Exploring comprehensive sexuality education experiences and barriers among students, teachers and principals in Nepal: a qualitative study.

BACKGROUND: Comprehensive sexuality education (CSE) is essential in empowering adolescents with the knowledge and confidence to manage their sexual and reproductive health. Despite its recognized benefits, access to quality CSE remains limited, especially in low-income countries, where societal norms and structural barriers hinder effective delivery. The aim of this study is to investigate the experiences and perceptions among students, teachers, and principals in Nepal about comprehensive sexuality education. METHODS: Qualitative methods were used. 13 Semi-structured interviews and 1 focus group discussion were carried out with 15 teachers and principals working at higher secondary schools and two focus group discussions were conducted with a total of 13 adolescents. Thematic analysis was used to analyze the data. RESULTS: Four themes were developed: Resistance to Teaching and Learning, Preparation and Engagement Strategies, Taboos and Silencing and Structural Barriers. Students, teachers, principals and students reported discomfort and embarrassment when discussing sensitive topics, with gender dynamics playing a significant role. Strategies like warm-up sessions and continuous interaction with students and parents were used to create a supportive learning environment. However, socio-cultural barriers and family attitudes continued to hinder open discussions about sexuality. Structural barriers, including the lack of formal training for teachers and inadequate instructional materials, further impeded effective CSE delivery. CONCLUSION: The experiences of CSE in Nepal among students, teachers and principals highlight significant barriers including cultural taboos, gender dynamics and insufficient resources. Addressing these barriers through comprehensive teacher training, curriculum reform, and societal engagement is critical to ensure access to CSE.

Adolescents' risky sexual behaviours and practices: Implications for sexuality education implementation in Zambia.

BACKGROUND:  Adolescents' risky sexual behaviours (RSB) are detrimental to their sexual and reproductive health (SRH) well-being and present a serious public health threat, particularly in low- and middle-income countries (LMICs). AIM:  This study aims to assess RSB among Grade 12 school-going adolescents after exposure to comprehensive sexuality education (CSE). SETTING:  This study was conducted in Kitwe district, Zambia. METHODS:  This cross-sectional study included 807 Grade 12 pupils at 13 selected secondary schools. Data were collected using a structured questionnaire. Proportionate probability sampling involving 13 schools was employed. Risky sexual behaviours binary outcome variables were based on transactional sex, sex while drunk, multiple sexual partners, age-disparate sexual relationships, and condomless sex. We conducted univariate and bivariate analyses to summarise sociodemographic factors and fitted binary and multivariable logistic regression models. RESULTS:  The prevalence of RSB was 40.4%. Drinking alcohol (adjusted odds ratio [AOR] = 20.825; 95% CI [6.7-64.489]); ever had sex (AOR = 9.024; 95% CI [1.953-41.704]); school location (AOR = 6.50; 95% CI [1.61-26.24]); living with mother only (AOR = 4.820; 95% CI [1.328-17.493]); sex (male) (AOR = 2.632; 95% CI [1.469-4.713]), watching pornography (AOR = 1.745; 95% CI [1008-3.021]); religion (AOR = 0.472; 95% CI [0.250-0.891]) and attending religious functions (AOR = 0.317; 95% CI [0.118-0.848]) were significantly associated with RSB. Of the sexually active pupils, 221 (67.7%), 64 (19.6%) and 41 (12.5%) were in the low, medium and high-risk categories, respectively. CONCLUSION:  Close to half of the respondents engaged in RSB. This is a significant number that needs intervention. The CSE programme needs to be linked with structural programmes that address the social drivers of RSB among adolescents.Contribution: The study provides a backdrop for evaluating current CSE strategies in LMICs.

Introducing comprehensive sexuality education in Italian schools: from the co-construction to the evaluation of a pilot intervention.

INTRODUCTION: School-based comprehensive sexuality education (CSE) is a powerful tool that provides young people with information on all aspects of sexuality and is aimed at protecting their sexual and reproductive health and well-being throughout their lives. Currently, CSE is not integrated within the schools' curriculum in Italy. This study describes the co-construction, implementation, and evaluation of a CSE project piloted among students attending lower secondary schools, in four regions of Italy. Evidence-based evaluation will be helpful in promote the inclusion of CSE programs in the Italian schools' curriculum. METHODS: The pilot scheme was co-constructed by a multidisciplinary curriculum development group through a Delphi process, including educators who conducted the activities. The evaluation followed three directions: the program (based on a literature review of CSE principles and recommended characteristics), implementation (assessing the execution of the program through the analysis of the reflection tools used by the educators), and short-term outcomes (assessing critical thinking and conscious behavioural choices through pre-post and satisfaction surveys). RESULTS: The main goal, learning modules and content were defined and structured in five interventions with the students, and two with families and teachers. A total of 638 students were involved in the activity, across 11 schools. Data analysis of pre/post surveys reported a significant increase in knowledge in 12 of the 15 items investigated (p < 0.05), and a high level of satisfaction with the topics addressed. Qualitative analysis added information on the pivotal role of educators in CSE. CONCLUSIONS: The national piloting of this educational activity provided positive insights regarding the co-construction, implementation and short-outcome evaluation, suggesting potential for scalability and future inclusion of CSE in the curricula of Italian schools.

Stakeholders' Experiences and Preferences Regarding Comprehensive Sexuality Education in Zambia: Implications for Determining Programme Priorities and Strategies.

BACKGROUND: Understanding and exploring stakeholders' perceptions and preferences regarding comprehensive sexuality education (CSE) is critical in enhancing programme acceptability. We conducted this qualitative study to explore stakeholders' experiences and preferences of CSE in Kitwe district, Zambia. METHODS: We employed a qualitative descriptive design within the interpretive paradigm at nine purposefully selected secondary schools. Data were collected through classroom observation, in-depth interviews, and focus group discussions. In depth interviews were undertaken among 21 pupils, 17 teachers, 4 policymakers, 4 parents, and 4 religious leaders. Two focus group discussions were conducted among 14 pupils with each group having seven pupils. Data were analysed using inductive thematic analysis. Interviews continued until data saturation. RESULTS: Our analysis yielded themes on stakeholder experiences of CSE which included: a lack of pupil-centred pedagogy; a lack of stakeholder engagement; a lack of CSE competency and skills; holding back culturally sensitive topics; a lack of guidance from the comprehensive sexuality curriculum; and a lack of CSE prioritisation in schools. Themes on preferences included: the formation of community advisory boards; the need to enhance teachers' professional competencies, linking CSE with community SRH services, pupils SRH needs assessment. CONCLUSIONS: A community participatory approach to the design and implementation of a CSE programme is critical in enhancing programme acceptability in schools. While understanding the experiences and preferences of pupils regarding CSE can help determine programme content and priority, improving teachers' competency and skills through appropriate CSE training can help to reconcile teachers' personal beliefs and the content of CSE.

Process evaluation of comprehensive sexuality education programme in Zambia: a focus on contextual factors, mechanisms of impact, quality of development and implementation process.

BACKGROUND: Comprehensive sexuality education (CSE) is critical in addressing negative sexual and reproductive health (SRH) outcomes among adolescents. Yet in many low- and middle-income countries (LMICs) including Zambia, little is known about the impact, realities of CSE implementation, the quality of teaching and the comprehensiveness of the content covered. METHODS: Our approach was informed by a process evaluation incorporating recommendations by the European Expert Group guidance on evaluating sexuality education programmes and the Medical Research Council (MRC) guidelines on process evaluation. The development process and quality of CSE implementation were assessed using eight and six quality criteria respectively. In-depth interviews (IDIs), focus group discussions (FGDs), document analysis and classroom observation were employed to assess contextual factors, implementation process and mechanisms of impact of CSE. In-depth interviews (50) and focus group discussions (2) with seven pupils in each group were conducted among 64 purposefully selected participants. The sample comprised pupils (35), parents (4) and teachers (17) from nine secondary schools (four peri-urban, four urban and one rural), policymakers (4), and religious leaders (4). We employed deductive content analysis to analyse the data. RESULTS: Contextual factors that influenced the implementation of CSE included: (1) piecemeal funding for the CSE programme; (2) lack of monitoring programmes in schools; (3) lack of community engagement; (4) religious and socio-cultural barriers; (5) lack of skills and competency to teach CSE; and (6) insufficient time allocation for CSE. The assessment of the quality of the development of CSE revealed: (1) a lack of sexual diversity; (2) no meaningful participation of pupils in programme implementation; (3) a lack of stakeholder engagement during programme implementation; (4)  lack of gender sensitivity; and (5) lack of human rights approach. Assessment of the quality of the implementation of CSE revealed: (1) no evidence of skill-based CSE teaching; (2) no linkage between CSE and SRH services in the communities; and (3) a lack of incorporation of multiple delivery methods during CSE teaching. The mechanisms of impact of CSE were related to the acceptability and positive changes in pupils' SRH practices. CONCLUSION: The complex influences of contextual factors during CSE implementation highlight the need for contextual analysis during the interventional design. Co-creation of the CSE programme through stakeholder participation could reduce social opposition and enable a culturally sensitive CSE. Comprehensive teacher training, a guiding curriculum as well as setting of appropriate monitoring tools and indicators are likely to enhance the quality of CSE implementation.

Decoloniality and women's agency in sex education in Zambia.

In 2018, 22 teachers and four government officers started a six-month development process, designed to integrate a gender-equity lens into sex education in Eastern Province, Zambia. The initiative was funded by the Dutch Government. In this article, I explore the emancipatory potential and limits of this gender transformative approach. Civil society privileges the empowerment of women's and girls' voices through participatory methods. This situated women-led 'encounter of change' between men and women addressed the 'harmful practices' of Chewa initiation, transcending patriarchal opposition in the process. Using an applied anthropological lens, I explore what enabled this contingent change in narrative among teachers, but I also question the coloniality inherent in efforts to transform the gender and sexuality of others through the ubiquity of voice.

Integrating critical thinking on gender and power within sexuality education has been praised for its ability to reduce unwanted pregnancies and sexually transmitted infections, including HIV. The Dutch government has been investing in this 'gender transformative approach' by strengthening the capacity of 64 schools in Zambia. I draw on findings of a multi-sited ethnography on the experiences of 22 male and female teachers and government officials in Zambia, who underwent training in this approach from 2018 to 2019. Female teachers and government workers utilized this training to critique and change harmful initiation rites of the Chewa peoples. However, this attempt at norm change was hindered by the 'fluidity of patriarchy,' which refers to the ability of powerful men to adapt to outside interventions. In this case, they undermined the project. Labeling this resistance simply as 'dealing with opposition', as Western NGOs have started doing recently, overlooks the ways in which traditions are reimagined and reinvented to sustain patriarchy and gender inequality. In this article, I critique the way Western programs listen to the voices of the young people they aim to support. Due to NGO jargon and a focus on evidence and effectiveness, these voices often go unheard. I urge policymakers and practitioners to ask self-critical questions about who gets to set the research agenda, whose voices are prioritized, and (ironically) how their own masculinist leadership norms and neoliberal practices may embody expressions of coloniality and patriarchy.

Women's Pornography Use Patterns and Sexuality Education in U.S. Public Schools.

This study investigated the relationship between sexuality education in U.S. public schools and women's pornography use. Utilizing quantitative methods, we examined a sample of women attending U.S. public schools who reported regular pornography use. Results revealed that, regardless of the type of sexuality education received, women exhibited similar rates of pornography use, with 60% reporting its use. A substantial portion (69%) of the women began using pornography during childhood or adolescence. Women who received abstinence only sexuality education reported higher frequencies of pornography use compared to their comprehensive sexuality education counterparts. About 79% of women using pornography perceived it as a source of sexuality learning, especially regarding sexual pleasure. However, they expressed reluctance in using pornography for sexual education and did not consider it a preferred method for learning about sexuality. The findings suggest the need for comprehensive sexuality education that addresses essential topics, such as sexual pleasure and sexual script development, to cater to women's diverse learning needs, ideally taught by parents or primary caregivers, but may be necessary for public education in the absence of parental instruction. Policymakers and educators should bridge these gaps to develop more effective sexuality education curricula. This study contributes valuable insights, highlighting the importance of an inclusive approach to sexuality education in U.S. public schools. Future research should explore the implications of different sexuality education approaches on women's sexual development and well-being, emphasizing comprehensive education to foster healthy sexual behaviors among women.

Sexuality education for school-aged children and adolescents: A concept analysis.

PURPOSE: Sexuality education is essential for children and adolescents to make better choices regarding their sexual well-being. Parents, teachers, and healthcare providers are not always comfortable talking to school-age children about sex, making sexuality education a concept of interest to be explored. The purpose of this paper is to explain the concept of sexuality education in school-aged children and adolescents. DESIGN AND METHODS: This paper uses Walker and Avant's concept analysis to help clarify its meaning. The sexuality education concept is explored in this article in the views of educating school systems K-12 with three types of sexuality education (abstinence-only, abstinence-plus, and comprehensive sexuality education). Literature from 1990 to 2023 was retrieved using PubMed, Google Scholar, and CINAHL. RESULTS: A model case is used to demonstrate the importance of sexuality education. A borderline case and a related case are proposed to explain other uses of the concept. Defining attributes, antecedents, consequences, and empirical referents are explored. Antecedents of sexuality education are grouped into three categories: resources, political environment, and social beliefs. PRACTICE IMPLICATIONS: A conceptual understanding of sexuality education can foster nurses' confidence in talking to their patients about this topic and encourage nurses to advocate for comprehensive sexuality education nationwide.

Development of a sexual consent intervention for adolescents with intellectual and developmental disabilities.

BACKGROUND: Tailored sexuality education for adolescents with intellectual and developmental disabilities is a crucial, yet unmet, need as this population is particularly at risk for sexual abuse and victimisation. However, there are no evidence-based interventions to specifically address this need. This paper presents the development of an intervention framework to address equity in sexuality education and support adolescents with intellectual and developmental disabilities to understand and provide sexual consent, a foundational aspect of sexuality education and sexual health. METHODS: The Sexual Health Equity Project team used a Community-Based Participatory Research approach to develop a four-module sexual consent intervention for adolescents with intellectual and developmental disabilities. We leveraged a diverse, interdisciplinary team in a suburban Midwestern school district, and used Backward Design to create objectives and assessments which were rooted in findings from qualitative data by special education teachers. RESULTS: The resulting sexual consent intervention, Ask Me First-Choices, is comprised of four modules covering topics including definition of sexual consent; decision-making strategies and practice; communicating consent and refusal, identifying situations of consent and non-consent; and legal issues surrounding consent. Each module is divided into five components for content delivery: (1) introduction, (2) lecture, (3) supplemental activity, (4) assessment, and (5) conclusion. We detail the intervention's unique aspects, emphasising areas where we used Universal Design for Learning principles to support teachers' instruction and students' learning. CONCLUSION: Our efforts to create a sexual consent intervention directly address sexuality education equity issues. We offer commentary on our design process and decisions, as well as recommendations for future groups who want to develop sexual health interventions in similar contexts for students with intellectual and developmental disabilities. Next steps include further testing and validation of the sexual consent intervention to build the evidence-base of sexuality education for adolescents with intellectual and developmental disabilities.

Preparation of the pre-service teacher to deliver comprehensive sexuality education: teaching content and evaluation of provision.

BACKGROUND: Despite the extensive benefits associated with the provision of comprehensive sexuality education (CSE) within a school context, many initial teacher training programs inadequately prepare pre-service teachers to deliver this content. Programs that do provide such instruction do not routinely share details of their curriculum, syllabi, or evaluation data. METHODS: This paper outlines the structure of an Australian undergraduate course for pre-service teachers that focuses on instruction in CSE. This course spans twelve teaching weeks, aligns with evidence-based principles for sexuality education, prioritises experiential learning and requires students to complete authentic, practical assessment tasks. Formative, process, and short-term impact evaluation data, based upon five years of delivery, are described. RESULTS: Students completing this course reported statistically significant improvements in attitudes associated with CSE and comfort in facilitating all domains of learning (knowledge, attitudes, skills). CONCLUSIONS: Positive process and short-term impact data provide strong evidence for the provision of CSE to pre-service teachers, regardless of future teaching speciality. Proposed amendments include the creation of a fully online tuition pattern and an expansion of content to incorporate other audiences, such as community-based educators.

Protocol for designing and evaluating an undergraduate public health course on sexual and reproductive health at a public university in California.

Introduction: Comprehensive sexuality education (CSE) is associated with positive sexual and reproductive health (SRH) outcomes, including increased contraceptive use, lower rates of unintended pregnancy and prevention of sexual violence. However, implementation of and requirements for CSE vary across the United States which can negatively impact students, both during and beyond high school, including among college students. Methods: and Analysis: This paper describes the research protocol for a multi-staged approach for designing, implementing and evaluating an SRH course for up to 60 undergraduate students at a public university in California. Before the class is offered, we will conduct 20 in-depth interviews with current students, educators and course design experts to learn from their experiences and seek their guidance on course design. To evaluate the course, enrolled students will complete a pre-course and a post-course survey before and after class is taught, to assess students' attitudes and values relevant to educational concepts and the format and delivery of the course and its modules and activities. Approximately 20 students will take part in an in-depth exit interview, after completing the course, to gather perceptions about how the course impacted their knowledge and behavior. The goal is to refine materials for future in-person course offerings and develop a prototype for a fully online version of the course. Discussion: This study introduces a novel university-level course to provide young adult students comprehensive, evidence-based education on sexual and reproductive health from a public health perspective. The program leverages existing CSE efforts, enhancing them with academic rigor, inclusive content and digital inclusion. This approach, inclusive of diverse sexual orientations, content on pleasure and sexual violence prevention, aims to fill existing gaps in university curricula and also set a new standard in CSE. The project's innovative and multidisciplinary design offers a model for broader impact within a large public university system and beyond.

Development and implementation of a worksite-based intervention to improve mothers' knowledge, attitudes, and skills in sharing information with their adolescent daughters on preventing sexual violence: lessons learned in a developing setting, Sri Lanka.

BACKGROUND: Sexual violence among adolescents has become a major public health concern in Sri Lanka. Lack of sexual awareness is a major reason for adverse sexual health outcomes among adolescents in Sri Lanka. This study was intended to explore the effectiveness of a worksite-based parent-targeted intervention to improve mothers' knowledge, and attitudes on preventing sexual violence among their adolescent female offspring and to improve mother-daughter communication of sexual violence prevention with the family. METHODS: "My mother is my best friend" is an intervention designed based on previous research and behavioral theories, to help parents to improve their sexual communication skills with their adolescent daughters. A quasi-experimental study was conducted from August 2020 to March 2023 in randomly selected two Medical Officer of Health (MOH)areas in Kalutara district, Sri Lanka. Pre and post-assessments were conducted among a sample of 135 mothers of adolescent girls aged 14-19 years in both intervention and control areas. RESULTS: Out of the 135 mothers who participated in the baseline survey, 127 mothers (94.1%) from the intervention area (IA) physically participated in at least one session of the intervention. The worksite-based intervention was effective in improving mothers' knowledge about adolescent sexual abuse prevention (Difference in percentage difference of pre and post intervention scores in IA and CA = 4.3%, p = 0.004), mother's attitudes in communicating sexual abuse prevention with adolescent girls (Difference in percentage difference of pre and post intervention scores in IA and CA = 5.9%, p = 0.005), and the content of mother-daughter sexual communication (Difference in percentage difference of pre and post intervention scores in IA and CA = 27.1%, p < 0.001). CONCLUSIONS AND RECOMMENDATIONS: Worksite-based parenting program was effective in improving mothers' knowledge about sexual abuse prevention among adolescent daughters and in improving the content of mother-daughter communication about sexual abuse prevention. Developing appropriate sexual health programs for mothers of different ethnicities, and cultures using different settings is important. Conduction of need assessment programs to identify the different needs of mothers is recommended.

Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study.

This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.

Effects of an Animation-Based Comprehensive Sexuality Education Package: A 2-Year Repeated Intervention Study.

BACKGROUND: Preadolescents, who are in a transitional phase of development, may experience higher exposure to heterosexual interactions while facing higher risks regarding misinformation in sexual knowledge and unsafe engagement in sexual activities. There is a deficiency in the availability of qualified educators and age-appropriate teaching materials for sexuality education in China. METHODS: We implemented an animation-based comprehensive sexuality education package among preadolescents aged 9 to 12 years from eight schools in Anhui, China. The first round of intervention included 1,835 participants, lasting 2 months from September to November 2020. A total of 374 participants, accounting for 52% of the intervention group, received a second round of intervention in September 2021. Participants completed immediate follow-up assessment and 1-year follow-up assessment to assess changes in their sexual knowledge, attitudes, and other outcomes. Propensity score matching and difference-in-difference analysis were performed to determine the short- and long-term impacts. RESULTS: Significant improvements were observed for both sexual knowledge and sexual attitudes in the immediate follow-up. There was no significant effect on pornography-seeking behavior or awareness of experiencing sexual abuse. After 1 year, the effect was sustained for sexual knowledge, but slightly declined for sexual attitudes. The second intervention significantly improved sexual knowledge; however, no significant change in sexual attitudes, pornography-seeking behavior, or awareness of experiencing sexual abuse was observed. CONCLUSIONS: Our comprehensive sexuality education package was effective in improving sexual knowledge both immediately and 1 year after the intervention. Repeated intervention can be an effective strategy for promoting preadolescent health development regarding comprehensive sexuality education.

Past experiences and preferences for LGBTQ + sex education among LGBTQ + college students.

Background: Lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) students experience more negative sexual health outcomes than their cisgender, heterosexual peers and do not have access to relevant sex education. This denial necessitates comprehensive sex education in college for LGBTQ + students. Objective: Given the rise of online learning and that LGBTQ + students are already drawn to online spaces, this research seeks to determine preferences in virtual LGBTQ + sexuality education content and delivery LGBTQ + college students. Methods: We conducted a survey with US college students who identified as LGBTQ+ (N = 91) to identify past experiences with sex education, desires for future sex education, and preferences for online learning. Results: Past sex education, resources used, consequences, preferences for LGBTQ + sexuality and online education are discussed. Conclusions: Overall, we find high comfort with online learning, heteronormative and cisnormative past sex education courses created negative physical and mental health outcomes, and desires for tailored sex education.

Sex 101: A Rapid Review of Research in the United States on the Impacts of College Sexual Health Curricula.

Comprehensive sexuality education (CSE) has been shown to have a wide range of positive impacts for K-12 students. Despite its demonstrated benefits, many K-12 students in the USA do not receive CSE. Because of this, college may be an opportune time to teach this information. However, little is known about the impact of CSE at institutions of higher education. To synthesise knowledge about the impacts of college-level sexual health courses in the USA, a review of the topic was conducted. A review searching Ebscohost, ProQuest, PubMed, and Google Scholar was undertaken. Following the search, a second coder reviewed the articles to confirm eligibility. 13 articles, published between 2001 and 2020, met the inclusion criteria and were included in the review. A wide range of outcomes were reported. These included increased health promoting behaviours, less homophobic and judgemental attitudes around sexuality, improved communication and relationships, and increased understanding of sexual violence. College sexual health courses have high potential efficacy to provide CSE and fill gaps in US students' sexual health knowledge. Future research should corroborate the existing outcomes using randomisation and more diverse samples and examine whether these courses are effective in preventing sexual assault.

School-based comprehensive sexuality education for prevention of adolescent pregnancy: a scoping review.

BACKGROUND: Adolescent pregnancy is a global public health problem. Numerous approaches for Comprehensive Sexuality Education (CSE) delivery in schools have been implemented around the world. Previous reviews on CSE did not follow the International Technical Guidance on Sexuality Education (ITGSE) because CSE is very diverse in terms of population, interventions, settings and outcomes. We conducted this scoping review to identify and map the evidence of school-based CSE for prevention of adolescent pregnancy with emphasis on adolescents' contraceptive use, unintended pregnancy and abortion. METHODS: We searched PubMed, CENTRAL, Scopus, ISI Web of Science, CINAHL, and WHO ICTRP to identify potential eligible studies from their inception to 4th Nov 2023.We included randomized controlled trials (RCTs) and non-RCTs of CSE implemented in public or private schools for adolescents. CSE was defined as a multi-session intervention in school that covered topics including contraception, pregnancy, abortion, and HIV/STI. School-based interventions were the main intervention that may be either stand-alone or multicomponent. There was no limitation on study's geographical area, but only English-language studies were considered. Two reviewers selected and extracted data independently, discussed for consensus or consulted the third reviewer if there were discrepancies for final conclusion. Data were presented using figures, map and table. RESULTS: Out of 5897 records, 79 studies (101 reports) were included in this review. Most studies were conducted in the United States and other high-income countries in secondary or high schools with cluster RCTs. All studies included participatory methods. Almost all studies included Sexual and Reproductive Health which is the eighth concept of CSE. Very few studies reported the prespecified primary outcomes of contraceptive use during last sex, unintended pregnancy and abortion and hence this highlighted the gaps of available evidence for these outcomes. The number of concepts, components, duration and providers of CSE varied across the included studies. However, none of the interventions identified in this scoping review adhered to the ITGSE recommended approach. CONCLUSIONS: Our scoping review shows gaps in school-based CSE implementation in terms of completeness of concepts, components, providers, duration and outcomes recommended by ITGSE.

Sexual Health and Well-Being: A Framework to Guide Care.

Although the acceptance of sex positivity centering pleasure and justice has grown, clinical and public health strategies for sexually transmitted infection management have remained focused on risk and adverse outcomes. To promote sex-positive health care practice in clinical settings and beyond, health care practitioners should use an integrated, patient-centered approach to sexual health. These strategies include initiating discussions, continued sexual health education, providing informative material for patients, and knowledge of different communication strategies. Patient-provider interactions might be enhanced by using such methods.

The effect of sexuality education based on the information, motivation, and behavioral skills model on improving the teachers' professional competence.

Introduction: Professional competence is the basic need of teachers in effective sexuality education. Therefore, the aim of this study was to evaluate the impact of school-based sexuality education (SBSE) on teachers' professional competence (TPC), using the information, motivation, and behavioral skills (IMB) model, in boys' schools. Methods: A randomized controlled field trial was conducted on 60 teachers who taught adolescents aged 11-19 years and were selected from 12 public boys' schools in Sari, northern Iran. Two groups (intervention and control) were assigned using a multi-stage stratified random sampling method. Researchers utilized a self-reported socio-demographic questionnaire and an IMB model-based questionnaire to assess the effects of the educational program. Four groups of 6-8 people underwent six 2-h training sessions based on an IBM model. Teachers were assessed before, immediately, and six weeks after the intervention to evaluate the outcome variables. The data were analyzed using the software SPSS-V19 and Chi-square test, Independent t-test, One-way ANOVA, and Repeated Measure ANOVA. Results: There were no significant differences between intervention and control groups at the baseline in socio-demographic characteristics and TPC (p > 0.05). The mean scores of TPC in sexuality education in every three dimensions of knowledge (P = 0.001), skill (P = 0.002), and attitude (P = 0.007) were significantly higher in the intervention group than in the control group. Conclusions: The results of this study show that by using the SBSE program based on the IMB model, the TPC for teaching sexual issues can be improved.

Exposure to comprehensive sexuality education in schools in South Africa: the implications on the uptake of HIV testing services among HIV positive adolescent girls.

Comprehensive sexuality education (CSE) is seen as a key instrument through which to affect behaviour and improve sexual and reproductive health (SRH) outcomes amongst adolescents. However, few studies have to date evaluated key SRH outcomes following exposure to CSE within a school setting. This study estimates the association between CSE and HIV testing and HIV testing self-efficacy amongst HIV positive adolescent girls. Data were collected from a cross-sectional survey administered in four high HIV prevalence districts . Independent variables included exposure to CSE, with outcome variables measuring uptake of HIV testing in the 12 months preceding the survey, and HIV testing self-efficacy. The sample comprised 505 HIV positive adolescent girls aged 12-19. . Attending CSE was associated with both; being more confident to get an HIV test (AOR: 2.44, 95% CI: 1.47-4.06, p < 0.001) and having ever tested for HIV (AOR: 2.15, 95% CI: 1.39-3.33, p < 0.001) while controlling for numerous variables. Results suggest CSE can play an important role in not only affecting HIV-related behaviours themselves, but also critical factors that affect HIV behaviours, including self-efficacy.