Table 2. CSE program impacts on students, parents, schools, communities, and structures.

Impacts on Students	Participant Responses
Sexuality Knowledge & Behaviors	Increases student knowledge about sexuality and confidence to speak about it
	Increases student knowledge of changes during adolescence before they occur
	Improves student knowledge and value of themselves and their bodies
	Improves student ability to define types of relationships
	Students start experimenting (with sex and love) †
Academic Motivation *	Increases student motivation to go to school and reduces dropouts
	Increases student comfort at school
	Increases student interest in academic studies
	Increases student interest in reading
	Makes lessons relevant to student’s everyday life
	Increases student’s sense of pride to be part of PJL school
	High interest in PJL programming leads students to be late to skip or neglect other classes †
Academic Performance	Improves student test scores
	Improves student’s ability to balance studies and entertainment/hobbies
	Students distracted by PJL educator †
Courage & Confidence *	Increases student self-confidence, ability to take action, and fully participate
	Increases student ability to share knowledge and ideas and opinions
	Increases student courage to ask questions
	Students have courage to share what they have learned in the community
	Increases student bravery to disclose violence
	Increases student ability to voice their problems
	Students have misplaced courage †
Accountability *	Increases student responsibility
	Promotes students looking to the future and goal setting
	Develops students into leaders
	Students become open minded
Skills	Promotes student hobbies and uncovers hidden talents
	Increases student general knowledge and skills
	Improves student life skills
Behaviors	Improves overall student behavior
	Improves student hygiene behaviors
	Students shift away from experimenting (with sex and love)
Problem Solving	Provides students with supports and resources for problem solving
	Addresses menstruation challenges for students
Mental Health	Improves students’ management of emotions
	Separating from the PJL educator makes the students sad †
	PJL educators’ diversity of talents makes kids sad †
Social Support *	Increases solidarity and relationships between students
	PJL students advise and help others
	Strengthens the relationship between parents and children (students)
	Students have a trustworthy person/resource to discuss personal matters
	Students become attached to PJL educator †
	Provides students and teachers with a mediator
Impact on Parents/Families
Family Relationship		Strengthens the relationship between parents and children
		Improves parenting
		Fathers take responsibility
		Parents with problems can use the PJL educator as a mediator
Parent Education & Training Opportunities		Parents receive education
		Parents become convinced and are motivated to attend trainings
Parent Engagement with School		Parents allow their children (students) to always go to school (if they are doing PJL)
		Encourages parent participation with school
Parent Acceptance		Parents become open-minded about sexuality and taboo topics
Impact on Schools
School Value		Develops and highlights value of the school
		Surrounding schools start to ask for a partnership with PJL
		School becomes a model school
School Environment		Solidarity flourishes in the school
		School becomes fun and welcoming due to PJL educator
		Develops humanity
		Students wish to become a PJL educator
		Creates positive ambiance in the school
		School becomes noisy/distracting †
		School has a youth activist
		School has an educator/colleague/helper
		Fills a gap in school’s sexuality education program
		Improves school management
		Lack of financial support for additional resources (e.g., books, sports balls, games) †
		Eliminates the gap between parents, and between parents and PJL educators
Teacher Effectiveness *		Increases ease of teaching lessons to students
		Increases understanding and communication between teachers and students
		Improves teaching methods and teachers’ skills
		Teachers become comfortable to participate in all the different games
		Difficulties coordinating the PJL work with the schedules of other teachers †
		Improves interactions between students and teachers
School Pregnancy Rates *		Decreased rates of student pregnancy at school
Impact on Communities
Community Role Models			PJL educator is a role model/leader in the community
Community Drugs & Violence			Facilitates the fight against drugs in the community
			Facilitates the fight against violence in the community
Malagasy Culture			Brings back Malagasy values/develops the culture in the community
			Erases taboos "little by little”
			Dance promoted by PJL contradicts local religious traditions †
Community Connections			Unites the surroundings, such as teachers and community members
			The community feels like it has friends who nurture and educate their children
			People trust the PJL educator
Community Awareness *			The kids use the lessons/knowledge from the PJL educator in their community
			Transmits the knowledge gained from PJL and cares for community
			Develops the mentality of the community and comfort discussing sexuality
			Knowledge gained is transmitted to others in the community
			Community becomes interested in PJL
Structural Impacts
Equity			Improves equity
Healthcare			Generates access to reliable healthcare
Infrastructure			Creates infrastructure and provides products (e.g., menstrual pads)

Italics = directly observed by school principals

* = identified as most important by school principals

† = may be interpreted as negative effects