Date of last evaluation: December 2003

Context:

The Program for Appropriate Technology in Health (PATH), in cooperation with the Thai Ministry of Education, developed a curriculum consisting of 8 two-hour sessions conducted once a week for college-age students in Bangkok, Thailand. The "Teens on Smart Sex" programme is based on the Theory of Reasoned Action behaviour change model, which suggests that young people must first learn and practice behaviours in order to successfully use them at the appropriate time.

As part of the present study, 6 rajabhat (teacher training) colleges in central Thailand located within 90 km of Bangkok were selected. All second-year students (more than 95% of whom were between the ages of 19 and 21 at baseline) from 3 of the colleges received the intervention; second-year students at the other 3 schools served as the control group. Students completed a structured questionnaire at baseline (T1), at post-intervention (4 months after baseline, or T2), and 4 months after that (T3). In total, 2450 students participated in the study, but only the 1786 who participated in the 3 rounds of data collection were included in the present analysis. Two-thirds of them were female.

In addition, 35 teachers and 4 administrators received 2 three-day training sessions to equip them to teach the curriculum. Teachers were trained in participatory methods and visited weekly during the course.

Increased Discussion of Development Issues:

This study finds that the programme helped increase communication among specific intervention subgroups, but that gaps remain. At T1, 9 and 6% of females with no sexual experience within the intervention and control groups, respectively, had discussed HIV/AIDS with a boyfriend. At T2, the proportion of these same women who had talked to a boyfriend more than doubled, even though there was only a modest increase in the control group (19 vs. 9%; p < .001). These figures were similar at T3. There were no statistically significant increases in communication with boyfriends among sexually active female students, or with girlfriends among male students, regardless of sexual experience.

At baseline, about one quarter of sexually experienced males in both groups reported discussing HIV/AIDS with a teacher or counselor. At T2, 37 and 29% in the intervention and control groups, respectively, reported this type of communication. However, this difference was not statistically significant until T3, when 40% of intervention males and 28% of control males reported discussing HIV/AIDS with a counselor or teacher (p < .05). Participation in the programme apparently had no effect on the proportion of students talking about HIV/AIDS with a parent, other family members, or health professionals.

Knowledge Shifts:

Among males in the intervention group, mean HIV knowledge scores increased from 82.9 (out of 100) at baseline to 85.5 at T2 and then decreased slightly to 84.4 at T3 (p < .001). Among females in the intervention group, these same scores increased from 81 at baseline to 83.7 at T2 and then decreased slightly to 82.8 (p < .001). In contrast, mean knowledge scores among males and females in the control group declined at T2 and T3 from baseline figures.

After the 3-day teacher training course, teachers' mean scores on HIV knowledge, attitudes about sexuality and gender, and attitudes toward people living with HIV/AIDS (PLHA) each increased significantly from baseline. For example, the mean score for correct answers on HIV knowledge rose from 79 to 89 (out of 100).

Attitudes:

The study found that the programme improved students' attitudes about condom use (e.g., feeling confident about using a condom correctly). Mean condom attitude scores among males in the intervention group increased from 71.4 (out of 100) at T1 to 73.8 at T2 and then remained relatively stable at 73.1 at T3 (p < .001). No similar change was found in the control group. Among females in the intervention group, improvements in attitudes about condom use were more substantial: 70.3 at T1 to 74.8 at T2, remaining stable at 74.5 at T3 (p < .001). Scores for females in the control group increased slightly between T1 and T3, but the differences were not be statistically significant.

At baseline, 41 and 47% of males in the control and intervention groups, respectively, agreed with the statement, "My friends encourage me to have sex," while only 5 and 7% of females in these groups felt the same way. Among both male and female students, participation in "Teens on Smart Sex" did not have a statistically significant effect on perceptions of peer pressure to have sex.

The programme was found to improve students' acceptance of PLHA (e.g., HIV-positive students should remain in school). Among males in the intervention group, the mean attitude score (out of 100) increased from 69.7 at T1 to 78.1 at T2, and then decreased slightly to 77 at T3 (p < .001). No such increase occurred among males in the control group. Similarly, the mean attitudes score for females in the intervention group increased from 71.6 at T1 to 78.1 at T2 and then decreased slightly to 76.9 at T3 (p < .001). There was also an improvement in the mean attitude score among females in the control group, although it was not as strong as the change observed in the intervention group (68.5 at T1 to 71 at T2 to 71.7 at T3; p < .05).

Practices:

Immediately after the programme, condom use among women in the intervention group increased. At baseline, about 25% of sexually experienced females in the intervention and control groups had used a condom the last time they had sex during the recall period. For females in the intervention group at T2, the figure increased to 38%, while the figure for the control group decreased to 16% (p < .001). At T3, however, there was a slight decline in the proportion of condom use at last sex among the intervention group and an increase in the control group. There was no similar increase in condom use among male students, although a greater proportion of males compared to females reported using condoms at baseline.

At baseline, 61 and 55% of males in the intervention and control groups, respectively, reported ever having sex. At T2, these proportions increased slightly to 65 and 61%, respectively. At T3, the proportion who had had sex in the intervention group increased slightly to 67%, but remained stable at 60% in the control group. A similar trend was observed among females. Researchers state that, "Although the proportion of students having sex increased in both groups, this increase was not statistically significant when comparing the intervention and control groups. This increase likely reflects the fact that as studentsbecome older, a growing proportion have their first sexual encounter."

Other Impacts:

Here is an excerpt from the study: "The fact that improvements in many of the attitude and behavior variables differed by sex and sexual experience highlights the importance of targeting the program to better fit the needs of specific subgroups. The study also demonstrates that intensive teacher training which includes follow-up, while fundamental to the success of school-based HIV programs, may not be sufficient to prepare teachers to teach all aspects of the curriculum. In the future, teachers should have more time to practice these topics during training, or health professionals should be brought into the classroom to help teach sensitive portions of the course."

Methodologies:

The study used a quasi-experimental design. Data were collected using the audio-computer-assisted for self-interview (ACASI) system. A qualitative component was integrated into the study to more deeply explore students' understanding of HIV/AIDS, their reactions to the course, and how exposure to the curriculum influenced their decision-making processes and sexual behaviour. Eight focus group discussions (FGDs) were carried out in the intervention colleges, and 2 were carried out in the control colleges. In-depth interviews were also conducted at these same colleges.

Participating teachers completed a self-administered questionnaire prior to their training and upon completion of teaching the curriculum. Researchers also conducted 41 observations of the teachers as they taught, as well as 6 FGDs to assess teachers' opinions of the course.

For full evaluation and more information, contact:

Horizons Program/Population Council

4301 Connecticut Ave., NW, Suite 280

Washington, DC 20008

United States

Tel: 1 202 237 9433

Fax: 1 202 237 8410

horizons@pcdc.org

Source:

Baker, S. et al. 2003 (December). "Programming for HIV Prevention Among College Students in Thailand," [PDF] Horizons Research Summary. Washington, D.C.: Population Council. This resource was forwarded in summary form to the UNESCO Bangkok HIV/AIDS Clearing House list server on May 17 2004 (click here to access the archives).

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