Examining LGBTI+ inclusive sexual health education from the perspective of both youth and facilitators: a systematic review

Abstract

ObjectivesTo critically appraise and synthesise the evidence in relation to both the receipt and delivery of LGBTI+ (Lesbian, Gay, Bisexual, Transgender, Intersex) inclusive sexual health education.DesignA systematic review and narrative synthesis.Data sourcesA systematic search of three online databases (EMBASE, PsychINFO and SocINDEX) from January 1990 to May 2021 was conducted.Eligibility criteriaStudies included were (1) peer-reviewed; (2) English; (3) quantitative, qualitative and mixed methods; that evaluated (4) inclusive sexual health in an educational or online setting and (5) focused on training or educating. Studies were excluded if (1) the population was not LGBTI+ inclusive; (2) the studies did not focus on original data or (3) the study was not available in full text.Data extraction and synthesisThe studies that met the inclusion criteria were assessed using the Critical Appraisal Skills Programme tool. A narrative synthesis was then completed employing content analysis focusing on the results section of each article.ResultsOf the 5656 records retrieved, 24 studies met the inclusion criteria. The majority of studies noted that both LGBTI+ youth and those who facilitate sexual health education are turning to online sources of information. Current sexual health education programmes operate mainly from a heterosexual perspective, creating a sense of exclusion for LGBTI+ youth. This is compounded by a lack of training, or provision of an inclusive curricula, resulting in facilitators feeling ill equipped or inhibited by their personal biases.ConclusionsLGBTI+ youth are not experiencing inclusive and comprehensive sexual health education. In parallel, educators report poor access to information, training and resources remain the primary reasons. There is a need to standardise sexual health curricula, making them LGBTI+ inclusive and incorporate holistic aspects of health such as pleasure and healthy relationships. Online approaches should be considered in the future, as they represent equality of access for both sexual health education professionals and LGBTI+ youth alike.

A rapid realist review of universal interventions to promote inclusivity and acceptance of diverse sexual and gender identities in schools

“…Inclusive curricula seem particularly effective for students who are severely victimized on the basis of gender expression or in schools with hostile climates 33 , 60 . Not all studies found reductions in bullying and victimization after implementing inclusive curricula 31 , 59 .…”

Effects of School Policies and Programs on Violence Among All High School Students and Sexual and Gender Minority Students

“…47 Furthermore, there are no standardized policies or curricula for delivering sexual health education inclusive of LGB and TGNC students, and many educators feel ill-equipped to provide this education. 48,49 Substantial research is needed to understand the effects of specific curricula, how they are being implemented, and the extent to which use of LGBT-inclusive sexual health curricula directly effects sexual violence and the extent to which the effect is mediated by school climate. Additionally, the finding that an inclusive sexual health curriculum was associated with increased dating violence among heterosexual cisgender students has not been found previously and warrants further research.…”

Promoting inclusivity and acceptance of diverse sexual and gender identities in schools: a Rapid Realist Review of universal interventions to improve mental health

“…This could be because inclusive curricula increase awareness ,understanding and acceptance (M1), normalise and validate sexual and gender minorities (M2), oppose compulsory heterosexuality (M3), and improve the school climate (M4). 29,31,37,[52][53][54][55][56][57][58][59][60][61][62][63][64]…”

“…Inclusive curricula seem to be most effective when they: avoid "deficit and at-risk narratives", make the contributions and achievements of LGBTQ+ role models visible, use workbooks and literature that include LGBTQ+ issues, facilitate in-depth reflection on LGBTQ+ topics beyond learning facts, have sticker systems to highlight books with LGBT themes and/or characters, include LGBTQ+ topics in sexual health education, and are implemented from an early age onwards (SAG, YPAG). 37,[52][53][54][55][56][57][58][59] Ideally, inclusive curricula should be co-designed and co-delivered by teachers and LGBTQ+ students (SAG). Our YPAG stated that students should be better educated on the history of LGBTQ+ people, for example the lesbian community providing activism and support during the HIV/AIDS crisis.…”

“…Inclusive curricula seem to be particularly effective for students who are severely victimised based on their gender expression, or in schools with hostile climates. 31,58 Not all studies found reductions in bullying and victimisation after implementing inclusive curricula. 29,57 While it is unclear what the underlying mechanisms of these differential effects are, it might be due to differing school climates and specific ingredients of curricula.…”