A comprehensive review of reviews of school-based interventions to improve sexual-health.
OBJECTIVE
To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people.


METHODS
Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis.


RESULTS
Thirty-seven systematic reviews (summarising 224 primary randomised controlled trials) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorised into five types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes.


CONCLUSIONS
School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions.
a Psychology Applied to Health Group, Institute of Health Research , University of Exeter Medical School , Exeter , UK.
Sarah
S
Denford
a Psychology Applied to Health Group, Institute of Health Research , University of Exeter Medical School , Exeter , UK.
Charles
C
Abraham
b School of Social and Community Medicine , University of Bristol , Bristol , UK.
Rona
R
Campbell
b School of Social and Community Medicine , University of Bristol , Bristol , UK.
Heide
H
Busse
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012572:School Health Services; D012736:Sex Education / Q000379:methods*; D047568:Unsafe Sex / Q000517:prevention & control*; D055815:Young Adult
Systematic review; behaviour change; school-based; sexual-health