Effect of Animated Video Using Theory-Based Sexting Intervention Module (SIM) on Intention and Willingness to Sext among Undergraduate Students, Malaysia: Randomized Controlled Trials (Preprint)

Abstract

BACKGROUND Sexting refers to the exchange of sexually explicit digital content in a form of texts, photos, or videos. In recent years, sexting has become one of the most significant public health concerns. In Malaysia, 73% of young adults have engaged in sexting, a rather high rate compared to other western nations. Given that sexting was associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior must be intervened to alleviate the resulting public health burden. Since few interventions specifically target sexting, this study employed a theory-based approach to develop the intervention. OBJECTIVE The study aimed to develop and implement a Sexting Intervention Module (SIM) guided by the Prototype Willingness Model, delivered using online animated video, and evaluate its effectiveness on the primary outcomes (intention and willingness to sext) and secondary outcomes (knowledge, attitude, perceived norm, and prototype perception) among undergraduate students from a public higher educational institution in Melaka, Malaysia. METHODS A two-armed, parallel, and single-blinded cluster randomized controlled trial was conducted among undergraduate students from a public higher educational institution in Melaka state. Twelve programs were randomly allocated into intervention and control groups. At baseline, both groups received a validated self-administered questionnaire assessing primary and secondary outcomes. The intervention group received five animated videos with a total duration of 24 minutes posted on a private Youtube platform. The control group was put on the waitlist. Participants were observed immediately and three months post-intervention. A generalized linear mixed model was performed to determine the effectiveness of the intervention. All data were analyzed using IBM SPSS (version 26), and P value (α) of 0.05 was considered statistically significant. RESULTS A total of 300 participants were analyzed with an attrition rate of 8.3%. After adjusting for age, sex, relationship status, and the amount of time spent online there was a significant difference in intention to sext ((β=-.12; P=.002; Cohen d =0.26), willingness to sext (β=-.16; P=<.001, Cohen d=0.40), knowledge (β=.12; P=<.001, Cohen d =0.39), attitude (β=-.11; P=.001; Cohen d =0.31), perceived norm (β=-.07; P=.04; Cohen d =0.22), and prototype perception (β=-.11;P =<.001; Cohen d =0.35) between intervention and control group which was observed over three months. CONCLUSIONS The SIM using the Prototype Willingness Model delivered using online, animated videos were effective in reducing intention and willingness to sext, increasing knowledge of sexting, and reducing positive attitude, perceived norm, and prototype perception among participants in the intervention group. This module could be implemented by relevant agencies related to the sexual and reproductive health of unmarried young adults. CLINICALTRIAL Thaiclinicaltrials.org TCTR20201002001; http://www.thaiclinicaltrials.org/show/ TCTR20201002001