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Impact of HIV and sexual health education on the sexual behaviour of young people: a review update |
Grunseit A |
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Authors' objectives To assess the effects of human immunodeficiency virus (HIV) and sexual health education on young people's sexual behaviour.
Searching Thirteen databases were searched: PsycLIT, Sociofile, APAIS, AUSTROM, MEDLINE, Family Resources, EMBASE, Mental Health Abstracts, Pascal, Social SciSearch, PAIS International, Dissertation Abstracts Online and Current Contents. No search terms or dates were reported. Experts were also contacted for additional material.
Study selection Study designs of evaluations included in the reviewAny study design was eligible for inclusion. The included studies were classified into four types of design: controlled intervention studies, other intervention studies, cross-sectional surveys, and national and international comparison studies. Studies had to report data on at least one behavioural outcome. Studies dealing solely with knowledge and attitudes regarding sex were excluded.
Specific interventions included in the reviewThe specific interventions varied considerably across the studies. All interventions provided information relevant to sexual health education. The intervention details of the included studies were provided in the report.
Participants included in the reviewYoung people of school and college age, ranging from approximately 11 to 21 years.
Outcomes assessed in the reviewBehavioural outcomes were the focus of the review and included adolescent pregnancy, abortion and birth rates, sexually-transmitted disease (STD) infection rates, and self-reported sexual activity.
How were decisions on the relevance of primary studies made?The author does not state how the papers were selected for the review, or how many of the reviewers performed the selection.
Assessment of study quality No formal assessment of quality was undertaken.
Data extraction The author does not state how the data were extracted for the review, or how many of the reviewers performed the data extraction. Extracted data included information relating to study details, intervention, sample and results.
Methods of synthesis How were the studies combined?A qualitative narrative synthesis was undertaken. No method for assessing publication bias was reported.
How were differences between studies investigated?The studies were grouped according to study design. In addition, three studies in which interventions had negative effects, e.g. increased sexual activity, were discussed separately.
Results of the review Sixty-eight studies were included (approximate n=158,940; the numbers of participants were not reported for some studies): 15 controlled intervention studies (approximate n=71,558; n not reported for 1 study), 38 other intervention studies (approximate n=32,979; n not reported for 4 studies), 10 cross-sectional surveys (n=54,403), and 5 national and international comparison studies (n not reported).
Overall, 53 studies evaluated specific interventions, 27 of which reported that HIV/AIDS and sexual health education had no effect on sexual activity and attendant rates of pregnancy and STDs. Twenty-two studies reported that HIV and/or sexual health education either delayed the onset of sexual activity, reduced the number of sexual partners, or reduced unplanned pregnancy and STD rates.
Three studies reported increases in sexual behaviour associated with sexual health education: 1 controlled intervention study, 1 other intervention and 1 cross-sectional survey.
Authors' conclusions There is little evidence that sexual health education encourages, or leads to, greater sexual activity among young people. The evidence indicates that safer sexual practice among young people may be achieved through education.
CRD commentary This was a methodologically-poor review. The review question was clearly stated, but the study inclusion criteria confused the issue. It is difficult, for example, when numerous randomised trials are available, to determine what additional information derives from the inclusion of other, less robust, study designs. Similarly, it is difficult to determine the extent to which the literature search was adequate, as neither search terms nor dates were reported. The methodological quality of included studies was not assessed formally. Details of the included studies were limited, particularly with respect to participant characteristics. Also, details of the review methodology were largely absent from the report, e.g. details concerning study selection, quality assessment and data extraction.
The report was generally, poorly constructed and contained inconsistencies, e.g. it was stated that 9 cross-sectional surveys were included, though data were extracted for 10 surveys. The author's conclusions do seem to follow from the results presented but, given the limitations of the review, these should be treated with caution.
Implications of the review for practice and research Practice: The author states that effective education programmes are grounded in Social Learning Theory; have focused curricula; give clear statements about behavioural aims; feature clear delineation of the risks of unprotected sex and methods to avoid it; focus on activities that address social influences; teach and allow for practice in communication and negotiation skills; encourage openness in communicating about sex; and equip young people with skills for decoding media messages, and their underlying assumptions and ideologies.
Research: The author states that researchers need to design interventions that incorporate the features that have been associated with successful interventions in the past, as well as including their own evaluation procedures. Programme evaluation should be grounded in solid study design, and valid and appropriate statistical techniques. The gender and developmental stage of the student are issues for the educator and researcher at both the design and evaluation stages of sexual health and HIV education development.
Bibliographic details Grunseit A. Impact of HIV and sexual health education on the sexual behaviour of young people: a review update. Geneva, Switzerland: UNAIDS. UNAIDS; 97.4. 1997 Indexing Status Subject indexing assigned by CRD MeSH Adolescent; Adolescent Behavior; HIV Infections /prevention & Pregnancy in Adolescence; Psychology, Adolescent; Risk-Taking; Sex Education; Sexual Behavior; Sexually Transmitted Diseases /prevention & control; control AccessionNumber 12000008136 Date bibliographic record published 31/01/2002 Date abstract record published 31/01/2002 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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