Pilot Implementation of a User-Driven, Web-Based Application Designed to Improve Sexual Health Knowledge and Communication Among Young Zambians: Mixed Methods Study.

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.

The sexual and reproductive health needs of school-going young people in the context of COVID-19 in rural KwaZulu-Natal, South Africa.

Background: The impact of school closures due to COVID-19 raised widespread concerns about children's health and well-being. We examine the impact on the sexual health needs of learners in the context of COVID-19 related lockdowns in rural KwaZulu-Natal, South Africa.Methods: In july-November 2020 and August-November 2021 we conducted 24 in-depth interviews and 8 group discussions with teachers and learners from 4 schools, community members and key education stakeholders. All interviews were conducted by telephone. We used a thematic analysis approach and Nvivo 12 software to manage the data.Results: Four main themes related to the COVID-19 pandemic emerged from the data: the sexual and reproductive health (SRH) of learners in the lead-up to the pandemic; the impact of COVID-19 on learners' SRH and wellbeing; the opportunities schools provided to support sexual well-being of learners during the pandemic; and the role of schools in supporting SRH for learners during the pandemic. Learners and stakeholders reported that the SRH of young people was affected by alcohol misuse, poor SRH knowledge and few pathways to link learners with services. Stakeholders working with schools reported that a lack of access to biomedical interventions (e.g., contraception) increased learner pregnancies. Gender-based violence in learners' households was reported to have increased during the COVID-19 pandemic related to loss of income. School closures disrupted the provision of a safe space to provide SRH and HIV-education through Life Orientation lessons and school nurse talks. This loss of a safe space also left learners vulnerable to sexual and physical violence. However, once schools re-opened, daily COVID-19 screening in schools provided the opportunity to identify and support vulnerable children who had other social needs (food and uniforms).Conclusion: The COVID-19 pandemic may have increased SRH needs and vulnerability of school-going children in a high HIV-burden rural setting. School shutdowns reduced the opportunity for schools to provide a vital safe space and information to enhance SRH for adolescents. Schools play a vital health promotion and social protection role.

A Media Literacy Education Approach to High School Sexual Health Education: Immediate Effects of Media Aware on Adolescents' Media, Sexual Health, and Communication Outcomes.

Media may function as sex educators for adolescents; unfortunately, media messages often glamorize risky sexual behaviors and unhealthy relationships and neglect sexual health behaviors and communication. Media Aware is a web-based comprehensive sexual health program for high school students that uses a media literacy education approach. It is designed to improve adolescents' critical thinking about media messages and provide medically-accurate information and skills building related to sexual health and communication. A randomized controlled trial was conducted in 2019-2020 with students (grades 9 and 10; n = 590) from 17 high schools across the United States. The sample was 53% female, 58% white/Caucasian; and 13% Hispanic/Latinx. One high school teacher per school and all of their 9th and 10th grade students were randomly assigned to either the intervention or delayed-intervention (control) condition. The study assessed the immediate (posttest) and short-term (3-month) effects of Media Aware on adolescents' media, sexual health, and communication outcomes. For 9 of the 17 schools, students were home from school due to the beginning of the COVID-19 pandemic during the time of their 3-month data collection, which left the short-term analyses underpowered. However, several impacts of the program were found in the immediate posttest analyses. Media Aware was found to improve sexual health knowledge and redress inaccurate normative beliefs about the frequency of risky teen sex. Media Aware also improved critical thinking about media messages with demonstrated improvements in media message deconstruction skills and decreases in the perceived realism of media messages. Moderator analyses found some differential immediate effects of the program attributable to gender. Media Aware reduced girls' normative beliefs about teen sex, generally, and increased their sexual health communication with parents as well as reduced boys' acceptance of dating violence. Students gave positive feedback about Media Aware, especially related to the online format of the program. The results from this study provide evidence that Media Aware is an effective web-based program for positively enhancing high school students' media, sexual health, and sexual health communication outcomes.

Diversity in Reproductive Health and Human Sexuality: Assessing Attitudes Comfort and Knowledge in Learners Before and After Pilot Curriculum.

BACKGROUND AND OBJECTIVES: A majority of medical students believe that treating sexual concerns is important for their careers. However, a minority feel that they have received adequate instruction in medical school. This novel supplemental reproductive and sexual health curriculum at a large academic medical center aimed to address this gap and to improve attitudes, comfort, and knowledge about sexual and reproductive health topics among learners. METHODS: Students participated in a series of sexual and reproductive health workshops taught by interdisciplinary health care workers, with the first cohort in a classroom setting and the second cohort using a virtual format due to the COVID-19 pandemic. We administered a novel pre- and postcourse survey to assess attitudes, comfort, and knowledge about the topics. We performed unpaired 1-tailed t tests and χ2 tests to compare the scores on the pre- and postcourse surveys. RESULTS: Sample size was 12 students for the first cohort and 23 students for the second cohort. Reported levels of comfort with taking sexual histories in different age groups and discussing reproductive and sexual health topics increased significantly: 0.92 for the classroom setting, and 0.50 for the virtual setting, with an average increase of 0.65 points on a 4-point Likert scale. There were no significant changes in student attitudes toward or knowledge of reproductive and sexual health. CONCLUSION: This course elaborated on topics to which medical students traditionally lack adequate exposure, with significant improvement in comfort counseling patients. A disparity between the classroom and virtual setting suggests limitations of online learning for these topics.