Meaningful evaluation of sex and relationship education

Effective sex and relationship education promotes agency and targets sexual practice as it is socially produced. The aim of evaluation therefore is to contribute to good sexual health through identifying when and how education is promoting agency and changes in sexual practice. Good evaluation takes account of the complexities of the specific object being addressed—sexual practice—which is fluid and essentially social. Innovative study design and the use of rigorous and transparent methods enable evaluators to track and understand the slow, unsteady and sometimes unpredictable mechanisms of change. The data gathered (both quantitative and qualitative) require interpretation, and interpretations inform the development of sex and relationship education programmes. Randomised controlled trials do not meet these criteria of meaningful evaluation, nor do evaluations of one‐off interventions. This paper considers the role of cross‐sectional and longitudinal surveys, in‐depth qualitative studies, and reviews in evaluating whether education works, how it works, how its messages are being actively taken up and transformed by the target population, and in informing the development of future education.     

Sexuality and relationships education: toward a social studies approach

Globally, gender norms and power differentials profoundly affect both girls' and boys' sexual attitudes, practices and health. One avenue for enabling young people to reflect on traditional gender arrangements that endanger their health—and to lay the groundwork for satisfying sexual lives—is sexuality and relationships education (SRE). Unfortunately, many SRE programmes address gender norms and critical thinking skills either superficially or not at all. Moreover, in some developing countries, SRE programmes do not reach the majority of girls aged 15–19, a high proportion of whom are simply not in school. This paper argues for grounding SRE within a social studies framework, emphasizing gender and social context. Such an approach can foster critical thinking skills, can provide a foundation for subsequent lessons on explicitly sexual topics, can illuminate the links between gender inequality and other social issues, can allow for a human‐rights emphasis that may prove politically less controversial than technical sexuality topics, and may ultimately prove vital to achieving better sexual health outcomes. The experience of community‐based programmes provides lessons for designing and evaluating such approaches in schools.     

Knowledge and attitudes of secondary school teachers regarding sexual health education in England

Objective To assess the sexual health knowledge of teachers who contribute to secondary school sexual health education in order to determine whether teachers are adequately prepared to implement present government education and public health policies.

Design Results were obtained from a questionnaire as part of a two‐phase intervention study.

Setting Nineteen mixed‐sex, state secondary schools in central England.

Participants One hundred and fifty‐five teachers (94 female, 61 male) participated.

Main outcome measures The questionnaires were distributed to teachers to assess their knowledge of sexual health, contraception and sexually transmitted infections. In addition, teachers' attitudes on the subject of sex and relationships education were evaluated.

Results The results suggest that teachers have insufficient sexual health knowledge to effectively teach sexually transmitted infections or emergency contraception, although their general sexual health knowledge was good. Therefore, at present teachers do not have adequate specialist knowledge in sexual health to contribute to current recommendations for sex and relationships education in secondary schools. There were no statistically significant differences in the results regarding location of school, area of residence, gender or age of the participant.

Conclusions Many teachers are being expected to contribute to secondary school sexual health education programmes at a time when they do not have sufficient knowledge to provide young people with adequate sexual health education and when they do not feel prepared to teach, and in many cases would prefer not to teach, these programmes.     

Design,implementation and evaluation of school-based sexual health education in sub-Saharan Africa: a qualitative study of researchers’ perspectives

This study investigated facilitators and challenges to designing, implementing and evaluating school-based sexual health education in sub-Saharan Africa, using interviews with intervention designers and researchers. At the pre-planning and planning stages, participants reported that facilitating factors included addressing the reproductive health needs of participants, contextual (culture, religion, economic and social) considerations and the adoption of holistic approach to sexuality education. Lack of open communication about sexual health matters between young people and adults; concerns that sexual health education could encourage sexual activity; and inadequate funding, were key barriers. Implementation was facilitated by the involvement of relevant stakeholders, the training of facilitators and adopting strategies to overcome resistance to sexual health education. The provision of structured, detailed lessons plans and monitoring with supportive supervision optimised fidelity of delivery. Barriers to implementation included facilitators’ resistance to teaching safe sex promotion and logistical challenges in school environments. Participants also reported that the validity of self-reported adolescent sexual behaviour (as part of evaluation) may be improved by complementing well-designed self-report surveys with computerised audio devices for data collection, qualitative interviews and participant observation. Study findings generate recommendations to improve future forms of school-based sexual health education in sub-Saharan Africa.     

Sex education,first sex and sexual health outcomes in adulthood: findings from a nationally representative sexual health survey

This study investigated the relationship between school sex education and sexual health behaviours at first sex and later in adulthood, using nationally representative data. Respondents were adults from the 2010 Irish Contraception and Crisis Pregnancy Survey, a cross-sectional survey designed to assess knowledge, attitudes and behaviours relating to sex, contraception and pregnancy in Ireland. Results indicate that respondents who received sex education were more likely to have first sex at an older age and use contraception on this occasion. Sex education also significantly increased the likelihood of using contraception at first sex, when first sex occurred before 17 years of age. The effect of sex education and sexual health behaviours into adulthood was also investigated. Sex education increased the likelihood of having a history of sexually transmitted infection testing and decreased the likelihood of having experienced a crisis pregnancy. No association was found between sex education and contraception use over the past year. Findings suggest that sex education is an important factor in the context of first sex and later sexual health, and programmes should continue to equip young people as they make immediate sexual behaviour decisions and further sexual health-related decisions throughout their lifespan.     

Evangelical Christian parents’ attitudes towards abstinence-based sex education: ‘I want my kids to have great sex!’

While an overwhelming majority of people in the USA support some form of school-based sexual education, the specific content and context for that instruction varies widely, making it difficult to assess support for particular types of programmes. This is particularly the case for evangelical Christians, about whom there is a lack of scholarly consensus concerning support for sexual education. This paper addresses this gap, and examines the assumption that evangelical Christians uniformly support abstinence-only sexual education, using qualitative analysis among a group of evangelical Christians in a medium-sized Texas city. Respondents were asked during interviews to identify the types of sex education-related content they support, and where and how they believe these messages should be taught. Respondents were also asked to identify their rationales for supporting (or opposing) certain elements of sexual education. Interviews revealed a group of evangelical Christian parents who verbalised their explicit opposition to abstinence-based sex education in schools, lamenting the sex-negative messages they believe to be associated with it. It additionally became apparent that these parents believe that their opposition to abstinence-based sexual education aligns with a silent majority of evangelical Christians.     

Educating queer sexual citizens? A feminist exploration of bisexual and queer young women’s sex education in Tasmania,Australia

There is a well-documented absence of inclusive school-based sex and relationships education (SRE) for Australian lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. Moreover, relatively few studies specifically examine how bisexual and queer-identifying young Australian women experience SRE. This qualitative study addresses the gap and contributes new perspectives by examining bisexual and queer young women’s experiences of school-based SRE in the state of Tasmania through the lens of sexual citizenship. Drawing on qualitative interviews with 15 Tasmanian bisexual and queer young women, we argue that biomedical, risk-based and heteronormative approaches to SRE reduce young women’s sexual health literacy. By framing SRE around the concept of ‘sexual citizenship’, this article provides important guidance on how SRE can more effectively provide bisexual and queer young women with the skills they need to be effective, engaged sexual citizens.     

Evaluating the need for sex education in developing countries: sexual behaviour,knowledge of preventing sexually transmitted infections/HIV and unplanned pregnancy

Young people's need for sex education is evidenced by their typically early initiation of sexual activity, the often involuntary context within which they have sexual intercourse, high‐risk sexual behaviours and the inadequate levels of knowledge of means of protecting their sexual health. The earliness of initiation of sexual intercourse has implications for the age by which sexuality education should be provided. The extent and context of sexual behaviour is a firm indicator of the need for sex education as well as for counselling, information and services related to sexual and reproductive health. Apart from behaviours, information on the extent of knowledge and accuracy of knowledge about risks to sexual health and about means of preventing unhealthy or undesired outcomes are important indicators of young people's need for information to help them make choices and to engage in safe and healthy behaviours. Such measures of behaviour and knowledge can also be relevant and valid indicators of the effectiveness of sex education interventions. The context with which young people live and key characteristics such as school attendance and literacy are important considerations in providing information and in evaluating interventions.     

Reviews

Introduction: Despite government support of culturally appropriate sex and relationships education (SRE), young people's access to information is limited and sexual health needs are not being met, particularly among youth from black and minority ethnic groups. Joint‐working between health, education, voluntary sectors and parents has been heralded as key in redressing inequalities in sexual health outcomes and access to information. Our study focuses on SRE provision for young Muslim Bangladeshis, highlighting the complexities involved in streamlining SRE messages.

Objective: To explore stakeholder views about SRE and ways to improve SRE delivery.

Design: Sixteen semi‐structured interviews were conducted in 2005 with stakeholders from schools, National Health Service, and parent and voluntary sector bodies in a London borough.

Results: Two key factors enhancing Bangladeshi youth's risk of infection and unwanted pregnancy were identified: inadequate parental understanding about sexual health and limited parent‐delivered SRE; and patchy provision of culturally appropriate, school‐based SRE. Factors affecting SRE provision included culturally rooted perceptions of sex/sexuality and limited participation of stakeholders, (religious leaders, parents), in developing and delivering SRE.

Conclusions: This study highlights the importance of widespread community engagement, underlining that joint‐working, and the development and delivery of culturally appropriate and consistent SRE, necessitates communication and collaboration among stakeholders in young people's health and well‐being.     

What Tanzanian parents want (and do not want) covered in school-based sex and relationships education

Despite evidence that demonstrates the benefits of school-based sex and relationships education (SRE) in promoting and protecting young people's sexual health, there are still controversies regarding what should be covered in the SRE curriculum among different stakeholders, including parents. This study assessed Tanzanian parents' attitudes towards the provision of SRE in schools in order to ascertain their level of support and what they wanted covered in school-based SRE. Two hundred and eighty-seven parents, recruited from one urban district and one rural district, completed a questionnaire assessing their attitudes towards school-based SRE. Results show that, in both districts, more than 75% supported the provision of SRE in schools as well as the inclusion of a wide range of topics in school-based SRE curriculum. However, the results also show that parents do not equally welcome the inclusion of some topics – especially those in the domain of attitudes and values, such as homosexuality and masturbation. The study concludes that, although parents may object to the inclusion of some topics, they generally support the provision of SRE in schools. It is hoped that the results of this study will help to overcome some of the resistance to a more widespread introduction of SRE in Tanzanian schools that rests on fears of parental reaction.     

Out in school: talking about sexual orientation and challenging homophobia across the Key Stage 4 curriculum

Rates of sexually transmitted infections and teenage pregnancy amongst the under-16s are causing increasing concern. There is limited evidence about the sexual behaviour and sex education preferences of this age group, especially of those from Black and minority ethnic groups. This study aimed to provide data on early heterosexual risk behaviour, and to examine preferences for the content and delivery of sex and relationships education (SRE), across ethnicity, gender and school year to inform priority setting and sex education strategies. A cross-sectional study of 3334 13–17-year-olds from 10 English urban and suburban secondary schools was conducted. Multivariate analysis was performed to examine the independent effect of demographic variables on sexual experience and preferences for sex education. A number of important differences in the sexual experience and condom use of males and females across the ethnic groups were identified. Differences in preferences for the content and delivery of sex education were also identified, particularly between male and female pupils. The findings indicate the potential for quite wide variation in sexual experience and preferences within school classrooms. The challenge for educators is therefore to develop SRE curricula that are inclusive within the constraints of school teaching.     

‘Youth in a void’: sexuality,HIV/AIDS and communication in Kenyan public schools

The disappearance of traditional sex education during rites of passage in African societies has left many youth uncertain of where to look for information. Against this backcloth, the objectives of this study were to identify knowledge gaps amongst adolescents in Kenya regarding sexuality, HIV/AIDS and reproductive health. A thematic analysis was conducted of questions posed by 735 school youth aged 12–18 years from Meru and Kajiado Districts. Results show that many questions showed curiosity and anxiousness. Knowledge appeared to be fragmented and sometimes revealed misconceptions, which may put youth at risk. The raised themes differed by gender and age. Questions on saying no to sex, sexual violence and female circumcision were a great concern for girls. Boys were more concerned with managing boy–girl relationships, preventing STI/HIV infection, and condoms. Concern about transition to adulthood, sexuality, STI and HIV/AIDS, myths and misconceptions, and intergenerational communication cut across both genders. Older teens were more concerned with questions on boy–girl relationships, norms and values regarding sexuality, and STI. Younger teens ( < 15 years) wanted to know about reproduction, saying no to sex, HIV/AIDS, condoms, sexual violence and female circumcision. Compounding these challenges was the lack of intergenerational communication. The study identified important knowledge and communication gaps in sexual and reproductive health among in-school adolescents in Kenya. There is a need for sex education interventions for different age groups and genders. These interventions should work with parents, teachers and health professionals.     

‘There are lots of different kinds of normal’: families and sex education – styles,approaches and concerns

This paper reports on qualitative research with Australian parents concerning their attitudes to sexuality and relationships education, both at home and in school. A wide range of values and attitudes were represented among parents in this study. Regardless of the varying approaches parents used, all participants expressed a desire for their children to be well informed about sex, sexual health and relationships, yet many felt inadequate to the task of providing high-quality sex education to their children. Some participants blamed this lack of confidence on their own limited education about sexuality. Their main concern was to ensure that their children are safe and that when they do become sexually active their experiences of sex are positive. Most participants saw sex education as primarily their responsibility, with school sex education as an important adjunct. They wanted to be well informed about the timing and content of school programmes for their children, and to be assured that those educators who will be teaching their children about sexual health have the skills and qualifications to do their job well, while remaining sensitive to the diversity of values among students and their families. While most parents who participated in the research supported sexuality education in schools, they did so with reservations. In particular, they wanted schools to take an active role in communicating with them about the content of sexuality education programmes and be open to meeting with those parents who expressed concerns.     

Teenage Pregnancy and Sex and Relationship Education: Myths and (mis)Conceptions

This paper explores the role of sex and relationship education (SRE) in reducing teenage pregnancy rates. It critically examines some of the assumptions underlying the emphasis placed on SRE within the teenage pregnancy strategy ( SEU, 1999 ) – in particular, the view that ignorance of sexual matters plays a key part in teenage conception. An analysis of these assumptions is used to explore the reasons why the research evidence on the efficacy of sex education in changing adolescent sexual behaviour is mixed. Attention is drawn to the wider contexts within which adolescent sexual behaviour occurs – and the wider contexts within which schools are operating to provide SRE. Also highlighted are suggestions from the literature about what young people want from sex education and the possible implications for reducing teenage pregnancy. The paper concludes that although important, SRE, on its own, is unlikely to be the panacea sought by politicians to reduce the incidence of teenage pregnancy in the United Kingdom.     

Motives,barriers, and ways of communicating in mother-daughter sexuality communication: a qualitative study of college women in Tanzania

In Tanzania, young women aged 15–24 are at high risk for HIV and nearly half (45%) of women experience pregnancy or childbirth before age 19. The HIV epidemic has motivated many parents to overcome cultural taboos and talk with their children about sexuality, but few studies in Tanzania have examined how young adults perceive these discussions. In-depth interviews with 31 Tanzanian college women (ages 18–25) reveal how they make sense of sexuality messages from mothers that are sometimes vague, admonishing and fear-based. Participants identified how mothers focused on the health, educational and social consequences of premarital sex and emphasised the avoidance of men as a strategy to maintain virginity. Mothers avoided providing specific information about safer-sex practices, or strategies to negotiate romantic relationships, sexual pressures or sexual desires. Findings offer insight into how relational and cultural contexts influence mothers’ sexual socialisation and can inform education and intervention approaches that consider the changing cultural landscape. Future qualitative research with mothers is recommended to develop programmes that are more responsive to mothers’ and daughters’ needs.     

Birth order and parental and sibling involvement in sex education. A nationally-representative analysis

This analysis set out to identify associations between birth order and sexual health outcomes, focusing on family involvement in sex education and early sexual experiences. The third National Survey of Sexual Attitudes and Lifestyles is a stratified probability sample survey of 15 162 men and women aged 16–74 in Britain. Logistic regression was conducted to identify odds ratios for the association between birth order and sexual health outcomes. Multiple logistic regression was performed adjusting for socio-demographic factors and sibling number. Middle-born and last-born men had lower odds of reporting ease talking to parents about sex around age 14 and learning about sex from their mothers. Last-born women had lower odds of reporting a parental main source of sex education or having learned about sex from their mother. Findings represent an exploratory analysis in an under-researched area, and provide the basis for further research on the association between birth order and parental involvement in sex education, as well as the role and impact of sex education provided by older siblings.     

Vernacular knowledge and critical pedagogy: conceptualising sexual health education for young men who have sex with men

Over 30 years after HIV was first recognised in the USA, the epidemic continues to pose a disproportionate threat to vulnerable and marginalised populations. Increasing HIV incidence among young men who have sex with men has spurred debate around the content and approach to HIV prevention interventions directed towards this vulnerable population. A comprehensive model for conceptualising the content of sexual health education is described, which can be tailored to the unique needs and experiences of young men who have sex with men through the application of social theory. Vernacular knowledge is incorporated as a manner of nesting sexual health messages within the shared understandings of young men regarding same-sex sexual practices, gender roles and expectations, community mores and conventions and other shared knowledge of sex and sexuality. Critical pedagogy is then discussed as a way of guiding one’s pedagogical approach during intervention design and implementation that is most conducive to both individual empowerment and community solidarity. The paper concludes with strategies for turning the corner from theory to practice, beginning with formative research that culminates in the design of relevant, community-based sexual health education programmes for young men who have sex with men.     

Of drama,dreams and desire: creative approaches to applied sex education in southern Africa

In the midst of a generalised HIV and AIDS epidemic in southern Africa, the argument for more coordinated and comprehensive youth sexual health interventions is intensifying. Yet the crucial question of how best to provide young people with these skills and knowledge remains a key challenge for policy-makers, researchers and practitioners in our region. Moreover, amongst the available literature on sex education in southern Africa, few authors have taken an applied perspective, to look at fresh approaches and tools with the potential to be implemented more broadly. This paper argues for a greater focus on concepts of masculinity and sexuality in the development of sexual health efforts in southern Africa. It aims to bridge theory and practice by advancing six promising approaches with the potential to create a suitable space and environment for participants to engage with these issues. Approaches include methods and tools currently being implemented in existing programmes, as well as ideas emerging from recent literature. Our paper is ultimately a call for further ‘out-of-the-box’ thinking to find more effective and creative practical ways of providing the sexual health education our region's youth urgently needs. It is also a call for more applied research, to better inform future sex education programmes in southern Africa.     

Rules of Engagement: Boys, Young Men and the Challenge of Effective Sex and Relationships Education

Over the last decade, the relationship between boys, young men and sex and relationships education (SRE) is one that has been characterised by a history of problematising. One of the main difficulties lies with young men's engagement with the subject, and in this article I make a retrospective examination of recent classroom experience with young people and training with professionals who deliver SRE. In the exploration of how best to engage this client group, I argue that masculinity and sexuality are potent issues in their lives and an understanding of these helps explain patterns in young men's behaviour, sexual health and attitudes towards SRE. Autoethnography is used as a method of enquiry to produce short vignettes in which I evaluate my successes and failures with four different boys and young men in terms of engagement. From these primary data, I have distilled four key domains in the form of a framework that I offer as a springboard for researchers, policy-makers and practitioners to consider more positive implications for future practice.     

The views,verdict and recommendations for school and home sex and relationships education by young deaf and hearing people

The purpose of this survey study was to explore the views of young deaf and hearing people (16–25 years old) on school and home sex and relationships education (SRE). The study addressed a critical knowledge gap in the research literature on deaf youth's perception of SRE. The small-scale study explored young deaf people's experiences of SRE and the challenges they had faced when learning about sexuality and relationships. Recommendations on how to improve school SRE lessons were also obtained. Data were collected from 81 young people (n = 27 deaf, n = 54 hearing). Overall, deaf participants indicated greater levels of satisfaction with school SRE than hearing respondents. More deaf young people than young hearing people felt that the school had provided them with enough opportunities to learn about sexuality and relationships. The deaf group showed a preference for school SRE lessons to start at a later age than the hearing group. Mothers and friends were the two sources most frequently consulted in both groups. Teachers and school nurses were a third source frequently used by the deaf group. The views of deaf and hearing youth on their own SRE are important for the development, implementation and delivery of the school SRE curriculum. The study's findings can provide educators with valuable insight on the needs of a minority group who are particularly vulnerable to sexual exploitation and sexual misinformation due to their sensory loss and associated factors.