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Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic

  • Sheyla D. Richards ORCID logo EMAIL logo , Eva Mendelson , Gabriella Flynn , Luz Messina , Diane Bushley , Mina Halpern , Silvia Amesty and Samantha Stonbraker
Published/Copyright: June 13, 2019
International Journal of Adolescent Medicine and Health
From the journal International Journal of Adolescent Medicine and Health Volume 33 Issue 5

Abstract

Background

The Dominican Republic (DR) has some of the highest rates of sexually transmitted infections (STI) and adolescent pregnancy in the Caribbean. Well-designed comprehensive sexuality education programs (CSEP) can reduce risky sexual behavior. This study sought to evaluate the Módulo Anexo Materno Infantil (MAMI) adolescent clinic’s CSEP in changing knowledge of STI and pregnancy and attitudes towards risky sexual behavior following implementation.

Methods

A mixed methods study was conducted among students aged 11–25 years from three schools between September 2017 and February 2018. Participants in MAMI CSEP completed questionnaires, before, immediately following, and 3 months following the CSEP. Questions assessed knowledge, attitude, and sexual experience, and obtained program feedback. There was one eight-participant focus group discussion (FGD) per school. Descriptive statistics summarized sample demographics and cross-sectional responses. McNemar’s test evaluated differences in the proportions of students selecting correct responses over time. Paired t-tests compared mean test scores across time.

Result

Overall response rate was 98.7% (1414/1432), with 486 pre-tests, 448 initial post-tests, and 480 3-month post-tests. Respondents identified as 53.5% (321/600) female and 46.5% (279/600) male with mean age of 14.2 years. More males (63.4%) reported sexual experience than females (35.8%) (p < 0.001). Increases in mean scores from pre-test to post-test and pre-test to 3-month post-test were statistically significant (p < 0.001). Three themes arose from the FGDs: (1) expanding sexual and reproductive health knowledge, (2) perception of curricular content, structure and delivery, and (3) student-health educator dynamic.

Conclusion

Improvement in test scores supports MAMI CSEP’s efficacy in educating students and reinforcing positive attitudes to reduce risky sexual behavior. Utilizing an interactive health educator model provided students with clear, accurate information in a safe environment with mutual trust. Selecting health educators employed by an adolescent clinic allows them to connect students to preventive and treatment services during the CSEP.

Keywords: adolescent; comprehensive sexuality education; Dominican Republic; program evaluation; sexually transmitted infection

Funding source: National Institute of Nursing Research

Award Identifier / Grant number: RHeaDI T32NR007969

Funding source: Columbia University

Award Identifier / Grant number: Friedman Funding for Scholarly Projects

Funding statement: National Institute of Nursing Research, National Institutes of Health, Grant Number: RHeaDI T32NR007969, Columbia University, Funder Id: http://dx.doi.org/10.13039/100006474, Grant Number: Friedman Funding for Scholarly Projects.

Acknowledgments

We thank the study participants and team, MAMI health education team, and Columbia University Program for Global and Population Health. We are grateful for Jimmy Duong who provided statistical guidance.

Appendix A

Pre-test

Evaluation of a Comprehensive Sexuality Education Program in La Romana, Dominican Republic

Pre-test, sexual education program

Name of school: ___________Course: _____Student number: ____Age: ___Sex: M F TF TM

  1. From whom have you received information about sexuality and reproductive health? (Select all the options that apply. You may select more than one option).

    1. Friends

    2. Parents

    3. School

    4. Church

    5. Communication sources (television, radio)

    6. Internet

    7. Health professionals

    8. MAMI

    9. No one

    10. Other: _____________________

  2. Which methods of contraception (family planning) have you heard of? (Select all the options that apply. You may select more than one option).

    1. Withdrawal or pull out (withdraw the penis before ejaculating)

    2. Oral (pills)

    3. Injections

    4. IUD (intrauterine device)

    5. Rhythm method

    6. Condom

    7. Implant

    8. Abstinence

    9. Other: __________________________

  3. Do you feel comfortable talking about sex with your partner? If you do not have a sexual partner, would you feel comfortable talking about sex?

    1. Yes

    2. No

    3. I think so

  4. Do you know the steps of correct condom use?

    1. Yes

    2. No

    3. I think so

  5. Do you know where to find methods of contraception (family planning)? Please give examples on the line below.

    1. Yes, where? ___________________________________________________

    2. No

  6. A healthy relationship is one where everyone involved feels happy and secure and is based on honesty and respect for everyone and their opinions.

    1. True

    2. False

  7. When should you use a condom?

    1. Only in the first sexual encounter with a new partner

    2. Only with your partner

    3. In each sexual encounter

  8. How are sexually transmitted infections (STIs) transmitted from person to person? (Select all the options that apply. You may select more than one option).

    1. Kissing

    2. Intimate physical contact (sexual relations without protection).

    3. Contact with infected objects

    4. Needles/injections

    5. Blood

    6. Other: _________________________

    7. I am not sure

  9. Which of the follow methods of contraceptive (family planning) also prevents sexually transmitted infections? (Select all the options that apply. You may select more than one option).

    1. Withdrawal or pull out (withdraw the penis before ejaculating)

    2. Oral (pills)

    3. Injections

    4. IUD (intrauterine device)

    5. Rhythm method

    6. Condom

    7. Implant

    8. Abstinence

    9. Other: ____________________________________

  10. If you suspected you had contracted a sexually transmitted infection would you get tested?

    1. Yes

    2. No

    3. Maybe

  11. HIV/AIDS can be transmitted by people who look and feel perfectly fine.

    1. True

    2. False

  12. Martha does not feel well. She recalls having sexual relations a month ago with a new partner for the first time. Martha suspects she has contracted a sexually transmitted infection based on the symptoms she has. What should Martha do?

    1. Martha should be ashamed and do nothing

    2. Martha should go to a health center, get tested, and share the test results with her partner

    3. Martha should withdraw from her partner

  13. A woman can get pregnant after having sexual relations for the first time without protection.

    1. Yes

    2. No

  14. Everyone can protect themselves against HIV/AIDS.

    1. True

    2. False

  15. Have you used or are you currently using a method of contraception (family planning) to prevent pregnancy? Select all the options that apply.

    1. Withdrawal or pull out (withdraw the penis before ejaculating)

    2. Oral (pills)

    3. Injections

    4. IUD (intrauterine device)

    5. Rhythm method

    6. Condom

    7. Implant

    8. None

    9. Does not apply (I have never had sexual relations)

  16. The last time I had sexual relations, my partner and I used a family planning method.

    1. Yes

    2. No

    3. I don’t know

    4. Does not apply (I have never had sexual relations)

  17. My partner and I use condoms in our sexual relations.

    1. Never

    2. Sometimes

    3. In each sexual encounter

    4. Does not apply (I have never had sexual relations)

If you chose not to participate, please explain why:

Appendix B

Post-test, initial and 3-month

Evaluation of a Comprehensive Sexuality Education Program in La Romana, Dominican Republic

Post-test, sexual education program

Name of school: ______________Course: _______Student number: ___Age: _Sex: M F TF TM

  1. Which methods of contraception (family planning) have you heard of? (Select all the options that apply. You may select more than one option).

    1. Withdrawal or pull out (withdraw the penis before ejaculating)

    2. Oral (pills)

    3. Injections

    4. IUD (intrauterine device)

    5. Rhythm method

    6. Condom

    7. Implant

    8. Abstinence

    9. Other: ____________________________________

  2. Do you feel comfortable talking about sex with your partner? If you do not have a sexual partner, would you feel comfortable talking about sex?

    1. Yes

    2. No

    3. I think so

  3. Do you know the steps of correct condom use?

    1. Yes

    2. No

    3. I think so

  4. Do you know where to find methods of contraception (family planning)? Please give examples on the line below.

    1. Yes, where? ___________________________________________________

    2. No

  5. A healthy relationship is one where everyone involved feels happy and secure and is based on honesty and respect for everyone and their opinions.

    1. True

    2. False

  6. When should you use a condom?

    1. Only in the first sexual encounter with a new partner

    2. Only with your partner

    3. In each sexual encounter

  7. How are sexually transmitted infections (STIs) transmitted from person to person? (Select all the options that apply. You may select more than one option).

    1. Kissing

    2. Intimate physical contact (sexual relations without protection)

    3. Contact with infected objects

    4. Needles/injections

    5. Blood

    6. Other: ____________________________________

  8. Which of the follow methods of contraceptive (family planning) also prevents sexually transmitted infections? (Select all the options that apply. You may select more than one option).

    1. Withdrawal or pull out (withdraw the penis before ejaculating)

    2. Oral (pills)

    3. Injections

    4. IUD (intrauterine device)

    5. Rhythm method

    6. Condom

    7. Implant

    8. Abstinence

    9. Other: ________________________

  9. If you suspected you had contracted a sexually transmitted infection, would you get tested?

    1. Yes

    2. No

    3. Maybe

  10. HIV/AIDS can be transmitted by people who look and feel perfectly fine.

    1. True

    2. False

  11. Martha does not feel well. She recalls having sexual relations a month ago with a new partner for the first time. Martha suspects she has contracted a sexually transmitted infection based on the symptoms she has. What should Martha do?

    1. Martha should be ashamed and do nothing.

    2. Martha should go to a health center, get tested, and share the test results with her partner.

    3. Martha should withdraw from her partner.

  12. A woman can get pregnant after having sexual relations for the first time without protection.

    1. Yes

    2. No

  13. Everyone can protect themselves against HIV/AIDS

    1. True

    2. False

  14. Have you used or are you currently using a method of contraception (family planning) to prevent pregnancy? Select all the options that apply.

    1. Withdrawal or pull out (withdraw the penis before ejaculating)

    2. Oral (pills)

    3. Injections

    4. IUD (intrauterine device)

    5. Rhythm method

    6. Condom

    7. Implant

    8. None

    9. Does not apply (I have never had sexual relations)

  15. The last time I had sexual relations, my partner and I used a family planning method.

    1. Yes

    2. No

    3. I don’t know

    4. Does not apply (I have never had sexual relations)

  16. My partner and I use condoms in our sexual relations.

    1. Never

    2. Sometimes

    3. In each sexual encounter

    4. Does not apply (I have never had sexual relations)

  17. The educators were open and I felt comfortable sharing with them.

    1. Yes

    2. No

  18. I have learned a lot in the sexual education classes.

    1. Yes

    2. No

  19. I felt comfortable talking about sex with the educators.

    1. Yes

    2. No

If you chose not to participate, please explain why:

Appendix C

Focus Group Discussion Question Guide

Evaluation of a Comprehensive Sexuality Education Program in La Romana, Dominican Republic

  1. What did you like about the sessions?

  2. What did you dislike about the sessions?

  3. How comfortable were you participating in the activities? Why or why not?

  4. How comfortable were you asking questions during the sessions? Why or why not?

  5. What did you think of the health educators? What should they do or could they have done differently? If so, how so?

  6. How important were the session themes? Why or why not?

  7. How have the sessions changed the way you think about sexual activity?

  8. What would you recommend changing about the program?

  9. Which additional themes, if any, should be included in the program?

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Received: 2019-01-16
Accepted: 2019-03-21
Published Online: 2019-06-13

© 2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. The effect of acupuncture on postoperative pain, nausea and vomiting after pediatric tonsillectomy: a systematic review
  4. Educational interventions to improve menstrual health: approaches and challenges
  5. Improving gluten free diet adherence by youth with celiac disease
  6. Which HIV-infected youth are at risk of developing depression and what treatments help? A systematic review focusing on Southern Africa
  7. Original Articles
  8. The relationship between social skills and misconduct with their teachers in high school students in the City Aligudarz 2018
  9. Examining the effect of implementation of the nursing process on students’ health behaviors
  10. Food safety knowledge and self-reported practices among adolescents in rural secondary schools in Nigeria
  11. Anthropometric evaluation of school-going native highlanders (4–19 years of age) from the Leh-Ladakh region in India
  12. Predictors of behaviour change for unhealthy sleep patterns among Indian dental students
  13. Characterizing the unmet mental health needs of urban adolescents
  14. The mediating role of difficulties in emotion regulation on attachment styles of adolescents with conduct disorders
  15. Menstrual disorders and medical counseling among schoolgirls in South Egypt: a cross-sectional study
  16. Electromyographic analysis of upper trapezius, abductor pollicis longus and abductor pollicis brevis during smartphone use in different positions among young male and female subjects
  17. What are the correlates of body image distortion and dissatisfaction among school-adolescents?
  18. Hypertension among adolescents in Nigeria: a retrospective study of adolescent university freshmen
  19. Does smartphone addiction affect social interaction: a study among dental students in Hyderabad
  20. Chronic health conditions and adolescent friendship: perspectives from social network analysis
  21. Prevalence of hypertension among school going adolescent boys in Najafgarh, Delhi, India
  22. Variations in cricket players’ upper body dynamic balance across different levels of competition
  23. Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic
  24. The correlation between marital satisfaction and childbearing characteristics in women in Tehran
  25. Adolescent characteristics and parenting style as the determinant factors of bullying in Indonesia: a cross-sectional study
  26. Development of a self-efficacy model in junior and senior high school students based on religiosity and family determinants: a cross sectional approach
  27. Facilitators and barriers in the utilization of World Health Organization’s Preventing Early Pregnancy Guidelines in formulating laws, policies and strategies: what do stakeholders in Ethiopia say?
  28. Problematic internet use: a cross-sectional study on a model from university students in Egypt
  29. Suicidal ideation and suicide attempt among Indonesian adolescent students
  30. Validity and reliability of the Psychosocial Impact of Dental Aesthetics Questionnaire in Kosovar adolescents
  31. Determinants of smoking behavior among young males in rural Indonesia
  32. ‘Selfie’- boon or a bane? A study from a private medical college in Southern India
  33. Short Communication
  34. Perspectives on the use of a health surveillance system for Guatemalan youth: a stakeholder analysis
https://doi.org/10.1515/ijamh-2019-0017
Keywords for this article
adolescent; comprehensive sexuality education; Dominican Republic; program evaluation; sexually transmitted infection

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. The effect of acupuncture on postoperative pain, nausea and vomiting after pediatric tonsillectomy: a systematic review
  4. Educational interventions to improve menstrual health: approaches and challenges
  5. Improving gluten free diet adherence by youth with celiac disease
  6. Which HIV-infected youth are at risk of developing depression and what treatments help? A systematic review focusing on Southern Africa
  7. Original Articles
  8. The relationship between social skills and misconduct with their teachers in high school students in the City Aligudarz 2018
  9. Examining the effect of implementation of the nursing process on students’ health behaviors
  10. Food safety knowledge and self-reported practices among adolescents in rural secondary schools in Nigeria
  11. Anthropometric evaluation of school-going native highlanders (4–19 years of age) from the Leh-Ladakh region in India
  12. Predictors of behaviour change for unhealthy sleep patterns among Indian dental students
  13. Characterizing the unmet mental health needs of urban adolescents
  14. The mediating role of difficulties in emotion regulation on attachment styles of adolescents with conduct disorders
  15. Menstrual disorders and medical counseling among schoolgirls in South Egypt: a cross-sectional study
  16. Electromyographic analysis of upper trapezius, abductor pollicis longus and abductor pollicis brevis during smartphone use in different positions among young male and female subjects
  17. What are the correlates of body image distortion and dissatisfaction among school-adolescents?
  18. Hypertension among adolescents in Nigeria: a retrospective study of adolescent university freshmen
  19. Does smartphone addiction affect social interaction: a study among dental students in Hyderabad
  20. Chronic health conditions and adolescent friendship: perspectives from social network analysis
  21. Prevalence of hypertension among school going adolescent boys in Najafgarh, Delhi, India
  22. Variations in cricket players’ upper body dynamic balance across different levels of competition
  23. Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic
  24. The correlation between marital satisfaction and childbearing characteristics in women in Tehran
  25. Adolescent characteristics and parenting style as the determinant factors of bullying in Indonesia: a cross-sectional study
  26. Development of a self-efficacy model in junior and senior high school students based on religiosity and family determinants: a cross sectional approach
  27. Facilitators and barriers in the utilization of World Health Organization’s Preventing Early Pregnancy Guidelines in formulating laws, policies and strategies: what do stakeholders in Ethiopia say?
  28. Problematic internet use: a cross-sectional study on a model from university students in Egypt
  29. Suicidal ideation and suicide attempt among Indonesian adolescent students
  30. Validity and reliability of the Psychosocial Impact of Dental Aesthetics Questionnaire in Kosovar adolescents
  31. Determinants of smoking behavior among young males in rural Indonesia
  32. ‘Selfie’- boon or a bane? A study from a private medical college in Southern India
  33. Short Communication
  34. Perspectives on the use of a health surveillance system for Guatemalan youth: a stakeholder analysis
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