Search

There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program’s impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.

There is a high prevalence of adolescent girls with ovulatory menstrual (OM) dysfunction, which is associated with school absenteeism and mental health challenges. Low menstrual health literacy among this group has evoked calls to review OM health education. This qualitative study sought to explore gaps in current OM health education and to validate a holistic school-based OM health literacy program named My Vital Cycles®. Findings are based on 19 written reflections, six focus group discussions and three interviews conducted with 28 girls aged 14–18 years from 11 schools, and five mothers. Six themes compared current OM health education with My Vital Cycles®: understating health, comprehensiveness, resources, teaching, parents and cycle tracking. Future refinements to the program comprised: inclusion of the complete reproductive lifespan, use of visual media and developing a mobile application. These findings inform future research in a whole school approach, strengths-based teaching and changes in the health curriculum.

Universities are undergoing rapid and unprecedented changes due to the COVID-19 pandemic, and the needs of learners during this transition are not necessarily well understood or addressed. This study aimed to examine the impact of the “remote internal” unit delivery in a large Western Australian university, as experienced by students and teaching staff within a department of health promotion and sexology (DHPS). In the remote internal mode, previously “internal” (face-to-face) students received prerecorded lectures and attended workshops and seminars in real time through use of the learning platforms. The mixed methods study was conducted across three phases in 2020. A quantitative online student survey was followed by student and teaching staff focus groups and document analysis. Six themes were uncovered regarding the student experience of the remote internal mode: (1) face-to-face contact provides a sense of community, (2) online learning is better when it is interactive, (3) online learning is convenient, (4) delivery mode affects student willingness to contribute to discussions, (5) students enjoy a mixture of teaching patterns, and (6) technological issues create barriers to effective learning. Five themes were revealed regarding teaching staff experience of the remote internal mode: (1) connections matter, (2) face-to-face delivery enhances engagement, (3) learning outcomes are a priority for teaching staff, (4) online delivery needs effective supports, and (5) students have online privacy concerns. Considerations for course modalities, methods to enhance interactivity, and supportive technology and infrastructure are recommended to ensure that the technological, demographic, and socio-environmental needs of students are adequately met.

Internationally, school-based sexuality education programmes have shown to improve sexual practices and health outcomes for young people. However, perceived parental discord is commonly cited as a barrier to implementation. Within Indonesia, there is limited empirical evidence regarding parents’ attitudes towards school-based sexuality education. A sample of 768 Indonesian parents and caregivers completed an online Qualtrics survey to determine their level of support or disapproval towards the provision of sexuality education within primary and secondary schools. The majority of parents supported school-based sexuality education (n = 756, 98.4%) and suggested certain topics should commence as early as kindergarten and elementary school (n = 615, 80.0%). Religious affiliation was not associated with permissiveness. When presented with a range of sexuality topics, most parents agreed their inclusion was important. However, for some topics, there was significant variability in opinion based upon the age, gender, or educational background of the parent; thereby providing opportunity for further work. This preliminary study challenges notions that parents, particularly those with religious affiliations, are barriers to the delivery of sexuality education within Indonesia schools. Further research and advocacy will hopefully encourage educators to expand their current levels of provision, to align with international and evidence-based guidelines.

This study explored the extent to which organisations responsible for initial teacher training, prepare pre-service teachers to deliver comprehensive sexuality education in schools. Five electronic...

IntroductionThere are a high prevalence of ovulatory-menstrual (OM) dysfunction and low levels of menstrual health literacy in adolescents, yet few evidence-based OM health education resources for schools.MethodThis two-phase study used an online Delphi methodology to build consensus across thirty-five purposively selected professionals from the diverse professions of health and education. The panellists were tasked to inform the development of a school-based OM health literacy resources.ResultsIn Round One, 86% of panellists determined the scope of these resources using guided and open-ended questions. The study then split into two phases which ran concurrently. In the first phase informing the intervention's development, 57% of panellists participated in Round Two, and 29% reviewed selected lessons. In the second phase informing the questionnaire's development, 51% of panellists participated in Round Two, and 69% in Round Three. The overall consensus reached for the intervention phase and questionnaire phase were 82% and 84%, respectively. The Panel's recommendations included a strengths-based position to counter menstrual stigma, teaching accurate self-report of cycle biomarkers, addressing multiple menstrual dysfunctions and adopting a whole-school approach.ConclusionAlthough time-consuming and requiring a sustained interest, this two-phase Delphi methodology offered anonymity to panellists from distinct professions which facilitated their independent contribution to developing OM health literacy school resources.

Background To better understand sexual and reproductive health (SRH) during the initial COVID-19 wave, we organized a multi-country cross-sectional survey. Methods Consortium research teams conducted online surveys in 30 countries. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Findings Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes Interpretation The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings. Funding United States National Institutes of Health, Latvia National Research Programme to Lessen the Effects of COVID-19 Research in context Evidence before this study In 2020, the COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 undercut already precarious health infrastructure and health service provision. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of SARS-CoV-2 infections (COVID-19 disease). Most studies have focused on high-income countries, rather than examining broader regional and global trends. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium. Consortium research teams in 30 low, middle, and high-income countries collaboratively developed the survey instrument using existing measures and items adapted for COVID-19. Topics included sociodemographic characteristics; compliance with COVID-19 mitigation measures; couple and family relationships; sexual behavior; contraceptive use and barriers to access; access to reproductive healthcare; abortion; sexual violence and intimate partner violence (IPV); HIV/STI testing and treatment; and optional sections including female genital cutting and early marriage; mental health; and food insecurity. This multi-country, cross-sectional study aimed to better understand SRH prior to and during the first wave of the COVID-19 pandemic in participating countries. Added value of this study This study was conducted in thirty diverse settings during a pandemic. In addition to providing needed evidence about SRH during COVID-19 across low-, middle-, and high-income countries, the study demonstrates the feasibility and utility of a new framework for global health collaboration. Using an inclusive open science approach, we were able to harmonize key sexual health variables across countries. Our use of online data collection and large reliance on convenience sampling provides both challenges and opportunities. Implications of all the available evidence This multi-country study provides detailed sexual and behavioral data across diverse global settings. Our findings suggest that COVID-19 measures during the initial wave of the COVID-19 pandemic impacted sexual and reproductive health behaviors and access to services worldwide. In particular, our findings show a sizable proportion of people needing SRH services including HIV/STI testing and abortion reported that their access to these services was limited due to COVID-19 measures. These results suggest the need for expanded use of decentralized SRH interventions that can be implemented in emergency settings, such as self-testing, self-collection, and telemedicine.

Background There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. Results Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%–42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%–5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%–8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Conclusions Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

This paper describes the formative, process and short term impact evaluation of sexuality and relationships education (SRE) training for teachers in Western Australia (WA) over a three year period....

Your inbox probably has more invitations to join online health research surveys than before the COVID-19 pandemic. Online surveys have become an important tool for COVID-19 research when conventional survey methods are not feasible. Yet the response to COVID-19 has also underlined the urgent need for high-quality behavioural data. Is the trend towards online health survey research an indication of practices to come or a stark reminder of the perils of convenient sampling methods? This Comment examines unique opportunities associated with online health research surveys, challenges in implementing and interpreting data from online surveys, and considerations for getting the most out of online health research.

Background Research focused on adolescents’ attitudes towards abortion is limited, and validated scales are not routinely used. A greater understanding of adolescents’ attitudes towards abortion could better inform the sexuality education strategies targeted at this age group. Methods: A cross-sectional survey was completed by 1470 adolescents (437 males, 1033 females) aged 12–19 years and living in Perth, Australia. Participants were recruited from secondary schools, antenatal clinics and termination clinics to capture varying experiences of sexual activity and pregnancy. Survey items investigated abortion attitudes, sexual behaviour and pregnancy history alongside other demographic and psychosocial factors. Analyses included comparative means and adjusted linear regressions. Results: Sexually active participants (n = 554) and females reporting a previous abortion (n = 196) held more supportive attitudes towards abortion (P < 0.001 for both). Among sexually active females, more supportive attitudes were held by those reporting a previous abortion (β = 2.60, 95% confidence interval 0.93–4.27, P = 0.002), later age (≥16 years) at first vaginal intercourse (P < 0.001), use of oral contraception at last sex (P = 0.029), previous condom use (P < 0.001) and/or three or more oral sex partners in the previous 12 months (P = 0.005). For sexually active males, more supportive attitudes were reported by those whose female partners had used oral contraception at last sex (P = 0.013) or ever (P = 0.017). Multivariable analyses indicated that other correlates, including risky sexual behaviour, had minimal or no effect on attitudes. Conclusions: Adolescents’ attitudes towards abortion appear to be influenced by their ability to personalise and contextualise the effect of a pregnancy. Associations between less-effective contraceptive use and reduced support for abortion may be explained by a diminished perceived risk of parenthood. Educational strategies should acknowledge and respond to differences in abortion attitudes as adolescents commence and navigate sexual relationships.

IntroductionA review of international and Australian school-based resources suggests that teaching of the ovulatory-menstrual (OM) cycle is predominantly couched in biology. A whole-person framework that integrates spiritual, intellectual, social and emotional dimensions with the physical changes of the OM cycle is needed to facilitate adolescent OM health literacy. This paper describes the protocol for a study that aims to develop and trial an intervention for adolescent girls aged 13–16 years that enhances positive attitudes towards OM health coupled with developing skills to monitor and self-report OM health. These skills aim to foster acceptance of the OM cycle as a ‘vital sign’ and facilitate confident communication of common OM disturbances (namely, dysmenorrhoea, abnormal uterine bleeding and premenstrual syndrome), which are known to impact school and social activities.Methods and analysisPhase I will comprise a Delphi panel of women’s health specialists, public health professionals and curriculum consultants and focus groups with adolescent girls, teachers and school healthcare professionals. This will inform the development of an intervention to facilitate OM health literacy. The Delphi panel will also inform the development of a valid and reliable questionnaire to evaluate OM health literacy. Phase II will trial the intervention with a convenience sample of at least 175 adolescent girls from one single-sex school. The mixed-method evaluation of the intervention will include a pre-intervention and post-intervention questionnaire. One-on-one interviews with teachers and school healthcare professionals will expand the understanding of the barriers, enablers and suitability of implementation of the intervention in a school-based setting. Finally, focus groups with purposively selected trial participants will further refine the intervention.Ethics and disseminationThe study findings will be disseminated through local community seminars, conferences, peer-review articles and media channels where appropriate. The Curtin University of Human Research Ethics Committee has approved this study (approval HRE2018-0101). This project is registered with the ‘Australian and New Zealand Clinical Trials Registry’.Trial registration numberACTRN12619000031167; Pre-results.

IntroductionThere is recognition of the importance of comprehensive relationships and sexuality education (RSE) throughout the school years worldwide. Interventions have found some positive outcomes; however, the need for a greater focus on positive sexuality and relevant contemporary issues has been identified by teachers and students. The Curtin RSE Project provides training for teachers and preservice teachers and supports schools through training and advice to implement comprehensive school health promotion (CSHP) focusing on RSE allowing schools to develop programmes relevant to their school community. To examine contemporary phenomenon within a real word context, a case study design will be used to measure implementation. This paper will describe the protocol for a multiple, embedded case study to measure the implementation of CSHP focusing on RSE in a purposive sample of Western Australian schools.Methods and analysisThis mixed methods study will include a multiple, embedded case study. Schools (n=3–4) will be purposively selected from within Western Australia based on their capacity to commit to implementing RSE as a case study school. Data will be collected from students (Grade 6 for primary school; Grades 7–12 for secondary school); teachers and other key staff and parents. Methods include school climate and school curriculum audits, documentation (collected with key staff at baseline and annually), interviews (parents and teachers at Year 2), focus groups (students at Year 2) and an online student survey (collected with students baseline and annually).Ethics and disseminationSchool principals will provide consent for school participation and staff and parents will provide individual consent. Student assent and parental consent will be obtained for student participants. Results will be disseminated through open-access reports, peer-reviewed journals and conference presentations.

Summary Background and purpose Despite decades of research, development and evaluation of educational and promotional strategies to prevent teenage pregnancy, we have only a limited understanding of the strategies that are effective and why. This study sought to explore female teenagers' attitudes, perceptions and experiences of contraceptive use, and describe the influence of this on pregnancy risk. Methods A qualitative approach was used to explore the contraceptive behaviour in a purposive sample of sexually active Australian females aged 14–19 years. Teenagers were drawn from three sub-groups: antenatal and postnatal services (pregnant-continuing); termination services (pregnant-terminating); and sexual health clinics (never-pregnant). Sixty-eight individual, semi-structured interviews were conducted. Thematic analysis was employed to analyse the data and generate a rich, description of contraceptive behaviour. Results Whilst participants were familiar with contraception, many used it inconsistently. Commitment to pregnancy prevention was firmly located within participants' attitudes toward teenage pregnancy and parenthood, perceptions of pregnancy risk and perceptions of the costs and benefits of using contraception. Further, motivation to use contraception fluctuated in different contexts, such as romantic relationships. Conclusions Our research highlights the importance of attitudes toward contraception, pregnancy and parenthood in shaping teenagers' motivation to use contraception. Educational and prevention programs must address the spectrum of attitudes underlying teenagers' contraceptive and reproductive decisions in order to alter pathways to teenage pregnancy and early parenting.

The aim of this study is to assess in older adults with memory complaints, the effects of a 6-month home-based physical activity (PA) intervention on short-term adherence, short and long-term self-efficacy and the predictors of adherence.Participants with memory complaints with or without mild cognitive impairment (MCI) were recruited from Perth, Western Australia between May 2004 and July 2006 and randomly assigned to a control or an intervention group. The intervention group received a 6-month PA programme and recorded sessions on a diary. Pedometer readings, questionnaires, and physical and cognitive measures were completed at 0, 6, 12 and 18 months.One hundred and seventy participants started the study. Retention rates were similar for both groups at all time-points however retention was higher for men than women (P0.01). Adherence to the prescribed PA was 72.8% (95% CI, 70.8 74.9%). Men had higher adherence rate than women (P0.001). Those with and without MCI had similar adherence. Compared to controls self-efficacy was higher in the intervention group after 6 months only (P0.01).Older adults with memory complaints, with or without MCI, can successfully participate in and enjoy home-based PA programmes. Long-term adherence to such interventions may require continued support and increased self-efficacy. (ACTRN012605000136606.).

Background Measurement scales seeking to quantify latent traits like attitudes, are often developed using traditional psychometric approaches. Application of the Rasch unidimensional measurement model may complement or replace these techniques, as the model can be used to construct scales and check their psychometric properties. If data fit the model, then a scale with invariant measurement properties, including interval-level scores, will have been developed. Aims This paper highlights the unique properties of the Rasch model. Items developed to measure adolescent attitudes towards abortion are used to exemplify the process. Method Ten attitude and intention items relating to abortion were answered by 406 adolescents aged 12 to 19 years, as part of the “Teen Relationships Study”. The sampling framework captured a range of sexual and pregnancy experiences. Items were assessed for fit to the Rasch model including checks for Differential Item Functioning (DIF) by gender, sexual experience or pregnancy experience. Results Rasch analysis of the original dataset initially demonstrated that some items did not fit the model. Rescoring of one item (B5) and removal of another (L31) resulted in fit, as shown by a non-significant item-trait interaction total chi-square and a mean log residual fit statistic for items of -0.05 (SD=1.43). No DIF existed for the revised scale. However, items did not distinguish as well amongst persons with the most intense attitudes as they did for other persons. A person separation index of 0.82 indicated good reliability. Conclusion Application of the Rasch model produced a valid and reliable scale measuring adolescent attitudes towards abortion, with stable measurement properties. The Rasch process provided an extensive range of diagnostic information concerning item and person fit, enabling changes to be made to scale items. This example shows the value of the Rasch model in developing scales for both social science and health disciplines. Key Words Rasch unidimensional measurement model, adolescent, abortion, attitudes, attitude scale

Purpose To better understand the factors that influence the initiation of first intercourse among adolescent females and to explore the context in which this occurs. Methods A purposive sample of sexually active female teenagers aged between 14 and 19 years were recruited from sexual and reproductive health clinics across the Perth metropolitan area. Sixty-eight in-depth, semistructured interviews were conducted. Thematic analysis was employed to analyze the narrative data. Meanings and interpretations that emerged were constantly verified through subsequent inquiry. Results The degree of personal control over the factors that led to their first experience of intercourse determined how teenagers reflected upon the experience. Those who were "ready" were more likely to have delayed intercourse until they were comfortable with both when and with whom this occurred. In contrast, conforming to peer norms, coercion from sexual partners and being intoxicated were common reasons for premature and unwanted first experience of sexual intercourse. Conclusions The explorative approach used in this study deepens current understanding of the factors influencing and associated with intercourse initiation, and how these reflect different aspects of adolescent development. In particular, the role of young peoples' sociocultural environment, including peer interaction and alcohol intoxication, alongside pressure from sexual partners in premature and unwanted sexual activity may assist in informing educational interventions of greater personal relevance and impact.