A comprehensive review of reviews of school-based interventions to improve sexual-health

ABSTRACT

Objective: To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people.

Methods: Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis.

Results: Thirty-seven systematic reviews (summarising 224 primary randomised controlled trials) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorised into five types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes.

Conclusions: School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions.

KEYWORDS:

• Systematic review
• behaviour change
• sexual-health
• school-based

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCiD

Rona Campbell http://orcid.org/0000-0002-1099-9319

Additional information

Funding

This study was funded as part of National Institute of Health Research’s School for Public Health Research (NIHR SPHR) project with additional support from the NIHR Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Author order represents extent of contribution. SPHR is a partnership between the Universities of Sheffield, Bristol, Cambridge, Exeter, UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. The School for Public Health Research and the Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula is funded by the National Institute for Health Research School for Public Health Research (NIHR) with additional support from the NIHR Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC).