Sexual Health Support Interventions for Prepubescents and Young Adolescents (7–14 Years) in the United States and Sub-Saharan Africa: A Scoping Review Protocol

Abstract

Prepubescent children and young adolescents (ages 7–14) are in a critical developmental stage for establishing the foundations of healthy sexual behavior. Increasing rates of precocious puberty, combined with limited access to accurate and age-appropriate sexual health education, heighten the vulnerability of this age group to sexual health risks. These risks include early and often coerced sexual initiation, exposure to sexual abuse, and consequent outcomes such as sexually transmitted infections and early pregnancies. However, comprehensive cross-regional analyses and evidence-based interventions addressing the sexual health needs of this age group remain limited. Addressing this gap promotes mutual learning, context-specific adaptation, and global alignment of sexual health support efforts, crucial for achieving the Sustainable Development Goal target of universal access to sexual and reproductive health care. This scoping review aims to map the available evidence on the scope and characteristics of sexual health interventions for prepubescents and young adolescents in the United States and Sub-Saharan Africa. The proposed scoping review will be conducted in accordance with the Arksey and O’Malley framework and Joanna Briggs Institute (JBI) methodology for scoping review. A systematic search of English-language articles published from 2010–2025 will be conducted across PubMed, CINAHL, PsycINFO, Scopus, Web of Science, ERIC, and African Index Medicus. Five reviewers will screen the articles in Covidence and independently assess full-text articles using a standardized data extraction form. Discrepancies will be resolved through discussion and with a sixth reviewer. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data will be summarized and synthesized to identify patterns in interventions, delivery methods, outcomes, and implications for practice, research, and policy. Comparative and gap analyses will highlight similarities, differences, and priorities for future research and interventions. An adolescent sexual health expert will help validate and contextualize findings. Results can guide strategies to address shared challenges and advance universal access to sexual health support for prepubescents and young adolescents.

1. Introduction

Prepubescents and young adolescents (ages 7–14) are in a crucial stage for establishing the foundations for healthy sexual development. Prepubescence, the stage preceding the visible onset of puberty, which can begin as early as age 7 with the current increase in precocious puberty [1,2], is marked by subtle physical, cognitive, and emotional changes that are fundamental for developing healthy attitudes toward the body, relationships, and personal boundaries [3]. With the rising number of reported cases involving sexual interest in prepubescent children [4], the need for early, age-appropriate sexual health interventions that promote body awareness, respect, and personal safety has become increasingly critical [3,5]. Globally, in 2024, an estimated 50 million girls and 40 million boys were victims of sexual assault during childhood [6]. In the United States (US), 34% of the 3.7 million reported cases of sexual abuse among individuals under 18 [7] involved children below 12 years old [8].

Young adolescents (ages 10–14), on the other hand, are characterized by significant physical, emotional, and social changes, and are in a period when foundational attitudes toward sexuality begin to shape [9]. In both high- and low-resource settings, including the United States (US) and Sub-Saharan Africa (SSA), this age group is characterized by early sexual debut (frequently involving coercion), and lack of access to accurate age-appropriate sexual and reproductive health (SRH) information. Additionally, young adolescents often have limited autonomy in making informed decisions about their own sexual health [10], leading to physical and psychological trauma, early pregnancies and sexually transmitted infections (STIs) including HIV and human papillomavirus (HPV). Currently, over 500,000 pregnancies occur among girls aged 10–14 in low- and middle-income countries, and SSA has twice the average of early pregnancies [11,12]. In 2023, the global birth rate for girls 10–14 years old was estimated at 1.5 per 1000 girls in this age group, with higher rates in SSA (4.4), Latin America and the Caribbean (2.3) [12]. In the US, each year, nearly 5000 pregnancies and 1763 births occur among girls ages 10–14, representing a birth rate of 0.2 births per 1000 girls aged 10–14 [13], and accounting for 1.3% of U.S. teen births. Also, nearly 3% of all abortions among adolescents occur among young adolescents below 15 years old [14,15]. While specific data for the prevalence of STIs among the 10–14 age range is limited in most parts of the world particularly in SSA, research indicates that STIs are increasingly common even at younger ages [16]. In 2024, there were 120,000 new HIV infections among children and young adolescents aged 0–14, and 86% were from SSA [17], and in Malawi 18.4% of the 11,575 new HIV infections occurred among children aged 0–14 [18]. In the US, in 2023, there were 11,561 (55.5/100,000) cases of chlamydia [19], 3171 (15.2/100,000) cases of gonorrhea [20], and 49 (0.2/100,000) cases of syphilis among 10–14-year-olds [21]. Additionally, 18% of new HIV infections occurred among those aged 13–24 [22].

The poor sexual health outcomes among prepubescents and young adolescents are often compounded by inadequate sexual health information and school-based education, policy gaps, limited access to HIV prevention, care and treatment services, sociocultural taboos, and lack of youth-friendly health services tailored for this age group [12,17,23]. Stigma, fear of provider bias and medical mistrust also play a critical role in the high STI rates among adolescents [24]. In addition, the onset of puberty often precedes access to formal sexual health education or support, leaving many prepubescents and young adolescents unprepared to make informed decisions about their bodies, relationships, and sexual health rights [3,25].

Despite these vulnerabilities, there is a significant gap in comprehensive reviews that explicitly describe and compare the nature, content, and impact of sexual health development support interventions tailored to this younger age group in the US and SSA. While prior reviews have examined sexual health interventions for adolescents [26,27,28,29,30,31], the reviews have been specific in scope, including focusing on SRH role modelling strategies [30], marketing approach [26], SRH interventions for youth in juvenile facilities [28] and the availability, acceptability, and uptake of SRH service delivery interventions for youth with disabilities [31]. Most existing reviews also group young adolescents with older adolescents and young adults (typically ages 11–25), obscuring the developmental differences and context-specific needs of 7–14-year-olds. Scoping reviews targeting sexual health support interventions for prepubescents and young adolescents are scarce. Furthermore, there is a notable lack of reviews that explicitly compare or describe the nature of sexual health development support interventions targeting the 7–14-year-olds in both the US and SSA. Consequently, little is known about which intervention strategies are most effective for this population across these differing contexts. This knowledge is urgently needed to inform the development, adaptation, and implementation of sexual health development programs that are age-appropriate, culturally responsive, context-specific, and transferrable. Without a clear understanding of what interventions have been tried, how they function, and their outcomes, efforts to support sexual health development of prepubescents and young adolescents risk being fragmented, duplicative, or ineffective. Moreover, investing in this knowledge can help close a critical evidence gap, allowing researchers, educators, and policymakers to align interventions with the unique developmental needs of this age group [27,32]. By identifying best practices and transferable insights across settings, stakeholders can better allocate resources, strengthen existing programs, and ensure that prepubescents and young adolescents everywhere are equipped with the knowledge and skills to recognize risky behaviors and make informed and healthy choices about their health and relationships, and confidently identify and report warning signs.

Given the urgent need for age-appropriate, culturally relevant, context-specific, and transferrable sexual health interventions for prepubescents and young adolescents, a comprehensive review of existing sexual health support strategies and interventions for this age group is both timely and essential. Scoping reviews are a valuable method for synthesizing broad bodies of literature, particularly in areas where research is nascent, scattered, or underdeveloped [33]. This scoping review aims to map, examine, describe, and synthesize the extent, range and nature of sexual health development support interventions targeting prepubescents and young adolescents in the US and SSA. In this review, sexual health development support refers to all human-centered, environmental, and system-level strategies, policies, and actions that help prepubescents and young adolescents develop the skills and capacities necessary to navigate key developmental tasks related to sexuality [34,35]. These developmental tasks include communicating sexual health related issues effectively with family, friends, and trusted people in their lives, knowing and being comfortable with their bodies and how they function, forming and maintaining healthy relationships, knowing how to access and use healthcare and information, recognizing risks and how to reduce them, setting appropriate boundaries, understanding their responsibilities & the impact of sexual choices, and acting responsibly according to their personal values, including making informed decisions about engaging in sexual activities [35]. A broader definition of sexual health development support is essential for this scoping review which is focused on prepubescents and young adolescents aged 7–14 because sexual health during this stage extends beyond the prevention of negative outcomes such as early sexual initiation, unintended pregnancy, or STIs. It encompasses the foundational skills, attitudes, and capacities that enable young people to understand, value, and manage their emerging sexuality in safe, informed, and developmentally appropriate ways. Children in this age group experience rapid physical, cognitive, emotional, and social changes that shape their understanding of identity, relationships, and bodily autonomy [3]. Therefore, sexual health development support must be conceptualized holistically to include not only individual-level education but also the broader environmental and systemic factors that influence healthy development, including family communication, peer and community norms, access to accurate information, supportive school environments, and policies that promote safety and inclusion. A comprehensive definition allows for the inclusion of diverse interventions and support ranging from social–emotional learning and body literacy programs to community-based initiatives and policy frameworks, that collectively contribute to healthy sexual development. Such an approach aligns with global frameworks, including the World Health Organization’s and UNESCO’s definitions of sexual health and sexuality education, which emphasize well-being, respect, and informed decision-making rather than solely risk avoidance [3,36,37]. By adopting a broader conceptualization, the review can more accurately capture the full spectrum of strategies that promote the skills and capacities of prepubescents and young adolescents need to navigate developmental tasks related to sexuality within their unique cultural and developmental contexts. This inclusive framing ensures that the review reflects the complexity of sexual health development support and identifies opportunities for integrated, age-appropriate, and context-sensitive support.

2. Materials and Methods

This proposed scoping review will follow the methodological framework first proposed by Arksey and O’Malley [38], and further elaborated in the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis [39]. This methodological framework will follow six stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarizing, and reporting the results, and (6) consultation. This combined approach ensures methodological rigor and alignment with current best practices in conducting scoping reviews [33,39]. The review will also adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [40]. A PRISMA-ScR checklist (

Table A1. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

SECTION	ITEM	PRISMA-ScR CHECKLIST ITEM	REPORTED ON PAGE #
TITLE
Title	1	Identify the report as a scoping review.	Click here to enter text.
ABSTRACT
Structured summary	2	Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.	Click here to enter text.
INTRODUCTION
Rationale	3	Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.	Click here to enter text.
Objectives	4	Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.	Click here to enter text.
METHODS
Protocol and registration	5	Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.	Click here to enter text.
Eligibility criteria	6	Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.	Click here to enter text.
Information sources *	7	Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.	Click here to enter text.
Search	8	Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated.	Click here to enter text.
Selection of sources of evidence †	9	State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.	Click here to enter text.
Data charting process ‡	10	Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.	Click here to enter text.
Data items	11	List and define all variables for which data were sought and any assumptions and simplifications made.	Click here to enter text.
Critical appraisal of individual sources of evidence §	12	If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).	Click here to enter text.
Synthesis of results	13	Describe the methods of handling and summarizing the data that were charted.	Click here to enter text.
RESULTS
Selection of sources of evidence	14	Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.	Click here to enter text.
Characteristics of sources of evidence	15	For each source of evidence, present characteristics for which data were charted and provide the citations.	Click here to enter text.
Critical appraisal within sources of evidence	16	If done, present data on critical appraisal of included sources of evidence (see item 12).	Click here to enter text.
Results of individual sources of evidence	17	For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.	Click here to enter text.
Synthesis of results	18	Summarize and/or present the charting results as they relate to the review questions and objectives.	Click here to enter text.
DISCUSSION
Summary of evidence	19	Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.	Click here to enter text.
Limitations	20	Discuss the limitations of the scoping review process.	Click here to enter text.
Conclusions	21	Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.	Click here to enter text.
FUNDING
Funding	22	Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.	Click here to enter text.

Note: JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O’Malley [6] and Levac and colleagues [7] and the JBI guidance [4,5] refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of ‼risk of bias‽ (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document). The symbol # stands for word number. This check list is adopted from Tricco et al. [40].

) will also be used to ensure a systematic and rigorous process of the review.

2.1. Stage 1: Identifying the Scoping Review Question

The primary research question guiding this review is as follows: What sexual health development support interventions exist for prepubescents and young adolescents (ages 7–14 years) in the US and SSA? Secondary questions include the following:

• What are the core principles guiding sexual health development support interventions for prepubescents and young adolescents in the US and SSA?
• What types and characteristics of sexual health development support interventions for prepubescents and young adolescents are implemented in the US and SSA, including working definitions, the implementation settings, target populations, measured outcomes, and underlying theoretical frameworks?
• What are the primary facilitators and barriers influencing the implementation of sexual health development support interventions for prepubescents and young adolescents in the US and SSA?

2.1.1. Keywords

To ensure a comprehensive and systematic search, a combination of keywords and controlled vocabulary terms was developed in consultation with a librarian and based on preliminary literature screening. The primary keywords include development, interventions, prepubescents, sexual health support, young adolescents, the United States, and Sub-Saharan Africa. These keywords were selected to reflect the core elements of the scoping review: the types of sexual health interventions, the target population, and the geographical focus. Synonyms and variations of these terms were also used to maximize search sensitivity and were adapted to the indexing systems of each database searched (e.g., MeSH in PubMed), and were used to develop the search strategy (Appendix B).

2.1.2. Eligibility Criteria

The search will be limited to English-language sources published from 2010 to 2025 focusing on sexual health development support interventions for prepubescents and young adolescents in the US and SSA. This eligibility criteria was identified in alignment with contemporary sexual health education and development support initiatives for prepubescents and young adolescents [3,36]. The period 2010–2025 aligns with growing global efforts on strengthening sexual and reproductive health education for adolescents, in response to United Nations-led initiatives to ending early childbearing and promoting comprehensive sexuality education (CSE). These include the United Nations’ commitment to the International Conference on Population and Development (ICPD) [41] UNESCO’s International Technical Guidance on Sexuality Education report published in 2009 and revised in 2018 [3,42] and commitment to improve access to SRH information and education under the Millennium Development Goals (MDGs) aimed to be achieved by 2015 [43] and later the Sustainable Development Goals (SDGs) to be achieved by the year 2030 [44], which have influenced national sexual health education and strategies to supporting prepubescents and young adolescents’ healthy sexual development in both the US and SSA. The selected timeframe allows the review to capture interventions developed and implemented in response to these global and regional policy shifts, ensuring relevance to current practices in adolescent sexual health development support.

Participants

Studies will be included if they describe or evaluate sexual health development support interventions targeting prepubescents and young adolescents aged 7–14 in the US and SSA. The decision to include ages 7–14 is informed by our previous research which showed that parents, older adolescents aged 15–19, and community stakeholders recommended initiating sexual health conversations early as 7 years old, with others suggesting starting during toddlerhood [45]. The inclusion of prepubescents and young adolescents aged 7–14 is also grounded in developmental, social, and public health considerations that make this period critical for sexual health support. This age range captures prepubescence and the transition from middle childhood to early adolescence, a formative stage when individuals begin to experience physical, emotional, and cognitive changes associated with puberty and identity formation [9]. Between ages 7 and 14, children develop increasing awareness of their bodies, gender roles, relationships, and social expectations. They also begin to form attitudes and values related to sexuality, health, and interpersonal behavior that influence future decision-making [9]. Studies have also demonstrated capacity for children from age 7 to engage and benefit from sexual health intervention [5]. Early interventions during this stage can therefore lay the foundation for healthy sexual development, promote body confidence, and strengthen communication and boundary-setting skills before sexual behaviors typically begin [46]. In both the US and SSA, evidence indicates that many young people encounter puberty-related changes, peer pressure, and exposure to sexual content before age 15. Targeting the 7–14 age group allows for the identification and evaluation of interventions that address early developmental sexual health needs, reduce misinformation, and build resilience before risky behaviors emerge. This age range also aligns with global frameworks such as UNESCO’s International Technical Guidance on Sexuality Education [3] and the WHO’s recommendations [47], which emphasize the importance of initiating comprehensive, developmentally appropriate sexual health education and support during childhood and early adolescence. Including interventions for this age group will help to capture programs that target children and focus on addressing challenges of the increased precocious puberty among preadolescents and young adolescents, particularly girls, with some showing signs of puberty as early as age 8 [48,49]. By capturing programs that begin in middle childhood, the review aims to reflect the evolving developmental needs of prepubescents and young adolescents and the early timing of puberty in diverse settings. Studies will be excluded if they focus exclusively on older adolescents (age 15 and 19) and adults.

Concept

Eligible studies will include peer-reviewed articles, program evaluations, and relevant grey literature that describe or evaluate sexual health support interventions, including their content, implementation, and outcomes. To be included, studies must feature an intervention component specifically targeting the sexual health development support of young adolescents. Interventions may encompass a wide range of approaches such as educational programs, peer support groups, community-based initiatives, or school-based curricula aimed at promoting SRH. For the purposes of this review, sexual health support interventions are defined broadly to include efforts that prevent STIs, including HIV and HPV; promote condom or contraceptive use; empower prepubescents and young adolescents to identify and report warning signs and make informed decisions about sexual behavior; promote the development of healthy relationships; and support the delay or safe initiation of sexual activity. Studies that do not focus on sexual health development support or lack an identifiable intervention component will be excluded.

Context

This scoping review focuses specifically on the US and SSA to explore sexual health support interventions for prepubescents and young adolescents in two geographically and socio-politically distinct regions. These settings were selected due to their contrasting yet globally interconnected approaches to adolescent sexual health. In the US, sexual health interventions are shaped by diverse educational policies, public health infrastructure, and ongoing debates between abstinence-only and comprehensive sexuality education approaches. In contrast, SSA continues to face a disproportionately high burden of adolescent sexual and reproductive health challenges, including high rates of HIV, early pregnancy, and limited access to youth-friendly services. Over the past decade, both regions have responded to global calls such as those outlined in the United Nations’ MDGs and SDGs [43,44], the 1994 ICPD [41], and the UNESCO’s International Technical Guidance on Sexuality Education [3,42] to strengthen the delivery of age-appropriate, rights-based sexual health education and support. Including both regions in this review enables a comparative analysis of how international frameworks are adapted across diverse cultural and institutional contexts. Importantly, the innovative interventions with proven effectiveness in SSA among vulnerable prepubescents and young adolescents in shifting social norms and resource-limited settings may offer valuable lessons for the US, particularly in improving access and engagement among marginalized populations such as rural youth, racial and ethnic minorities, and those with limited access to school-based health education. In addition, the US and SSA share certain structural and governance similarities that make their comparison meaningful. The US comprises 50 states operating under a federal system, while SSA consists of multiple sovereign nations with diverse but interlinked political and health governance structures. Both contexts involve multi-level systems of policy implementation, where national or federal directives are adapted and executed at state or local levels. This structural parallel provides a useful basis for examining how sexual health interventions are developed, adapted, and delivered across different administrative and cultural settings. By examining interventions from both contexts, the review seeks to highlight scalable practices, regional adaptations, and opportunities for cross-context learning in the advancement of adolescent sexual health.

Nevertheless, the cultural, social, and structural and systemic differences may influence how sexual health development support is conceptualized, implemented, and evaluated, and this element will be put into consideration when interpreting and discussing the findings. In addition, data will be analyzed within each context, taking into account cultural norms, policy environments, and health system structures. The intention is also not to equate the two settings but to identify both context-specific and cross-cutting themes that can inform a broader understanding of sexual health development support for prepubescents and young adolescents.

2.1.3. Types of Sources

This scoping review will consider experimental, non-experimental, and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, and pre and postintervention studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case–control studies and cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion. Qualitative studies will also be considered that focus on interventions for sexual health development support for prepubescents and young adolescents including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. In addition, systematic reviews that meet the inclusion criteria will also be considered, depending on the research question. Text and opinion papers will also be considered for inclusion in this scoping review.

2.2. Stage 2: Identifying Relevant Studies

Search Strategy

An initial limited search of PubMed and CINAHL was undertaken to determine the availability of articles on the topic of sexual health development support interventions for prepubescents and young adolescents in the US and SSA. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE (via PubMed), CINAHL, PsycINFO, Scopus, Web of Science, ERIC, and African Index Medicus (see Appendix B). The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source. The search strategy includes a combination of controlled vocabulary (e.g., MeSH terms) and free-text terms related to sexual health, adolescence, interventions, support services, and geographical filters for the US and SSA. The reference lists of all included sources of evidence will be screened for additional studies. A comprehensive search strategy was developed in collaboration with the University of Illinois Chicago Health Sciences Librarian, an expert in scoping reviews and systematic reviews. The search strategy will aim to locate both published and unpublished studies conducted from the year 2010–2025. Grey literature will also be sought from international organizations such as the WHO, UNICEF, and UNFPA, as well as relevant government and non-governmental organization reports. No scoping review or systematic review related to this topic was identified or is currently underway.

2.3. Stage 3: Study/Source of Evidence Selection

Following the search, all identified articles will be imported into Covidence [50], a web-based platform designed to streamline the process of conducting systematic reviews and other types of evidence synthesis. It helps researchers manage various stages of the review process, including screening, removing duplicates, data extraction, quality assessment, and collaboration [50]. Title and abstract screening will follow the pre-established inclusion and exclusion criteria. The screening will be conducted independently by five reviewers, but each article or citation will be screened by two reviewers as already set by Covidence. Conflicts from the screening will be resolved through discussion during the reviewers’ meeting. The full text of records that remain after title and abstract screening will be assessed in detail against the inclusion criteria by the five reviewers, with each article reviewed independently by two reviewers. Reasons for exclusion of sources of evidence at full text that do not meet the inclusion criteria will be recorded and reported. Any disagreements that arise between the reviewers at each stage of review of full text records will be resolved through discussion, or with an additional reviewer. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a PRISMA-ScR flow diagram [40].

2.4. Stage 4: Data Extraction (Charting the Data)

Data will be extracted from papers included in the scoping review by five independent reviewers using a data extraction tool developed by the reviewers. The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review questions. A draft standardized extraction form is provided (

Table A2. Data Extraction Instrument.

Title	Sexual Health Support Interventions for Young Adolescents in the US and SSA
Objective	To examine and map the extent, range, and characteristics of sexual health support interventions for prepubescents and young adolescents in the US and SSA.
Questions	Primary question: What sexual health support interventions exist for prepubescents and young adolescents in the US and SSA? Secondary questions What key concepts underpin the sexual health interventions for prepubescents and young adolescents in the US and SSA? What are the types and characteristics of sexual health interventions for prepubescents and young adolescents in the US and SSA, including working definitions, the implementation settings, target populations, measured outcomes, and any theoretical frameworks that inform their design and delivery? What are the facilitators and barriers to implementation of sexual health interventions for prepubescents and young adolescents in the US and SSA?
Eligibility Criteria	English articles that focus on sexual health support interventions for prepubescents and young adolescents published between 2010-2025 in the United States and sub-Saharan Africa Types of evidence Experimental, quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, and pre and post intervention studies. Analytical observational studies including prospective and retrospective cohort studies, case–control studies and analytical cross-sectional studies will be considered for inclusion. Descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies.
Citation Author/date	Study purpose	Design	Setting /Country	Target Population/Sample (Participants’ age/Race/ SES/Education	Type of intervention (Family-based/ School-based/Psychosocial/ Sibling based/Peer-based, etc.)	Details of the intervention Theoretical underpinning, what was involved	Outcomes	Remarks eg., recommendations

). A standardized data extraction form will be piloted by the review team to ensure consistency [33]. The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included evidence source. The form will capture relevant information including author(s), year of publication, country and setting, study design, characteristics of the target population, description of the intervention (e.g., content, delivery mode, frequency), theoretical or conceptual framework, implementers, and key outcomes. Additionally, data on implementation processes, facilitators, barriers, and context-specific insights will be extracted where available. Results will be presented according to the categories embedded within the definition of sexual health development support for this review, supported by illustrative examples where appropriate. This clarification will enhance consistency during data extraction and charting, and help readers better understand the nuances and scope of the interventions included in the review. Any modifications will be detailed in the scoping review paper. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer (NC), an expert in adolescent sexual health promotion. If appropriate, authors of the papers selected for full text review will be contacted to request missing, additional data or seek clarification where necessary.

2.5. Stage 5: Collating, Summarizing, and Reporting the Results: Data Analysis and Presentation

Extracted data will be summarized using both descriptive statistics (e.g., frequency tables, charts) and qualitative narrative synthesis [33,39]. A narrative synthesis will be conducted to identify patterns and themes across studies, such as types of interventions, delivery mechanisms, outcome measures and implications for practice, research and policy [51]. Comparative analysis will be used to highlight similarities and differences between interventions implemented in the US and those in SSA. The review will also include a gap analysis to identify areas where evidence is sparse or missing, with particular attention to age-specific and region-specific disparities. As this is a scoping review, the primary aim is to map the existing evidence rather than to assess the quality or risk of bias of individual studies. Data from text and opinion papers, as well as from trials and observational studies, will be managed using the same data charting framework to ensure consistency in data extraction and synthesis. Information from text and opinion papers will be used to provide contextual insights, identify conceptual frameworks, and highlight gaps or emerging themes that complement empirical findings. While formal critical appraisal is not required for scoping reviews, we will note the type and source of each evidence category to ensure transparency and allow readers to interpret findings in light of the evidence strength. Where applicable, we will use descriptive indicators (e.g., study design, evidence type, publication source) to distinguish between empirical and non-empirical contributions in the synthesis.

2.6. Stage 6: Consultation with Stakeholders

In alignment with the recommendations of Levac, Colquhoun and O′Brien [51], we will consult with a senior researcher and an adolescent sexual health promotion expert to validate themes to ensure socio-cultural and geographical relevance, check missing grey literature and suggest additional sources that may be missing from the review, and offer insights into real-world application and relevance. Feedback from these consultations will be integrated into the final analysis and interpretation of the results.

3. Limitation

This review is limited to studies conducted in the US and SSA and published in English. As a result, relevant studies from other regions or those published in other languages may be excluded. Additionally, by restricting the inclusion criteria to studies published from 2010 onward, earlier research that could provide valuable historical or contextual insights may not be captured. These limitations may affect the comprehensiveness of the findings and should be considered when interpreting the results. Also, the geographical location of the study presents a limitation. The cultural, social, and systemic differences between US and SSA contexts may limit direct comparability. Consequently, the findings will have to be interpreted with sensitivity to contextual variation, recognizing that strategies effective in one setting may require adaptation before being applied in another.

4. Conclusions

This protocol outlines a proposed scoping review that aims to map existing sexual health support interventions targeting prepubescents and young adolescents in the US and SSA. This protocol has outlined the purpose, rationale, and methodological approach of the review, including eligibility criteria, search strategy, and key concepts. By systematically identifying and synthesizing relevant literature, this review will provide a comprehensive overview of current interventions and highlight gaps in research targeting prepubescents and young adolescents’ sexual health development support and inform future research, policy, and program development to better support the sexual health needs of prepubescents and young adolescents.