Scholarly article on topic 'The Effectiveness of a School-based Sexual Health Education Program for Junior High School Students in Khon Kaen, Thailand'

The Effectiveness of a School-based Sexual Health Education Program for Junior High School Students in Khon Kaen, Thailand Academic research paper on "Economics and business"

CC BY-NC-ND
0
0
Share paper
OECD Field of science
Keywords
{"school-based education" / "sexual health" / sexuality / "early adolescent" / "junior high school student"}

Abstract of research paper on Economics and business, author of scientific article — Jetnipit Sommart, Chulaporn Sota

Abstract This quasi-experimental pre-test and post-test design was used to evaluate the effectiveness of a school-based sexual health education program among intervention students (n=33) compared with control students (n=33). The data were collected from self-administered questionnaires and analyzed by using paired t-test and independence t-test. The results showed that after intervention the intervention group had significant difference in their knowledge and attitude, while the control group had no significant. Thus, school staff, health personnel, and relevant agencies should consider adopting this approach to protect adolescent students from unsafe sexual behavior.

Academic research paper on topic "The Effectiveness of a School-based Sexual Health Education Program for Junior High School Students in Khon Kaen, Thailand"

Available online at www.sciencedirect.com

ScienceDirect

Procedia - Social and Behavioral Sciences 91 (2013) 208 - 214

PSU-USM International Conference on Humanities and Social Sciences

The effectiveness of a school-based sexual health education program for junior high school students in Khon Kaen, Thailand

Jetnipit Sommartab*, Chulaporn Sotac

aPhD candidate in Public Health Program, Graduate School, Khon kaen University, Khon Kaen 40002, Thailand

bSirindhorn College of Public Health Khon Kaen Province 40000, Thailand cDepartment of Health Education, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand

Abstract

This quasi-experimental pre-test and post-test design was used to evaluate the effectiveness of a school-based sexual health education program among intervention students (n=33) compared with control students (n=33). The data were collected from self-administered questionnaires and analyzed by using paired t-test and independence t-test. The results showed that after intervention the intervention group had significant difference in their knowledge and attitude, while the control group had no significant. Thus, school staff, health personnel, and relevant agencies should consider adopting this approach to protect adolescent students from unsafe sexual behavior.

© 2013 TheAuthors.Publishedby Elsevier Ltd.

Selectionand peer-review under responsibility of Universiti Sains Malaysia.

Keywords: school-based education; sexual health; sexuality; early adolescent; junior high school student

1. Introduction

Sexual health issues among Thai adolescents are becoming a considerable problem particularly among early adolescents, because they are easily exposed to risk of unwanted pregnancies and sexually transmitted diseases (STDs), including HIV/AIDS. Studies in Thailand have reported that young people are more likely to engage in high-risk behavior, such as unprotected sex [1, 2, 3, 4, 5]. The age of sexual initiation has also become lower [1, 2]. Among those, some had pregnancies and some resorted to abortion, especially abortions which performed outside hospitals or by non-health officers. There is a greater risk of complications among those young women [6,7]. In urban areas, adolescents are more sexually active than in rural areas, because Thai traditional culture in rural area is still a very strong influence regarding sexual behavior among young people and the reaction of parents to any teenage pregnancies [5, 8]. A study by Soonthorndhada [9] revealed that when a young girl becomes pregnant, she has to leave school and the boy who fathered the child has to leave school as well. Among the factors which influenced the engagement in sexual relationships and inappropriate sexual

* Corresponding author. Tel.: +66-89-418-2818; fax: +66-43-221-770 ext 102. E-mail address: jetnipitsm@gmail.com

1877-0428 © 2013 The Authors. Published by Elsevier Ltd.

Selection and peer-review under responsibility of Universiti Sains Malaysia.

doi: 10.1016/j.sbspro.2013.08.419

experiences among early adolescents were family, peers [10, 11], and social factors such as drinking alcohol, substance abuse, including media sources [12, 13].

Considering the concepts of sex education at schools in Thailand, it was found that the contents of the text books are inadequate. Moreover, a study by Boonmongkon [14], which revealed that sex education in schools, is not successful due to the fact that teachers had a didactic approach and insufficient resources. Thus, more appropriate approaches were needed to diminish sexual health problems among early adolescents. The school-based intervention should be beneficial to improving sexual health and preventing negative outcomes (such as sexually transmitted infections, unwanted pregnancies) in this target group [15]. The effectiveness of this approach can change sexual behavior based on a theoretical method, especially social cognitive theory [16]. Therefore, we evaluated this approach with junior high school students in order to help them decrease their inappropriate sexual behavior.

The objective of this study was to evaluate the effectiveness of a sexual health education program on sexual health knowledge, and attitude toward sexuality among junior high school students in urban area of Khon Kaen, Thailand.

2. Methods

2.1. Participants

Participants were junior high school students (aged 12-14) recruited from two high schools located in urban areas of Khon Kaen using purposive sampling. Schools were selected based on students' demographic characteristics and location. After being notified of the purpose of the study, both of the schools were willing to participate. The selected students, and their parents, were informed about the purpose of the study, and then they were asked to sign an informed consent form before the intervention to indicate that they were willing to participate. Finally, the participants included 66 junior high school students (33 students for the intervention group and 33 students for the control group).

2.2. Study design and procedures

A quasi-experimental research pre-test and post-test design was used to evaluate the effectiveness of the sexual health education program. A baseline survey, and a 'before intervention' test using self-administered questionnaires were conducted with both the intervention and control group one week before the intervention began. After that, we provided seven weekly sessions of education for the students in the intervention group. Post-test questionnaires, which were the same as the 'before intervention' test, were completed by all the participants two month after the intervention. The questionnaires were collected by the researcher during school hours. To ensure confidentiality, students' names and codes were not recorded.

2.3. Sexual health intervention

The sexual health intervention program for the intervention group was based on the results of collaboration between the researcher and key stakeholders, including school administrators, teachers, parent representatives, community representatives, and student representatives. A meeting was held to clarify the content, objective, date, time and materials of the intervention program. The program was revised three times to comply with the unmet needs of the target group. A draft sexual health program was pilot tested on 20 students from a high school in the urban area of Khon Kaen who did not participate in the main study. The demographic characteristics of the students who took part in the pilot test were similar to those of the students in the participating schools. Suggestions from the pilot test were used for making a final draft of the intervention program.

Finally, the appropriate program comprised of five topics, which were: 1) adolescent development; 2) inappropriate sexual behavior and prevention, including negotiation skills; 3) sexually transmitted diseases (STDs) and prevention; 4) teen pregnancy and prevention; and 5) contraceptive methods (such as condoms, birth control pills) and the impact of premarital sex. The program was performed by using a participatory learning process. The activity styles that were used were: role play, demonstration, case study, and group discussion. 50 minutes was allocated for each class-room topic, and the program was completed in seven weeks. All sessions were conducted by the researcher and four facilitators who were all health personnel and they were welcomed by the students. Before the intervention began, the facilitators spent two days to practicing both the contents of the program and the ways to carry out the participatory techniques, to ensure that the implementation was completed effectively. There were no sexual health education programs using a participatory learning process given to the control group. They only received their school's regular curriculum.

2.4. Data analysis

Statistical analysis was conducted by using STATA (version 10.0). The statistical methods used were as follows: descriptive statistics were used to describe the baseline data such as frequency, percentage, mean and standard deviation; and paired t-test and independence t-test were used to compare mean differences before and after the intervention.

2.5. Ethical consideration

Ethical approval for this study was granted by the Human Research Ethics Committee of Khon Kaen University.

3. Results

3.1. Demographic characteristics of the participants

The baseline of the participants at both high schools showed that the intervention and control groups were similar. The average ages of the participants in the intervention and control groups were 13.42±0.56 and 13.70±0.53 years respectively. The majority of students in both groups were male (57.58%, 54.55% respectively). GPA ranged from 2.38 to 3.96, and 2.19 to 3.96 respectively. More than half of the participants in both groups reported living with parents and family status showed their parents living together as showed in table1.

Table 1. Demographic characteristic of the participants

Intervention group

Control group

Demographic characteristics

[N=33 (%)]

[N=33 (%)]

1. Age (years) mean ± S.D. Median (Min-max)

2. Sex Male Female

3. Grade point average (GPA) mean ± S.D.

Median (Min-max)

3.23 (2.38 - 3.96) 3.25 (2.19 - 3.96)

3.24 ± 0.42

13.42±0.56

13 (12-14)

19 (57.58) 14 (42.42)

3.22 ± 0.46

13.70±0.53

14 (12-14)

18 (54.55) 15 (45.45)

Jetnipit Sommart and Chulaporn Sota /Procedia - Social and Behavioral Sciences 91 (2013) 208 - 214 Table 1. Demographic characteristic of the participants (Continued)

Demographic characteristics

Intervention group

Control group

[N=33 (%)]

[N=33 (%)]

4. Person with whom participants live Both mother and father

Mother Relatives

5. Family status Parents live together Parents divorced

Father and/or mother dead

21 (63.64) 5 (15.15) 7 (21.21)

28 (84.85) 4 (12.12) 1 (3.03)

24 (72.73) 7(21.21) 2 (6.06)

24 (72.73) 8 (24.24) 1 (6.06)

3.2. Effectiveness of intervention • Sexual health knowledge

The mean scores of sexual health knowledge in the intervention and control groups before intervention were at a moderate level. After intervention, we found that the mean scores of the intervention group at post-test were higher than at pre-test with statistically significance (mean diff.=1.58; P=0.0013; 95% CI=0.6 to 2.56). Mean scores between the two groups showed that the intervention group had higher scores than the control group with statistically significant differences (mean diff.=0.94; P=0.0160; 95% CI=0.08 to 1.80) as showed in table 2.

Table 2. Mean scores, standard deviation and comparison of sexual health knowledge before and after intervention

Mean ± S.D.

Before After

intervention intervention

Mean difference

within group (95% CI) (P-value)

Mean difference between group (95% CI) (P-value)

Intervention group (n = 33)

Control group (n = 33)

10.15±2.11 11.73±1.82

10.30±1.47 10.79±1.65

1.58 (0.60 to 2.56) (P=0.0013) 0.48 (-0.12 to 1.09) (P=0.0553)

0.94 (0.08 to 1.80) (P=0.016)

• Attitude toward sexuality

Before intervention, we found that mean scores of attitude toward sexuality in the two groups were at a moderate level. After intervention, the mean scores of the intervention group at post-test were higher than those at pre-test, with statistically significance (mean diff.=4.42; P=0.0001; 95% CI=2.31 to 6.54). The mean scores in the intervention group were higher than the control group with significant differences (mean diff.=6.52; P<0.0001; 95% CI=3.66 to 9.37) as showed in table 3.

Table 3. Mean scores, standard deviation and comparison of attitude towards sexuality before and after intervention

Mean ± S.D. Mean difference Mean difference

Before After within group between group

intervention intervention (95% CI) (95% CI)

(P-value) (P-value)

Intervention group 51.91±7.72 56.33±4.57 4.42 6.52

(n = 33) (2.31 to 6.54) (3.66 to 9.37)

(P=0.0001) (P<0.0001)

Control group 48.94±7.45 49.82±6.81 0.88

(n = 33) (-0.60 to 2.36)

(P=0.1177)

4. Discussions

4.1. Effectiveness of the sexual health education program

The main objective of this study was to evaluate the effectiveness of a school-based sexual health education program among junior high school students. The results indicated that the program was effective in enhancing sexual health knowledge, creating a positive attitude toward sexuality, and fostering among students in the intervention group the intention to refuse to take sexual risks. These findings are consistent with the findings of other school-based studies [17, 18], which tried to evaluate the impact of a school-based HIV/AIDS education program on knowledge, attitude, and behavior among adolescents. In addition, the study by Andrade HH et al suggested that school-based sex education influenced positive changes in sexual behavior among adolescents [19]. However, the mean difference of students' knowledge between two groups was rather small (mean diff. =0.94). This may due to the students in both groups also having received sexual information from other sources such as teachers, parents, friends, or media. This observation corresponds to the findings of Yazici S et al [20], which indicated that adolescents received information about sexual and reproductive health from parents and friends. Also, a study by Bleakley A et al [21] confirmed that adolescents obtained sexual information from friends, teachers, parents, and media. Although we found an improvement in students' attitude towards sexuality with significant differences at pre-test and post-test in the intervention group, the mean scores of pre-test and post-test remained at a moderate level. This finding agreed with a study by Madeni F et al [22] which showed an increase in adolescents' knowledge and behavior about sexuality, but there was no significant difference in attitude at pre-test and post-test. They suggested that attitudes may be difficult to change.

4.2. Program implementation

We used a participative method during the implementation process. All of the activities were based on brainstorming with the student representatives before implementation, in order to obtain appropriate activities which corresponded to their unmet needs. After the intervention, the students had increased positive improvement in both knowledge and attitude. It indicated that participatory learning is beneficial, and better than learning by passive activities [18]. In addition, the collaboration and support from school administrators, teachers and parents during the intervention period were significant in the success of the program [23]. Also, any future facilitators should have knowledge and experience in sexual and reproductive health education. However,

cooperation from all relevant agencies is needed to explore proper strategies for sustaining such a program in the long term.

5. Conclusion

In conclusion, the school-based sexual health education program was effective in generating positive changes in sexual health knowledge, and attitudes towards sexuality among junior high school students. The results suggest that school administrators, teachers, health personnel, and relevant agencies should consider adopting a school-based education approach to preventing sexual risks among early adolescents. Also, this education program should be provided to other high schools.

6. Limitations

Firstly, participating schools were not randomized into intervention and control groups. We chose the intervention school using purposive sampling and the school administrator was willing to participate in the study; then the other high school was chosen as a control group. This sampling can be biased. Secondly, the intervention period was short, only two months (July to August 2012). Therefore, the impact and sustainability of the program could not be assessed. Thus, long-term assessment is essential for further study.

Acknowledgements

We would like to thank Graduate School, Khon Kaen University, Thailand for financial support and also thank both schools including the students as well as parents who participated in the study.

References

[1] Allen, D.R., Carey, J.W., Manopaiboon, C., Jenkins, R.A., Uthaivoravit, W., Kilmarx, P.H., et al. (2003). Sexual health risk among young Thai women: Implication for HIV/STD prevention and contraception. AIDS and behavior, 7(1): 9-12.

[2] Celentano, D.D., Sirirojn, B., Sutcliffe, C.G., Quan, V.M., Thomson, N., Keawvichit, R., et al. (2008). Sexually Transmitted Infections and Sexual and Substance Use Correlates among Young Adults in Chiang Mai, Thailand. Sexually Transmitted Diseases, 35(4): 400-5.

[3] Liu, A., Kilmarx, P., Jenkins, R.A., Manopaiboon, C., Mock, P.A., Jeeyapunt, S., Uthaivoravit, W., &Van Griensven, F. (2006). Sexual initiation, substance use, and sexual behavior and knowledge among vocational students in Northern Thailand. International Family Planning Perspectives, 32(3): 126-35.

[4] Rongkavilit, C., Naar-King, S., Chuenyam, T., Wang, B., Wright, K., &Phanuphak, P. (2007). Health risk behaviors among HIV-infected youth in Bangkok, Thailand. J Adolesc. Health, 40(4): 358.e1-8.

[5] Podhisita, C., Xenos, P., &Varangrat, A. (2001). The risk of premarital sex among Thai youth: Individual and family influence. East-West Center Working Papers: Population series, 108-5.

[6] Warakamin, S., &Boonthai, N. (2002). Fact Sheet: Abortion Situation in Thailand, 1999. Health Situation and Environment, 7(5). [In Thai].

[7] Warakamin, S., Boonthai, N., &Tangcharoensathien, V. (2004). Induced abortion in Thailand: current situation in public hospitals and legal perspectives. Reprod Health Matters, 12 (24 Suppl), 147-56. [Abstract]

[8] Sridawruang, C., Crozier, K., &Pfeil, M. (2010). Attitudes of adolescents and parents towards premarital sex in rural Thailand: A qualitative exploration. Sexual&Reproductive Healthcare, 1(4): 181-87.

[9] Soonthorndhada, A., Kittisuksathit, S., Punpuing, S., Varangrat, A., Malhotra, A., Curran, S.R., et al. (2005). Youth at Odds: Thai Youth's Precarious Futures in a Globalized World. (1st ed), Nakhon Pathom: Institute for Population and Social Research, Mahidol Universty.

[10] Wang, B., Li, X., Stanton, B., kamali, V., Naar-King, S., Shah, I, et al. (2007). Sexual attitudes, pattern of communication, and sexual behavior among unmarried out-of-school youths in China. BMC Public Health, 7: 189. Doi 10.1186/1471-2458-7-189.

[11] Adhikari, R., &Tamang, J. (2009). Premarital Sexual Behavior among Male College Students of Kathmandu, Nepal. BMC Public Health, 9: 241. Doi: 10.1186/1471-2458-9-241.

[12] Wong, M.L., Chan, R.K., Koh, D., Tan, H.H., Lim, F.S., Emmanuel, S., et al. (2009). Premarital sexual intercourse among adolescents in an Asia country: Multilevel ecological factors. Pediatrics, 124(1): e44-e52.

[13] Phillips-Howard, P.A., Bellis, M.A., Briant, L.B., Jones, H., Downing, J., Kelly, I.E., et al. (2010). Wellbeing, alcohol use and sexual activity in young teenagers: finding from a cross-sectional survey in school children in North West England. Substance Abuse Treatment, Prevention, and Policy, 5:27. Doi: 10.1186/1747-597X-5-27.

[14] Boonmongkon, P., &Thaweesit, S. (2011). The Asian-Pacific Resource and Research Centre for Women (ARROW). Reclaiming & Redefining Rights - Thematic Studies Series 1: Sexuality & Rights in Asia. Kuala Lumpur, Malaysia: ARROW.

[15] McKay, A. (2005). Sexual health education in the schools: Questions&Answers. SIECCAN, Sex Information and Education Council of Canada. Canada: Toronto.

[16] Peters, L.W., Kok, G., Ten Dam, G.T., Buijs, G.J., &Paulussen, T.G. (2009). Effective elements of school health promotion across behavioral domains: a systematic review of reviews. BMC Public Health, 9: 182. Doi: 10.1186/1471-2458-9-182.

[17] Kinsler, J., Sneed, C.D., Morisky, D.E., &Ang, A. (2004). Evaluation of a school-based intervention for HIV/AIDS prevention among Belizean adolescents. Health Educ Res, 19(6):730-8.

[18] Cheng, Y., Lou, C.H., Mueller, L.M., Zhao, S.L., Yang, J.H., Tu, X.W., et al. (2008). Effectiveness of a school-based AIDS education program among rural students in HIV high epidemic area of China. J Adolesc Health, 42(2):184-91.

[19] Andrade, H.H., Mello, M.B., Sousa, M.H., Makuch, M.Y., Bertoni, N., &Faundes, A. (2009). Changes in sexual behaviour following a sex education program in Brazillian public schools. Cad Saude Publica; 25(5):1168-76.

[20] Yazici, S., Dolgun, G., Oztürk, Y., &Yilmaz, F. (2011). The Level of Knowledge and Behavior of Adolescent Male and Female Students in Turkey on the Matter of Reproductive Health._Sex Disabil, 29(3): 217-27.

[21] Bleakley, A., Hennessy, M., Fishbein, M., &Jordan, A. (2009). How sources of sexual information relate to adolescents' beliefs about sex. Am J Health Behav, 33(1):37-48.

[22] Madeni, F., Horiuchi, S., &Iida, M. (2011). Evaluation of a reproductive health awareness program for adolescence in urban Tanzania-A quasi-experimental pre-test post-test research. Reprod Health, 8:21. Doi: 10.1186/1742-4755-8-21.

[23] Hong, J., Fongkaew, W., Senaratana, W., &Tonmukayakul, O. (2010). Development of a theory-based sexual and reproductive health promotion and HIV prevention program for Chinese early adolescents. Nurs Health Sci, 12(3):360-8.