Educación sexual en la adolescenciarevisión sistemática de programas y meta-análisis

Resum

Despite various factors that indicate the need to provide sexual education during schooling, it is currently not implemented in many educational centers. On the other hand, there are various approaches on how to carry out interventions and offer sexual education from a holistic and comprehensive perspective that addresses all aspects of sexuality. In addition, previous studies have shown that sexual education programs do not advance the age of onset of sexual relations, reduce the rate of unwanted pregnancies and encourage the use of preventive methods against Sexually Transmitted Infections (STIs). The objective of this research is to quantitatively evaluate the effectiveness of sexual education programs in educational centers aimed at adolescents at an international level and to qualitatively analyze the elements of the curriculum of the selected programs. A systematic review and meta-analysis was carried out on the scientific evidence of the effectiveness of sexual education programs aimed at adolescents developed exclusively in schools in different countries. The guidelines of the PRISMA 2020 Declaration (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) and the PICOS strategy (population, intervention, comparator, outcome, study characteristics) were used. The bibliographic search was carried out through six electronic databases Web of Science, Scopus and ScienceDirect, Dialnet, InDICE CSIC and ERIC from 2000 to 2020. The review included 47 studies. The quantitative analysis was performed with the statistical programs SPSS and Comprehensive MetaAnalysis. Effect size was calculated using Hedges' g for attitudes, knowledge, selfefficacy, intention to use condoms, and abstinence in each study. The random effects model was applied to calculate the mean effect size. Heterogeneity was analyzed with Cochran's Q test and the I 2 statistic. The influence of moderating variables on effect size was analyzed by subgroup analysis on qualitative variables and meta-regression calculations on continuous variables. Finally, the objectives, contents, methodology and theories of each program were qualitatively analyzed. Only results related to risk behaviors could be analyzed since the selected programs did not evaluate other variables. The programs increased attitudes towards sexuality and condoms (Hedges' g = 0.363), knowledge (g = 0.611), self-efficacy in condom use (g = 0.271), intention to use condoms (g = 0.583) and abstinence (g = 0.219). Heterogeneity was high in all the outcome variables, for which different moderating variables were analyzed. The regression analyzes carried out show that attitudes towards sexuality are influenced by the number of women in the sample, the methodological quality of the studies and ethnicity. Knowledge is influenced by the professional who carried out the intervention, the number of sessions and the instrument used to evaluate the program. On the other hand, the programs that were based on abstinence obtained worse results than the rest of the programs. Based on the characteristics of the programs analyzed, recommendations have been made for the design of programs and the evaluation of their effectiveness. Sex education programs are effective and obtain good results in the variables analyzed. However, the programs are very focused on risk behaviors and do not adopt a comprehensive approach to sexuality, close to the biographical model. On the other hand, only the short-term effects have been analysed, so programs that evaluate the long-term results must be carried out, following quality methodological criteria. Studies that analyze the effectiveness of programs should be increased in order to improve existing ones and design new interventions based on scientific evidence.