Cultural appropriateness of a comprehensive sexuality education programme. Implications for programme adaptation and implementation in Zambia

ABSTRACT

Comprehensive sexuality education (CSE) inclusive of cultural values and viewpoints is vital for promoting healthy sexual behaviour among adolescents. Although culture forms a huge part of the adolescent’s external environment and influences sexual behaviour, it is not always clear how culture has been conceptualised and integrated into CSE. We conducted a document review and interviews in nine selected schools in Kitwe district, Zambia. In-depth interviews (50) and two focus groups took place with 64 purposefully selected participants including pupils (35), parents (4), teachers (17), policymakers (4) and religious leaders (4). Data collection continued until saturation. Thematic analysis was employed to analyse the data. The findings revealed six main themes: the relevance of culturally appropriate CSE; lack of cultural diversity; the breakdown of traditional and social fabrics; imported CSE Western content; lack of participatory and learner-centred approaches to CSE; and age-inappropriate CSE. Analysis of the Zambian CSE framework revealed no evidence of culture being conceptualised and incorporated into the CSE curriculum. There is a need to ensure that CSE programmes are adapted to the cultural contexts in which they are applied. Engagement with the local community may be helpful in this respect.

KEYWORDS:

• Comprehensive sexuality education
• culture
• adolescents
• Kitwe
• Sexual health

Background

Internationally, young people and adolescents aged 15–24 years represent a key population in need of sexual and reproductive health (SRH) services (McCarraher et al. 2018). Of the 1.3 million new HIV infections worldwide in 2022, 27% occurred in people between the ages of 15 and 24 years (Dzinamarira and Moyo 2024). In 2019, an estimated 1.7 million adolescents aged between 10 and 19 were living with HIV worldwide (Mabaso et al. 2021). Adolescence is a significant period marked by biological, physical and emotional changes which are central to sexual health and development (Steinberg 2008). During this period, some young people may engage in risky sexual behaviour with consequences for sexual and reproductive health (Malunga, Sangong, and Ishaque Saah 2023).

In many low and middle-income countries, comprehensive sexuality education (CSE) has become a key source of sexual health information for adolescents especially those in school (Achen et al. 2023). CSE aims to provide an age-appropriate, culturally relevant programme aimed at equipping pupils with sexual health information and skills to improve SRH outcomes (Wangamati 2020). Variations exist in definitions of CSE. While UNESCO has placed an emphasis on sexuality, relationships and cultural relevance, UNFPA has historically made reference to rights and gender (Esther, Le Mat, and Hague 2020). Many benefits have been associated with CSE implementation in schools including the delayed onset of sexual activity, reduced rates of teenage pregnancy, reduced frequency of engaging in sexual intercourse, and demystifying incorrect cultural ideas about sexuality (Haberland 2015). The school environment provides an ideal environment in which to communicate sexual health messages to adolescents (Mbizvo et al. 2023; Browes 2015), however, opposition to CSE by some teachers exists due to religious beliefs and their cultural background (Shibuya et al. 2023).

In countries such as Zambia, several approaches have been used to teach sexuality education. They include faith-based approaches (imparting cultural and religious moralistic views with an emphasis on abstinence-only messages); public health approaches (aimed at imparting sexual health knowledge to help adolescents make informed decisions about sexual health), and rights-based approaches (with an emphasis on sexual and reproductive rights (Wangamati 2020). Many low and middle income countries have adopted faith-based and public health approaches aimed at enhancing sexual health knowledge, raising awareness of the ‘dangers’ of sex outside marriage, and prioritising abstinence messages (Browes 2015; Singh and Deardorff 2016). However, this approach to teaching sexuality education lacks holism and is often neglectful of the needs of sexually active adolescents and key populations such as gender and sexuality diverse youth (O’Farrell, Corcoran, and Davoren 2021; Wangamati 2020). Regardless of the approach adopted, lack of consideration of contextual factors in the development and implementation of sexuality education is a major weakness of the approaches adopted (Browes 2015). In countries such as Zambia, CSE in particular is perceived to be aligned with Western values and in conflict with local social norms held by stakeholders such as parents and religious leaders (c.f. Al Zaabi et al. 2020).

In order to be effective, sexuality education needs to engage with the cultural factors that influence sexual behaviour (Browes 2015). Multiple authors have stressed the need for culturally sensitive CSE programmes because culture forms a major part of the external environment that influences the sexual behaviour of adolescents (Browes 2015; Villar and Concha 2012). In addition, multiple values exist in any society. This makes ensuring the cultural relevance of sexuality education difficult (Villar and Concha 2012; Deardorff, Tschann, and Flores 2008; Singh and Deardorff 2016).

Zambia is a pluralistic country characterised by political, cultural, religious, and ethnic diversity. To enhance SRH knowledge among adolescents, the government of Zambia rolled out a new Framework for Comprehensive Sexuality Education in 2014, targeting children and adolescents enrolled in grades 5–12 (Zulu et al. 2019). The framework was developed with reference to UNESCO guidelines and grounded in a human rights framework (UNESCO 2018). Despite this policy advance, a nationally representative survey showed that 71% of female adolescents aged 15–17 years and those aged 18–19 years were sexually active and engaged in sexual risk behaviour (Quraish et al. 2023). Between 2011 and 2019, a total of 120,878 pregnancies were reported among schoolgirls (Mbizvo et al. 2023). Because of concerns among teachers that the CSE they are required to teach is incompatible with religious and cultural norms (Chavula et al. 2022b; Mukonka, Mushibwe, and Jacobs 2023), many skip the content which conflicts with their religious and cultural beliefs. The content of what is currently taught in schools remains contested among parents, civic leaders, and religious leaders due to reservations tied to fears that CSE encourages premature sexual activity in young people (Mbizvo et al. 2023). Although the current CSE programme is considered culturally relevant to the Zambian CSE framework (Ministry of Education 2013), it is not clear how culture was conceptualised and integrated into the framework and how a more culturally responsive approach which recognises diversity of values in Zambia, could be developed and implemented. This study aimed to explore the cultural appropriateness of the current CSE programme in Zambia.

Methods

Study design

This was an exploratory qualitative study. It began with a review of the Zambian CSE policy framework followed by the analysis of interview data from pupils, teachers, parents, policymakers and religious leaders. Naturalistic inquiry allowed for inductive theory development informed by participants’ perceptions and experiences (Doyle et al. 2020).

Study setting

The study was conducted in nine purposively selected public secondary schools in the Kitwe district of Zambia. The schools were chosen to include different geographic areas (four urban, four peri-urban and one rural). Kitwe is located in Copperbelt province which had a population of 2,669,635 in 2020 (Ministry of Health 2021), and the third-highest prevalence of sexually transmitted infections (STIs) (Ministry of Health 2021), and an HIV prevalence of about 14.2% reported in 2021 (Mwanza et al. 2022). Importantly, social and structural vulnerabilities act as barriers to adolescents’ access to the much-needed SRH services (Parmley et al. 2023).

Sampling and target population

We utilised purposive sampling to select information-rich participants comprising grade 12 pupils aged between 16–20 years, teachers, parents, policymakers, and religious leaders. Grade 12 teachers who were involved in teaching CSE and pupils learning CSE were selected from the nine secondary schools that had implemented the CSE programme. Teachers were selected from across different subjects, and grade 12 pupils were selected from different classes but who were members of school-based sexual health clubs. Parents and religious leaders selected were members of the parent-teacher associations.

Inclusion and exclusion criteria

We included grade 12 pupils who had received CSE classes CSE from grade 8 to 12. In addition, we included grade 12 teachers, parents and religious leaders who were members of the PTAs in different schools, and policymakers, teachers, and religious leaders who were involved in the implementation of CSE.

Study instruments

The in-depth interviews (IDIs) and focus group discussions (FGDs) were guided by the mesosystem level of Bronfenbrenner’s socio-ecological model. The broad research question was centred on exploring the cultural appropriateness of CSE, and there were five probe questions on cultural adaptation, age appropriateness, and culturally appropriate content and conflict with religious and cultural values. We piloted the interview guides at a school which was not part of the selected schools to identify any flaws and assess the acceptability of the interviews.

Data collection

We further conducted an initial document review of the 2014 Zambia CSE framework to assess the extent to which cultural considerations were taken into account in the development of the CSE framework. Subsequently, qualitative data were collected through 50 IDIs and two FGDs with seven pupils in each group. We conducted FGDs with pupils to enhance the data obtained through individual interviews. One FGD took place with seven girls whilst the other group was mixed sex (three boys and four girls). The 50 IDIs involved parents (4), teachers (17), policymakers (4), pupils (21), and religious leaders (4) (see Table 1). Data collection took place from January to April 2023. IDIs and FGDs were held in quiet places to ensure privacy and confidentiality. Before starting the interviews, permission was obtained from the participants to record what was said. Data collection continued until saturation was achieved. The IDIs lasted between 40 and 50 minutes, and the FGDs lasted 60 minutes. We determined data saturation when no new theoretical insights were observed in the emerged data.

Table 1. Number of IDIs and FGDs with different stakeholders.

Stakeholders	Number of in-depth Interviews	Number of FGDs
Pupils	21	2
Teachers	17	0
Parents	4	0
Religious leaders	4	0
Policymakers	4	0
Total	50	2

Data analysis

The audio recordings were transcribed verbatim and saved in a Word document. The transcripts were reviewed repeatedly by all members of the research team. We used the six step approach to thematic coding recommended by Braun and Clarke (2006) and Bernard and Gery (2010). We re-read the transcripts to familiarise ourselves with the data after which we organised the data in a meaningful and systematic way to generate the initial codes. The generated codes were examined and fitted into themes. We further reviewed and modified the codes and developed them into preliminary themes. Lastly, we refined the themes to identify and name the central content of each theme.

Theoretical framework

Bronfenbrenner’s socio-ecological theory was used throughout the study to explore the influence of socio-ecological factors (microsystem, mesosystem, ecosystems, macrosystem and chronosystem) on health-seeking behaviour (Lee and Park 2021; Khuzwayo and Taylor 2018). Particular attention was given to the macrosystem in which factors such as norms, values, and cultural beliefs might be expected to influence young people’s lives (Kilanowski 2017). Lerner and Steinberg have stressed how ‘sexual development among adolescents is shaped by social, economic, cultural and community contexts’ (Lerner and Steinberg 2009).

Ethical considerations

Ethical approval for the study was granted by the Tropical Diseases Research Centre in Ndola, Zambia (IRB Registration Number: 00002911 & FWA Number: 00003729) and permission to conduct the study was received from the National Health Research Authority, Zambia (Ref No: NHRA000001/01/06/2022). The Biomedical Research Committee of the University of KwaZulu-Natal, South Africa also approved the study (Reference: BRE/00004141/2022).

Written informed consent was obtained from all participants prior to data collection. Participants were assured that data collected would respect confidentiality and anonymity. Before data collection, letters of support were obtained from the district education office and all the participating schools. For adolescents and young people under the age of 18 years, we obtained assent from their parents and guardians to participate in the study. Participants were informed about the purpose, benefits and possible harms of the study.

Trustworthiness and rigour of the study

Guba and Lincoln’s criteria of credibility, dependability, transferability, and confirmability were used to enhance the rigour of the study (Nowell et al. 2017). To strengthen credibility, we spent about eight weeks in the field engaging with participants in their natural settings, and participants were asked to cross-check and validate the transcription scripts. We held regular peer debriefing meetings during which members of the research team were asked to review and assess the transcripts, methodology and research findings. A dependability audit also took place whereby an independent qualitative researcher was engaged to review the data collection process. Transferability was enhanced by providing thick descriptions of the study methods used in detailed drafts of the study protocol (Forero et al. 2018). We ensured that data collection continued until no further theoretical insights were observed.

Results

A total of 64 stakeholders participated in the study; of these, 35 were pupils, 4 were parents, 17 were teachers, 4 were policymakers and 4 were religious leaders. The mean ages for pupils and teachers were 17.5 (SD = 0.95) years, and 38.8 (SD = 7.3) years respectively. Of the 35 pupils, 19 (54.3%) were girls, while 16(45.7%) were boys. Of the 17 teachers, 11 (64.7%) were women, while 6(35.3%) were men (Table 2).

Table 2. Socio-demographic characteristics of participants (n = 64).

Study sample	Characteristic	Number of participants (n(%))
Pupils (n = 35)	Female	19 (54.3)
		16 (45.7)
Mean age (SD)	Male	17.5 (0.95)
Teachers (n = 17)	Female	11 (64.7)
		6 (35.3)
Mean age (SD)	Male	38.8 (7.3)
School (n = 9)	Peri-urban	4 (44.4)
	Urban	4 (44.4)
	Rural	1 (11.1)
Parents (n = 4)	Female	2 (50.0)
	Male	2 (50,0)
Policymakers (n = 4)	Male	2 (50.0)
	Female	2 (50.0)
Religious leaders (n = 4)	Male	2 (50.0)
	Female	2 (50.0)

Themes

Six themes were developed from the interview and focus group data (Table 3).

Table 3. Perspectives on CSE socio-cultural appropriateness.

Main theme	Sub-theme	Codes	Illustrative quotations
Relevance of a culturally appropriate CSE	Need for a culturally sensitive CSE to enhance acceptance among teachers and pupils	Importance of addressing cultural norms	‘The programme has been helpful to our children because they are now taught things about their sexuality which we fail to teach them due to cultural taboos. But there is a need to align it with our cultural values. What we would not want is our children to be exposed to teachings that are not in line with our religious and cultural norms’.
Lack of cultural diversity	Lack of cultural complexity to address diverse cultural views and affiliations among pupils and teachers	Overly simplistic views about culture	‘Zambia has a cultural pluralism and I doubt the programme has a holistic approach to addressing these cultural complexities considering that it’s a Western programme. I feel there is a need for stakeholder engagement to adapt the programme to align it with our cultural viewpoints, though I am not sure how this can be achieved’.
Breakdown of traditional and social fabrics	Encouraging pupils to engage in sexual practices which are contrary to community customs and values	Encourages pupils to have sex	‘I have not been teaching CSE because I feel the programme encourages pupils to engage in sexual activities and corrupts the morals of children. Also, my Biblical beliefs and values do not permit me to share such things’
	Promotes sex out of wedlock, since only people who are married should engage in sex.	Sacredness of sex	‘Teaching young people about sex is just not right, our traditions and religious beliefs only allow sex to be done in marriage, but this programme allows young to have sex and use contraception’.
	Conflicts with traditional/religious values and norms governing sexuality.	Un-Christian values	‘My biblical beliefs and values do not permit me to share such things’.
	Loose application and use of the term sexuality in CSE	Use of the term ‘sex’	‘The problem has been the framing of the term sexuality which is a sensitive topic in most cultures in Zambia. I think the way it is makes people think that the programme is all about teaching pupils how to engage in sexual activities and to support homosexuals’.
	Erodes the sexual morals of pupils.	Violation of sexual ethics	‘In my opinion, this programme erodes the good sexual morals of pupils, the more you teach them the more they indulge in illicit sexual activities’.
Imported CSE Western content	CSE content imported from the West together with values different from local values and norms	Western secularism	‘The CSE programme is an imported programme from the West, and its values do not align with our cultural values. The programme promotes the sexual rights of other sexual identities which is against the laws of the land. We have since urged the government to review the content and make it more culturally appropriate’.
	CSE content not contextualised to address socio-cultural and political factors shaping sexual behaviour locally	Culturally inappropriate	‘I feel the content of the programme is being misapplied in that it’s a clear deviation from our cultural teachings, maybe they need to align it to suit our cultural values’.
Age- inappropriate CSE	Primary and secondary school pupils are too young to be taught about sex.	Premature sexual initiation	‘I feel the content of CSE is not appropriate because you can’t be teaching primary school pupils matters of sex, no. How do you teach young people who have not become of age issues of sex? Our values do not permit this’.
Lack of participatory and learner-centred approaches to CSE	Lack of participatory approaches to teaching CSE to enable pupils to reflect upon their lives as influenced by cultural factors.	Learner-centred approaches to CSE	‘Though I appreciate that we are taught CSE, the whole thing (CSE) lacks delivery methods that allow for pupil participation. In many cases teachers just teach for a few minutes, there is nothing like songs, drama, or role-play. I feel these methods can allow us to address cultural taboos surrounding SRH just like we do in sexual health clubs such as DREAMS’.

Theme 1: Relevance of culturally appropriate CSE

Participants felt the need for a culturally appropriate CSE programme which took into account the influence of families, community norms and cultural beliefs on sexual decision-making. While parents recognised the importance of CSE in addressing the barriers to sexual health communication, they expressed the need for CSE to accommodate diverse viewpoints.

The programme has been helpful to our children because they are now taught things about their sexuality which we fail to teach them due to cultural taboos. But there is a need to align it with our cultural values. What we would not want is our children to be exposed to teachings that are not in line with our religious and cultural norms.

(Parent 1, Female 29 yrs, IDI)

Additionally, some teachers highlighted the need to make the programme culturally relevant and acceptable to stakeholders such as parents, since beliefs and values about sex are often shaped by families and the community norms where adolescents live and play.

Beliefs and values about sex are shaped by families, community norms and cultural beliefs, so CSE must address these otherwise the programme will continue to be rejected by stakeholders such as parents and teachers.

(Teacher, Male, 34 yrs, IDI)

Theme 2: Lack of cultural diversity

Policymakers and teachers felt that the CSE programme adopted an overly simplistic approach and lacked the sophistication to address diverse cultural viewpoints. One teacher expressed concern that it was not clear how culture had been conceptualised in the programme.

This is a good programme, but it does not address various cultural viewpoints. As Africans, we respect our culture a lot and it is something we are attached to, and it is not clear how the concept of culture has been conceptualised and defined in the CSE framework.

(Teacher, Male, 34 years” IDI)

A policymaker expressed concern about the CSE programme’s failure to engage with the cultural pluralism that is characteristic of most Zambian communities. He questioned how the programme would address such cultural complexities.

Zambia has a cultural pluralism and I doubt the programme has a holistic approach to addressing these cultural complexities considering that it’s a Western programme. I feel there is a need for stakeholder engagement to adapt the programme to align it with our cultural viewpoints, although I am not sure how this can be achieved.

(Policymaker, Female, 41 yrs, IDI)

Theme 3: Breakdown of traditional and social fabrics

Participants expressed concern regarding the content of the CSE programme which they perceived as promoting the use of contraception among school-going adolescents. Most participants perceived this as likely to erode the social and moral fabric of the local community.

I have not been teaching CSE because I feel the programme encourages pupils to engage in sexual activities and corrupts the morals of children. Also, my biblical beliefs and values do not permit me to share such things.

(Teacher, Female, 33 yrs, IDI)

Other participants expressed concern that the programme breached the sacredness of sex in that it encouraged pupils to use contraception such as condoms for prevention against STIs, and unwanted pregnancies before marriage.

Teaching young people about sex is just not right. Our traditions and religious beliefs only allow sex to be done in marriage, but this programme allows young people to have sex and use contraception

(Religious leader, Male, 44 yrs, IDI)

Theme 4: Imported Western CSE content

Most participants felt that the CSE programme adopted a Western focus. One participant went so far as to say the programme had been ‘imported from the West’ since the content was not aligned with the cultural values of Zambia. Specifically, concern was expressed about the programme promoting the rights of diverse social groups such as ‘homosexuals’ under the umbrella of promoting the sexual and reproductive health rights of key populations.

The CSE programme is an imported programme from the West, and its values do not align with our cultural values. The programme promotes the sexual rights of other sexual identities which is against the laws of the land. We have since urged the government to review the content and make it more culturally appropriate.

(Parent, Male, 46 yrs, IDI)

Theme 5: Age-inappropriate CSE

Participants expressed concern that the content of CSE was not suitable for primary and secondary school pupils. Specifically, participants felt that teaching CSE in primary and secondary schools was a violation of cultural norms and values and likely to contribute to premature sexual initiation, which posed a risk for HIV.

I feel the content of CSE is not appropriate because you can’t be teaching primary school pupils matters of sex, no. How do you teach young people who have not become of age issues of sex? Our values do not permit this.

(Teacher, Female, 41 yrs, IDI)

Theme 6: Lack of participatory and learner-centred approaches to CSE

In contrast to adults, most pupils were in favour of teaching CSE in schools. Specifically, pupils cited the positive aspects of CSE such as open discussion about sexuality, increase in sexual health knowledge, making the right choices, practising safe sex, and learning about changes in their bodies. However, some pupils expressed concern that CSE teaching lacked effective delivery and approaches that could support pupils to question social and cultural norms relating to sexuality.

CSE offers opportunities for us to discuss openly issues of sexuality. It is very difficult for our parents to discuss issues of sexuality with us due to cultural taboos even though most teachers are shy about teaching CSE, especially male teachers.

(Pupil, Female, 18 yrs. IDI)

Though I appreciate that we are taught CSE, the whole thing (CSE) lacks delivery methods that allow for pupil participation. In many cases teachers just teach for a few minutes, there is nothing like songs, drama, or role-play. I feel these methods can allow us to address cultural taboos surrounding SRH, just like we do in sexual health clubs such as DREAMS.

(Pupil, Male, 18 yrs, IDI)

Policy analysis of the Zambian sexuality framework

Our review of the year 2014 Zambian Comprehensive Sexuality Framework confirmed that although the CSE programme was considered culturally relevant by its authors, it was not clear how or what made the programme so, and how culture was conceptualised within it (Ministry of Education 2013). While multiple studies have identified the need for cultural adaptation to modify the content and presentation of CSE (see for example Falicov 2009; Singh and Deardorff 2016; Kreuter et al. 2003), through an in-depth examination of specific themes within the Zambian CSE framework, we found no evidence of the incorporation of culturally relevant concepts and activities. Additionally, no attempt has been made to engage with local cultural terminology and forms of expression. Moreover, although the CSE framework places an emphasis on increasing sexual health knowledge and skills, it lacks a focus on addressing the structural factors influencing young people’s sexual behaviour (Lee and Park 2021).

Discussion

This paper has explored the cultural appropriateness of CSE implementation in Kitwe district, Zambia. Findings from the study support existing evidence that considering cultural factors during the development and implementation of CSE is critical to enhancing the effectiveness of CSE programmes (Goldfarb and Constantine 2011; Singh and Deardorff 2016). In Zambia, CSE implementation has faced opposition from stakeholders such as teachers, parents and religious leaders. Specifically, some teachers have held back on teaching CSE content which they perceive as conflicting with their cultural and religious beliefs. These findings corroborate findings elsewhere (Browes 2015; Singh and Deardorff 2016; Gunasekara 2017). Although the CSE programme was accepted by pupils in schools, concerns were cited about its lack of engagement with cultural diversity. We note similar findings from a study in Tanzania where young people regarded CSE as ‘not for us’, claiming that the programme was Western-aligned (Coultas et al. 2020).

The need for sexuality education programmes to look beyond the individual to address cultural beliefs and norms, is increasingly recognised (Browes 2015). Adapting CSE to the local context is critical in order to engage with the socio-cultural factors that shape stakeholders’ perceptions of sexuality (Singh and Deardorff 2016; Gunasekara 2017). Cultural adaptation involves making programme modifications that are culturally sensitive and tailored to particular groups and views (Barrera and Castro 2006; Castro, Barrera, and Holleran Steiker 2010). Cultural adaptation is mainly needed when there is an intervention-population mismatch so as to make purposeful changes to the programme content in order to increase its relevance and fit (Castro, Barrera, and Holleran Steiker 2010). Attending to presentation entails modifying content to appeal to specific groups by focusing on the visual aesthetic, colours and images (Falicov 2009). This should be guided by an in-depth examination of the target population and formative qualitative research (Singh and Deardorff 2016). Kreuter et al. (2003) have recommended the use of content, terminologies and forms of expression that appeal to members of the target group.

That said, relatively few frameworks have been developed to inform the design of culturally relevant school-based sexuality interventions. One framework developed by Barrera and Castro (2006) highlights some of the key steps involved: using qualitative and quantitative data to determine the need for, and direction of, cultural adaptation; determining which aspects of the interventions are to be changed and; testing the effects of intervention adaptation. Through their work in Colombia, Morales et al. (2019) also identified a number of steps that need to be followed in culturally adapting a sexual health programme: 1) stakeholder consultation; 2) exploring the lived experiences of diverse groups of adolescents; 3) identifying priorities and areas for improvement; 4) engaging with social cognitive theory, the information-motivation-behavioural skills model, and the ecological framework as relevant in programme design; 5) adapting the intervention content, activities and materials; and 6) quantitative evaluation.

However, the effectiveness of CSE programme adaptation not only depends on modifying content and presentation but also on the quality of development, implementation and delivery methods (Ketting, Friele, and Michielsen 2016). Thus, a large body of evidence has recommended the development of theory-driven CSE using the principles of intervention mapping (IM), which takes an ecological approach to programme design and planning (Mkumbo et al. 2009; Leerlooijer et al. 2014). The application of such a strategy could be key to successful CSE cultural adaptation as it seeks to guide collaboration between programme developers, pupils, teachers and other key stakeholders such as parents and religious leaders (Mkumbo et al. 2009). Critical to CSE adaptation is a needs assessment with pupils in relation to the topics and content to be included (Mkumbo et al. 2009). In making adaptations, programme developers must take into account pupils’ cultural characteristics, including social norms, attitudes and language use (Castro, Barrera, and Holleran Steiker 2010). Al Zaabi et al. (2019) and Kemigisha et al. (2019) have highlighted how the inclusion of parents and teachers is also an important part of CSE programme adaptation. In particular, it can help programme planners understand the teachers’ and parents’ conflicting cultural schemas with respect to sexuality education (de Haas and Hutter 2020).

The education and training of teachers should also be a priority in order to dispel misconceptions about CSE which is critical when adapting the programme to the local context (Chavula et al. 2022a). Without adequate skills in the teaching of CSE, teachers may fail to address pupils’ cultural viewpoints and needs (Chavula et al. 2022b). In this study, pupils expressed concern about the lack of participatory and learner-centred approaches to teaching CSE. Prior research in South Africa has highlighted similar issues (Koch and Beyers 2023). A learner-centred approach to teaching CSE is crucial to creating an environment in which lessons are interactive, skills practised, and pupils are allowed to reflect upon their everyday realities as influenced by cultural factors (Koch and Beyers 2023). A learner-centred approach can also enhance the quality of pupil-teacher interactions (Singh and Deardorff 2016).

Limitations

The findings documented in this paper should be understood in light of several limitations. First, owing to the sensitivity of the subject some stakeholders could have provided inaccurate responses. Second, as with any qualitative research, it is possible that social desirability bias may have affected the results. However, by triangulating data collection from a variety of sources, and pursuing data collection to saturation, we were able to enhance the trustworthiness of the study findings.

Conclusion

In its current form, the Zambian CSE Framework has a number of serious deficiencies with respect to enhancing positive sexual health outcomes among pupils. There is a need to ensure that both it and future CSE programmes are adapted to fit the cultural context(s) in which they are applied. Specifically, engagement with a variety of stakeholders in the local community is recommended, recognising that the world is changing, and the majority of countries are culturally diverse.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data analysed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

The research was made possible through a HEARD doctoral scholarship at the University of KwaZulu-Natal (UKZN) funded by the Swedish International Development Agency (SIDA). The opinions, findings, and conclusions or recommendations expressed here are those of the authors alone and do not necessarily reflect the views of HEARD, UKZN or SIDA.