National Conference on Comprehensive Sexuality Education 24 – 25 May 2023, Kathmandu Intervention on Comprehensive Sexuality Education: A Mixed Methods Systematic Review

1. Ashok Pandey1,2
1Policy Research Institute, Department of Research, A government
Think Tank, Narayanhity, Kathmandu
2Public Health Research Society Nepal, Chabahil, Kathmandu
1

2. Declaration of
Conflicts of
Interest
• The authors declare that the study
was conducted in the absence of any
commercial or financial relationship
that would constitute a potential
conflict of interest. By making this
declaration, I aim to uphold the
principles of fairness, accountability,
and ethical conduct.
• This presentation is done based on
the researcher’s knowledge and
expertise. It will use only for 2

3. Outline of the
presentation
3
Background
Objectives
Methodology/ Implementation Approach
Results/ Findings
Challenges/ Lesson Learned
Conclusions/ Recommendations

4. Background
 In order to fulfill health, well-being, and dignity; children and
young people need to acquire the knowledge, skills, attitudes,
and values that CSE attempts to give them
 The CSE interventions, represent one of the most used
preventive actions that can be delivered in person, remotely, or
in a mixed way
 Intervention approaches include abstinence, comprehensive
and risk-oriented, mixed-sex group & dose–effectiveness
relation interventions are effectively implemented
 Theoretical Framework: The health belief model, Social
cognitive theory, Theory of reasoned action, Health behavior
theory, information, motivation, and behavioral skills model,
etc. can be used.
4

5. Objective
To identify the shared components of
successful CSE interventions through a
systematic review over the last twenty years.
To gain a better understanding of the impact
of CSE intervention on health promotion.
5

6. Methodology/Implementation Approach
Study design: Mixed methods study (Systematic Review)
• 5 electronic databases were searched (Pubmed, Google Scholar,
Research Gate, Scopus and Web of Science) & all (19) WHO/ICTRP
clinical trial registries
Techniques: 2002 onwards research studies; 2 researchers
independently conducted (appropriate truncations and Boolean
operators were used)
• The duplicated articles were eliminated with the Zotero software.
• The article’s title, inclusion & exclusion criteria, and statistical
analysis were screened via REVMAN software.
Synthesis Method: intervention’s approach, session, intervention types,
theoretical framework, facilitators’ training, and intervention
methodology
6

7. Interventions
Intervention Methodology: icebreakers, demonstrations, games, brief
lectures, worksheets, critical thinking activities, group discussions, role-plays,
photo-novellas, stories, problem-solving, exercises, music, and group
activities (e.g., artistic expression).
• 94.4% of them used a participatory–interactive methodology
• 33.3% of the interventions included one or more videos in the sessions
Facilitator’s Training: The training was given through in-person sessions,
online tutorial sessions, training and intervention manuals, demonstration
videos or audio, the literature about session topics, and pilot training.
Session: The number of intervention sessions went from 1 to 25
Intervention Outcomes: Health impact (psychosocial outcomes, knowledge
and preventive measures)
7

8. 8
Records identified from*:
Databases (n =3700 )
Registers (n = 567 )
Records removed before screening:
Duplicate records removed (n = 350)
Records marked as ineligible by automation tools (n =760 )
Records removed for other reasons (n = 250 )
Records screened
(n = 2897)
Records excluded**
(n =2740 )
Articles sought for retrieval
(n = 157)
article not retrieved
(n = 34)
articles assessed for eligibility
(n =123 ) Reports excluded (n=109):
Reason 1 No CSE intervention (n = 87 )
Reason 2 Without qualitative and quantitative outcomes (n
=20 )
Reason 3 article wasn’t written in English (n =2 )
Studies included in the review
(n = 14)
Identification of studies via databases and registers
Identification
Screening
Included

9. 9
Intervention Study Setting Country
CSE intervention Kemigisha et al., 2019 Educational Uganda (Mbarara district)
CSE program Yakubu et al., 2019 ,, Ghana (Tamale Metropolis)
FH and Sexuality module Goesling et al., 2016 ,, United States (Chicago)
High School FLASH Constantine et al.,
2015
,, United States (Los Angeles)
PREPARE 1 Mathews et al., 2016 ,, South Africa (Western Cape)
PREPARE 2 Mmbaga et al., 2017 ,, Tanzania (Dar es Salaam)
Reducing the Risk Barbee et al., 2016 ,, United States (Louisville,
Kentucky)
Reducing the Risk + Reyna and Mills, 2014 ,, United States (Arizona, Texas &
NY)
SAFETY intervention Jerlström et al., 2020 ,, Sweden
Skills for Adolescents with
a Healthy Sexuality
Espada et al., 2002,
2007, 2017
,, Spain
Teen Outreach Program Walsh-Buhi et al.,
2016
,, United States (Florida)
Teenage Pregnancy Taylor et al., 2014 ,, South Africa (KwaZulu-Natal)
Results/ Findings

10. Interventions
10
Intervention Total hrs Facilitators Approach Methodology Facilitators Training
SAFETY intervention 80 min. Professional actors (staff,
youth & school nurse)
Risk-oriented Participatory Trained facilitator
CSE program NI Qualified midwives Comprehensiv
e
Participatory NI
Reducing the Risk 13 Trained facilitators Comprehensiv
e
PV Trained facilitator
Love Notes 13 Trained facilitators Comprehensiv
e
PV ,,
FH and Sexuality module 10.1 School teachers Comprehensiv
e
PV 3 days’ training
High School FLASH 10 Planned Parenthood Comprehensiv
e
Participatory 2 days’ training
PREPARE 1 26.3 Trained facilitators Comprehensiv
e
Participatory 2-week training
course
PREPARE 2 19 Teachers, peer educators,
& providers
Comprehensiv
e
PI Trained facilitator
Reducing the Risk + 16 Research assistants Abstinence-
plus
PI Over 16 h of
training
The HIV/STI risk-reduction
intervention
12. Women and men bilingual
in English and Xhosa
Risk-oriented PI 8 days’ training
Teen Outreach Program 24 Trained facilitators Comprehensiv PV Trained facilitator
PI: Participatory–interactive, PV: Participatory video

11. Theoretical frameworks
11
Intervention SAFE
TY
interv
entio
n
CSE
prog
ram
Red
ucin
g
the
Risk
Love
Not
es
FH &
Sexuali
ty
modul
e
High
Scho
ol
FLAS
H
PREP
ARE
1
PREP
ARE
2
Redu
cing
the
Risk
+
HIV/STI
risk-
reductio
n
intervent
ion
Teen
Outr
each
Prog
ram
CSE
interve
ntion
Teena
ge
Pregna
ncy
Preven
tion
Skills
for
Adole
scents
AIDS Risk Reduction
Model
x
Brecht’s Theory x
Cognitive-Behavioral
Theory
x x x
Eco-developmental
Theory
x
Empathy Model of
Altruism
x x
Fuzzy-Trace Theory x x
Health Belief Model x x
I-Change Model x x

12. Contd …
Intervention SAFETY
interve
ntion
CSE
progr
am
Redu
cing
the
Risk
Love
Notes
FH &
Sexuality
module
High
School
FLASH
PREPA
RE 1
PREPA
RE 2
Reducin
g the
Risk +
The
HIV/STI
risk-
reduction
interventi
on
Teen
Outre
ach
Progra
m
CSE
interventi
on
Teenag
e
Pregna
ncy
Prevent
ion
Skills for
Adolesce
nts
Jewkes Conceptual
Framework
x x
Positive Youth
Development
x x
Social
Cognitive/Learning
Theory
x x x x x
Social Influence
Theory
x x
Social Inoculation
Theory
x x
The Information-
Motivation-Behavioral
Skills Model
x x x
The Social Ecological
Model
x
Theory of Planned
Behavior
x x x x
12

13. Interventions outcomes
13
CSE program Increased knowledge on the use of contraceptives and susceptibility to adolescent
pregnancy.
Improved abstinence and intention to abstain from sex.
Increased perceived severity of teenage pregnancy, perceived barriers to adolescent
pregnancy prevention, perceived benefits of delaying pregnancy, and perceived self-
efficacy.
SAFETY intervention Increased knowledge on condom use, chlamydia, and protection.
Better attitudes toward condoms.
Less risky behavior about condom use.
FH & Sexuality
module
Greater exposure to information on reproductive health topics.
Higher knowledge of contraceptive methods and STI transmission.
Reducing the Risk Fewer sexual partners.
Greater use of birth control.
Love Notes Greater use of birth control and condoms.
High School FLASH
1
Access to sexual health information.
Awareness of sexual health services.
More likelihood to have used sexual health services.
More likelihood to be carrying a condom.
Favorable attitudes about relationship rights.
Higher levels of sexual health knowledge, self-efficacy to manage risky situations, and

14. Contd …
PREPARE 1 Lower rates of intimate partner violence.
PREPARE 2 Decreased incidence of sexual initiation.
Higher condom use.
Increased action planning for condom use.
Reducing the Risk
+
Lower intentions to have sex.
Lower number of sexual partners.
Less favorable attitudes towards sex.
Less permissive peer norms perceived.
Knowledge about prophylaxis, sexual risk taking, pregnancy, and STIs.
Greater self-efficacy for refusing sex and for prophylaxis (using
contraception).
Higher risk perception.
Skills for
Adolescents with
a Healthy
Sexuality
Better attitudes toward condom use.
More knowledge about HIV.
More favorable attitudes toward HIV testing and toward people living with
HIV.
Increased sexual risk perception.
Increased perceptions about the peers’ consistent condom use. 14

15. Conclusions/ Recommendations
15
1. It is necessary to first identify the behavior change
theoretical models that the methods use. Examples
include Ajzen's theory of planned conduct, Bandura's
social cognitive theory, etc.
2. Integrating ecological methods that take community
and context
3. The use of participatory methods promotes
involvement, modeling, and the growth of critical
thinking.
4. Treatments targeted at mixed-sex groups would be
more advantageous for adolescent sex education.
5. A weekly intervention schedule of at least 15 hours is

16. Challenges/ Lesson
Learned
• There is strong evidence that CSE has a
beneficial effect on SRH but the studies
in developing nations are limited.
• Intervention qualities may be linked to
CSE results, including empowerment,
alteration of gender norms, and
meaningful contextualization of
students' experiences.
• To be effective program
implementation, CSE content must
correctly address the unique context 16

17. Acknowledgement
Co-authors
Dr. Om Maharjan, Family Planning
Association of Nepal
Kusum Dhungana, Public Health Research
Society Nepal, Kathmandu
Ayuska Parajuli, Public Health Research
Society Nepal, Kathmandu
Name: Dr. Nimananda Rijal, Public Health
Research Society Nepal, Kathmandu

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