How to evaluate a sexual health education intervention: experience from an Italian pilot project

Abstract Introduction Evaluation is an essential dimension of every educational activity, however it is a very crucial and problematic aspect to be considered. It is necessary to focus on some fundamental concepts: the idea of ‘measurement’, the definition of expected goals for the educational activity, whether they are measurable, and if not, how they can be evaluated. Finally, effectiveness may be assessed only after longer periods of time and by adopting coherent instruments. Outcomes of educational activities on sensitive themes such as sexuality education, are challenging to evaluate through causal relationships. So a fundamental question is: what is really possible to evaluate in the field of sexuality education (SE)? Methods A desk review was carried out to collect information about national policies, international literature and guidelines on SE evaluation. A literature review was performed to collect and collate reported field experience and evaluation data. Results and discussion In literature it is possible to find a consistent number of studies aimed at evaluating SE programs (in particular inspired by the models ‘abstinence-only’ and ‘abstinence-plus'), whose goal is to understand their impact on adolescents sexual health. Most of the studies reported limited evidences on SE efficacy on sexual health-related outcomes. This may be attributed to two different causes: methodological - evaluation instruments are epistemologically difficult to develop; and theoretical - the underlying philosophical frameworks they refer to may not fully reflect the complexity of sexuality education for adolescents. Conclusions Based on the findings, evaluation instruments were developed to collect experiences from educators performing school-based sexuality education within the context of EduforIST project funded by the Italian Ministry of Health. Analysis of the collected data were still ongoing at the time of submission.


Introduction:
This study describes the preliminary results of a School-based sexuality education (SBSE) pilot activity developed and implemented within EduForIST project, funded by the Italian Ministry of Health.

Methods:
The pilot activity (5 modules of 2 hours each delivered per classroom) targeted lower secondary schools students. A total of 20 schools located in 4 different Italian regions participated. The educators were staff of several HIV/AIDS civil society organisations operating in Italy. A 2-days intensive workshop for educators was performed. Pre and post tests were conducted.

Results:
At the time of submission, pre-test results were available from 14 classrooms of 5 schools within 2 Italian Regions, for a total of 266 students. Among these, 37,4% were unsure that personal identity is built through social comparison; 21,8% reported that emotions don't get more intense during adolescence, while 18,1% were unsure about the response; 42,1% reported a higher level of uncertainty concerning the definitions of gender identity, sexual orientation and stereotype. The highest level of uncertainty were reported for STIs symptoms (58,7%), impact of treatment on HIV+ people (61,9%) and efficacy of contraceptive pills in preventing STIs (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p < 0.05) for 12 of 15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with preliminary positive results.

Conclusions:
Since activities are ongoing, further data will be soon available for more exhaustive analyses. Early pre/post evaluations suggested that the pilot experience was effective in enhancing knowledge and decreasing uncertainty in the different domains addressed in the pilot. Evidence collected through this study shall raise awareness among decision makers on the urgency of introducing CSE in Italian school curricula and inform future policy options.

Introduction:
Evaluation is an essential dimension of every educational activity, however it is a very crucial and problematic aspect to be considered. It is necessary to focus on some fundamental concepts: the idea of 'measurement', the definition of expected goals for the educational activity, whether they are measurable, and if not, how they can be evaluated. Finally, effectiveness may be assessed only after longer periods of time and by adopting coherent instruments. Outcomes of educational activities on sensitive themes such as sexuality education, are challenging to evaluate through causal relationships. So a fundamental question is: what is really possible to evaluate in the field of sexuality education (SE)?

Methods:
A desk review was carried out to collect information about national policies, international literature and guidelines on SE evaluation. A literature review was performed to collect and collate reported field experience and evaluation data.

Results and discussion:
In literature it is possible to find a consistent number of studies aimed at evaluating SE programs (in particular inspired by the models 'abstinence-only' and 'abstinence-plus'), whose goal is to understand their impact on adolescents sexual health. Most of the studies reported limited evidences on SE efficacy on sexual health-related outcomes. This may be attributed to two different causes: methodological -evaluation instruments are epistemologically difficult to develop; and theoretical -the underlying philosophical frameworks they refer to may not fully reflect the complexity of sexuality education for adolescents.

Conclusions:
Based on the findings, evaluation instruments were developed to collect experiences from educators performing school-based sexuality education within the context of EduforIST project funded by the Italian Ministry of Health. Analysis of the collected data were still ongoing at the time of submission.