A study to assess the knowledge about sexual health among male students of junior colleges of an urban area
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0975-2870.148825
Background: Sexuality is an important part of personality of adolescents. The age of sexual debut is falling globally. The subject of adolescent sexuality is taboo in most societies. Since 2007 sexual health education program has been banned in six states including Maharashtra and Karnataka. This may lead to misconceptions about sexual heath knowledge and practices among young people. Objective: The aim was to assess the knowledge about sexual health among male students of junior colleges of an urban area and to evaluate the change in their knowledge after imparting sexual health education. Settings and Design: Pre-post-intervention study. Materials and Methods: All 245 male students of 11 th standard of all three educational streams of two junior colleges were included in the study. The data analysis was performed using Statistical Package for Social Sciences 18. Results: Science students had "adequate" knowledge about sexual health when compared to arts and commerce students (P = 0.004). Students whose parents were unskilled and semiskilled by occupation had "inadequate" knowledge about sexual health when compared with students whose parents were skilled by occupation (P < 0.05). Education of parents had positive effect on the knowledge about sexual health of students (P = 0.062). In posttest, the knowledge about sexual health of students was found to have increased significantly when compared to pretest. The mean posttest score was 12.61 (standard deviation [SD] 3.12), which was significantly higher than the mean pretest score of 6.34 (SD 3.23) (P < 0.001). Students from nuclear families had "adequate" knowledge about sexual health when compared to students from joint families (P = 0.158) Conclusion: Imparting knowledge about sexual health in adolescent age will be beneficial to the students in avoiding risky sexual behavior. Such educational programs must be given due importance to achieve desirable behavior change among them. Keywords: Adolescent, contraception, masturbation, nocturnal emission, sexual health, sexually transmitted disease
The World Health Organization has stated that sexuality is an integral part of the personality of everyone: Man, woman and child. It is a basic need and aspect of being human that cannot be separated from other aspects of life and it influences thoughts, feelings, actions and interactions and thereby our mental and physical health. [1] "Sexuality is a concept that is doubly difficult because most persons do not want to talk about their own sexuality or they most likely do not know the term… in the Philippine languages there is no term for sexuality." [2] Sexual health is fundamental to the physical and emotional health and to the social and economic development of communities and countries. [3] The need to address sexuality in a frank and direct manner has increased so that youngsters can adopt safer sexual practices which will help to curb the HIV epidemic. [4] Half of all new HIV infections occur in people aged 15-24 years. The age of sexual debut is falling globally. [5] The subject of adolescent sexuality is taboo in most societies. Since 2007 sexual health education program has been banned in six states including Maharashtra and Karnataka. [6] This may lead to misconceptions about sexual heath knowledge and practices among young people. Misconceptions can lead to mental and physical health impact such as anxiety, neurosis, teenage pregnancy and risk of sexually transmitted diseases (STDs) including HIV. Unfortunately, need for sexual health education is not perceived and fulfilled in India. [7] For many years "sexual health education" focused on the human reproductive system and urged sexual abstinence from young people. In recent years, the concepts of sexual health education have started to replace this kind of program and have become holistic education. It teaches an individual self-acceptance, responsible behavior, attitude and skills of interpersonal relationship. In Australia and many other western countries, schools have become the primary site for programs to promote sexual health in young people. [8],[9] This study was carried out to assess the knowledge about sexual health and to study the effects of socioeconomic factors on knowledge about sexual health and to evaluate the change in their knowledge after imparting sexual health education to adolescent male students.
It was a pre-post-intervention study. The study was carried out in the urban field practice area of a medical college in Pune. Students from two colleges in this area were chosen for the study. The study was carried out from November 2012 to May 2013. All 245 male students of 11 th standard of all three educational streams (i.e., arts, commerce and science) of these two colleges were the study subjects. Written informed consent was obtained from each student before administering the questionnaire. Students were given the opportunity to ask questions about the study. In order to encourage honest responses to the questionnaire, which was of a sensitive nature, students were assured anonymity and were free to refuse to participate. Students who did not wish to participate were asked to return the unanswered questionnaire. A pretested and self-administered questionnaire with both closed and open ended questions was used for the assessment of students. The maximum score of the questionnaire was 21 marks. Opportunity to ask any questions or clarify doubts was given to the students. Immediately after pretest, sexual health education session of 60 min was conducted for each batch of 20 students. Sexual health education sessions were conducted by same person. Points discussed in the sexual health education session are given in [Table 1].
In the questionnaire used for the study, each correct option was given equal score. For analytical purposes all above topics were clubbed in to five groups. Theoretical basis of developing above contents of session was that these problems were commonly faced by boys during their early adolescent age. During the session the book "On the horizon of adulthood" [10] was used to explain the above points. Not a single student had refused to participate in the study. In 2005-2006 when sexual health education program was launched, teachers were trained for this program and they had objections regarding few specific words used in sexual health education curriculum. During this study, teachers in both the junior colleges did not have any objection about imparting knowledge about sexual health because they were already trained in sexual health education for 3 days under the National AIDS Control Program by medical officers of the state health services. After a gap of 3 months the same students were reassessed using the same questionnaire. The questionnaire was administered without prior notice. Out of 245 male students, only 215 could be administered the posttest as 30 students were not available. For statistical analysis, the scores of the pre- and post-test were categorized as given in [Table 2].
Wrong answers and un-attempted questions were given "zero" score. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS 18, 233 South Wacker Drive, Chicago, IL). For statistical analysis Chi-square test and paired t-test were applied. P < 0.05 was considered as significant. Ethical considerations The study was reviewed and approved by the Ethical Committee of Padmashree Dr. D Y Patil Medical College, Pimpri, Pune. Permission to carry out the study was obtained from the Principals of the colleges prior to initiation of the study.
The age group and other sociodemographic variables of students who were included in the study are shown in [Table 3]. Using Kuppuswamy's method of socioeconomic scale (updated income ranges for the year 2012), [11] 100 (40.80%) students were from upper middle class 73 (29.80%) were from lower middle class, 59 (24.10%) were from upper lower class, while 13 (5.30%) were from upper class.
Majority of students, that is, 119 (48.60%) had received knowledge from friends, followed by teacher 96 (39.20%). Only 91 (37.10%) had acquired knowledge from the internet, while 101 students acquired knowledge about sexual health from more than one source. During one session, one student had an objection on the topic of discussion. However after elaborating few points like it is the knowledge about human body just like he learns about nature, environment and animals, he agreed to attend the session and gave the written consent voluntarily. It was found that students in joint family had "inadequate" knowledge about sexual health compared with students in nuclear family. However, the difference was not statistically significant. Majority of students were Hindu by religion, while Christian and Muslims were very few in numbers, hence no conclusions were attempted by comparing these groups. Majority of students of science stream had "adequate" knowledge about sexual health as compared with arts and commerce students. As shown in [Table 4] students whose parents had studied up to primary class had "inadequate" knowledge about sexual health when compared with students whose parents had studied up to higher secondary certificate (HSC) and above.
There were 12 students whose father's occupation was not mentioned as their fathers were not alive at the time of study. These students were excluded from the analysis. As shown in [Table 5], it was found that students whose parents were unskilled and semiskilled by occupation had "inadequate" knowledge about sexual health as compared with students whose parents were skilled by occupation. At the time of enrollment into the study, there were three students whose mothers were not alive; hence, they were excluded from the analysis.
[Table 6] summarizes the item-wise [Table 1] pre- and post-test scores. Topic nos. 1 and 2 are related to physiological changes that occur during early adolescent age of boys which they should know, so more importance was given to this topic (score 11). The mean posttest score at 5.58 (standard deviation [SD] 2.08) was significantly higher (P < 0.001) than the mean pretest score, which was 2.43 (SD 2.12).
Topic nos. 3 and 4 are related to sexual difficulties, which were faced by adolescents (score 4). The mean posttest score at 2.90 (SD 1.07) was significantly higher (P < 0.001) than the mean pretest score, which was 0.984 (SD 1.07). Topic no. 5 is related to general knowledge of law, which adolescents must know (score 2). The mean posttest score which was 1.73 (SD 0.57) was significantly higher (P = 0.004) than the mean pretest score, which was 1.43 (SD 0.739). Topic no. 6 is related to identification of STDs and their prevention so that adolescents can protect themselves from acquiring these diseases (score 2). The mean posttest score at 1.36 (SD 0.55) was significantly higher (P = 0.001) than the mean pretest score which was 0.95 (SD 0.338). Similar improvement was noted in score of topic 7 which had questions related to contraceptives. As shown in [Figure 1], at the time of pretest only 7.3% of students were having "adequate" knowledge about sexual health which increased to 63.3% during posttest.
As shown in [Table 6], statistical analysis revealed significant improvement in the knowledge of students after health education session in all the five groups assessed using the questionnaire. Sociodemographic characteristics of the students who were available for follow-up when compared with those who were not available for follow-up did not differ significantly and hence the loss to follow-up has not affected the study findings.
Students participated in the study were between 15 and 20 years age group. The study conducted by Zimet et al. in high school and junior high school students found that knowledge did not increase from 10 th through 12 th grade. [12] In this study, it was found that students from joint family had "inadequate" knowledge about sexual health compared with students from nuclear family. This is likely to be due to the structure of nuclear family, which enables increasing dialogue between parents and their children as compared to joint families in discussing issues like sexual health. This may be hampered in large and impersonal relationships in joint families. In this study, arts and commerce students were found to have "inadequate" knowledge about sexual health compared to science students. This is likely to be due to science students having more information about human anatomy and reproduction as part of their curriculum, which results in "adequate" knowledge about sexual health compared to arts and commerce students. Students whose fathers were illiterate had "inadequate" knowledge about sexual health as compared to students whose fathers had studied up to HSC and above. This may be due to parents with low education not having knowledge and the ability to provide their adolescents with knowledge about sexual health. Students whose mothers studied up to primary class had "inadequate" knowledge about sexual health as compared with students whose mothers had studied up to HSC and above. Kempner in RH Reality Check, stated that Black and Hispanic teens, those from lower-income groups and those whose mothers had fewer years of education were less likely to receive any formal sexual health education. [13] Students whose fathers were unskilled and semiskilled by occupation had "inadequate" knowledge about sexual health as compared with students whose fathers were skilled by occupation. Students whose mothers were unskilled and semiskilled by occupation have "inadequate" knowledge about sexual health as compared with students whose mothers were skilled by occupation. A study conducted by Thornton and Camburn, no discernable effect of mother's employment was found on adolescent's sexual attitudes and behavior. [14] In this study, no significant relation was seen between socioeconomic status and knowledge about sexual health of the adolescents. In a study conducted by Atkins et al. in high schools in the United States that included 11 th graders found that high school students from low socioeconomic communities are less knowledgeable about sexual health than their peers from more affluent communities. [15] In posttest the students whose knowledge about sexual health was "adequate" were significantly increased in number 136 (63.3%) when compared to pretest 18 (7.3%); this is likely to be due to intervention by sexual health knowledge talk for 1 h. It was found to be statistically significant. Study conducted by Rusakaniko et al. among adolescents in Zimbabwe found that the reproductive health education intervention had an impact on aspects of reproductive biology and contraception as measured by the increased scoring at follow-up when comparing intervention and control schools. [16] The study conducted by Thato, et al. revealed in a school-based intervention in Thailand, secondary students who were exposed to a comprehensive sexual education program had greater knowledge than other students, and were more likely to intend to refuse sex and to decrease frequency of sex, but no change was seen in consistent condom use. [17] Thus it can be interpreted that sexual health education sessions have a long term impact on the knowledge of students and it will be more beneficial to them. It is given close to the time when they are about to become sexually active. Adolescence is also an important age group because at their age children are more curious about sexual life and if not given the right information, they may engage in high risk behavior making them vulnerable to STDs and also HIV/AIDS. Giving sexual health education to them at right time will help them to be assertive, and learning to say "no" to risky and harmful behavior like casual sex before marriage. [18] Limitation The study was limited to boys due to the social difficulties in imparting knowledge about sexual health and assessing the girl students. The period of 3 months was considered enough to assess the retention of the subject which is not a part of curriculum. Period of 3 months was given as a wash out period and surprise assessment was done. We cannot predict on the basis of the study for how long this knowledge will be retained and what will be the effect of this improved knowledge on actual practice of safe sexual behavior. Nevertheless, the study established the feasibility and acceptability of sexual health education in the study population.
This one time educational input intervention program, which was conducted for adolescents of the selected colleges has successfully brought significant improvement in the knowledge about sexual health in the adolescents. This study clearly showed that an educational intervention program can bring about a desirable change in knowledge among adolescent males regarding sexual health. The results of this study suggest that health education can improve knowledge about sexual health in adolescent males. Such educational programs must be given due importance not only to improve the knowledge about sexual health among adolescents, but also to achieve desirable behavior change among them.
Authors wish to express their sincere thanks to the Principals of both colleges for permitting this study to be conducted in their colleges.
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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