Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda

Abstract

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for secondary school students in Uganda. The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation. Teachers' confidence in teaching WSWM was negatively associated with dose delivered. Confidence in educating and discussing sexuality issues in class was positively associated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fidelity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial support and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers' beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa.

Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention

“…Several teacher-level factors were found to be significantly related to teachers’ initial implementation of FOYC. Consistent with previous research [ 10 , 12 , 16 ], we found that teachers’ attitudes towards the prevention program, their comfort level with the intervention curriculum, and teachers’ attendance at curriculum training workshop are strong predictors of the teacher’s quality of implementation (defined by high degrees of implementation and fidelity of implementation). Higher levels of comfort among teachers with the curriculum may lead to greater confidence in their ability to conduct the intervention sessions (including sensitive topics such as condom use, teen pregnancy and sexual harassment/abuse) in the classroom.…”

“…At pre- and post-intervention delivery, all grade six participating teachers were asked to complete questionnaires assessing factors described in the prior research as influencing fidelity of intervention implementation. Information was collected on teacher’s level of formal education (associate degree, teaching certificate, bachelor degree, master degree, doctoral degree), years as a teacher/guidance counselor (1–2 years, 3–5 years, 5–10 years, 10–20 years, >20 years), teacher’s attendance at FOYC training workshop (1 = did not attend, 2 = attended part of a training workshop, 3 = fully attended a training workshop), training in interactive methods (1 = none, 2 = a little, 3 = some, 4 = a lot), prior experience of teaching FOYC or other HIV prevention programs (yes/no), teachers’ attitude towards FOYC/HIV prevention intervention measured as their perceptions of the importance of prevention programs, HIV prevention and the FOYC intervention (1 = not important, 2 = somewhat important, 3 = very important), comfort level with the FOYC curriculum (e.g., “how comfortable do you think you will feel in teaching the materials in FOYC?” 1 = not at all, 2 = somewhat comfortable, 3 = very comfortable), and teacher’s sense of “ownership” of the curriculum [e.g., a belief that the intervention addresses a local issue and reflects Bahamian values and input [ 7 , 12 ]. The Cronbach’s alpha for perceptions of program importance (five items) was 0.75.…”

“…Teacher/program provider training is well recognized as an essential component of successful implementation of prevention curricula [ 10 , 11 ]. A number of teacher characteristics have been found to predict the fidelity of implementation including teacher’s favorable attitude towards prevention programs [ 12 ], confidence in their ability to teach prevention program and to affect student performance [ 13 ], perception of community ownership of the program [ 14 ], and shorter duration of time as teacher [ 15 ]. Organizational characteristics including receptivity to the prevention program, support by the principal or other school administrators, and the organization’s readiness to implement new programs have been shown to be related to fidelity of implementation [ 7 , 12 ].…”

Teachers’ conflicting cultural schemas of teaching comprehensive school-based sexuality education in Kampala, Uganda

“…Francis (2013Francis ( , 2016 has found that, generally speaking, teachers only teach those parts of sexuality education with which they feel comfortable and argues that research on sexuality education should 'prioritise teacher comfort' . Other studies have shown that schoolbased sexuality education programmes are more likely to be successfully implemented when teachers feel confident and comfortable teaching them (Ahmed et al 2006;Mathews et al 2006;Rijsdijk et al 2014).…”

How Sexuality Education Programs Have Been Evaluated in Low- and Lower-Middle-Income Countries? A Systematic Review

“…From the 455 identified records, 20 studies met the inclusion criteria [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39].…”