Sexual health education interventions for young people: a methodological review

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Abstract
Objectives: To locate reports of sexual health education interventions for young people, assess the methodological quality of evaluations, identify the subgroup with a methodologically sound design, and assess the evidence with respect to the effectiveness of different approaches to promoting young people's sexual health. Design: Survey of reports in English by means of electronic databases and hand searches for relevant studies conducted in the developed world since 1982. Papers were reviewed for eight methodological qualities. The evidence on effectiveness generated by studies meeting four core criteria was assessed. Judgments on effectiveness by reviewers and authors were compared. Papers: 270 papers reporting sexual health interventions. Main outcome measure: The methodological quality of evaluations. Results: 73 reports of evaluations of sexual health interventions examining the effectiveness of these interventions in changing knowledge, attitudes, or behavioural outcomes were identified, of which 65 were separate outcome evaluations. Of these studies, 45 (69%) lacked random control groups, 44 (68%) failed to present preintervention and 38 (59%) postintervention data, and 26 (40%) omitted to discuss the relevance of loss of data caused by drop outs. Only 12 (18%) of the 65 outcome evaluations were judged to be methodologically sound. Academic reviewers were more likely than authors to judge studies as unclear because of design faults. Only two of the sound evaluations recorded interventions which were effective in showing an impact on young people's sexual behaviour. Conclusions: The design of evaluations in sexual health intervention needs to be improved so that reliable evidence of the effectiveness of different approaches to promoting young people's sexual health may be generated. Key messages There should be greater awareness among health education researchers, practitioners, and policy makers of the need to base sexual health education strategies for young people on sound evidence of effectiveness Journals should refuse to accept methodo- logically flawed papers Funders should refuse to support studies with methodologically flawed designs By using the best evidence available a randomised controlled trial should be under- taken of a sexual health education intervention for young people with 5–10 years of follow up