The Effect of School-Linked Module-Based Friendly-Health Education on Adolescents’ Sexual and Reproductive Health Knowledge, Guji Zone, Ethiopia - Cluster Randomized Controlled Trial

Figures & data

Figure 1 Study areas map of school-linked life skills interventional study in East Guji Zone, Oromia, south Ethiopia November 2020–May 2021.

Figure 2 School-linked sexual and reproductive health interventional study clustering sampling process in the east Guji zone, Ethiopia. November 2020 to May 2021 (n=1532).

Table 1 Descriptions of a School-Linked Module-Based Friendly Health Education Program for Adolescents Among Trial Schools in Gorodola District, Guji Zone, Ethiopia, November 2020 to May 2021

Intervention	Contents	# of Session	Goals	Teaching Methods
Nature of adolescent and their behavior	Early adolescents (10–13) Middle adolescents (14–16) Late adolescents (17–19) Adolescent behavior and life skills	4 4 4 8	Understand biological changes during early adolescence. Understand biological and psychological changes. Understand sexual organs and peer pressure in the relationship learn emerging behaviors and develop essential life skills	Lecture, control over, group learning, focused dialogue Group learning, Lecture, Role play scenarios, and discussion Dialogue on Scenarios, videos, read and discussion group learning Lecture, dialogue, group learning videos, reading and discussion
Sexual education	Reproductive health rights and well-being Healthy sexual behavior and relationship	8 10	Understand reproductive rights and well-being. Learn healthy sexual behavior and develop confidence among peers	Lecture, Role play scenarios, discussion, and group learning Lecturing, worksheets, role play Lecture and discussion,
Understanding gender, Gender equality, and equity	Sex and Gender Gender equality and equity	8 8	Learn the difference between sex and gender Understand and act for gender equality and equity	Lecture, group learning, role play, and discussion, Instruct, question and answer, role play, and interactive discussions.
Adolescent SRH health problems	Early sexual debate and its consequences Early marriage Risk Sexual Behavior Unintended pregnancy and unsafe abortion Sociocultural determinants of RH services	8 8 8 8 10	Learn the drawbacks of early sexual debate Understand the consequences of early marriage Learn risk sexual behavior Prevent unwanted pregnancy and abortion. Learn sociocultural that prohibit SRH Services utilization of adolescents	Tutors, group learning, role-play, focused discussion Tutors, Lecture, scenarios, group discussion, Group learning, dialogue, and worksheet Lectures, group learning, and scenarios Group learning, lectures, worksheets, dialogue, and posters

Figure 3 School-linked module-based friendly health education Social cognitive theory framework adopted from Bandura (2014). High school adolescents of Guji Zone, South Ethiopia, February 2022.

Table 2 Socio-Demographic Characteristics of Research Participants Disaggregated by Baseline and End Line, Trial and Control Clusters, East Guji Zone, Oromia, Ethiopia, November 2020 to May 2021, (n=1532)

Variables	Category	Baseline (N=788, n=773)				End Line (N=788, n=759)
		Trial n=384		Control n=389		Trial n=375		Control n=384
		Freq.	%	Freq.	%	Freq.	%	Freq	%
Residence	Urban	145	37.8%	195	50.1%	162	43.2%	202	52.6%
	Rural	239	62.2%	194	49.9%	213	56.8%	182	47.4%
Age	Middle adolescent	119	30.9%	109	28.1%	129	34.4%	116	30.2%
	Late adolescents	265	68.9%	280	72%	246	65.6%	268	69.8%
Sex	Male	256	66.7%	203	52.2%	231	61.6%	201	52.3%
	Female	128	33.3%	186	47.8%	144	38.4%	183	47.7%
Marital status	Single	347	90.4%	360	92.5%	345	92%	357	93%
	Married	34	8.9%	25	6.4%	30	8%	16	4.2%
Education	Grades 9 and 10	196	51.1%	190	48.9%	204	54.4%	228	59.3%
	Grades 11 and 12	188	49%	199	51.1%	171	45.6%	156	40.6%

Table 3 Mean Scores, Proportion, Standard Deviations, and Comparison of SRH Knowledge Among High School Adolescents, East Guji Zone, Oromia, Ethiopia, February 2022

Variables	Baseline				End Line
	Intervention Clusters (n=384)	Control Clusters (n=389)	P(95% CI)	Mean Diff.	Intervention Clusters (n=375)	Control Clusters (n=384)	P(95% CI)	Mean Diff.
Trial & control Mean scores	44.16% (0.16248)	49.34% (0.15928)	P<0.001, (−0.075 to −0.029)	−0.052	73.3% (0.10635)	66.5% (0.09673)	P<0.001, (0.053 to 0.083)	0.06837
Trial clusters’ pre-post mean scores	44.44%				73.27%		P<0.001, (0.2687–0.3)	0.28827
Control clusters pre-post mean score		49.34%				66.45%	P<0.001, (0.152 to 0.19)	0.17104
The proportion of SRH Knowledge.	168 (44%)	235 (60%)		−16%	244 (65%)	238 (62%)		3%

Figure 4 Line Graph compares mean scores of SRH knowledge at baseline and end line among control and intervention arms in high school adolescents, East Guji Zone, Ethiopia, February 2022.

Table 4 Comparison of Mean Scores of Covariates Predicts Sexual and Reproductive Health Knowledge Among High Schools in Guji Zone, Ethiopia, February 2022 (n =759)

Variables	Control		Intervention		X^2 test	Coefficient of Beta (β)	P-value
	Frequency	%	Frequency	%
They communicated about SRH information.							0.001
Yes	121	31.5%	256	68.3%	58.672	0.038
No	263	65.5%	119	31.7%
Know FHS provided at HFs.							0.001
Yes	281	73.2%	331	88.3%	13.218	0.05
No	103	26.8%	44	11.7%
Compassionate care to right and need base FHS							0.001
Agree	282	73.4%	342	91.2%	112	0.107
Disagree	102	26.6%	33	8.8%
Utilized SRH pocketed PVt HF Services?							0.001
Yes	67	17.4%	107	28.5%	51.756	0.045
No	317	82.6%	268	71.5%
Confident enough to make a safe, informed decision							0.001
Yes	198	51.8%	255	68%	58.4	0.045
No	186	48.4%	120	32%