Comprehensive sexuality education may help prevent intimate partner violence, but few evaluations of sexuality education courses have measured this. Here we explore how such a course that encourages critical reflection about gendered social norms might help prevent partner violence among young people in Mexico. We conducted a longitudinal quasi-experimental study at a state-run technical secondary school in Mexico City, with data collection including in-depth interviews and focus groups with students, teachers, and health educators. We found that the course supported both prevention of and response to partner violence among young people. The data suggest the course promoted critical reflection that appeared to lead to changes in beliefs, intentions, and behaviors related to gender, sexuality, and violence. We identify four elements of the course that seem crucial to preventing partner violence. First, encouraging participants' reflection about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships, and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The findings reinforce the importance of schools for violence prevention and have implications for educational policy regarding sexuality education. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.

Despite calls for evaluation practice to take a complex systems approach, there are few examples of how to incorporate complexity into real-life evaluations. This article presents the case for using a complex systems approach to evaluate a school-based intimate partner violence-prevention intervention. We conducted a post hoc analysis of qualitative evaluation data to examine the intervention as a potential system disruptor. We analysed data in relation to complexity concepts particularly relevant to schools: ‘diverse and dynamic agents’, ‘interaction’, ‘unpredictability’, ‘emergence’ and ‘context dependency’. The data—two focus groups with facilitators and 33 repeat interviews with 14–17-year-old students—came from an evaluation of a comprehensive sexuality education intervention in Mexico City, which serves as a case study for this analysis. The findings demonstrate an application of complex adaptive systems concepts to qualitative evaluation data. We provide examples of how this approach can shed light on the ways in which interpersonal interactions, group dynamics, the core messages of the course and context influenced the implementation and outcomes of this intervention. This gender-transformative intervention appeared to disrupt pervasive gender norms and reshape beliefs about how to engage in relationships. An intervention comprises multiple dynamic and interacting elements, all of which are unlikely to be consistent across implementation settings. Applying complexity concepts to our analysis added value by helping reframe implementation-related data to focus on how the ‘social’ aspects of complexity influenced the intervention. Without examining both individual and group processes, evaluations may miss key insights about how the intervention generates change, for whom, and how it interacts with its context. A social complex adaptive systems approach is well-suited to the evaluation of gender-transformative interventions and can help identify how such interventions disrupt the complex social systems in which they are implemented to address intractable societal problems.

New York City has growing numbers of Mexican and Caribbean born residents, who have been identified as underserved communities for reproductive health care. We conducted exploratory focus groups to develop and test messages about emergency contraception that would be culturally relevant to these communities. Findings reveal lack of knowledge about what emergency contraception is and how it works, concerns about safety, and health care barriers. Multiple messages were tested in Spanish and English, and participants expressed positive attitudes about using emergency contraception once they knew that is was different from an abortion pill.

Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre—post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in receiving a 2.5-hour training session at their work site. Methods: Human subjects approval was obtained from an Internal Review Board. Anonymous surveys were administered a few weeks prior to the training session and at completion of the training session. The training programme was free and not conditional on survey completion. No incentives were offered for research participation. Results: A single training session was associated with increased knowledge about the timing, efficacy, and safety of emergency contraceptive pills as well as with more positive attitudes about use of emergency contraceptive pills. This was true for health care workers, health educators, and social service providers. Social service providers had the least amount of knowledge prior to the training session, but had the same amount of knowledge as the other two groups after the training session. Social service providers also had the least positive attitudes about emergency contraception before and after the training session, when compared with the other two groups; however, positive attitudes of social service workers did significantly increase after the training session, which resulted in smaller differences between the groups at post-test. Conclusion: Among other educational and motivational tools to increase use of emergency contraception, training of human service professionals can increase the knowledge and attitudes necessary for informing their numerous clients about how to access emergency contraceptive pills as well as their safety and efficacy.

Comprehensive sexuality education may help prevent intimate partner violence, but few evaluations of sexuality education courses have measured this. Here we explore how such a course that encourages critical reflection about gendered social norms might help prevent partner violence among young people in Mexico. We conducted a longitudinal quasi-experimental study at a state-run technical secondary school in Mexico City, with data collection including in-depth interviews and focus groups with students, teachers and health educators. We found that the course supported both prevention of and response to partner violence among young people. The data suggest the course promoted critical reflection that appeared to lead to changes in beliefs, intentions and behaviors related to gender, sexuality and violence. We identify four elements of the course that seem crucial to preventing partner violence. First, encouraging participants’ reflection about romantic relationships, which helped them question whether jealousy and possessive behaviors are signs of love; second, helping them develop skills to communicate about sexuality, inequitable relationships and reproductive health; third, encouraging care-seeking behavior; and fourth, addressing norms around gender and sexuality, for example demystifying and decreasing discrimination towards sexually diverse populations. The findings reinforce the importance of schools for violence prevention and have implications for educational policy regarding sexuality education. The results suggest that this promising and relatively short-term intervention should be considered as a school-based strategy to prevent and respond to partner violence.