Leeds Health Education Database 2015

Interventions using schools

September 2013

For background information on the project including selection criteria click here. Please send any feedback on database and suggestions for items to include to sarah@hubley.co.uk

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Contents

1.   AIDS, STDs and Reproductive health

2. Family planning and population education

3. Maternal and Child Health - no entries for this category

4. Childbirth/safe motherhood  - no entries for this category       

5. Breast feeding promotion      

6. Oral rehydration therapy and the management of diarrhoea

7. Immunization uptake 

8. Acute respiratory infections - no entries for this category

9. Growth monitoring  - no entries for this category                                                                                      

10. Nutrition education                                                    

11.Control of Infectious diseases including tropical and parasitic diseases

12. Oral/dental health promotion                                  

13. Eye health and the prevention of blindness       

14. Environmental health including, water, sanitation and hygiene education

15. Chronic diseases, substance abuse and mental health

16. Miscellaneous health topics, patient education, accident prevention/safety education


Note: reference numbers refer to the papers location in the reference manager programme maintained at Leeds and have no special significance. Papers marked borderline did not meet the full criteria for inclusion in the database but were retained because of special features of the methodology used and their continued inclusion will be reviewed on a regular basis.

1. AIDS and Sexually Transmitted Diseases

Aplasca, M.R., Siegel, D., Mandel, J.S., Santana-Arciaga, R.T., Paul, J., Hudes, E.S., Monzon, O.T. and Hearst, N. (1995) Results of a model AIDS prevention program for high school students in the Philippines. AIDS 9 Suppl 1, S7-13. Ref ID : 4093

Target Group /Country High school students  aged 13-16 yrs in a semi-urban district of Metro Manila, the Philippines

Intervention Methodology 30 teachers attended a two day workshop on AIDS education and a core group of participating teachers were involved in the design of a school-based educational curriculum. The curriculum covered five areas: human sexuality and STDs, AIDS, the immune system, development of self esteem, decision-making skills  and refusal skills. The educational programme consisted of 12 lessons taught as two 40 minute lessons per week over six weeks. As well as traditional lectures, sessions included role playing, games, dialogues, group discussions and exercises. Support materials included a teacher's manual, flip charts and audiotapes.

Evaluation Method Pre-test post-test in two intervention schools (n=420) and two control schools (n=384). The intervention and control schools were randomly assigned from a pool of 10 schools. One class in each year in both schools were randomly selected for the measurement. Pupils were given self-administered questionnaires to assess knowledge, attitudes, beliefs and behaviour patterns. Details of timing of pre- and post-tests are not provided.

Impact Achieved Intervention group had higher levels of HIV-related knowledge (p<0.01), were and scored higher positive attitudes (less likely to avoid people with AIDS (p<0.01) and more likely to show compassion to persons with AIDS (p<0001). The slight increase in students stated intentions to adopt safer sexual behaviour was not significant although there was a significant increase in the proportion of students who agreed that students should delay sex until they became adults (p<0.0001 data not shown).  Possible reasons identified for lack of impact on attitudes include: the need to provide more training to teachers beyond the initial 2 day programme, the need to allow more time for exploring peer pressure and practicing resistance and refusal skills and the need to incorporate more intensive student participation.

Awasthi,S., Nichter,M. and Pande,V.K. (2011)  Developing an interactive STD-prevention programme for youth; lessons from a North Indian slum.  Studies in Family Planning  31, 138-150. Ref ID 8753

Target group/country Young men in urban slums in Lucknow, India

Intervention Methodology The intervention consisted of three educational sessions at two-week intervals. The educational programme was designed to provide basic information to young men about: (a) reproductive anatomy and physiology, fertility and conception; b) how STDs are transmitted, types of STDs, the signs and symptoms of STDs and asymptomatic infection; (c) the link between STDs and HIV infection; d) the HIV test and when one should take them; and e) methods of STD prevention and harm reduction that are and are not effective. The session facilitator was supported by three male assistants who made themselves available for individual consultations afterwards. Each session lasted approximately an hour. During the last 15 minutes, a taped set of educational messages about sexual health was played that repeated key points made in the live sessions. A voluntary urine test to detect bacterial infections was provided at the second educational to generate information to feed back to the young people at the third session.

Evaluation Method 28 of 261 slums were selected randomly. A sample of young men was drawn - 377 (mean age 18.3 yrs 33.4% still at school) in the intervention group and 343 (mean age 18.2 yrs 25.7% still at school) in the control group. Data was collected each boy's sexual history and knowledge of STDs and the same survey was administered to the boys 6 - 8 weeks after the intervention. Loss to follow-up in the intervention group was 4% (14 boys) in the intervention group and none in the control. The leukocyte esterase test was administered as a proxy measure of bacterial infection .

Impact Achieved There was a significant increase in awareness that STDs could be caught from women other than prostitutes in the intervention group from 46.9% to 76% (p<0.001). There were significant increases in knowledge about symptoms of STDs in the intervention group (p<0.001). The intervention failed to increase young men's awareness of the long time it can take for symptoms of STDs to emerge and also failed to dispel the myth that washing the private parts with disinfectants can prevent STDs. The evaluation reviewed valuable insights into the sexual practices of young men. One notable finding was that young men who engage in high risk sex with prostitutes were also more likely to engage in sex with men and that information was required on forms of coitus other than vaginal sex. The urine test was found to be an unreliable predictor of infection with and STD in a population with low levels of sexual intercourse.

Caceres,C.F., Rosasco,A.M., Mandel,J.S. and Hearst,N. (1994)  Evaluating a school-based intervention for STD/AIDS prevention in Peru.  Journal of Adolescent Health  15, 582-591. Ref, ID 8720

Target Group /Country Secondary school pupils in Lima, Peru

Intervention Methodology The programme was designed to take into account Social Learning Theory, the Freireian model of education and the constructs of machismo and erotophilia- erotophobia (openess towards sexuality). It consisted of seven weekly two-hour sessions which included discussions, verbal exercises, role playing, familiarization with condoms/contraceptives, and lectures. Homework promoted interaction with family, friends and local health institutions. Trained teachers facilitated the program. Contents were organize in seven units: 1)adult sexuality, puberty including puberty and adolescence; 2)reproductive anatomy and physiology; 3)conception, prenatal care, delivery, breastfeeding and unplanned pregnancy; 4) planned parenthood, contraception and abortion; 5) STDs, HIV/AIDS and safer sex; 6)sexuality as a social/cultural construct, sexual roles and orientation; 7) decision-making and communication skills. Teachers from the schools with experience as school counselors were given 3 day training course to act as facilitators.

Evaluation Method A quasi-experimental study. 14 schools were randomly assigned as intervention and controls. A pre-test was given the intervention (n=604) and control (n=609). Post-tests were given 3 months later to intervention (n=406) and controls (n=402). The pre-test and post-test consisted of a self-completed questionnaire with likert -type scales to measure erotophila, machismo, attitude towards contraception, attitude towards condoms and attitude toward persons with HIV/AIDS. The questionnaire used a Guttman-type scale to measure self-efficacy and behavioural intentions. Separate questionnaires were developed for male and female students.

Impact Achieved Significant changes in knowledge on sexuality and AIDS (p<0.0001), erotophilia (p=0.004), acceptance of contraception (p=0.002), machismo (p<0.0001), and discrimination against persons with HIV/AIDS (p<0.0001)were found in the intervention group, as compared to the control group. Self-efficacy (p<0.0001) and prevention-oriented behavioral intentions  (p<0.0001) were significantly better in the intervention group. Multivariate analysis found that machismo decreased more in boys than girls but knowledge of AIDS and self-efficacy outcomes were more positive among girls. Cost exclusive of research expenses was $3 per student reached.

Dalrymple, L. and du-Toit, M.K. (1993) The evaluation of a drama approach to AIDS education. Educational Psychology 13(2):147-154, 1993. Ref ID : 3634 

Dalrymple (1992) Drama approach to AIDS education: a report on an AIDS and lifestyle education project undertaken in a rural school in Zululand, Unpublished Report Kwa Dlangezwa 3886, South Africa:  Department of Drama, University of Zululand. Ref ID 1792

Target Group /Country Zulu-speaking high school pupils in South Africa.

Intervention Methodology A play about AIDS was presented to students who were then given the opportunity to attend drama workshops to design their own plays, songs and poetry. These were presented at an open day

Evaluation Method A self-completed questionnaire in simple English with 47 items including a likert-type attitude scale and knowledge test was developed, tested and given to 72 Zulu-speaking high school pupils 'randomly selected' from each participating class before and after drama intervention. Details of sampling method or age/sex composition of the sample not provided. There were no controls.

Impact Achieved Mean knowledge scores increased from 4.19 to 7.15 p<0.01).At baseline student already had a positive attitude to AIDS which did not change during the intervention. There was a decrease in the number of pupils who agreed with the statement "I would like to have more than one sexual partner" (p<0.01). The authors considered that their data on attitude scales was affected by the level of English of the pupils. Note: raw data not provided in published evaluation.

Fawole, I.O., Asuzu, M.C., Oduntan, S.O. and Brieger, W.R. (1999) A school-based AIDS education programme for secondary school students in Nigeria: a review of effectiveness. Health Education Research: Theory and Practice 14, 675-683.Ref ID : 8593

Target Group /Country/Reference Secondary school pupils in two schools in Ibadan South East Local government Area of SouthWest Nigeria

Intervention Methodology A community physician and two trained teachers gave six weekly sessions of 2-6 hrs including lectures, film, role plays, stories, songs and debates about HIV and AIDS prevention. (very little detail of the content of the sessions provided)

Evaluation Method A self-administered questionnaire was given to 233 students randomly selected from senior classes of two schools before receiving the health education intervention and compared with 217 controls. The questionnaire was modified and re-administered 6 months after the intervention. Questions determined knowledge of transmission and  prevention of AIDS, attitudes (Likert scale) and self-reported behaviours.

Impact Achieved At post-test, intervention students exhibited greater knowledge about HIV/AIDS transmission and prevention (P < 0.05). Intervention students were less likely to feel AIDS is a white man's disease and were more likely to be tolerant of people living with the disease (P < 0.05). After the intervention, the mean number of reported sexual partners among the experimental students significantly decreased from 1.51 to 1.06, while it increased from 1.3 to 1.39 among the controls (p<0.05). Among the intervention students there was also an increase in consistent use of the condom and the use of the condom at last sexual Intercourse but this was not statistically significant. Sustainability of intervention limited by use of external persons to do AIDS education.

Fitzgerald,A.M., Stanton,B.F., Terreri,N., Shipena,H., Li,X., Kahihuata,J., Ricardo,I.B., Galbraith,J.S. and De Jaeger,A.M. (1999)  Use of Western-based HIV risk-reduction interventions targeting adolescents in an - African setting.  Journal of Adolescent Health  25, 52-61.Reference ID: 8586

Target Group /Country/Reference Adolescents attending 10 secondary schools in two districts  in Namibia

Intervention Methodology The intervention was adapted from one previous used in USA and adapted to Namibia. Following piloting, the programme consisted of 14 two-hour sessions over 7 weeks which focused on basic facts about reproduction and risk behaviours such as alcohol, drug abuse and violence. The sessions were derived from 'Protective Motivation Theory' emphasized communication and decision-making skills. The sessions were facilitated during after-school hours by a volunteer teacher and an out-of-school youth (either a student teacher or a youth who had completed Grade 12 in a classroom to groups of 15-20 mixed gender students

Evaluation Method Pupils were asked to volunteer for study. 80% agreed. 515 youth (median age 17 years; median grade 11)were given a baseline self-completed questionnaire and randomly assigned to the control or intervention group. A follow-up questionnaire was given immediately after the intervention. The questionnaire measured knowledge, attitudes, intentions, and HIV risk behaviors. Following the post-intervention questionnaire controls were given the intervention.

Impact Achieved Knowledge increased significantly among intervention compared to control youth (88% vs. 82%; correct responses, p < .0001). At post-intervention follow-up, more intervention than control youth believed that they could be intimate without having sex (p<0.05%), could have a girlfriend or boyfriend for a long time without having sex (p<0.01), could explain the process of impregnation (p<0.05), knew how to use a condom (p<0.0001) and could ask for condoms in a clinic (p<0.05). Fewer intervention than control youth believed that if a girl refused to have sex with her boyfriend it was permissible for him to strike her (p<0.01), and that condoms took away a boy's pleasure. More intervention than control youth anticipated using a condom when they did have sex (p<0.05) , and fewer expected to drink alcohol (p<0.05). Finally, after intervention, there was a trend for increased condom use (but not significant). There were significant gender-related differences at baseline, although the intervention method had similar impact on both sexes.

Harvey,B., Stuart,J. and Swan,T. (2011)  Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial.  Int. J. STD AIDS  11, 105-111. Ref ID 8726

Dalrymple, L. and du-Toit, M.K. (1993) The evaluation of a drama approach to AIDS education. Educational Psychology 13(2):147-154, 1993. Ref ID : 3634 

Target group/country 800,00 pupils in 800 secondary schools in KwaZulu, South Africa

Intervention Methodology The programme was carried out in 1993/4. During the first phase, teams composed qualified teachers/actors and nurses presented a play incorporating issues surrounding HIV and AIDS to each school. The second stage involved team members running drama workshops in the schools with teachers and students using participatory techniques such as role play. The programme ended with a 'school open day' focusing on HIV and AIDS through drama, song, dance, poetry and posters all prepared and presented by the students..

Evaluation method Two schools separated by more than 10 km in each of five districts (4 rural and 1 urban) were selected were selected to be intervention (receiving the drama programme) and control schools (receiving a 10 page booklet on AIDS). A self-completed questionnaire was given to the same standard 8 class pupils before (n= 1080) and 6 months later after the intervention (n=699 ) - mean age 18.3 in range 13-25 years. The questionnaire included sections on knowledge about HIV/AIDS, attitudes relating to personal susceptibility, immediacy of threat and perceived severity, attitudes towards people with AIDS, self-efficacy and reported behaviour including, whether have had sex, condom use, number of partners)

Impact Achieved There was a greater increase (p<0.0002) in mean percentage score on attitudes relating to HIV/AIDS increased from 38.1 (n=491) to 50.5 (n=305) in intervention schools compared with  the control schools (50.0, n=585 to 51.8, n=394).  There was also a greater increase (p<0.0000) in mean percentage score on attitudes with the intervention schools 38.1, n=491 before and 50.5, n=305 afterwards) compared with the control schools (40.5, n-586 and 40.3, n=392). There slightly higher behaviour change among the sexually active students in the intervention group but the increase was only significant for increased condom use (p<0.01). There was no evidence of an increase in sexual activity as a result of the educational programme. The main limitations in this study which the authors noted was lack of linking of pre and post-test (because the questionnaires were anonymous), the use of outcomes based on self-reporting and the loss of pupils from the original pre-test sample. However, it is important to not that the achievements measured had been sustained over the six month period between pre-and post-test showing that the intervention had achieved more than merely short-term improvements.

Kinsman,J., Nakiyingi,J.K.A., Carpenter,L.Q.M.P.R. and Whitworth,J. (2012)  Evaluation of a comprehensive school-based AIDS education programme in rural Masaka, Uganda.  Health Education Research: Theory and Practice  16, 85-100.Ref ID: 8810

Target group/Country Schoolchildren in primary and secondary schools in Masaka District, Southwest Uganda

Intervention Methodology The programme was an an adapted version of WHO/UNESCO (1994) School health Education to prevent AIDS and STD - A resource Package for Curriculum Planners. Two teachers from each participating school attended a series of three training and evaluation workshops of total length 5 days over 12 months. The teachers were expected to introduce the programme in classroom and out-of-school activities over the 12 month period.  The programme and subsequent evaluation was influenced by the behavioural Change for Interventions (BCI) Model which is closely related to the Theory of Reasoned Action and identifies the following 5 elements and important for behaviour change: knowledge acquisition, skills development, attitude development and motivational support.

Evaluation Method 1274 students from 20 intervention schools and 803 students from 11 control schools completed questionnaires in English at baseline and their classes were followed up. The self-completed questionnaires measured the four elements of the BCI model. Students in the intervention schools completed questionnaire directly before the programme began (round 1), immediately after it ended (round 2, 10-12 months later) and again 6 months after that (round 3). Students in the top 2 years of the primary schools and the lower 2 years of the secondary schools were asked to complete questionnaires at baseline and these classes were then followed up in subsequent rounds. Logistical problems prevented the children in control schools from completing the questionnaire at round 1 and they completed rounds 2&3.  In addition 93 students from 5 of the intervention schools participated in 12 focus group discussions.

Impact Achieved Analysis of the questionnaires suggest that the programmes overall effect was minimal and not statistically significant. Data from the focus group suggested that the programme was incompletely implemented and that key activities such as condoms and the role play exercises were covered only very superficially. The main reasons for this were a shortage of classroom time as well as teachers' fear of controversy and the unfamiliar. The findings highlighted the problems of locating AIDS education within a science curriculum and suggest that AIDS needs to be more fully incorporated into the national curriculum and located within the life skills curriculum with teachers receiving more training in participatory methods.

Klepp,K.I., Ndeki,S.S., Seha,A.M., Hannan,P.Lyimo,B.A., Msuya,M.H., Irema,M.N. and Schreiner, A. AIDS education for primary school children in Tanzania: an evaluation study. AIDS :1157-1162, 1994. Ref ID : 258

Target Group /Country/Reference Public primary schools in Arusha and Kilimanjaro regions, Tanzania.

Intervention Methodology Local teachers and health workers attended a 1-week training workshop before implementing the program over a 2-3-month period (averaging 20 school hours per class).Theory of Reasoned Action and Social Learning Theory was used to guide development of the educational programme which consisted of: (1) Teacher supported by health workers providing factual teaching; (2)pupils making posters showing HIV risk factors; (3) pupils writing songs about the danger of AIDS and how children can protect themselves; (4) pupils in small groups discussing what they can do to reduce their risk; (5) pupils writing and performing role plays practicing refusal skills (6) performing plays, songs, poetry to younger pupils. Te programme was called 'Ngao' -meaning shield in Swahili - children were given t-shirts with the ngao symbol.

Evaluation Method A quasi-experimental, nested cross-sectional design including baseline and 6-month follow-up surveys. Schools, stratified according to location, were randomly assigned to intervention (n = 6) or comparison conditions (n = 12). A total of 2026 sixth and seventh grade pupils (average age, 14.0 years) participated at baseline (85%) and 1785 at follow-up 6 months later.

Impact Achieved Following this program, intervention pupils reported significantly higher scores for the following outcome measures than pupils attending the comparison schools: AIDS information (13.1 versus 10.5; P = 0.0001), AIDS communication (10.9 versus 7.8; P = 0.0001) AIDS knowledge (14.5 versus 11.5; P = 0.0001), attitudes towards people with AIDS (9.0 versus 6.7; P = 0.0008), subjective norms (45.5 versus 43.9; P = 0.011), and intention (1.3 versus 1.4; P = 0.020). No program effect was seen for attitudes towards sexual intercourse (47.0 versus 46.3, P = 0.44).

Kuhn, L., Steinberg, M., and Mathews, C. Participation of the school community in AIDS education: an evaluation of a high school programme in South Africa. AIDS Care 6(2):161-171, 1994. Ref ID : 15

Target Group /Country A high school in a socio-economically disadvantaged, urban, African area in South Africa.

Intervention Methodology School nurses addressed a meeting of parents who gave their consent. Teachers and pupil representatives then planned the activity which was an intensive school-wide programme over two weeks. The programme implemented by the teachers included structured classroom sessions on AIDS, open discussions, integration into language teaching of the theme, showing of videos in breaks, a grafitti wall, stickers and condom distribution through a designated teacher.

Evaluation Method Students’ knowledge of and attitudes towards AIDS prevention were measured using a self-completed questionnaire in Xosa language before and after the AIDS programme, and compared to a neighbouring school, in which no AIDS education was conducted. 231 children in the intervention group and 336 in the control group at baseline and 206 in the intervention group and 276 in the control group at post-test. Teachers' knowledge was also evaluated before and after the programme.

Impact Achieved Following the intervention, students' knowledge about HIV transmission, prevention and the role of condoms, and the course of the disease was greater in the intervention school (p<0.001). Reported willingness to accept someone with AIDS increased (p<0.001) but was still at a low level (41.2%). There was a significant increase in numbers of pupils who claimed to have discussed AIDS with parents, nurses, teachers, friends and sexual partners (p<0.1). There was a small but statistically insignificant increase in student's intention to use condoms. Teachers' knowledge of AIDS improved but some misconceptions still remained as well as a hesitance to accept a person with AIDS. An unfortunate consequence of the programme was that a rumour circulated that the reason that they had had the AIDS education programme was because students and teachers had AIDS. This caused distress to the pupils.

MacLachlan, M., Chimombo, M. and Mpemba, N. (1997) AIDS education for youth through active learning: a school-based approach from Malawi. International Journal Of Educational Development 17, 41-50. Ref ID : 6866

Target Group /Country Secondary school pupils in one school in Malawi.

Intervention Methodology In this 3-year project, run by lecturers in the University of Malawi, a questionnaire survey of 756 secondary school children had showed that pupils gave more than 70% correct answers to knowledge questions on AIDS. This was followed by development, trial use, and evaluation of an educational board game. In this pupils had to give and explain and justify their response to a set of questions in order to advance in the game..

Evaluation Method 72 pupils aged 13-20 were selected from one school. These students were given a questionnaire and then played the game weekly for four weeks. Their game scores were recorded. One month from the last game session the questionnaire was re-administered. There were no controls.The questionnaire consisted of 40 true/false items were developed over a 2.5-year period and were drawn from separate and complementary sources including pupil observation, teachers, medical doctors, and government representatives.

Impact Achieved The test score increased each time the game was played. Although scores dropped between the final session on one month follow-up there was still an overall increase in scores between baseline and follow-up (73.5) and follow-up (88.2 p<0.001) The knowledge of pupils at the experimental school who did not play the game also improved, showing a “trickle down” effect. these results led to further development and distribution of the board game, dubbed “The AIDS Challenge.”.

Meekers,D. (1998)  The effectiveness of targeted social marketing to promote adolescent reproductive health: the case of Soweto, South Africa. PSI Research Division Working Paper No 16,  Washington:  Population Services International. Ref ID8755

Target group/country Young people in Soweto, South Africa

Intervention Methodology The Soweto Adolescent Reproductive Health Programme was implemented from June 1994 through April 1997 as part of a wider social marketing programme. During the intervention 70 adolescents were trained in participatory media development, peer education and condom distribution. Using participatory media development Soweto youths developed materials that were distributed through radio, television, print media, educational materials and interpersonal communications. To ensure adequate condom distribution, over 3000 condom distribution outlets were opened. Communications materials including radio advertisements, posters, T-shirts, buttons, slogans and a 44 page adolescent sexuality booklet. Soweto Community Radio and Voice of Soweto broadcast weekly 2 hour talk shows which included live call-in questions and discussions. . A six part documentary on condoms and safer sex was produced for South African TV and for showing as videos.

Evaluation Method Both men and women aged 17-20 were sampled but only the data from men could be used because of technical problems in data collection. A quasi-experimental control group design with a pre-intervention survey in in Soweto 1996 (n=118) and control area Umlazi (n=108) and a post-intervention survey in 1997 in Soweto (n=101) and Umlazi (n=103). Choice of questions was designed using a behavioural model combining the Health Belief Model and Self Efficacy.

Impact Achieved The % of young women who received instruction about pregnancy, contraceptives, STDs and HIV/AIDS increased rapidly in the intervention location but did not change in the control location (p<0.1).The results also suggested that the Soweto intervention influence health beliefs (p<0.1) including increased awareness of risk of becoming pregnant, that condoms can prevent HIV/AIDS, that young people do not have problems in preventing pregnancy, STDs  and HIV/AIDS. There was an increase in the % of women reporting to have talked about contraception with someone  (but not about STD/HIV prevention). In Soweto there was an increase in proportion of women who ever used condoms and the proportion of women who used condoms in last sex increased significantly in both areas. There was no change in other sexual behaviours (either a reduction or increase in sexual activity) The findings suggested that the intervention was more effective in changing beliefs related to pregnancy prevention than those related to STD/HIV. Thus may be a consequence of the fact that the young people in Soweto were more concerned about pregnancy prevention and this influence the content of the participatory. Note that the control community had a higher level of STD/AIDS and the young people were also exposed to education on HIV/AIDS from other sources. The sample sizes were small which may be a reason for the low p values

Meekers,D., Stallworth,G. and Harris,J. (1977)  Changing adolescent's beliefs about protective sexual behavior: the Botswana Tsa Banana program. PSI Research Division Working Paper No. 3,  Washington:  Population Services International. Ref ID 8754


Target group/country
Young people in Botswana

Intervention Methodology The Tsa Banana programme was designed to help persuade young people that reproductive health services exist not only for other people but for adolescents and they should use them. The project was implemented in Lobatse from March 1995 to March 1996 and included: 1) a communications campaigns with radio messages, printed media, information campaigns directed towards parents, teachers and youth community leaders; 2)youth-oriented social marketing of condoms including teen-oriented inserts into magazines; 3) community outreach through peer sales educators; and 4) the development to of adolescent friendly outlets - retail outlets and health clinics were trained to participate in the service and given a special sign . In addition the programme promoted less risky behaviour A.B.C. "Abstain, Be faithful and Condomize". Peer educators taught negotiation skills such as and refusal skills or requesting the use of condoms. Peer education was provided in primary and secondary schools. In secondary schools all students were targeted and messages included safer sexual behaviours and condom use. In primary school children aged 13 and over were targeted and messages provided mainly information on puberty and encouraged abstinence. The Health Belief Model was used as a framework for educational activities and subsequent evaluation.

Evaluation Method A quasi-experimental control group research design was used with a pre-intervention and post-intervention survey conducted on a sample of male and female adolescents aged 13-18 years in both the intervention location and a comparison location. The first round of surveys were conducted in 1994 in the intervention (n=507) and comparison area Francistown (n=495). The second round was carried out in 8 months after implementation of the project  (n=1230 and n=1196 for intervention and comparison areas). Both questionnaires contained questions on reproductive health  and AIDs-related topics and the second one contained further questions relating to exposure to the programme activities.

Impact Achieved 41% of female and 33% of male adolescents were directly involved in programme activities (including low-level involvement such as wearing a T-shirt.68% of female and 71% of males had heard of the programme. A significant positive change among both males and females in the intervention location was an increased belief that people use condoms to avoid sexual risks (p<0.01), a reduction in belief among males that it is hard to convince a partner to use condoms (p<0.01 ) and a reduced belief among females that sex is good because it leads to marriage  and increases among females in the belief that AIDS cannot be cured and that people may abstain from sexual risk. The evaluation also indicated that the programme had brought about some undesirable changes. Females in both comparison and intervention locations were more likely to feel shy about purchasing condoms in public, to believe that women lose respect if they initiate condom use and to believe that few of their friends use condoms (p<0.01). This is used by the authors to suggest that that AIDS prevention programmes need to recognize possible conflicts between encouraging awareness of individual risks from unsafe sexual practices on the one hand and de-stigmatizing condom use on the other. (Though the presence of the same trend in the control does suggest that factors other than the intervention may be operating). The programme had different effects on males and females suggesting that in future these need to be targeted separately with different approaches and messages.

Migliori, G.B., Spanevello, A., Manfrin, V., Abongomera, A., Pedretti, R.F., Ballardini, L., Neri, M., and Borghesi, A. AIDS and tuberculosis control programmes: an integrated approach at educational level. Monaldi.Arch.Chest Dis. 51(2):102-107, 1996. Ref ID : 7251

Target Group /Country Secondary schools in Arua District Uganda

Intervention Methodology A 1.5 hour standardized HE session (covering the key- points of AIDS and TB control including treatment and need for case-finding and compliance with tuberculosis treatment.

Evaluation Method  The impact  was evaluated by comparing answers to 1,478.pre- and post-test questionnaires (multiple choice) before and three months after the intervention and evaluating TB case-finding performances from clinic records in the period preceding and following the survey. A control was not used.

Impact Achieved The overall impact of the health education on the knowledge scores was significant at p<00001 level. .However, a notable exception was a lack of significant impact on the knowledge of males on the preventive role of condoms In the period preceding the study 188 new cases of TB were diagnosed versus 241 in the following period. 19% of them were sent by one of the students or their families. (p<0.001). 12 defaulters started treatment in the period before the health education and 21 in the period following.

Monteiro, S.S., Rebello, S.M., and Schall, V.T. Zigzaids—an educational game about AIDS for children. Hygie 10(4):32-35, 1991.  Ref ID : 490  (Borderline for inclusion in database)

Schall,V., Monteiro,S., Rebello,S.M. and Torres,M. (1999)  Evaluation of the ZIG-ZAIDS game: an entertaining AIDS tool for HIV/AIDS prevention.  Cadernos de Saude Publica  15, 107-119.Ref ID: 8806  (Borderline for inclusion in database)

Target Group/Country Young people aged 10-14 years in Brazil.

Intervention Methodology Zigzaids is a board game with 23 spaces that contain instructions for moving forwards or backwards. Players roll the dice to move along but must answer questions about AIDS contained in cards. Additionally, the game also includes “surprise topics” that deal with such issues as haemophilia, blood transfusion, and drug action. A player wins by arriving to first to the end, and his or her prize is a condom. called Zigzaids. The educational theories of Paulo Freire were incorporated into the design of the game. The game also contained a leaflet for parents and teachers. In its original form the game was intended to be marketed through commercial outlets but the sexual language in the dictionary provided, the nature of the topic and the inclusion of a condom as a prize led to disappointing sales. The game was re-issued without the condom prize and sold mainly to government and NGO projects rather than through commercial channels.

Evaluation Method An evaluation sample was selected of 34 children aged 9-14 yrs attending two public and two private schools in Rio de Janeiro State. Some had volunteered and some were randomly selected. The game was evaluated by observing children as they played and then asking them to complete an oral questionnaire before and after they played. The children were also asked to write comments on their enjoyment of the game. There were no controls. The methodology for the observational study is not described. In addition a feedback questionnaire was sent to people ordering the game and questionnaires were sent to

Impact Achieved The game was widely distributed (100,000 copies alone were purchased and distributed by the National AIDS Control Programme). The feedback from schools and other institutions were very positive. The game was used in a variety of settings including classrooms, parents' meetings, vocational courses, day-care centres, company education programmes, supervision sessions for health workers etc. Following the playing of the game, the observational study found changes in the children’s ideas and attitudes concerning the disease. The children no longer considered embracing, eating, or playing with an individual with AIDS to be risky behaviour. Asked whether they had learned any new knowledge, all but 1 of the children said yes. And again, of the 11children that responded to the question of whether they would play the game again, only 1 child said no. Raw data is not presented and there were no significance tests. It is disappointing that given the innovative nature of this programme, so little data is presented on impact.

Nastasi, B., Schensul, J.J., Amarasiri de Silfa, M.W., Varjas, K., Silva, K.T., Ratnayake, P. and Schensul, S. (1998) Community-based sexual risk prevention programme for Sri Lankan youth: influencing sexual-risk decision making. International Quarterly of Community Health Education 18, 139-155.Ref ID : 8037

Target Group /Country Urban youth aged 17-27 years in Sri Lanka

Intervention Methodology Following two years ethnographic research a peer education programme for young persons aged 17-27 years was developed based on theory-driven risk-reduction mode (social construction theory that takes into account : 1) social competencies; 2) personal resources; 3)cultural norms; 4) socialization practices: and 5)cultural agents).Peer educators were selected and provided 30 hour training programme. These peer educators ran a training programme consisting of 12x90 minute sessions over four weeks.

Evaluation Method The training was evaluated by documentation of the programme and pre- and post-test measures of sexual knowledge, attitudes, perception of risk and decision-making through self-report questionnaires of 66 persons who had attended at least 6 of the sessions. There were no controls.

Impact Achieved There was a significant interest in knowledge of women on condoms (p<0.01) and sex terms (p<0.001) but no increase for men. There was no significant impact on attitudes towards sex or perception of future risk. There was no impact in the confidence of women and a decline in confidence of men (p<0.05). Some impact of the programme is claimed on perception of risks as measured by responses to open-ended scenarios - but no analysis of qualitative findings is presented. The significance of this evaluation is limited by its short-term nature and by the fact that impact is studied of the training on the peer educators and not the subsequent peer education activities among young people in the community.

Sankaranarayan, S., Naik, E., Reddy, P.S., Gurunani, G., Ganesh, K., Gandewar, K., Singh, K.P., and Vermund, S.H. Impact of school-based HIV and AIDS education for adolescents in Bombay, India. Southeast.Asian.J.Trop.Med.Public Health 27(4):692-695, 1996. Ref ID : 7792

Target Group /Country Pupils aged 12-15 in 10 schools in F North District of Bombay (Mumbai), India

Intervention Methodology An education program was instituted for one half school day at ten secondary schools selected out of a total of 45 schools in the district. The content consisted of a presentation on AIDS (causes, distribution, transmission, treatment and prevention) followed by a video and street play. (details are not provided, but it is likely that the presentation was to the whole school and not individual classes)

Evaluation Method A pre-test-post-test evaluation of a school-based HIV/AIDS educational program. The pre-test self-administered questionnaire in English and Marathi modes of transmission and prevention of HIV/AID was administered to a convenience sample of all pupils from 8,9 and 10th grade attending that day from 10 schools  - total sample 2,919 students, the post-test was administered to 2,400 students one month after the presentation

Impact Achieved There were increases (p<0.001) in the following areas of knowledge: that HIV/AIDS is transmitted sexually (43.995.6%), that there is no treatment (3492.4%); that HIV is not transmitted by mosquitoes (2476%); condoms can prevent AIDS (31.786.1); Vaccines are not available (24.786.4%) and voluntary blood donors are better than professional donors 30.186.5%). Principles of two schools refused to allow the AIDS education. Some class teachers did not attend the sessions because they were embarrassed.

Rossem,R.V. and Meekers,D. (1999)  An evaluation of the effectiveness of targeted social marketing to promote adolescent reproductive health in Guinea. PSI Research Division Working Paper No. 23,  Washington:  Population Services International. Ref ID8756

Target group/country Young people aged 12-19 years in Conakry and Karkan cities in Guinea

Intervention Methodology The objectives of the adolescent reproductive health programme included to increase youth's knowledge of STDs and AIDS, to increase knowledge and use of condoms an other modern contraceptives, to increase delayed sexual initiation and sexual abstinence and to increase access to affordable condoms. The intervention was integrated into a larger nationwide contraceptive social marketing programme. The programme recruited and provided a two week training for 36 peer educators in Conakry and 22 in Kankan. Peer educators were equally selected from males and females who were active members of youth programmes or were volunteers. Training focused on topics related to family, STD/HIV and on communication techniques. The adolescents developed the project logo Mon avenir d'abord ("my future first") used to identify youth-friendly retail outlets . Peer educators handed out youth-oriented materials including posters, flyers, T-shirts, stickers, badges and caps. Billboards with information on STDs/AIDS were also installed. The peer educators also organized monthly discussion groups, educational theatre and dances and soccer tournaments.

Evaluation Method A pre- (Jan/Feb 1997) and post-intervention ( 8 months later in March 1998) survey design in two regions - each containing both experimental sites where the intervention took place and geographically distant control sites with no intervention. The 1997 baseline survey included 2508 adolescents divided equally between intervention and control communities and the 1988 follow-up study included 1009 intervention and 796 control. The questions were based on a modified Health Belief Model.

Impact Achieved 38.9% of the men but only 14.5% of the women in the intervention sites reported to have participated in programme activities. Soccer was the most popular of programme activities. 15% reported attending soccer games, 14% discussion groups, 9% attended theatre and 9% dances. Men participated more in all of these activities. There was no evidence of an effect of the programme on young people's perception of the risk of AIDS, awareness of sexual risk, perception of the benefits of prevention. The intervention did not affect the proportion of youths who reported sexual experience. 24% of the young people in the sample from the intervention area reported to have changed their sexual behaviour in response to the programme (use of condoms 13%, faithfulness 11% and abstinence 10%).There was a significant increase (a=5%) in condom use among sexually active men from an already high level of 53% to 65% (no effect on women) in the intervention area and a slight decrease in the control area. The authors attribute the lack of impact of the programme to the low educational potential of the most popular activity soccer, the short 8 month duration of the campaign and the fact that the need to have distinct control communities in the study design meant that there was no mass media support for the interpersonal activities.

Shuey, D.A., Babishangire, B.B., Omiat, S. and Bagarukayo, H. (1999) Increased sexual abstinence among in-school adolescents as a result of school health education in Soroti district, Uganda. Health Education Research: Theory and Practice 14, 411-419.Ref ID : 8437

Target Group /Country Primary schools aimed in Soroti district of Uganda

Intervention Methodology Activities included sensitization of local leaders and head teachers in a one-day workshop and an initial survey of school children. Teachers were trained on implementation of the school health curriculum, AIDS prevention and the use of child-to-child techniques. Activities in the schools consisted of formation and meetings of school health clubs, application of child-to-child health education  techniques, and competitions in plays, essays, poems and songs on health-related issues.

Evaluation Method A cross-sectional sample of 10 students (5 boys/5 girls) average age 14 years, in their final year of primary school was drawn from 38 randomly selected schools. They were given a self-completed questionnaire in English (but questions were explained in local language). The questionnaire was given to a similar sample of children in that same year after 2 years of interventions.

Impact Achieved The percentage of students who stated they had been sexually active fell from 42.9% (123 of 287) to 11.1% (31 of 280) in the intervention group (p<0.001%), while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters (p=0.34). Increases in reasons given by students for abstaining from sex over the study period occurred in those reasons associated with a rational decision-making model rather than fear of punishment. The project had aimed to achieve sustainability through working through the existing structures and only employed one additional full-time. Details of the total number of children reached are not provided,

Visser,M. (1996)  Evaluation of the First AIDS Kit, the AIDS and lifestyle education programme for teenagers.  South African Journal of Psychology/Suid-Afrikaanse Tydskrif vir Sielkunde  26, 103-113.Ref ID 8680

Target Group /Country Teenagers at 11 schools from different language groups in South Africa

Intervention Methodology The First AIDS Kit is an AIDS and lifestyle education program for teenagers developed by the Department of National Health and Population Development. The programme was based around the Theory of Reasoned Action, The Health Belief Model and the self-efficacy approach. The kit consists of 5 modules covering: 1) adolescence; 2) AIDS and STDs; 3) relationships; 4) life skills; and 5) safe sex skills. The kit included a video, quiz to teach facts and exercises in assertiveness, decision-making, negotiation skills, choosing low risk behaviours. Teachers were encouraged to select parts of the kit that they considered appropriate to the students' needs.

Evaluation Method The program was evaluated using a self-completed questionnaire before and one week after the program by187 pupils in standards 6-9 in 11 schools , as well as by focus group discussions with students and interviews with the teachers. The questionnaire was adapted from one issued by WHO and consisted of questions to measure knowledge, attitudes towards people with AIDS, behavioural intention to engage in high-risk behaviour and perception of condom use. The intention had been to select schools from all the language groups but the sample had to be reduced by two schools initiating their programme before receiving the pretest with result that the sample include the following language groups Afrikaans (53, 28%), English (78, 42%) and African (29, 16%) and not completed (27, 14%).  A control was not used because of the cost involved.

Impact Achieved There was improvement (p<0.005) on all the knowledge scales except susceptibility and the attititude towards people with AIDS (p<0.005). No significant improvements were found in the behavioural intention and perceptions of condom use.. Students gave favorable evaluations of the program and offered suggestions on how to improve it with regard to the content, presenter, educational techniques, the role of parents, and how to address moral issues. AIDS education should form part of long-term life skills and sex education, with a focus upon behavioral change. No significant difference between the pre-test and post-test results of students with an African home language - probably due to their small numbers in the sample.

Wolf,R.C., Tawfik,L.A. and Bond,K.C. (2011)  Peer promotion programs and social networks in Ghana: methods for monitoring and evaluating AIDS prevention and reproductive health programs among adolescents and young adults.  Journal of Health Communication  5, 61-80. Ref ID 8752 (Borderline for inclusion in database)

Target Group/Country Young people aged between 11 and 26 years in three urban locations in Ghana

Intervention Methodology Peer education programmes in different cities in Ghana carried out inside and out-of-school. No information is provided of the educational content of the training and the instructions provided to the peer educators on how to conduct their peer education. Five one-day training sessions were conducted with groups of up to 40 peer promoters. Each of the 106 peer educators was trained (no information provided on content).

Evaluation Method Multiple semi-structured interviews with 106 peer promoters (41% male,59% female; 64% currently attending school) ) and 526 contacts (46% male/54% female; 64% attending school) from three sites in Ghana (Accra, Kumasi and Aflao). The peer educators were paired up and each of the pair administered the questionnaire to the other in the pair. Each was then given questionnaires to give to five peer contacts - people they normally talk to and counsel about reported health and HIV/AIDS. They were instructed to return the completed questionnaires after a two week  period. The questionnaire included four components: demographic characteristics, behavioural indicators and message exposure, network and peer influence data and a summary of the peer education encounter including the main issues and messages delivered and services provided by the peer educator during their one-on-one peer encounter.

Impact Achieved 28% of contacts report having heard of AIDS within the past 30 days from a peer educators. Peer educators report that their contacts are mainly their friends (46%). More than half (53%) see the people from the peer encounter every day. Another 29% see them once a week. Peer educators who attend school tend to mainly reach others who attend school - even if the peer education programme is not school-based. Only 9% of peer educators and 58% of their contacts said they had done anything to protect themselves from AIDS and no information is provided to explain this. The value of this study is severely limited by the lack of information on the peer education programmes from which the sample of peer educators and contacts are drawn.

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2 Family Planning and Population Education

Eggleston,E., Jackson,J., Rountree,W. and Pan,Z. (2011)  Evaluation of a sexuality education program for young adolescents in Jamaica.  Revista Panamerica de Salud Publica  7, 102-112. Ref ID: 8892 (Borderline for inclusion in database)
Target Group /Country School children in 7th grade (aged 11-14) in Jamaica

Intervention Methodology A Grade 7 project initiated in 10  schools across Jamaica in 1995-1997. It was designed to delay initiation of sexual activity and promote  use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Female educator-counselors employed by the project conducted Grade 7 project sessions once per week throughout the 9 month academic year. Sessions were coeducational, lasted 45 minutes and had calls sizes from 30-60. The sessions included classroom lectures supported by visual aids and question-and-answer sessions. Small group discussions were held during some sessions.

Evaluation Method 5 intervention schools were compared with 5 schools with the standard sex education curriculum.  945(490 girls, 455 boys) completed a baseline self-completed  questionnaire in Sept 1995 and 75% of these completed the post test questionnaire in June 1996 (short-term ) and in June 1997 (long term).  The questionnaire was pre-tested, revised and the final version was pre-tested again as considerable changes were required to ensure that the questions could be answered by students who could not read and write very well.

Impact Achieved   Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P = .08) by adolescents who reported first intercourse during the study period (n=91); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. Note the short term impact on use of contraception is encouraging but the p value is greater than the standard value of acceptability of p<0.05 which can be attributed to the small sample of 91 children who had their first intercourse during the study. Note that lack of significant impact on the project on initiation of intercourse can be consider a positive outcome reinforcing various reviews that have argued that sex education does not lead to early experimentation.

Martiniuk,A.L., O'Connor,K.S., & King,W.D. 2013, A cluster randomized trial of a sex education programme in Belize, Central America, International Journal of Epidemiology, 32(6)131-136. Ref ID: 9067

Target Group/Country Adolescents aged 13-19 years in schools in Belize, Central America

Intervention Methodology A responsible sexuality education programme (RSP) based on Bandura's Social Learning Theory and using modeling, role playing and shaping techniques. The 3 hour scripted responsible sexuality education programme sought to provide a framework for adolescents for decision making in relationships and unbiased information about sex and sexuality. Very little information is provided on the actual sessions, who taught them and what activities took place.

Evaluation Method A cluster randomized design. Seven high schools in Belize City were selected; 8 classrooms were randomized to the intervention arm and 11 classrooms to the control arm (N = 399). Data were colleted using a 79-item questionnaire. Parts One and Two examined attitudes and behavioural intent rated on a five-point Likert scale. Part Three examined knowledge using 20 true/false,don't know questions.

Impact Achieved Greater changes in knowledge were observed in the intervention group than in the control group following the intervention. The intervention was associated with two more correct answers on the post-test (difference score was 2.22 points, 95% CI = 0.53, 3.91) after adjusting for gender and previous sexual experience. Changes were not observed for the attitude or behavioural intent domains. After controlling for gender and previous sexual experience, the intervention was associated with no change in the attitudes (0.06, 95% CI: -2.89, 2.82) or behavioural intent domains (0.84, 95% CI: -1.12, 2.46). The authors discuss possible errors introduced by the randomization process which was at the class room level. While they feel that there was unlikely to be contamination between control and intervention classes in the same school, the randomization resulted in inbalances in gender and previous sexual experience. Given that the input was only for three hours a lack of impact on behaviour is unsurprising. However, It is disappointing that no information is provided on the actual quality of the educational inputs.

Mbizvo, M.T., Kasule, J., Gupta, V., Rusakaniko, S., Kinoti, S.N., Mpanju-Shumbushu, W., Sebina-Zziwa, A.J., Mwateba, R. and Padayachy, J. (1997) Effects of a randomized health education intervention on aspects of reproductive health knowledge and reported behaviour among adolescents in Zimbabwe. Social Science & Medicine 44, 573-577. Ref ID : 6736

Rusakaniko, S., Mbizvo, M.T., Kasule, J., Gupta, V., Kinoti, S.N., Mpanju-Shumbushu, W., Sebina-Zziwa, J., Mwateba, R. and Padayachy, J. (1997) Trends in reproductive health knowledge following a health education intervention among adolescents in Zimbabwe. Central African Journal of Medicine 43, 1-6..Ref ID : 6868

Target Group/Country Secondary school pupils from 11 schools mainly from rural areas of in Zimbabwe

Intervention Methodology An educational programme on male and female reproductive function, female anatomy, STDs, AIDS, human sexuality and responsible behaviour. Lectures supported by videos, leaflets, pamphlets and posters were given on reproductive biology, STD/HIV/AIDS, unwanted pregnancy and contraception, human sexuality and responsible behaviour. Details of the duration of the educational sessions not provided.

Evaluation Method  A randomized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage random cluster sample with 30 selected from each of forms 1-6 with a sample of 180 per rural schools. The schools included one Catholic and two Salvation Army Schools. A self-administered questionnaire was used to assess aspects of reproductive health knowledge and behaviour at baseline and five and nine months after the health education intervention. Results are based on 1689 responses made up of 1159 intervention and 530 control respondents mean age 14.6+/- 3.1yrs. Details are not given how the controls were selected.

Impact Achieved   There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.4-6.1). Significantly, (OR = 2.0, 95%CI = 1.1-3.9) more pupils from intervention than control schools scored knowledge of correct practice relating to menstruation. Knowledge of wet dreams increased by 11.7% in intervention group and 1.3% in controls (p<0.01) Pupils from intervention schools were more likely (P < 0.001) to know that a boy between 13-19 years could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse (OR = 1.4, 95%CI = 1.1-1.9). Understanding of family planning increased in intervention schools from 24.6% at baseline to 51.4% at 5 mo. (p<0.01) and in controls from 18.8% to 43.1% Knowledge of specific family methods increased (odds ration 1.4. 9.5% CI 1.1-1.7). Improvements were sustained over time. Note: increases in the level of knowledge of controls indicated that pupils are exposed to sources of health education on family planning outside of schools

Russel-Browne, P., Rice, J.C., Hector, O. and Bertrand, J.T. (1992) The effect of sex education on teenagers in St Kitts and Nevis. Bull. Pan. Am. Health. Organ. 26, 67-78.Ref ID : 6513

Target/Country 12-15 year old school children from all six government high schools in St Kitts Nevis, Caribbean

Intervention method A syllabus covering human reproduction, growth and development, emotional development and issues and values in adolescent sexuality was developed for 12-15 age group  to be delivered through two 40-minute sessions for 26 weeks in St Kitts and Nevis in the mid 1980s. The 12 participating teachers received a four week training course in sex education.

Evaluation Method Evaluation was carried out using a before and after self-administered questionnaire of 2,202 children in experimental (six schools) and 1,321 children in control schools.  Follow-up questionnaires were given 10 months and one year after baseline. Questionnaires for follow-up consisted of The evaluation focused on four areas of knowledge: changes at puberty, reproductive anatomy and physiology, intercourse and pregnancy and contraception. Questions also asked about level of sexual activity and use of contraceptives on last sexual encounter.

Impact Achieved Despite some non-equivalence of the experimental and control group for age and a drop-out from the original sample in the follow-up questionnaire, the programme is claimed to have an impact of knowledge in the four domains (raw data and % given, statistical tests were reported to have been carried out but no p values given). The programme did not appear to influence contraceptive practices. There was no increase in sexual activity among the intervention group. No significant gender differences were found on the impact of the intervention on knowledge.

Turner, R. (1994) Sex education gains strength in Mexican public schools. International Family Planning Perspectives 20, 73-74.  Ref ID : 6787

Target/Country Schools in 72 secondary schools in 30 states in Mexico

Intervention method The evaluation of a sex education course Planning Your Life was used to develop a further course Adolescence and Development which combine factual and psychosocial elements and involve extensive role playing.

Evaluation Method The evaluation of Planning your life involved 1076 students who took the course and 556 as controls. Students were interviewed at baseline and again post-intervention. The evaluation of Adolescence and development involved giving 2011 pupils  a questionnaire at baseline and 1945 at follow-up . Also 1795 were given an opinion survey at the end of the course. 10% of teachers were given "tests" of attitudes and knowledge and 82 were also given an "opinion survey" at the end of the year. Details of sampling or measuring instruments are not provided.

Evaluation impact Unfortunately this publication only gives a brief account of the programme with no raw data or statistical analysis. The courses are claimed to have earned praise from parents and students despite fears from researchers that sex education would be rejected by Roman Catholics. In an evaluation of "Planning Your Life" performed in 1988-89 at 2 Mexican schools, it was found that exposure to this course led a significantly larger portion of the students who were having sex to use contraceptives. Evaluation of "Adolescence and Development" was undertaken to determine the attitudes of teachers, school authorities, parents, and students toward sex education. The teachers are claimed to have reported attitudes of other teachers, parents, and students as being either very positive (51-63%) or positive (33-45%). Attitude and knowledge scores of the students were reported to have  improved by the course, and most students liked the course a lot. 87% of parents were in favour of continuing the course, and 68% felt it should be required. By the time that newspaper advertisements appeared demanding that the course be stopped, it had gained sufficient support that its creator, the Instituto Mexicano de Investigacion de Familia y Poblacion (IMIFAP), was asked to develop more educational programs. By July 1993, the Mexican Congress passed a General Education Law which encourages sex and family education.

Vadies, E. and Clark, J. Comprehensive adolescent fertility project in urban Jamaica. Hygie 9(2):21-26, 1990. Ref ID : 538

Target Grou;p/Country Youth in 8 communities (total population 100,000)  in Jamaica, Caribbean

Intervention MethodologyThe Duhaney Park Youth Project and Health Centre in Jamaica is aimed at providing counseling, family life education, health, family planning and STD treatment, recreation and sports for youth. Activities included counselling, training of peer counselling, 3 day special topic youth workshops and an evening youth clinic. The project provided a central local point for activities through a new youth centre. There were four full time youth project staff who received 750 hours training.

Evaluation Method  Evaluation was through monitoring clinic attendances during the first year of operation. There were no controls or baseline

Impact Achieved   Over 12 months from April 1985 there were 419 visits to the youth clinic by a total of 285 patients. 120 (29)% were for family planning and 102 (24%) for STD consultations. Attendance was slow for nine months (35 per months) then increased by 100% in the 4th quarter of the year. Clinic users were predominantly female (1 male for every 9 women and 71% were aged 19+ years.  The main significance of this study is that it demonstrates that young people will use youth clinics  - however it does not seemed to have reached the young people 18 years and under. No information is provided on long term sustainability of the programme.

Wong, T. and Travers, K. (1997) Evaluation of a peer health education project in the Gambia, West Africa. International Quarterly of Community Health Education 17, 43-56. Ref ID : 7258

Target/Country Secondary school pupils in10 high schools in the Gambia

Intervention method A peer health education program among high school students. A variety of methods were used including group-work, lectures and distribution of leaflets on AIDS, drugs, stress, nutrition, alcohol, environmental health, family planning and STDs. No information is provided on selection, training, supervision of peers or the specific activities that they were supposed to undertake. From information presented in the discussion of the results it looks as if peer educators were supposed to give presentation in classes.

Evaluation Method Two of the ten high schools targeted by the program (one urban end one rural) were selected for evaluation. A total of eighty respondents, forty from each school. were randomly selected for participation. A self-completed questionnaire with both open and closed-ended questions was the data collection instrument which was subjected to qualitative content analysis and quantitative descriptive analysis. 74 participants completed the questionnaire for a response rate of 92  percent. The questionnaire was applied to one school after the project had run for 8 months and for 11 months in the other school. There was no baseline or control.

Impact Achieved 98% of respondents were aware of the existence of the peer education programme and 67% of those who were aware had received information from youth sources. 94% of respondents indicated that they had applied the information learned from peer education to their lives. Content analysis of their responses indicated that 67.7% of those had applied it to behaviour change in their own lives and 22.4% indicated that increased awareness of health issues was informing anticipated future choices. This evaluation is severely limited by the lack of specific information on the actual peer education programme, the nature and extent of peer education activities, the views of the peer educators themselves and the vagueness of the data on the impact on pupils.

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10 Nutrition education

Knight, J., Grantham McGregor, S., Ismail, S., and Ashley, D. A child-to-child programme in rural Jamaica. Child Care, Health and Development 17(1):49-58, 1991. Ref ID : 1351 (Borderline for inclusion in database)

Target Group/Country Mothers and schoolchildren average age 9 years in the parish of St Thomas, rural Jamaica

Intervention Methodology Teachers were trained through 15 workshops over a school year on the Child-to-Child approach which included development of curriculum; action-oriented songs, stories, skits, jingles, games, and pictures - all based on indigenous Jamaican folk music and patois intelligible to children with low literacy levels. The content covered nutrition (including breastfeeding and weaning)., healthy environment (including causes/spread of disease, flies, mosquitoes, food handling, personal hygiene) and child development (including play).

Evaluation Method Evaluation took place in 4 intervention (423 children) and two control schools (199). At the end of the year children were given a simple knowledge quiz. Mothers were administered questionnaires pre- and post project schools. Knowledge scores were tested with a simple post-test which only required ticking.

An earlier more complex questionnaire had been used for a pre-test but when the children had difficulties completing it had to be abandoned hence there is no baseline.

Impact Achieved At the end of the year the mean knowledge scores of 82 children in intervention schools was 23.24 and control schools 13.47. which was significant at the p <0.01 level. There was no change in knowledge of parents. Lack of a baseline limits the value of this study which is one of the few published evaluations of the Child-to-Child programme

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11 Infectious and tropical diseases

Migliori, G.B., Spanevello, A., Manfrin, V., Abongomera, A., Pedretti, R.F., Ballardini, L., Neri, M., and Borghesi, A. AIDS and tuberculosis control programmes: an integrated approach at educational level. Monaldi.Arch.Chest Dis. 51(2):102-107, 1996.  Ref ID : 7251

Target Group/Country Secondary schools in Arua District Uganda

Intervention Methodology A 1.5 hour standardized heath education session (co

Health education