Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

See all formats and pricing
More options …
Ahead of print


Evaluation of a comprehensive sexuality education program in La Romana, Dominican Republic

Sheyla D. RichardsORCID iD: https://orcid.org/0000-0001-8082-1607 / Eva Mendelson / Gabriella Flynn
  • Columbia University Program for Global and Population Health, Vagelos College of Physicians and Surgeons, New York, NY, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Luz Messina / Diane Bushley / Mina Halpern / Silvia Amesty
  • Columbia University Program for Global and Population Health, Vagelos College of Physicians and Surgeons, New York, NY, USA
  • Columbia University Center for Family and Community Medicine, New York, NY, USA
  • Heilbrunn Department of Population and Family Health, New York, NY, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Samantha Stonbraker
  • Clínica de Familia, La Romana, Dominican Republic
  • Columbia University School of Nursing, New York, NY, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-06-13 | DOI: https://doi.org/10.1515/ijamh-2019-0017



The Dominican Republic (DR) has some of the highest rates of sexually transmitted infections (STI) and adolescent pregnancy in the Caribbean. Well-designed comprehensive sexuality education programs (CSEP) can reduce risky sexual behavior. This study sought to evaluate the Módulo Anexo Materno Infantil (MAMI) adolescent clinic’s CSEP in changing knowledge of STI and pregnancy and attitudes towards risky sexual behavior following implementation.


A mixed methods study was conducted among students aged 11–25 years from three schools between September 2017 and February 2018. Participants in MAMI CSEP completed questionnaires, before, immediately following, and 3 months following the CSEP. Questions assessed knowledge, attitude, and sexual experience, and obtained program feedback. There was one eight-participant focus group discussion (FGD) per school. Descriptive statistics summarized sample demographics and cross-sectional responses. McNemar’s test evaluated differences in the proportions of students selecting correct responses over time. Paired t-tests compared mean test scores across time.


Overall response rate was 98.7% (1414/1432), with 486 pre-tests, 448 initial post-tests, and 480 3-month post-tests. Respondents identified as 53.5% (321/600) female and 46.5% (279/600) male with mean age of 14.2 years. More males (63.4%) reported sexual experience than females (35.8%) (p < 0.001). Increases in mean scores from pre-test to post-test and pre-test to 3-month post-test were statistically significant (p < 0.001). Three themes arose from the FGDs: (1) expanding sexual and reproductive health knowledge, (2) perception of curricular content, structure and delivery, and (3) student-health educator dynamic.


Improvement in test scores supports MAMI CSEP’s efficacy in educating students and reinforcing positive attitudes to reduce risky sexual behavior. Utilizing an interactive health educator model provided students with clear, accurate information in a safe environment with mutual trust. Selecting health educators employed by an adolescent clinic allows them to connect students to preventive and treatment services during the CSEP.

Keywords: adolescent; comprehensive sexuality education; Dominican Republic; program evaluation; sexually transmitted infection


  • [1]

    Glasier A, Gülmezoglu M, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: a matter of life and death. Lancet. 2006;368:1595–607.PubMedCrossrefGoogle Scholar

  • [2]

    Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374(9693):881–92.Web of ScienceCrossrefPubMedGoogle Scholar

  • [3]

    Minnisa AM, Marchi K, Ralph L, Biggs MA, Schwartz S, Arons A, et al. Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations. Immigr Minor Heal [Internet]. 2013;15(2):334–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479330/pdf/nihms386382.pdf.Crossref

  • [4]

    Hindin MJ, Fatusi AO. Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. Int Perspect Sex Reprod Health. 2009;35(2):58–62.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [5]

    Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS Databook. 2017.Google Scholar

  • [6]

    United Nations Childrens Fund. State of the World’s Children. 2016.Google Scholar

  • [7]

    Achécar MM, Ramírez N, Polanco JJ, Quiterio G. Demographic Health Survey 2007. Santo Domingo, Dominican Republic; 2008. https://www.dhsprogram.com/pubs/pdf/FR205/FR205.pdf.

  • [8]

    Rojas P, Malow R, Ruffin B, Rothe EM, Rosenberg R. The HIV/AIDS epidemic in the Dominican Republic: key contributing factors. J Int Assoc Physicians AIDS Care [Internet]. 2011;10(5):306–15. Available from: http://jia.sagepub.com/cgi/doi/10.1177/1545109710397770.Crossref

  • [9]

    Achécaringo MM, Ramirez MN, Polanco JJ, Quiterio G, Guzman JM, Cox A, et al. Encuesta demografíca y de salud 2013. Santo Domingo; 2014.Google Scholar

  • [10]

    UNAIDS. UNAIDS Country factsheets: Dominican Republic. 2017.Google Scholar

  • [11]

    Breuner CC, Mattson G. Sexuality education for children and adolescents. Pediatrics. 2016;138(2):e20161348.Web of ScienceGoogle Scholar

  • [12]

    Chin HB, Sipe TA, Elder R, Mercer SL, Chattopadhyay SK, Jacob V, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the g. Am J Prev Med. 2012;42(3):272–94.Web of ScienceCrossrefGoogle Scholar

  • [13]

    Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Heal. 2008;42(4):344–51.CrossrefGoogle Scholar

  • [14]

    Halpern M. Report Anual 2017. La Romana; 2017.Google Scholar

  • [15]

    Ferrara BJ, Townsley E, MacKay CR, Lin HC, Loh LC. Short-term global health education programs abroad: disease patterns observed in Haitian migrant worker communities around la Romana, Dominican Republic. Am J Trop Med Hyg. 2014;91(5):871–5.Web of ScienceCrossrefPubMedGoogle Scholar

  • [16]

    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossrefPubMedGoogle Scholar

  • [17]

    Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63(04):655–60.CrossrefPubMedGoogle Scholar

  • [18]

    Creswell AJW. Qualitative inquiry and research design: choosing among five approaches. Third. Habib L, editor. Thousand Oaks: Sage Publications, Inc.; 2013. 473 p.Google Scholar

  • [19]

    Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossrefPubMedGoogle Scholar

  • [20]

    Paul-Ebhohimhen VA, Poobalan A, van Teijlingen ER. A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health. 2008;8:4.Web of SciencePubMedCrossrefGoogle Scholar

  • [21]

    Alfred L, Jnr D. The efficacy of HIV and sex education interventions among youths in developing countries: a review. Public Health. 2016;6(1):1–17.Google Scholar

  • [22]

    Michielsen K, Chersich MF, Luchters S, De Koker P, Van Rossem R, Temmerman M. Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials. Aids. 2010;24(8):1193–202.CrossrefPubMedGoogle Scholar

  • [23]

    Amaugo LG, Papadopoulos C, Ochieng BMN, Ali N. The effectiveness of HIV/AIDS school-based sexual health education programmes in Nigeria: a systematic review. Health Educ Res. 2014;29(4):633–48.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [24]

    Ajuwon AJ, Brieger WR. Evaluation of a school-based reproductive health education program in rural south western, Nigeria. Afr J Reprod Health. 2007;11(2):47.CrossrefPubMedGoogle Scholar

  • [25]

    Givaudan M, Leenen I, Van de Vijver FJ, Poortinga YH, Pick S. Longitudinal study of a school based HIV/AIDS early prevention program for Mexican Adolescents. Psychol Health Med. 2008;13(1):98–110.CrossrefPubMedGoogle Scholar

  • [26]

    International Religious Freedom Report Bureau of Democracy, Human Rights, and Labor [Internet]. US Department of State. 2001 [cited 2019 Nov 3]. p. 1. Available from: https://www.state.gov/reports/2016-report-on-international-religious-freedom/dominican-republic/.

  • [27]

    Van Der Maas F, Otte WM. Evaluation of HIV/AIDS secondary school peer education in rural Nigeria. Health Educ Res. 2009;24(4):547–57.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [28]

    Acharya D, Thomas M, Cann R. Evaluating school-based sexual health education programme in Nepal: an outcome from a randomised controlled trial. Int J Educ Res. 2017;82:147–58.CrossrefWeb of ScienceGoogle Scholar

  • [29]

    Kirby DB, Ph D, Laris BA, Rolleri LA. Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. J Adolesc Health. 2007;40:206–17.Web of ScienceCrossrefPubMedGoogle Scholar

  • [30]

    Chandra-Mouli V, Lane C, Wong S, Bankole A, Blum RW, Brady M, et al. What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices. Glob Heal Sci Pract. 2015;3(3):1–2.Google Scholar

  • [31]

    Fonner VA, Armstrong KS, Kennedy CE, O’Reilly KR, Sweat MD. School based sex education and HIV prevention in lowand middle-income countries: a systematic review and meta-analysis. PLoS One. 2014;9(3).Google Scholar

  • [32]

    Napierala Mavedzenge SM, Doyle AM, Ross DA. HIV prevention in young people in sub-Saharan Africa: a systematic review. J Adolesc Heal. 2011;49(6):568–86.CrossrefGoogle Scholar

About the article

Received: 2019-01-16

Accepted: 2019-03-21

Published Online: 2019-06-13

Funding Source: National Institute of Nursing Research

Award identifier / Grant number: RHeaDI T32NR007969

Funding Source: Columbia University

Award identifier / Grant number: Friedman Funding for Scholarly Projects

National Institute of Nursing Research, National Institutes of Health, Grant Number: RHeaDI T32NR007969, Columbia University, Funder Id: http://dx.doi.org/10.13039/100006474, Grant Number: Friedman Funding for Scholarly Projects.

Citation Information: International Journal of Adolescent Medicine and Health, 20190017, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2019-0017.

Export Citation

© 2019 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in