ETR Associates

Published by Family Health International (FHI) in 2005, this 45-page report summarises a review of 83 evaluations of sex and HIV education programmes in developing and developed countries that are based on a written curriculum and that are implemented among groups of youth in schools, clinics, or other community settings. It evaluates the strategy of using such a curriculum - in both in- and out-of-school settings - to educate young people about sex and HIV prevention - with the ultimate aim of shaping behaviour. In short, "the evidence was strong that many programs had positive effects on...the very factors specified by many psychosocial theories as being the determinants of behavior. Furthermore, all of these factors have been demonstrated empirically to be related to their respective sexual behaviors."

Specifically, the purpose of the analysis is to decipher:

1. the effects, if any, of curriculum-based sex and HIV education programmes on sexual risk behaviours, sexually transmitted infection (STI) and pregnancy rates, and mediating factors such as knowledge and attitudes that affect those behaviours
2. the common characteristics of the curricula-based programmes that were effective in changing sexual risk behaviours

Examining programmes that tended to focus on pregnancy or HIV/STI prevention behaviours (not on broader issues of sexuality, such as developmental stages, gender roles, or romantic relationships), the research review identified 83 studies that matched the study criteria, 18 of which were conducted in developing countries (Belize, Brazil, Chile, Jamaica, Kenya, Mexico, Namibia, Nigeria, South Africa, Tanzania, Thailand, and Zambia). This component of the research was followed by a content analysis of 19 curricula that were clearly effective at changing behaviour.

The resource provides evidence to indicate that these programmes are a promising type of intervention for reducing adolescent sexual risk-taking behaviours, and provides guidance and recommendations for those seeking to implement and/or evaluate such programmes:

1. Characteristics of the studies reviewed - More than four-fifths of the evaluations identified one or more theories that formed the basis for the programme, such as social learning theory and social cognitive theory (which formed the basis for more than half of the programmes evaluated). About half of the studies employed an experimental design; the remaining half used a quasi-experimental design. Only 23 studies measured impact on pregnancy or STI rates, and of these, only 9 used laboratory tests to measure these health outcomes. "Many of these studies or their published articles had significant limitations such as limited explanations of the programs, problems with implementation, weak evaluation designs, measurement issues, and statistical shortcomings."
2. Impact of programmes on sexual risk behaviours and pregnancy and STI rates - Overall, the results strongly indicate that the programmes were far more likely to have a positive impact on behaviour than a negative impact. Two-thirds (65%) of the studies found a significant positive impact on one or more of these sexual behaviours or outcomes, while only 7% found a significant negative impact. One-third had a positive impact on two or more behaviors or outcomes. Furthermore, some of these programmes had positive impacts for two or three years or more. In general, the patterns of findings for all the studies were similar in both developing and developed countries. They were effective with both low and middle-income youth, in both rural and urban areas, with girls and boys, with different age groups, and in school, clinic, and community settings.
3. Impact of programmes on mediating factors for sexual risk behaviours - Sharing specific data, the authors glean highlights from the studies' report on mediating factors that contribute to the behaviour changes, such as knowledge, perceived risk, values and attitudes, perception of peer norms, self-efficacy and skills, and communication with others."
4. Characteristics of the curricula-based programmes that positively affected behaviours:
   
   • The teams that developed the criteria involved multiple people with varied backgrounds, used a logic model approach that specified health goals and other details, assessed relevant needs and assets of the groups being addressed, designed activities consistent with community values and available resources, and pilot-tested the programme.
   • Effective curricula created a safe environment for youth, focused on clear goals of preventing HIV/STI and/or pregnancy, focused on specific behaviours leading to these health goals and gave a clear message about those behaviours, addressed psychosocial risk and protective factors affecting those sexual behaviours, included multiple activities to change the targeted risk and protective factors, employed instructionally sound teaching methods that actively involved the participants and helped them personalise the information, employed appropriate activities and messages (for participants' culture, age, sexual experience), and covered topics in a logical sequence.
   • When implementing curricula, effective programmes commonly selected and trained educators with desired characteristics, secured at least minimal support from authorities, recruited youth if necessary, and implemented virtually all activities as designed.

The report concludes with a series of programmatic and research recommendations. To cite a few examples of the latter, the authors urge that more rigourous studies - particularly those using randomised experimental designs - of promising programmes should be conducted in developing countries. Researchers should determine which mediating factors are most important across cultures and then measure these factors more consistently to foster easier comparison. In addition, the authors suggest, published results of evaluations should provide more complete descriptions of their programmes.

Editor's note: A longer version of the review summarised in this resource provides additional details, particularly about the evaluations from developed countries; this version also includes one-page summaries sheets of all 83 studies that were reviewed, offering specific information from each study (e.g., key data such as study results related to both sexual risk behaviours and mediating factors). Click here to access download options for this version.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.