Evaluation Of Different Sex And Reproductive Health (SRH) Education And Service Models Among Vocational High School Students In Shanghai

[OBJECTIVES] To evaluate the impact and acceptability of sexual and reproductive health education and service which was conducted by school teachers and medical professionals respectively in vocational high schools, and to explore the factors that influence the effects of the sexual and reproductive health education and service for vocational high school students.[METHODS] It was a school-based intervention study. Three vocational high schools in two districts were selected as study sites. Two of them were selected as the intervention groups and the other one as the control group. The study subjects consisted of all of students enrolled in 2005 in these schools. Two intervention models were adopted in the intervention schools. The sexual and reproductive health education and service in the intervention school 1 and school 2 was provided by teachers in the school (model 1) and health professionals out of the school (model 2), respectively. The intervention lasted two years. The intervention activities in the intervention school 1 contained providing life-planning skill training, delivering lectures, distributing educational booklets, playing video, holding debate and drama competitions and offering counseling. Besides the intervention activities that took in the intervention school 1, an after-school counseling room was set up nearby the intervention school 2 during the intervention period. In this counseling room, education and services including group discussions, playing video, counseling and contraceptives and free pregnancy testing would be implemented by the health professionals. Data was collected through questionnaires survey (baseline and end-line), focus group discussions and individual-depth interview among students. The impact of intervention was evaluated by comparing the respondents’ sexual and reproductive health knowledge, attitudes, skills and practices between before and after intervention, between the intervention and the control schools, and between two intervention schools.[RESULTS] Among 1,846 students surveyed, 1,837 valid questionnaires were collected at baseline survey (621 in the control school, 631 in the intervention school 1 and 585 in the intervention school 2). While at the end-line survey, totally 1,624 students were surveyed and 1617 valid questionnaires were collected. Among them, 564, 542 and 511 were from the control school, the intervention school 1 and school 2, respectively.At the baseline survey, the knowledge score of vocational high school students were rather low with the mean score being 33.5 (the full score was 100). While their attitudes towards sexual issues were considerable open. 56.0% students approved premarital sexual behaviors. The proportion of the sex-related behavior was high, i.e. the proportion of students who had ever had dating, hugging, kissing, petting and sexual activity with opposite sex was 41.8%, 45.8%, 30.3%, 19.4% and 4.2%, respectively, while the consciousness of having safe sexual activity among students was low.Both intervention models significantly increased students’ sexual and reproductive health knowledge. The average increased scores of total and each type of knowledge in both intervention groups were higher than that of the control group. After adjusting potential influencing factors, difference of the increased score between the intervention school 1 and the control school was 8.4, and that between the intervention school 2 and the control school was 18.2. Students from the intervention school 2 had a higher increased score of total sexual and reproductive health knowledge when compared with those from the intervention school 1 (the difference of the increased knowledge score between the two intervention schools was 9.8). In addition to increasing knowledge scores, both the two intervention schools improved self-assessment level of students and decreased the proportion of intimate behaviors. Moreover, the intervention school 2 strenghtened students’ consciousness of having safe sexual activity, as well as reduced dating and unintended first intercourse. However, no significant difference about sex-related attitude, initiation of sexual activity and contraceptive use in first intercourse was found between the baseline and end-line survey in both intervention schools.Comparing to the sexual and reproductive health education and service provided by school teachers in the intervention school 1, students had higher evaluation on the education and service provided by health professionals out of the school in the intervention school 2. Comparing to teachers, students were more willing to consulting health professionals for sex-related sensitive issues. The proportion of students who considered the life-planning skill trainings, lectures, educational booklets and video were useful for themselves in the intervention school 2 was 74.1%, 69.8%, 69.1% and 63.6%, respectively. While the corresponding proportion in the intervention school 1 was all lower than that in the intervention school 2 (60.6%、61.8%、60.5% and 52.5%, respectively). 85% students in the intervention group 2 had ever participated in the activities offered in the after-school counseling room.[CONCLUSION] : Both intervention models increased students’ sexual and reproductive health knowledge, improved their self-assessment level, and decreased the proportion of intimate behaviors. The intervention model 2 had more obvious effects on increasing knowledge scores than that of the intervention model 1, and what’s more, the intervention model 2 strenghtened the consciousness of having safe sexual activity, reduced the proportion of dating and unintended first intercourse and had higher acceptability among students.