Design, implementation, and evaluation of school-based sexual health education interventions in sub-Saharan Africa

Abstract

School-based sexual health education is commonly used to promote the sexual health of young people and guide them in their relationships. This thesis reports on research that aimed to provide evidence-based recommendations to optimise the effectiveness of school-based sexual health education in sub-Saharan Africa (sSA). There are six chapters in the thesis. Chapter 1 introduces the thesis, Chapters 2 to 5 consist of four empirical studies, and Chapter 6 provides an overall discussion and looks at the strengths, limitations, and implications of the findings. Chapter 2 is a systematic review and meta-analysis of school-based sexual health education in sSA. It provides some evidence of the interventions in promoting self-reported condom use. However, it shows there are no harmful or beneficial effects with respect to sexually transmitted infections (STI) as evidenced by biomarkers. It highlights the paucity of evaluated interventions using biomedical markers, and reports on the process of evaluation, which limits our understanding of why interventions work or do not work. Features associated with effective interventions are noted. Chapter 3 is a case study involving MEMA Kwa Vijana, an adolescent sexual and reproductive health intervention implemented in Tanzania. This study highlights the influence of structural factors in schools and wider environmental factors on the effectiveness of school-based sexual health interventions. Furthermore, it identifies the social and cultural factors that influence young people’s sexual behaviours and that must be addressed beyond the education and health sectors. Chapter 4 is a multiple case study of seven school-based sexual health interventions implemented in five sub-Saharan African countries. It 4 identifies the design, implementation, and evaluation features that differentiate between effective and ineffective interventions. Chapter 5 is a qualitative study of researchers’ experiences of school-based sexual health education in sSA. This study extends previous work by generating a set of valuable recommendations based on researchers’ experiences of interventions that could improve future interventions in sSA. Overall, this research project demonstrates the potential of school-based sexual health education in promoting sexual health and preventing STIs in sSA. It provides a series of recommendations for the design, implementation, and evaluation of school-based sexual health interventions.