INTRODUCTION:

Adolescence is tinged with growth, changes, the emergence of a variety of important events and teenagers often face the risk of reproductive health because most have become sexually active.¹ Teenagers don't have adequate life skills, so they are at risk of having unhealthy dating behaviours, and among others; have pre-marital sex.²Twenty-five percent of teens of age 15 years old has experienced sexual intercourse, resulting in Sexually Transmitted Disease (STD) and unwanted pregnancy.³

Based on the report, a school health program can help improve the health status of children and adolescents, including behavioral health, education and social.⁴ One of the teen health programs conducted at the school is the Centre for Information and Counselling (PIK-in Bahasa) for teenagers/students or school-based peer education.⁵ Some of the results of the study showed the majority of teens prefer discussions about reproductive health, sex and relationships with peers, apart from online sources compared to their parents.⁶ In addition, other studies show that teens want and utilize web-based sexual education.⁷ via Centre for Information and Counselling managed by peers, teenagers are expected not to be hesitated and have a place and friends, who have been trained and prepared through training, to discuss.8 Yet many adolescent men as well as women who are not aware of these facilities and haven’t made use of the counselling information service.²

Systematic review is essential because even though the educational programs that focused on teenagers sexual health has been applied, teenagers only know a little thing about it. The findings in many research recommended one of the keys required in improving reproductive health is teenagers empowerment, especially though educational program.⁹

Sex education is defined as a wide program that aims to build a strong foundation for lifelong sexual health by acquiring information and attitudes, beliefs and values about one's identity, relationships and intimacy. Sexual health is considered to be a state of physical, emotional, mental, and social well-being in relation to sexuality and not merely the absence of disease or infirmity as defined by the WHO.¹⁰ Psychological and sociocultural impacts in the delivery of this education can increase the likelihood of effectiveness. Primarily, during adolescence (10–19 years) its provision is a crucial safeguard tool, as it is the opportune time when young people experience developmental changes in their physiology and behaviour as they enter adulthood. The complex emotional state in which youth find themselves in, stigma surrounding matters of a sexual nature in the Indian culture and widespread gender inequality faced makes it increasingly challenging for adolescents to attain the knowledge they need. Through what is named “family life education” (FLE), we can hope to teach the roles and responsibilities of males and females toward each other in all relationships in familial and social settings, thus endowing the knowledge necessary to maintain sexual health as they navigate through the vulnerabilities of life.¹¹ However, the existence of strong stigma and controversy handicaps any existing adolescent health programs, with them being incomprehensive and failing to completely address the main health issues adolescents are vulnerable to. These include several negative sexual and reproductive health outcomes, such as early and closely spaced pregnancy, unsafe abortions, sexually transmitted infection (STI), HIV/AIDS, and sexual violence, the rates of which are now expanding at an upsetting rate.¹²

In India, while talking about sex education, much emphasis is given on teenage pregnancy and HIV/AIDS infection. It has often been observed that there is lack of awareness not only with regard to ‘homosexuality’ but also ‘menstruation’. In spite of having discussions around teenage pregnancy, there is also a lack of awareness around safe sex. Despite the current growing awareness around child sexual abuse, there are still very little attempts taken by schools to incorporate the understanding of difference between the non-sexual and sexual touch.

A study conducted by the Indian Ministry of Women and Children Development and carried out by UNICEF and Prayas, a non-governmental organization provides us insight about these issues. They interviewed 12,247 children and 2324 young adults in 13 Indian states. The study revealed that a shocking 53% of children between the ages of 5 and 12 have been sexually abused. Most often, this abuse was perpetrated by parents, legal guardians or close members of the family. Further, the study disturbingly notes that more than half of all these cases of sexual abuse and rape go unreported.¹³

MATERIALS AND METHODS:

The present study was evaluative approach with using one group pre-test post-test research design as the study aimed at the development of an intervention (An information guide sheet) for assessing the knowledge of 120 adolescents in selected schools at Udaipur.

Sample Size and Sampling:

In the present study sample comprise 120 adolescents (age 10-19 years). The Sample was selected through a purposive sampling technique because of the limited amount of time and availability of subjects according to the sampling criteria.

Assessment Tool:

Includes (a) 9 demographic variables (age in years, gender, education qualification, type of family, monthly income, father or mother educational status and sources of information about sex education or sexual awareness), (b) 36 structured knowledge questionnaires (developed by the researcher with a review of articles and opinion from experts).

Intervention Tool:

An information guide sheet was developed including the topics a) Sex Education: General anatomy and physiology of the human reproductive system, Puberty and changes during adolescent’s age, Safe sex and sexual abstinence (STD’s and Contraception), b) Sexual Awareness: Impact of using porn sites: Physical, Mental, Emotional etc…, Reproductive health and Reproductive rights of the adolescents, Sexual abuse.

Study Procedure:

After obtaining permission from research committee of Venkteshwar College of Nursing, Udaipur prior permission was obtained from principal/headmistress of Govt. Sr. Sec. School, Manvakhera, Udaipur or Govt. Sr. Sec. School, Umarda, Udaipur and consent was taken from each participant who had participated in the study. The purpose of the study was explained to samples prior to the study. The pre-test questionnaire was administered on 12^th to 13^th March, 2020 to assess the knowledge level of the adolescents on awareness regarding sex education. On the same day an information guide sheet was administered. Post-test was done on 19^th March, 2020 with the same questionnaire to assess the knowledge level of the adolescents on awareness regarding sex education.

RESULT:

The collected data was entered in a master sheet for tabulation and statistical processing. The data is analyzed and interpreted using descriptive and inferential statistics based on the objectives and hypothesis formulated for the present study.

The findings organized and presented in 3 sections as shows below:

Section I: Description of demographic variables.

Section II: Findings related to knowledge score of adolescents on awareness regarding sex education

Part- I: Area wise pre-test knowledge score of participants on awareness regarding sex education.

Part- II: Area wise post-test knowledge score of participants on awareness regarding sex education.

Part- III: Evaluation of the effectiveness of an information guide sheet on awareness regarding sex education.

Section III: Finding related to association between pre-test knowledge score with selected demographic variables of adolescents

Table 1: Description of Demographic Variables N = 120

S.No	Demographic Variables	Frequency	(%)
1.	Age in years
	a) 10-13 years	45	37.5
	b) 14-16 years	37	30.83
	c) 17 years and above	38	31.67
2.	Gender
	a) Male	68	56.67
	b) Female	52	43.33
3.	Education qualification
	a) Secondary	55	45.83
	b) Senior Secondary	56	54.17
4.	Family type
	a) Nuclear family	48	40
	b) Joint or extended family	72	60
5.	Monthly family income
	a) ≤ 10,000 Rs.	40	33.33
	b) 10,001-15,000 Rs.	50	41.67
	c) ≥ 15,001 Rs.	30	25
6.	Birth order
	a) First	40	33.33
	b) Second	45	37.5
	c) Third and above	35	29.15
7.	Father educational status
	a) No formal education	26	21.67
	b) Primary education	34	28.33
	c) Secondary or senior secondary education	37	30.83
	d) Graduation and above	23	19.17
8.	Mother educational status
	a) No formal education	37	30.83
	b) Primary education	29	24.17
	c) Secondary or senior secondary education	30	25
	d) Graduation and above	24	20
9.	Any previous sources of knowledge on sex education or sexual awareness
	a) Yes	93	77.5
	b) No	27	22.5
	If yes, specify-
	a) Teachers (In schools)	20	16.67
	b) Peer group or family members	22	18.33
	c) Health professionals	20	16.67
	d) Other sources (Mobile, Internet, Computer, Radio, Newspaper etc…)	31	25.83

Table 2: Area Wise Pre-Test Knowledge Score of Participants on Awareness Regarding Sex Education N = 120

Area	Max score	Mean	Mean Percentage	S.D.
Sex Education	18	5.24	29.12	12.26
Sexual Awareness	18	5.41	30.05	12.20

Table 3: Area Wise Post-Test Knowledge Score of Participants on Awareness Regarding Sex Education N = 120

Area	Max score	Mean	Mean Percentage	S.D.
Sex Education	18	12.63	70.14	27.81
Sexual Awareness	18	12.67	70.37	27.85

Table 4: Effectiveness of an Information Guide Sheet on Awareness Regarding Sex Education in Adolescents N= 120

Test	Mean	Mean %	SD	Enhancement	Enhancement %	df	“t” value	Inference
Pre-test	10.7	29.72	2.24	14.59	40.53	119	45.59	Significant
Post-test	25.29	70.25	2.56	14.59	40.53	119	45.59	Significant

Figure 1: Comparison between Pre - test or Post - test knowledge score of participants on awareness regarding sex education

Table 5: Finding Related To Association between Pre-Test Knowledge Score with Selected Demographic Variables of Adolescents N= 120

S.N.	Demographic Variables		Above Median	Below Median	Total	χ2	df	P Value (0.05)	Interference
1.	Age in years
	a) 10-13 years		26	19	45	2.07	2	5.99	Non Significant
	b) 14-16 years		15	22	37
	c) 17 years and above		21	17	38
	Total		62	58	120
2.	Gender
	a) Male		39	30	69	3.27	1	3.84	Non Significant
	b) Female		24	27	51
	Total		63	57	120
3.	Education qualification
	a) Secondary		31	24	55	3.91	1	3.84	Significant
	b) Senior Secondary		31	34	65
	Total		62	58	120
4.	Family type
	a) Nuclear family		24	24	48	12.91	1	3.84	Significant
	b) Joint or extended family		37	35	72
	Total		62	58	120
5.	Monthly family income
	a) ≤ 10,000 Rs.		21	19	40	10.5	2	5.99	Significant
	b) 10,001-15,000 Rs.		23	27	50
	c) ≥ 15,001 Rs.		18	12	30
	Total		62	58	120
6.	Birth order
	a) First		23	17	40	4.2	2	5.99	Non Significant
	b) Second		20	25	45
	c) Third and above		19	16	35
	Total		62	58	120
7.	Father educational status
	a) No formal education		14	12	26	8.86	3	7.82	Significant
	b) Primary education		18	16	34	8.86	3	7.82	Significant
	c) Secondary or senior secondary education		19	18	37
	d) Graduation and above		12	11	23
	Total		63	57	120
8.	Mother educational status
	a) No formal education		18	19	37	4.61	3	7.82	Non Significant
	b) Primary education		15	14	29
	c) Secondary or senior secondary education		16	14	30
	d) Graduation and above		13	11	24
	Total		62	58	120
9.	Any previous sources of knowledge on sex education or sexual awareness
	Yes	a) Teacher (In school)	10	10	20	13.6	4	9.49	Significant
		b) Pear group or family members	12	10	22
		c) Health professionals	9	11	20
		d) Other sources (Mobile, Computer, Internet, Radio etc...)	19	12	31
	No		14	13	27
	Total		64	56	120

DISCUSSION:

The present study has been undertaken to assess the effectiveness of an information guide sheet on awareness regarding sex education in adolescents of selected secondary or senior secondary schools at Udaipur.

The findings of the study are discussed under the following headings:

Section I: Description of Demographic Variables of Participants

Age in years: The majority of participants 37.5 % belong to the age group of 10-13 years, 30.83 % participants to age group of 14-16 years, and 31.67 % belong to the age group of 17 years and above.

Gender: The majority of the participants 56.67 % were males, 43.33 % participants were females.

Educational Qualification:

The majority of the participants 54.17 % studying in senior secondary and 45.83 % of the participants studying in secondary education

Family Type:

The majority of participants 60 % belongs to the joint / extended family and 40 % belong to the nuclear family.

Monthly family income:

The majority of participants 41.67 % belong to the 10,000 -15,000 Rs. Monthly family income, 33.33 % belongs to ≤ 10,000 Rs.income, and 25 % belongs to > 15,000 Rs. Monthly family income.

Birth Order:

The majority of participants 37.5 % belong to the second child in birth order, 33.33 % belongs to the first child and 29.17 % belongs to the third or above child in birth order.

Father Educational Status:

The majority of participants 30.83 % of the participant’s fathers have secondary or senior secondary education, 28.33 % have primary education, 21.67 % have no formal education, and 19.17 % have graduation and above education.

Mother Educational Status:

The majority of participants 30.83 % of the participant’s mothers have no formal education, 24.17 % have primary education, 25 % have secondary or senior secondary education and 20 % have graduation and above education.

Sources For Getting Knowledge Regarding Sex Education:

The majority of participants 25.83 % have source of knowledge regarding sex education from others (mobile, computer, internet, radio etc…), 18.33 % from peer groups or family members, 16.67 % from Health professionals, 16.67 % participants from teachers and 22.5 % have no source of knowledge regarding sex education.

Section II: Pre-Test Knowledge Score of Adolescents on Awareness Regarding Sex Education in Secondary or Senior Secondary Schools:

The level of knowledge among adolescents on awareness regarding sex education was assessed in pre-test, out of 120 participants 100 percent had inadequate knowledge, and 0 percent adolescents had moderate knowledge and adequate knowledge on awareness regarding sex education in secondary or senior secondary schools. The overall mean of pre-test knowledge among adolescents on awareness regarding sex education was 10.7 with standard deviation of 2.24.

Section III: Post-Test Knowledge Score of Adolescents on Awareness Regarding Sex Education in Secondary or Senior Secondary Schools:

The level of knowledge among adolescents on awareness regarding sex education was assessed in post-test, out of 120 participants 77.5 percent had moderately adequate knowledge, 22.5 percent adolescents had adequate knowledge and no adolescents had inadequate knowledge on awareness regarding sex education in secondary or senior secondary schools. The overall mean of post-test knowledge among adolescents on awareness regarding sex education was 25.29 with standard deviation of 2.56.

Section IV: Comparison Between Pre-Test and Post-Test Knowledge Scores of Adolescents on Awareness Regarding Sex Education in Secondary or Senior Secondary Schools:

The mean score of post-test knowledge 25.29 was apparently higher than the mean score of pre-test knowledge 10.7, suggesting that an information guide sheet was effective in increasing the knowledge of the adolescents on awareness regarding sex education in secondary or senior secondary schools. The mean difference 14.59 between pre-test and post-test knowledge score of the adolescents was found to be significant.

Section V: Association between Pre-Test Knowledge Score with Selected Demographic Variables:

There is a significant association between knowledge of adolescents and selected demographic variablessuch as education qualification (χ 2= 3.97), family type (χ 2= 12.91), monthly family income (χ 2= 10.5), father educational status (χ 2= 8.86) and sources of getting knowledge regarding sex education (χ 2= 13.6), Hence research hypothesis is accepted and null hypothesis is rejected.

This result was consistent with the study conducted by Randhir Kumar, Anmol Goyal, et al A Cross-Sectional Study on Knowledge Attitude and Perception of Sex Education among School Going Adolescents in Ambala District, Haryana, India. The study revealed that there was a significant association between practice and socio-demographic variables such as educational qualification, family type, family income and sources of getting knowledge.¹⁴

There is no significant association between knowledge of adolescents and selected demographic variables such as Age in years (χ2= 2.07), Gender (χ2= 3.27), Birth Order (χ2= 4.2) and Mother educational status (χ2 = 4.61) were not significant at 0.05 level of significance. Hence the research hypothesis is rejected at the 0.05 level of significance.

CONCLUSION:

This study concludes that there is an improvement in the level of knowledge of adolescents which indicates that an information guide sheet is effective. The demographic variables of adolescents significantly associated with the pre-test knowledge score.

ACKNOWLEDGMENTS:

I render my sincere gratitude to lord almighty for the completion of the research project. I owe my profound gratitude to Mr. Jayesh Soni, HOD Child Health Nursing for their support and guidance throughout the study. My sincere Thanks to faculties of Venkteshwar College of Nursing, Udaipur. My immeasurable Thanks to all the Principals of the schools who permitted me to conduct study or participants who participate in the study and everyone who were behind the successful completion of the study.

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Received on 10.10.2021 Modified on 18.12.2021

Asian J. Nursing Education and Research. 2022; 12(2):191-196.

DOI: 10.52711/2349-2996.2022.00038