“Effectiveness of Sexual Health Education Interventions Addressing Sexual Violence and Sexual Safety for Adolescents: A Systematic Review Protocol”

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Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search “Effectiveness of Sexual Health Education Interventions Addressing Sexual Violence and Sexual Safety for Adolescents: A Systematic Review Protocol” View ORCID Profile Margaret Noonan , Patrick Cotter , Josephine Hegarty , James O Mahony , Sharon Lambert doi: https://doi.org/10.1101/2025.06.20.25328154 Margaret Noonan 1 School of Nursing and Midwifery, University College Cork , Cork, Ireland Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Margaret Noonan For correspondence: 97990035{at}umail.ucc.ie Patrick Cotter 1 School of Nursing and Midwifery, University College Cork , Cork, Ireland Find this author on Google Scholar Find this author on PubMed Search for this author on this site Josephine Hegarty 1 School of Nursing and Midwifery, University College Cork , Cork, Ireland Find this author on Google Scholar Find this author on PubMed Search for this author on this site James O Mahony 1 School of Nursing and Midwifery, University College Cork , Cork, Ireland Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sharon Lambert 2 School of Applied Psychology, University College Cork , Cork, Ireland Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Sexual health education interventions should provide adolescents with the knowledge and skills to assist them to navigate and develop safe and healthy relationships allowing them to positively transition from adolescence to adulthood. However, many sexual health education interventions omit addressing sexual violence and sexual safety. Of the interventions that do address sexual violence and sexual safety many are poorly or not at all evaluated. This paper details a protocol for a mixed-methods systematic review to critically appraise the evidence on the effectiveness of sexual health interventions that address sexual violence and sexual safety for adolescents. Methods A systematic review of the literature following the Preferred Reporting Guidelines for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines will be undertaken. A search of the following databases will be conducted: CINAHL, PSYCHINFO, ERIC, EMBASE, PubMed, JSTOR, Scopus, PyscArticles, Soc Index with Full Text, Humanities Full Text (H. W. Wilson) and the British Education Index. Citations will be evaluated against predefined eligibility criteria using a two-stage screening process which will be conducted independently in pairs. Data will be extracted from eligible papers using pilot-tested data extraction forms focusing on measurements of effectiveness of the intervention and the impact of the intervention. Quality of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT). The Template for intervention and description (TIDieR) ) framework will be utilised to describe the included interventions. Discussion This study will describe sexual health education interventions that address sexual violence and sexual safety for adolescents and their efficacy. The evidence will help inform future planning for sexual health education interventions which address sexual violence and/or safety. OSF Registration: https://doi.org/10.17605/OSF.IO/YP2XQ Introduction Sexual violence is a worldwide public health problem that affects every gender, sexuality, and society ( 1 ). The World Health Organisation estimates that 1 in 5 (18%) of girls have experienced child sexual abuse and while acknowledging the magnitude of child sexual abuse affecting boys has yet to be uncovered, with estimates that 1 in 7 boys will experience some form of sexual violence ( 2 ). Banvard et al. (2020) ( 3 ) argue that preventing adolescent sexual violence could significantly improve long-term health outcomes for this population, while also having a substantial impact on public health and health economics. Lameiras-Fernández et al (2021) (4 pg2) define sexual health education as “any combination of learning experiences aimed at facilitating voluntary behaviour conducive to sexual health”. Article 19 of the United Nations Convention on the Rights of the Child (UNCRC) (1989) obliges states to take appropriate measures to protect children from all forms of violence, ( 5 ) while the Council of Europe Convention, (Istanbul Convention, 2014), states that primary sexual violence prevention programs should be provided through educational programs, ( 6 ). In 2007, The Lanzarote Convention specified that children need to be taught about the risks of sexual exploitation, sexual abuse and how to stay safe ( 7 ). The United Nations Educational, Scientific, and Cultural Organisation (UNESCO) suggests that, comprehensive sexuality education plays a central role in the preparing young people for a safe productive fulfilling life, ( 8 ). Studies have shown that students who received education about sexual violence before attending college had less rape myth acceptance when in college ( 9 ) and have less chance of being a victim or a perpetrator ( 10 ). In a study by Denning et al (2023) ( 11 ) survivors of sexual violence were more than twice as likely to report never having sexual education or engaging in sex education for an insufficient duration compared to those who had never experienced sexual violence. However, sex education programs have traditionally focused on abstinence or taken a female gender lens, all of which serve to alienate groups of students and fail to address key areas about sexual violence and safety ( 6 , 10 , 12 , 13 ). Excluding sexual violence from sexuality education may render young people vulnerable to victimization and perpetration and may deter them from seeking help if needed( 14 ). UNESCO determine the key concepts of a comprehensive sex education program to include relationships; values; rights; culture and sexuality; understanding gender; violence and staying safe; skills for health and well-being; the human body and development; sexuality and sexual behaviour, and sexual and reproductive health. In one of their systematic reviews of sexual education interventions more than 30% of interventions only briefly cover sexual violence with 10% not covering sexual abuse/violence at all ( 8 , 15 ). The UNESCO Global review of Sexuality Education (2020) ( 15 ) also highlights that many sexuality education interventions do not provide enough coverage for marginalised groups including those living with a disability, LGBTQ+ communities, and male students. Higher Education Institutions have developed policies and programs, but students in third level education believe that this is too late to receive this education and suggest that education should start much earlier in second level education and in schools ideally before student’s first romantic/sexual encounter ( 10 ). Review Aim This systematic review aims to gather, assess, and synthesize evidence on the effectiveness of sexual health education interventions that address sexual violence and sexual safety among adolescents. Review Questions What sexual health educational interventions for adolescents that specifically address sexual violence and sexual safety have been implemented and evaluated? Within the included interventions, what content specifically related to sexual violence and sexual safety? How was effectiveness of the intervention evaluated and what tools were used to measure effectiveness? How effective were the interventions in addressing the primary outcomes of attitudes, beliefs, knowledge, intentions related to sexual violence and sexual safety and the secondary outcomes of behaviours related to sexual violence and sexual safety. Methods Protocol and Registration This protocol is registered at Open Science Framework, under this number of identification: osf.10/854bv. The protocol was prepared and reported according to the “Preferred Reporting Items for Systematic Review and Meta-analysis Protocols” ( 16 ). Eligibility criteria The eligibility criteria are organised according to the Population, Intervention, Comparison, Outcome, (PICO) framework ( 17 ). Types of Populations The population of interest will be adolescents. The World Health Organisation defines adolescence as the period between childhood and adulthood, 10 years to 19 years of age ( 18 ). For this review, studies with participants aged from 10 years to 19 years in any pre-university setting will be considered for inclusion. Any studies aimed at a younger population, an older population, those in third level education or educators will be excluded. Types of Interventions or Exposure The review will examine any sexual health educational interventions that include content specifically addressing sexual violence and/or sexual safety. The WHO defines sexual violence “as any act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed against a person’s sexuality using coercion, by any person, regardless of their relationship to the victim, in any setting, including but not limited to school and work”, ( 19 ). Sexual safety is a broader concept than safe sex which is about protecting one’s health. Sexual safety includes the emotional, psychological and relational safety ensuring that all aspects of the sexual experience are secure and respectful ( 20 ). Sexual health education in the context of this review means education that equips adolescents with the knowledge, skills, attitudes and values that help them to protect their health, develop healthy respectful relationships, make responsible choices and understand their rights and those of others and to protect the rights of others ( 21 ). There will be no restriction on characteristics of the educational intervention such as mode of delivery, participant group size, setting of intervention, duration of intervention, or the developers and facilitators of interventions. Types of Studies Empirical studies of any design provided they have a clear evaluative aim, and were conducted in any setting will be included. Relevant linked process evaluations will also be included. The timing of when measures are applied may also vary between studies with some studies completing pre-and post-test measures and others reporting only post-test measures. Systematic reviews will be tagged for reference list checks. Type of Outcomes The primary outcomes are measures of effectiveness of sexual health education interventions that specifically address sexual violence and sexual safety, relating to the knowledge, attitudes, beliefs, intentions of adolescents towards sexual violence and sexual safety. Due to the nature of the interventions, there may be a variety of outcome measures used e.g. a rape myth acceptance scale to measure changes in attitudes and beliefs. The secondary outcomes will be measures of intentions and behaviours of adolescents linked to sexual violence, sexual safety, and sexual health. As the most recent Global Status review by UNESCO ( 15 ) of the comprehensive sexuality education was in 2020 a time limit of 10 years will apply. This time limit affords 5 years either side of the review therefore progress as per UNSECO recommendations should be visible in the later education programs. Search strategy Potentially relevant citations will be identified by searching electronic databases. A comprehensive search strategy will be developed and implemented across databases to retrieve potentially relevant studies. Databases to be searched will include CINAHL, PSYCHINFO, ERIC, EMBASE, PubMed, JSTOR, Scopus, PyscArticles, Soc Index with Full Text, Humanities Full Text (H. W. Wilson) and Social Sciences Full Text (H. W. Wilson) and the British Education Index. The reference list of included studies will be reviewed for further potentially relevant studies. When indicated, study authors will be contacted to obtain further information to clarify study characteristics. When study protocols are identified without sourcing subsequent publication of results, authors will be contacted to check if results have been published and determine eligibility for inclusion in this review. Study records Search and Screening Process The files from each database will be collected and imported into Covidence. Duplicates will be removed automatically within the software. Selection Process MN will assess the eligibility of all identified studies by reviewing titles and abstracts independently in pairs with PC, JH, JOM and SL. The reviewers will be blinded to each other’s decisions. A third reviewer will resolve conflicts. If titles and abstracts do not provide enough information to determine the eligibility of a particular study, the corresponding paper will be subjected to a full-text examination. Two reviewers will review all the full text papers and be blinded to each other’s decisions. A third reviewer will resolve any conflicts at either title/abstract screening or full text screening. The rationale for excluding studies from the review at the full text screening stage will be recorded and reported in the systematic review. To illustrate the study selection process and reasons for exclusion, a PRISMA( 22 ) flow chart will be used to visually represent the process. Data extraction The process of data extraction will begin with collecting key details including the authors, title, year of publication, language, country of publication, from each included paper. Next, the study characteristics will be outlined, covering aspects such as the study location and design, details of the facilitators who conducted and delivered the intervention, and the number of students involved. Additional demographic information such as the age, race, and gender of the participants will also be recorded. The characteristics of the intervention will be examined using the Template for Intervention Description and Replication Checklist (TIDieR) framework ( 23 ), ensuring a systematic approach to understanding its components and implementation. For the outcome measures, an extraction tool will be piloted on a subset of the studies to confirm that the necessary data to answer the review question is being accurately collected. Depending on the findings from the pilot, the data extraction tool may be refined to capture the most relevant information, facilitating a meaningful synthesis of the results. Quality Assessment All included studies will be subject to quality assessment and a risk of bias assessment. Several intervention types will be used in this systematic review; therefore, quality assessment will be carried out using the Mixed Methods Appraisal Tool (MMAT). This tool was designed to critically appraise quantitative, qualitative and mixed methods studies and provides a set of criteria and screening questions to provide an overall quality score ( 24 ). Risk of Bias Randomized controlled trials will be assessed for risk of bias using the RoB2 ( 25 ). Non-randomized comparative studies and pre/post-test intervention studies will be assessed using the ROBINS-1 tool,( 26 ). Data synthesis and Presentation The data will first be assessed for similarity or variation in outcome measures, measurement scales, and types of interventions before it is determined whether a meta-analysis is appropriate. If sufficient homogeneity exists between the studies, a meta-analysis will be performed, and the findings will be presented graphically in a forest plot to facilitate visual inspection and provide a summary of the data. If a meta-analysis is conducted, heterogeneity will be assessed statistically using the standard χ² and I² tests. Statistical analyses will be performed using a random effects model to facilitate generalization of the findings. To explore potential sources of heterogeneity, subgroup analyses will be performed based on the intervention’s theoretical basis, including the facilitator, delivery mode, and evaluation tool used to measure effectiveness. If there is substantial variation in the data and statistical pooling is not feasible, the findings will be presented in a narrative format, supplemented by tables and figures to aid in the interpretation and visualization of the data. The narrative synthesis will be informed by the guidance of the synthesis without meta-analysis in systematic reviews reporting guidelines (SWiM) ( 27 ) and will include 1) a detailed description of the methods used for data collection and analysis, such as the types of studies included, the criteria for inclusion and exclusion, and the statistical techniques employed and 2) a comprehensive summary of the findings, highlighting key trends, patterns, and outcomes observed in the data, as well as any limitations or biases identified during the synthesis process. We will assess the quality of evidence for key outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. This evaluation will encompass several domains, including risk of bias, consistency, directness, precision, and publication bias. Based on these criteria, the evidence will be classified as high, moderate, or low quality. Discussion Several systematic reviews addressing similar aims have previously been carried out ( Table 2 ) however, none of these reviews focused specifically on sexual violence and sexual safety education for adolescents. This systematic review aims to address this gap in sexual health education. Understanding and implementing effective sexual health interventions that address sexual violence and sexual safety that positively influence adolescents’ behaviour, knowledge and skills is crucial. These interventions not only cater to the needs of the adolescents but will also have a broader impact on their families, communities and society. Moreover, they also play a role in alleviating the burden on the healthcare system by promoting sexual safety and addressing issues related to sexual violence. This systematic review will help to identify which educational intervention methods are the most effective, which will inform the development of programs that equip young people with the emotional, cognitive and relational skills required for development of healthy relationships ( 15 ). View this table: View inline View popup Table 1 Summary of eligibility criteria View this table: View inline View popup Table 2 Summary of systematic reviews addressing similar aim Data Availability No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion. Footnotes ↵ ¶ MN is primary author ↵ & PC, JH, JoM, SL also contributed to this work References 1. ↵ Ozaki R , Brandon A . 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Assessment of Psychosocial Programs to Prevent Sexual Violence During Adolescence: A Systematic Review and Meta-analysis . JAMA Netw Open . 2022 ; 5 ( 11 ): e2240895 . doi: 10.1001/jamanetworkopen.2022.40895 OpenUrl CrossRef View the discussion thread. Back to top Previous Next Posted June 20, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following “Effectiveness of Sexual Health Education Interventions Addressing Sexual Violence and Sexual Safety for Adolescents: A Systematic Review Protocol” Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. 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