SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Participants and Sampling
2.3. Development of the Intervention: The SESS Model
- School-based networks involving educators, health professionals, and student leaders co-developed sexual health strategies.
- Online support platforms were co-managed to disseminate reliable sexual health content and foster peer learning.
- Stakeholder workshops co-designed a curriculum aligned with adolescent needs.
- Activities involved role-play, skill-building, problem-solving, and reflection, focusing on sexuality education, health promotion, pregnancy prevention, and rights.
2.4. Data Collection and Instruments
2.4.1. Data Collection
2.4.2. Instruments
2.4.3. Outcome Ascertainment for Pregnancies and STIs
2.4.4. Process Evaluation
2.5. Data Analysis
2.6. Ethical Considerations
3. Results
Participant Characteristics
- Exploratory analyses compared pre- and post-intervention scores between the intervention and comparison schools, with baseline adjustment using ANCOVA. Effect sizes and 95% confidence intervals (CIs) are reported, and p-values are presented descriptively given the allocation of one cluster per arm.
- The intervention group’s perception scores increased from 18.33 ± 7.69 at baseline to 32.00 ± 6.19 post-intervention, while the comparison group remained stable (17.80 ± 9.67 to 18.26 ± 9.84). The adjusted mean difference was 13.74 (95% CI: 10.51 to 16.97; descriptive p < 0.001), indicating higher post-intervention perceptions in the intervention group.
- Attitude scores showed only minimal change in the intervention group (111.89 ± 12.32 to 113.53 ± 11.83) compared with the comparison group (94.25 ± 5.52 to 94.58 ± 5.67). The adjusted mean difference was 18.95 (95% CI: 16.85 to 21.05; descriptive p < 0.001). Although statistically notable, the small absolute change may suggest a ceiling effect or response shift bias.
- Inadequate Sexual Knowledge: Existing curricula failed to address practical aspects of reproductive health.
- Limited Communication: Adolescents faced barriers in discussing sexual issues with adults, relying instead on peers and social media.
- Need for Confidential Support: The absence of private counseling areas and trained personnel hindered students from seeking help.
- Positive Peer-led Engagement: Peer learning and experiential activities were perceived as effective in promoting behavior change.
4. Discussion
4.1. Interpretation of Outcomes
4.2. Process Evaluation
4.3. Limitations
4.4. Implications and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Variable | Intervention Group (n = 120) | Comparison Group (n = 120) | p-Value * |
---|---|---|---|
Age (mean ± SD) | 16.9 ± 1.2 | 17.0 ± 1.1 | 0.514 |
Gender: Female | 75 (62.5%) | 74 (61.7%) | 0.873 |
Live with parents | 95 (79.2%) | 93 (77.5%) | 0.692 |
Received sex education | 55 (45.8%) | 53 (44.2%) | 0.843 |
Heard sexual health info from social media | 80 (66.7%) | 78 (65.0%) | 0.729 |
Parental cohabitation | 90 (75.0%) | 88 (73.3%) | 0.815 |
Outcome Domain | Intervention Group | Comparison Group | Adjusted Mean Difference (95% CI) * | Descriptive p-Value | ||
---|---|---|---|---|---|---|
Pre-Test (mean ± SD) | Post-Test (mean ± SD) | Pre-Test (mean ± SD) | Post-Test (mean ± SD) | |||
Perceptions | 18.33 ± 7.69 | 32.00 ± 6.19 | 17.80 ± 9.67 | 18.26 ± 9.84 | +13.74 (10.51 to 16.97) | <0.001 |
Attitudes | 111.89± 12.32 | 113.53 ± 11.83 | 94.25 ± 5.52 | 94.58 ± 5.67 | +18.95 (16.85 to 21.05) | <0.001 |
Preventive practices | 71.03 ± 7.04 | 64.58 ± 7.77 | 63.25 ± 8.23 | 63.01 ± 8.16 | +1.57 (−0.56 to 3.70) | 0.148 |
Level | Objective | Key Outcomes |
---|---|---|
1. Collaboration & System Readiness | Establish a collaborative task force |
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2. Supportive School Environment | Promote safe spaces & access |
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3. Behavioral Impact | Reduce risk behaviors |
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Norkaew, J.; Homchampa, P.; Chanthamath, S.; Wongkongdech, R. SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand. Int. J. Environ. Res. Public Health 2025, 22, 1536. https://doi.org/10.3390/ijerph22101536
Norkaew J, Homchampa P, Chanthamath S, Wongkongdech R. SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand. International Journal of Environmental Research and Public Health. 2025; 22(10):1536. https://doi.org/10.3390/ijerph22101536
Chicago/Turabian StyleNorkaew, Jun, Pissamai Homchampa, Souksathaphone Chanthamath, and Ranee Wongkongdech. 2025. "SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand" International Journal of Environmental Research and Public Health 22, no. 10: 1536. https://doi.org/10.3390/ijerph22101536
APA StyleNorkaew, J., Homchampa, P., Chanthamath, S., & Wongkongdech, R. (2025). SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand. International Journal of Environmental Research and Public Health, 22(10), 1536. https://doi.org/10.3390/ijerph22101536