19-year-olds continues to grow the need to meet the increasing demand for contraceptive services and information that address adolescent-specific needs cannot be underestimated. To inform Sexual and Reproductive health services for the youth, we explored strategies for optimizing uptake of contraceptives among this age group.

Methods

An exploratory qualitative cross-sectional study was conducted at Nsanje District Hospital and Nyamadzere Community Day Secondary School guided by Social-Ecological Framework to understand strategies that may optimize the uptake of contraceptives among adolescents aged 15–19. Nsanje district was purposively selected based on the reason that it is the second district in Malawi with the highest rate of adolescent childbearing of girls aged 15–19 years. We conducted a Focus Group Discussion (FGD) with 9 traditional leaders, 11 Key Informant Interviews (KIIs) with health workers, 20 In-depth Interviews (IDIs) with 12 adolescents, 4 teachers, and 4 parents. All data were digitally recorded, transcribed verbatim into English. The data was analyzed and managed using deductive thematic analysis guided by Social-Ecological Framework.

Results

Adolescents suggested accessing contraceptives from local drug stores, pharmacies and hospitals at a health system level and through Youth Centres, clubs, and corners at a Community level. There is a need to ensure a continuous supply of various kinds of contraceptives and the presence of youth-friendly health care workers in the specified areas.

Conclusion

There is no one way of delivering contraceptives to adolescents. Multiple avenues existent at the health facility and community could be leveraged to optimize delivery and uptake of contraceptives in a manner that is not intimidating to an adolescent while involving key stakeholders.