Abstract
Context
National guidelines recommend that Canadian sexual and reproductive health (SRH) education promote access to SRH services and effectively target SRH information to adolescents prior to their leaving secondary school. Within the context of rapidly changing health technologies (HPV vaccine, contraception innovations), SRH education can be an essential health promotion strategy targeting Canada’s youth. SRH education in publicly funded Catholic and secular (“public”) secondary schools in the National Capital Region, Canada was evaluated to determine whether it meets the standards of health promotion.
Methods
SRH strategies were collected by semi-structured interviews with 44 SRH educators: 15 public school teachers, 15 Catholic school teachers and 14 referent health partners and 31 young adults. Interview transcripts were subjected to deductive content analysis using the Information, Motivation, Behavioural Skills (IMB) model.
Results
Student uptake of SRH classroom themes (reproductive anatomy, contraceptive/condom use and risk prevention) was fairly consistent with teacher self-report. Students were encouraged to abstain from sexual activity by both public and Catholic teachers. SRH skill-building activities included relationship scenarios and facilitated access to SRH services by teachers from both Catholic and public schools, however only public schools provided condom demonstrations. Students recommended a more sex-positive education as sex was presented as an inherently negative and risky activity.
Conclusions
SRH education, framed by the IMB model and in the context of school–community health partnerships, is an effective tool for health promotion. Knowledge transfer of biomedical SRH information is effective; however improvements can be made in the promotion of SRH self-efficacy.
Key words: Health, sex education, sexual and reproductive health, IMB model, health promotion
Résumé
Contexte
Les lignes directrices nationales recommandent que l’éducation en santé sexuelle et reproductive (SSR) au Canada favorise l’accès aux services de SSR et cible efficacement les informations destinées aux jeunes avant la fin de leurs études secondaires. Vu l’évolution rapide des technologies de la santé (vaccin contre le VPH, innovations dans le domaine de la contraception), l’éducation en SSR peut être une stratégie essentielle pour promouvoir la santé des jeunes au Canada. Nous avons évalué l’éducation en SSR offerte dans les écoles secondaires publiques (catholiques et laïques) de la région de la capitale nationale du Canada afin de déterminer si elle satisfait aux normes de promotion de la santé.
Méthode
Les données sur les stratégies d’éducation en SSR ont été recueillies par des entretiens semi-structurés avec 44 éducateurs en SSR: 15 enseignants des écoles laïques, 15 enseignants des écoles catholiques, 14 partenaires de la santé et 31 jeunes adultes. Les transcriptions des entretiens ont fait l’objet d’une analyse de contenu déductive utilisant le modèle théorique « Information, Motivation, habiletés de Comportement » (IMC).
Résultats
La compréhension des thèmes de la SSR par les élèves (anatomie de la reproduction, utilisation des méthodes contraceptives/du condom, prévention des risques) est conforme à l’auto-évaluation des enseignants. Les élèves sont encouragés à ne pas avoir de rapports sexuels, tant par les enseignants des écoles laïques que par ceux des écoles catholiques. Les activités de renforcement des compétences en SSR comprennent des scénarios de relations et facilitent l’accès aux services en SSR dans les deux secteurs (catholique et laïc). Toutefois, seules les écoles laïques offrent des démonstrations sur l’utilisation du condom. Les élèves ont recommandé que la sexualité soit présentée sous un jour plus positif et non plus comme une activité intrinsèquement négative et risquée.
Conclusion
L’éducation en SSR guidée par le modèle IMC et donnée dans le cadre de partenariats école–santé communautaire constitue un outil efficace pour la promotion de la santé. Le transfert de connaissances centrées sur l’information biomédicale est adéquat, mais des améliorations peuvent être apportées pour promouvoir de façon encore plus efficace la SSR.
Mots clés: santé, éducation sexuelle, santé sexuelle et reproductive, modèle IMC, promotion de la santé
Footnotes
Acknowledgements: This project was funded by a grant from the Canadian Social Sciences, Humanities Research Council (SSHRC). We are profoundly indebted to the participants who volunteered their time to be interviewed for this project. We also thank Laurence Clennett-Sirois, Megan Reid, Brittany Piovesan, Joëlle Michaud and Julia Williams for their invaluable research assistance.
Conflict of Interest: None to declare.
References
- 1.World Health Organization, Reproductive Health Programme Development: Implementing Cairo, Biennial Report 1998–1999. WHO/RHR/00.5.
- 2.International Conference on PopulationDevelopment ICPD, Summary of the ICPD programme of action. Chapter IV: Gender equality, equity and empowerment of women. 1995. [Google Scholar]
- 3.Health Canada. Canadian Guidelines for Sexual Health Education. 2003. [Google Scholar]
- 4.Martinez A, Phillips KP. Challenging ethno-cultural and sexual inequities: An intersectional feminist analysis of Ottawa teachers, health partners and university students’ views on adolescent sexual and reproductive rights. Can J Human Sex. 2008;17(3):141–59. [Google Scholar]
- 5.Ontario Ministry of EducationTraining . The Ontario Curriculum, Grades 9 and 10. Health and Physical Education. 1999. [Google Scholar]
- 6.Green LW, Kreuter MW. Health Promotion Planning: An Educational and Ecological Approach. 3rd. Mountain View, CA: Mayfield; 1999. [Google Scholar]
- 7.Bartholomew LK, Parcel GS, Kok G, Gottlieb N. Intervention Mapping: A Process for Designing Theory- and Evidence-based Health Education Programs. Mountain View: Mayfield; 2001. [DOI] [PubMed] [Google Scholar]
- 8.Schaalma HP, Abraham C, Gillmore MR, Kok G. Sex education as health promotion: What does it take? Arch Sex Behavior. 2004;33(3):259–69. doi: 10.1023/B:ASEB.0000026625.65171.1d. [DOI] [PubMed] [Google Scholar]
- 9.Fisher JD, Fisher WA, Misovich SJ, Kimble DL, Malloy TE. Changing AIDS risk behavior: Effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population. Health Psych. 1996;15(2):114–23. doi: 10.1037/0278-6133.15.2.114. [DOI] [PubMed] [Google Scholar]
- 10.Fisher JD, Fisher WA, Bryan AD, Misovich SJ. Information motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psych. 2002;21(2):177–86. doi: 10.1037/0278-6133.21.2.177. [DOI] [PubMed] [Google Scholar]
- 11.Martinez A, Phillips KP. La promotion de l’équité en éducation sexuelle dans les écoles secondaires de la région de la capitale nationale. Can J Educ. 2009;32(1):60–86. [Google Scholar]
- 12.Smylie L, Maticka-Tyndale E, Boyd D. Adolescent Sexual Health Planning Committee. Evaluation of a school-based sex education programme delivered to Grade Nine students in Canada. Sex Education. 2008;8(1):25–46. doi: 10.1080/14681810701811795. [DOI] [Google Scholar]
- 13.Sanfilippo JS, Lara-Torre E. Adolescent gynecology. Obstet Gynecol. 2009;113(4):935–47. doi: 10.1097/AOG.0b013e31819b6303. [DOI] [PubMed] [Google Scholar]
- 14.Tarr ME, Gilliam ML. Sexually transmitted infections in adolescent women. Clin Obstet Gynecol. 2008;51(2):306–18. doi: 10.1097/GRF.0b013e31816d7386. [DOI] [PubMed] [Google Scholar]
- 15.Maticka T. Sexuality and sexual health of Canadian adolescents: Yesterday, today and tomorrow. Can J Human Sex. 2008;17(3):85–95. [Google Scholar]
- 16.Kirby D. Understanding what works and what doesn’t in reducing adolescent sexual risk taking. Fam Plan Perspect. 2001;33(6):276–81. doi: 10.2307/3030195. [DOI] [PubMed] [Google Scholar]
- 17.Santelli J, Ott MA, Lyon M, Rogers J, Summers D, Schleifer R. Abstinence and abstinence-only education: A review of U.S. policies and programs. J Adolesc Health. 2006;38:72–81. doi: 10.1016/j.jadohealth.2005.10.006. [DOI] [PubMed] [Google Scholar]
- 18.Hansen L, Mann J, McMahon S, Wong T. Sexual health. BMC Women’s Health. 2004;4:S24. doi: 10.1186/1472-6874-4-S1-S24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: A meta-analysis. Psychol Bull. 1999;125(1):90–132. doi: 10.1037/0033-2909.125.1.90. [DOI] [PubMed] [Google Scholar]
- 20.Kirby D, Short L, Collins J, Rugg D, Kolbe L, Howard M, et al. School-based programs to reduce sexual risk behaviors: A review of effectiveness. Public Health Reports. 1994;10:339–60. [PMC free article] [PubMed] [Google Scholar]
- 21.Klein JD, Wilson KM, McNulty M, Kapphahn C, Collins KS. Access to medical care for adolescents: Results from the 1997 Commonwealth Fund Survey of the health of adolescent girls. J Adolescent Health. 1999;25:120–30. doi: 10.1016/S1054-139X(98)00146-3. [DOI] [PubMed] [Google Scholar]
- 22.McKee MD, Karasz A, Weber CM. Health care seeking among urban minority adolescent girls: The crisis at sexual debut. Ann Fam Med. 2004;2:549–54. doi: 10.1370/afm.124. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.DiCenso A, Borthwick VW, Busca CA, Creatura C, Holmes JA, Kalagian WF, et al. Completing the picture: Adolescents talk about what’s missing in sexual health services. Can J Public Health. 2001;92(1):35–38. doi: 10.1007/BF03404840. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.von Sadovszky V, Kovar CK, Brown C, Armbruster M. The need for sexual health information: Perceptions and desires of young adults. Am J Maternal Child Nurs. 2006;31(6):373–79. doi: 10.1097/00005721-200611000-00008. [DOI] [PubMed] [Google Scholar]
- 25.Pollack AE, Balkin M, Edouard L, Cutts F, Broutet N. WHO/UNFPA Working Group on Sexual and Reproductive Health and HPV Vaccines. Ensuring access to HPV vaccines through integrated services: A reproductive health perspective. Bull WHO. 2007;85:57–63. doi: 10.2471/BLT.06.034397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Kirby D, Laris B, Rolleri L. Youth Research Working Paper No. 2 Impact of sex and HIV education programs on sexual behaviours of youth in developing and developed countries. Washington, DC: Family Health International; 2005. [Google Scholar]
- 27.Rodgers S, Downie J. Abortion: Ensuring access. CMAJ. 2006;175(1):9. doi: 10.1503/cmaj.060548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Shoveller J, Johnson J, Prkachin M, Patrick D. Around here, they roll up the sidewalks at night: A qualitative study of youth living in a rural Canadian community. Health Place. 2007;13:826–38. doi: 10.1016/j.healthplace.2007.01.004. [DOI] [PubMed] [Google Scholar]
- 29.Open Medicine. 2008.
- 30.Rickert V, Sanghvi R, Wiemann CM. Is lack of sexual assertiveness among adolescent and young adult women a cause for concern? Perspect Sex Reprod Health. 2002;34:178–83. doi: 10.2307/3097727. [DOI] [PubMed] [Google Scholar]