Primary care health professionals should integrate sex education into preventive programmes, complementing the information adolescents receive from their families, peer groups and schools [1]. An issue of great relevance and topicality in reference to sex education is the influence of the Internet and social networks on it. It is not in vain that it is the source from which adolescents obtain most of their information [2].
It is advisable to provide clear and coherent messages about contraceptive methods during adolescence. It is important to provide accurate information and to emphasise the need for shared responsibility in sexual relations [3]. It is also essential to know that the theoretical efficacy of a method can be far from the real one if it is not used in a continuous and proper way [4, 5]. 20% of Andalusian adolescents between 11 and 17 years old who have had coital sexual relations did not use condoms, and 5.2% did not use any method. 2.5% of girls had had at least one pregnancy, with the highest risk age being 15–16 years old. Regarding voluntary termination of pregnancy, there is an upward trend in Andalusia [6].
Concerning sexually transmitted infections (STIs), since 2011 there has been an increase in Andalusia due to a lower perception of risk [7], with the consequent lower use of preventive measures such as condoms, as well as the emergence of new sexual behaviour patterns. The age of initiation of sexual relations has advanced in recent years. In Andalusia, the average age for coital sexual debut is 15 years old [8].
A study [9] by the Youth and Social Inclusion Network and the University of the Balearic Islands on pornography consumption among young people has recently been published. This study reveals that one in four boys watch pornography before the age of 13 and the first access to pornography is as early as 8 years old. There has been a progressive increase in pornography consumption among girls over the last 5 years. 33% of the boys who watch pornography report that they do so to learn about sex. The easy access to new technologies through mobile screens makes the contents of the “new pornography” the main source of information on sex education for adolescents.
We cannot ignore the fact that the messages contained in this type of pornography have a strong sexist component and encourage violence and risky practices: repetitive ritual practices, risky behaviour (non-use of barrier methods), violent relationships (it is not uncommon to see videos in which women are subdued against their will). Moreover, the type of interpersonal relationships they engage in are based on sporadic contact with multiple people at the same time and without a previous relationship. It is not so much a question of “banning” the consumption of pornography but rather of critically analysing what is presented on it. The authors conclude that the only possible way to try to counteract the enormous influence of the new pornography on our young people must be based on sex education programmes in schools and aimed at parents, for them to provide adolescents with the tools to make decisions when it comes to living their sexuality.
In this regard, educational programmes in schools and educational institutions have been shown to be effective in providing information to adolescents and parents on STI prevention, HIV, and contraception [10,11,12,13,14,15,16,17,18,19,20,21,22]. There are few studies demonstrating the effectiveness of internet-based educational interventions for this purpose, although it should be an increasingly used resource [23].
All these aspects are addressed in the Forma Joven Programme.
Forma Joven is an inter and multidisciplinary Health Program that has been developed in Andalusia since 2001 and in which professionals from various sectors related to the health and education of the adolescent population participate [24]. The Program was born as a need to respond to the educational and informative aspects that this group systematically raises, and tries to intervene in “risk situations” that derive from certain attitudes and behaviors to try to modify and reduce their negative effects on the health from promotion and prevention (Diezma & De la Cruz, 2002; Hernández Gutiérrez et al., 2000).
It covers five basic areas:
1. Socio-emotional education.
2. Healthy lifestyles.
3. Sexuality and egalitarian relationships.
4. Positive use of Information and Communication Technologies (ICTs).
5. Prevention of consumption of alcohol, cannabis and other drugs.
The activities carried out in the Program to address said contents are:
Informative consultancies, Workshops, Group talks and Training of mediators.
The Forma Joven strategy was born with the aim of approaching those spaces that young people and adolescents frequent: both educational centers and other youth meeting spaces. It is in the educational field where Forma Joven has had a greater evolution and permanence in relation to the affiliation of centers and actions aimed at promoting healthy environments and behaviors among young people.
Informative advice has become a privileged and permanent “observatory” that is essential to meet the real information needs of adolescents and to introduce appropriate modifications both in the type of interventions and in their content. It is a space where students come voluntarily individually or in small groups (2–6) to raise their doubts directly with the professional who attends to them. During the development of the consultancies, an approach is attempted from the philosophy of “meaningful learning” and the gender perspective, where they themselves are actors in the construction of their own knowledge. Although, as mentioned above, the program includes a wide variety of interventions developed by the professionals involved in it (workshops, meetings, group talks, training of health agents), counseling can be considered the “main core” of the program. Since this is where the boys and girls raise their “real” doubts about the issues that concern them. In addition, we consider that the information provided to them during their attendance at them will probably be extended to the rest of the peer group due to the “wave effect” that is generated among them. In this way, a “potentiation” of the effects of our interventions is produced. It can be said that it is a program adapted to the adolescent population of each educational center, and based on their demands and needs for information and training.
Informational advisories are held during school hours, typically 1 hour per week. The students of the center can go to these advisory services on their own initiative and by requesting an appointment with the counselor. They take place in a physical space located in the center (preferably the counselor’s office), specifically adapted to the situation where, in addition to preserving privacy and confidentiality, graphic support material is available for the sessions and internet connection. They will be attended by the counselor and/or a health professional from the health centers who usually come to the educational center at that time. This is the fundamental activity of the program and the basis for guiding the contents to be developed in the rest of the activities. For this reason, it has been decided to select the criterion of “level of exposure to consultancies” to compare the different groups.
The group sessions and workshops are carried out both by collaborators outside the educational center (doctors, nurses and social workers), as well as by the center’s own teachers (teachers and counselor). Their contents must be adapted to each group. The coordination of the activities corresponds to the counselor or person in charge of the program in the educational center.
The mediators are male and female students of the school who, due to their specific characteristics (leadership, learning capacity and knowledge transmission), are selected by the center’s teachers and counselor to interact with their peers and act as educators among their peers.
According to the latest data published by the Forma Joven programme, professionals have covered 821 points located in educational centres in Andalusia. A total of 300.966 adolescents (153.666 boys and 114.7297 girls) have been assisted in counselling sessions [25, 26].
The counselling sessions have become a privileged and permanent “observatory” essential to know the real information needs of adolescents and to introduce modifications in the educational interventions implemented in educational centres. During the counselling sessions, the approach is based on the philosophy of meaningful learning and gender perspective, where adolescents are the main actors of their own knowledge construction.
Counselling can be considered the core of the Programme, since it is in these sessions where the boys and girls raise their real doubts about the issues that concern them. They take place during school hours, generally 1 hour a week. Students can attend individually or in small groups (2–6). They take place in a physical space located in the centre, specifically adapted to the situation, preserving privacy and confidentiality. This is the key activity of the programme and the basis to guide the contents to be developed in the rest of the activities. For this reason, it was decided to select the criterion of “level of exposure to counselling” to compare the different groups.
In terms of the literature on the subject, there are different studies published on sexuality and contraception in adolescence. However, no article has been found on the evaluation of the results of sex education interventions in a collaborative environment between educators and health professionals. We did find a recent publication that evaluates the Forma Joven Programme in three areas: sexuality, consumption of addictive substances and road safety.
This is a quasi-experimental study conducted in 50 secondary schools in the city of Seville that evaluates the impact of the Forma Joven Programme, comparing the participating students with a control group. It concludes that there are no significant differences between the two groups, and that there is a lack of systematisation in the implementation of the programme’s records. In contrast to this study, significant differences were found in some questions related to attitudes towards sexuality in adolescents in an educational intervention conducted in two compulsory secondary schools (intervention group/control group) in Huelva, with a sample of 222 students [27].
In a Cochrane systematic literature review on the effectiveness of school-based adolescent sexuality education programmes in reducing STIs and unintended pregnancy, the authors conclude that there is little evidence that curriculum-based education programmes alone are effective in improving adolescent sexual and reproductive health outcomes.
Incentive-based interventions focused on keeping young people in secondary school may reduce adolescent pregnancy, but we need more trials to confirm this [28].
For this reason, we decided to carry out this project in the adolescent population of the secondary schools in the so-called Huelva-Costa Health District in the province of Huelva, to study whether different “degrees of intervention”, determined by the number of counselling sessions conducted lead to differences in the knowledge and attitudes of the adolescents, as well as to determine whether the number of counselling sessions is related to certain characteristics of the teacher. This is a novel research project, as there are no publications in this area in the province of Huelva. Initial hypothesis: “A greater number of educational interventions on knowledge and attitudes towards sexuality in compulsory secondary school students generate an increase in said knowledge and an improvement in attitudes”.
As reflected in the Madrid consensus document “Science-based sexuality education” [29], an international group of experts on the subject proposes to conduct surveys on the attitudes towards sexuality of children and adolescents, as a strategy to design the educational curricula. The Forma Joven programme meets many of the characteristics suggested in that document as “important” for effective sexuality education programmes.
The main objective of this study is to evaluate whether different levels of educational intervention on sexuality, quantified by the number of informative counselling sessions, lead to differences in the knowledge and attitudes of adolescents participating in the Forma Joven Programme.
Other purposes are to analyse knowledge and attitudes towards sexuality and the use of contraceptive methods in students in Compulsory Secondary Education and Baccalaureate, and determine whether there are differences between groups according to the different levels of educational intervention, based on the activity log of the official platform Forma Joven from the Ministry of Health and Families of the Andalusian Regional Government, specifically on the number of counselling sessions conducted in the centres.
