Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic

Abstract

Background The Dominican Republic (DR) has some of the highest rates of sexually transmitted infections (STI) and adolescent pregnancy in the Caribbean. Well-designed comprehensive sexuality education programs (CSEP) can reduce risky sexual behavior. This study sought to evaluate the Módulo Anexo Materno Infantil (MAMI) adolescent clinic’s CSEP in changing knowledge of STI and pregnancy and attitudes towards risky sexual behavior following implementation. Methods A mixed methods study was conducted among students aged 11–25 years from three schools between September 2017 and February 2018. Participants in MAMI CSEP completed questionnaires, before, immediately following, and 3 months following the CSEP. Questions assessed knowledge, attitude, and sexual experience, and obtained program feedback. There was one eight-participant focus group discussion (FGD) per school. Descriptive statistics summarized sample demographics and cross-sectional responses. McNemar’s test evaluated differences in the proportions of students selecting correct responses over time. Paired t-tests compared mean test scores across time. Result Overall response rate was 98.7% (1414/1432), with 486 pre-tests, 448 initial post-tests, and 480 3-month post-tests. Respondents identified as 53.5% (321/600) female and 46.5% (279/600) male with mean age of 14.2 years. More males (63.4%) reported sexual experience than females (35.8%) (p < 0.001). Increases in mean scores from pre-test to post-test and pre-test to 3-month post-test were statistically significant (p < 0.001). Three themes arose from the FGDs: (1) expanding sexual and reproductive health knowledge, (2) perception of curricular content, structure and delivery, and (3) student-health educator dynamic. Conclusion Improvement in test scores supports MAMI CSEP’s efficacy in educating students and reinforcing positive attitudes to reduce risky sexual behavior. Utilizing an interactive health educator model provided students with clear, accurate information in a safe environment with mutual trust. Selecting health educators employed by an adolescent clinic allows them to connect students to preventive and treatment services during the CSEP.

Interventions to Promote a Healthy Sexuality among School Adolescents: A Scoping Review

“…Surveys were the most used form of collecting data (28), followed by combined techniques. These techniques included the use of surveys combined with interviews [24][25][26], focus groups [27,28], and an online environment [29]. A field diary and participating observation were also found as combined data collection techniques [22,30].…”

A Meta-Analysis of the Effects of Comprehensive Sexuality Education Programs on Children and Adolescents

“…It is known that the changes in knowledge brought about through CSE have a direct positive effect on the responsibility for children and adolescents’ sexual behavior [ 13 ], thus making it one of the most crucial effects of education. In the current context, where ambiguous information related to sex is easily accessible [ 73 , 74 ], comprehensive sexuality education, which equips children and adolescents with the knowledge and skills for responsible decision making, not just the mere dissemination of sexual knowledge, can be considered essential for effective health promotion [ 42 , 75 , 76 ].…”

“… Total odds ratio of Comprehensive Sexuality Education ( n = 34) [ 17 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. …”