Online Tutoring on Health Promotion Interventions for improving Sexual Health

Executive Summary

This paper discusses the various intervention strategies that can be used for the objective of improving sexual health and decreasing the rates of pregnancies and transmission of sexual diseases between individuals of 15 – 24 years of age. The paper discusses six strategies to health intervention in the dimensions educational, social, and behavioral strategies – two strategies of each have been discussed. A literature review of each strategy has been conducted taking into account the works of authors and authorities in health intervention strategies. The strengths and weaknesses, where present, have been discussed to provide a holistic perspective to the formulation of intervention strategies. Through the discussion of strategies, and the elucidation of the potential weaknesses of each, a final set of recommendations have been put forth. This includes the implementation of a two-tier intervention approach, the first tier involving the use of the Information, Motivational, and Behavioral (IMB) model and the second tier using a mixture of social and behavioral approaches such as the Integrative approach to change behavioral and social aspects to sexual health.

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1.0 Introduction:

            Health promotion interventions in the context of sexual health are carried out not only to spread awareness about the use of modern contraceptive methods, but also to diminish the desire of engaging in sexual activities at an early, unsuitable age. The strategies employed for intervention integrate decision-making, motivational control, planning, and setting goals to decrease the number of teenage pregnancies and mitigate the risk of contracting sexually transmitted diseases (STD’s) such as HIV/AIDS. This report will discuss the educational, social, and behavioral strategies to improve sexual health by discussing the various perspectives and theoretical models that are applied in each dimension. It is unlikely for adolescents to partake in unprotected sexual intercourse if they have developed the social skills to dealing with romantic and sexual relationships. However, due to a variety of social pressures, the relevant social skills may be rendered ineffective; as a result, different programs applicable in the context of schools, national policies, civil society, and individual behavior will be discussed in this report.

1.1 The use of interventions:

In the case of STD prevention and the reduction of the rate of teenage pregnancies, ‘interventions’ constitute an integrated approach towards the incorporation of theoretical models and strategies that are supported by a body of research and that have been proven to effectively encourage sexual health and promote behavioral change (Allen, 1987). The following are the different strategies employed to design and implement sexual health programs on the basis of findings and assessments about the current state of sexual health:

1. Educational: Informational, Motivation, and Behavioral Skills (IMB) Model and the Social Learning Theory;
2. Social change: Social Cognitive Theory;
3. Behavioral: Transtheoretical Model and Theory of Planned Behavior.

2.1 – The Informational, Motivation, and Behavioral skills Model (IMB):

            In the context of education, i.e. high school or college education that introduces the aspects of sexual health in a learning atmosphere, the IMB model has been used as an effective strategy towards improving sexual health (Allen, 1987). Within the sexual health programs that may be employed to promote sexual health, evidence supports that the inclusion of the elements of information, motivation, and behavior greatly improve the effectiveness of the considered program. These three elements form the foundations for behaviorally improving the perception towards sexual health and making individuals realize the need for sexual health (Allen, 1987). This is done through communication of basic concepts that can be easily understood by both educators and audiences alike. Specific terms applicable to IMB are discussed as follows:

• Information: In order for sexual health programs to be effective, information needs to be given in the form of evidence so that the individual can translate this information into behaviors that induce them to realize the importance of sexual health;
• Motivation: Once the individual has been provisioned with relevant and effective information regarding their sexual health, they need to be sufficiently motivated to act upon what they have learnt. Accordingly, the IMB model discusses the various forms of motivation that can be used in the context of education to provoke individuals to set goals and priorities regarding sexual health themselves.
• Behavioral: Having acquire information and the necessary motivation to act upon it, individuals must enact the specific behaviors that enable them to prioritize their sexual health and abstain from negative sexual outcomes.

Acquiring information regarding the use of contraceptives in a learning atmosphere that is devoid of bias and prejudice, individuals can acquire information about how birth works and how the chances of contracting an STD can be reduced (Allen, 1987). They are given information about where they can acquire modern contraceptives, how they can pay for them, how they work, and how they may discuss the use of contraceptives with their partners. In the friendly environment of a learning institution, IMB focuses on educating both the youth and their parents so that an overall orientation towards improving sexual health can be developed (Family Planning Association, 1991).

2.2 – Social Learning Theory:

            The Social Learning Theory has been applied to sexual education along with various other areas of health promotion. This theory aims to change educate participants on the need for sexual health and is therefore applicable to the context of educational strategies. By promoting sexual health through education, the Social Learning Theory attempts to change behavior in participants by using a mixture of personal knowledge, skills, interpersonal relationships, environmental influences, and attitudes. Educational methods in the classroom are used to provide a model of positive sexual behavior to students so that they are given an idealized view of sexual health (Bandura, 1977). This is done to counter the effects of the media, which has popularized sexual activity through movies, music, and magazines. The majority of this modeled behavior, i.e. through the media, has little or no mention of sexual health, contraceptive methods, and the danger associated with engaging in sexual activities at an early age (Family Planning Association, 1991).

            The Social Learning Theory, as a method of intervention, therefore attempts to provide the youth with practice in exercising their social and behavioral skills through education. Students are taught to practice the ability to say “no” to the pressure of having sex (Bandura, 1977).

3.1 – Transtheoretical model:

The Transtheoretical model forms the basis of an effective intervention strategy that inspires social change to contribute towards an attitude that values and prioritizes sexual health. The model focuses on behavioral change and inducing the attitudes that encourage the individual to focus on their sexual health (Bandura, 1977). According to the Transtheoretical model, behavioral change is a process rather than an isolated event. Behavioral change occurs incrementally, and through a five-stage process which is as follows:

1. Precontemplation: the individual has little or no intention to change their behavior or attitude in the near future at this stage;
2. Contemplation: the individual now intends to change their behavior in the near future, i.e. in the coming six months;
3. Preparation: the individual now has the intention to take steps and is motivated to change their behavior in the coming six months;
4. Action: the action stage sees the individual engaging in behavior that improves sexual health;
5. Maintenance: this is the consistent practice of the desired behavior and working to prevent any form of relapse to old habits and behaviors.

The Transtheoretical model therefore holds promise for adolescents, in that it is a planned approach towards changing behaviors regarding sexual health (Kirby, 1987). In a particular study, it was also discovered that having a partner or an older person looking after you made it more likely for the individual to pass through the five stages of behavioral change (Kirby, 1987).

With respect to the Transtheoretical model, the set timeframes that define the time gradual stages the individual undergoes to transform their behavior, it has been argued that the time periods are largely arbitrary (Massey, 1990). This casts doubt on whether the stages are necessarily distinct or different from another and not just a random mixture of different processes occurring simultaneously (Massey, 1990). Moreover, the use of arbitrary timeframes fails to appreciate the changes in behavior that occur over several years or from a daily routine of an attempt to change, rather than a gradual though out plan of changing. Furthermore, for some individuals, a bad experience or an epiphany is enough for a permanent change in their behavior (Kirby, 1987).

3.2 – Theory of Planned Behavior:

The Theory of Planned Behavior or the Theory of Reasoned Action provides a tested intervention strategy for changing individual behavior. It provides the theoretical foundations of strategies that target HIV prevention and encourage the use of contraceptive methods. The theory goes into the roots of why individuals intend to behave in a particular way; the intention is determined by two major factors, i.e. the attitude and subjective norm the person has (Tupper, 2013). By ‘attitude’ is meant the individual’s positive or negative feelings towards a specific behavior whereas a ‘subjective norm’ is linked with the perception of other people’s opinions regarding the individual’s actions. The Theory of Planned Behavior takes into account that the social impact of perceived judgment from other social actors influences the behavioral intention of the individual (Tupper, 2013). The Theory of Planned Behavior can also be taken to be an extension of the Theory of Reasoned Action, which considers behavioral intention as a function of attitudes and subjective norms towards that behavior. It compels the individual to realize whether they can indeed perform the behavior, or whether the potential social cost might be too great if they choose to indulge in said behavior. Within the context of sexual health, whether or not the individual partakes in destructive sexual activities will be decided by the social attitudes that surround sexual health. A study found that individuals have a greater desire for using contraceptive methods when the intervention strategy focused on inspiring positive attitudes towards condom use and expounded on their protective effect against STD’s. Moreover, an individual’s desire to use contraceptive methods drastically increased if their partners and peers were likely to approve of their use (Tupper, 2013).

The Theory of Planned Behavior has also criticized for neglecting the importance of real life social factors that are determinants for an individual’s behavior. The effects of the mass media, culture, and tradition are not wholly considered. The important question is to what extend the individual’s exposure to the mass media will have to be limited before they are completely isolated from the world (Prochaska, 2010). The approach does not take into account the realistic factors that individuals may be forming opinions regarding sexual health which are transmitted by elders, i.e. parents, siblings, or guardians.

4.1 – Social Cognitive Theory:

            The Social Cognitive Theory focuses on modifying aspects of an individual’s behavior by focusing on the social and environmental factors that contribute towards the prioritization of a valued norm that forms the basis of the overall attitude(s) in a society. The Social Cognitive Theory helps to modify the individual’s behavior by enabling them to observe, imitate, and model another person. The theory provides the framework for understanding human behavior in a social context that is not limited to just the individual (Bandura, 1977). The Social Cognitive theory would define the behavior of the youth as an interaction of different factors; namely personal factors including knowledge, expectations, and attitudes, behavioral factors such as practice and self-efficacy, and environmental factors such as social norms and the influences of others. The Social Cognitive Theory can be used to form a strategy for health promotion intervention by designing programs that provide sexual health education to both parents and their children. The program can possibly target parents, guardians, or elder siblings to promote their self-efficacy, positive expectations from their children or younger siblings, and intentions to discuss topics regarding sexual health with them. The youth is therefore targeted through their social environment, i.e. the institution of a family which encourages and promotes norms that value sexual health (Bandura, 1977). The individual learns behaviors from their environment and eventually comes to model them as they realize what is expected of them and the social responsibility they owe to society to value their personal sexual health. It was found through a research that, consistent with the practices of SCT, developing understanding about HIV and STD prevention among fathers and increasing their communication skills with their sons resulted in more positive outcomes such as higher levels of self-efficacy in their sons’ decision making.

The Social Cognitive Theory, according to critics, ignores the developmental and maturation stages that occur in an individual’s lifetime. This poses an important constraint, i.e. an individual’s personality and motivation changes over time. The individual’s attitudes are constantly in flux and different influences may encourage different behaviors. Therefore, a strategy that simultaneously targets current behaviors and expected behaviors in the future that may be a result of different attitudes is not possible (Bandura, 1977).

4.2 – Integrative Theory:

            The Integrative theory incorporates the health belief model, the Social Cognitive Theory, and the Theory of Planned Behavior. Under this model, whether a specific behavior is adopted depends on whether the individual intends to engage in that behavior, whether they have the skills to perform such behavior, and whether there are environmental constraints that prevent such behavior (Kirby, 1987). The integrative approach therefore focuses on uncovering the intentions of the person and reducing the incentives that are associated with sexual behavior by expounding upon the different harms that may be incurred. Moreover, the social constraints are tightened by affecting social change. This involves the introduction of social sanctions that will discourage negative sexual outcomes and promote sexual health. Social change is encouraged by focusing on the preexisting social norms that already encourage sexual health and through affecting new norms that value sexual health given that there is ample evidence to suggest the need for prioritization of sexual health (Kirby, 1987).

5.0 – Recommendations and conclusion:

Each intervention strategy comes with its own set of advantages and disadvantages. While critics have worked towards the development and evolution of specific strategies in promoting sexual health, some strategies such as the theory of planned behavior fail to take into account the practicality aspect of limiting the possible negative influences on the individual. Moreover, the Transtheoretical approach as well as the Social Cognitive Theory do not consider the different, often overlapping stages of an individual’s life. The arbitrary standards used in analyzing the different stages as per the Transtheoretical model may not hold true in the real world.

The Integrative Theory, which takes into account the Social Cognitive Theory and the Theory of Planned Behavior, along with the IMB model which takes into account the need for information, motivation, and behavioral change can be used as a two-tier approach towards a successful sexual health promotion strategy.

The first tier involves the use of the IMB approach, which will first furnish the individual with the necessary information regarding the dangers associated with poor sexual health, the motivation to act on the information, and the behavioral change required that constitutes the action stage. This direct intervention strategy can then be proceeded by the second tier, which involves the use of the Integrative Theory to meld the different approaches towards social and behavioral change. The use of an Integrative approach following the IMB approach, which has already transmitted the required information through education, will limit the social influences that may induce negative sexual outcomes. Instead, it will provide a model for desired sexual behavior and lead the individual through exemplification. Specific behaviors and their intentions will be targeted and replaced by alternative behaviors and modes of thinking.

No one, unique model can be used as an intervention strategy for decreasing teenage pregnancy and diminishing the rates of sexually transmitted diseases among individuals of 15 -24 years of age. An approach combining the different aspects of education, social change, and behavior change must be considered. This mixture will comprise of the various intervention strategies that can be applied. While sexual health is a sensitive issue, and many argue that the discussion of sexual health directly spreads the awareness the provokes the individual to engage in sexual activities, it is necessary to provide the relevant information regarding modern contraceptive methods to individuals so they can seek alternative modes of action and use the means available to lead a life of good sexual health. Through the use of the aforementioned strategies and approaches to intervention, the task of improving sexual health and decreasing the rate of pregnancies and sexually transmitted diseases can be achieved.

 

References

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Family Planning Association. (1991). in: Sex Education in Schools: Factsheet. Family Planning               Association, London.

Jones, E.F. et al. (1985). Teenage pregnancy in developed countries: determinants and policy                    implications. Family Planning Perspectives. 2: 53–63

Kirby, D. (1987). School-based programmes to reduce sexual risk taking behaviours. Journal of               School   Health; 62: 280–287

Kirby, D. (2001). “Emerging Answers: Research Findings on Programs to Reduce Teen                             Pregnancy”. National Campaign to Prevent Teen Pregnancy. Homepage of the study.

Massey, D.E. (1990). School sex education: knitting without a pattern. Health Education Journal.                         49.

Tupper, Kenneth (2013). “Sex, Drugs and the Honour Roll: The Perennial Challenges of                           Addressing Moral Purity Issues in Schools”. Critical Public Health 24 (2): 115–131.                     doi:10.1080/09581596.2013.862517. Retrieved December 2013.

Oringanje, C; Meremikwu, MM; Eko, H; Esu, E; Meremikwu, A; Ehiri, JE (Oct 7, 2009).                         “Interventions for preventing unintended pregnancies among adolescents.”. The                             Cochrane database of systematic reviews (4): CD005215.

Prochaska, JO. & Norcross. (2010) JC Systems of psychotherapy: a transtheoretical analysis. 7th              edition Brooks & Cole, CA.