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Randomized Controlled Trial
. 2025 Jul 3;22(1):123.
doi: 10.1186/s12978-025-02071-5.

Effectiveness of an online sexual and reproductive health educational program on knowledge, attitudes, and behaviours among senior primary school students: a cluster randomized controlled trial

Ruru Guo  1 , Wen Pan  1 , Wei Zhao  1 , Mingli Zhao  2 , Jingjing Wang  3
Affiliations
Randomized Controlled Trial

Effectiveness of an online sexual and reproductive health educational program on knowledge, attitudes, and behaviours among senior primary school students: a cluster randomized controlled trial

Ruru Guo et al. Reprod Health. .

Abstract

Background: Sexual and reproductive health education is crucial for senior primary school students as they enter adolescence. Implementing such education in resource-limited settings faces challenges like untrained educators, cultural taboos, and lack of materials. An online sexual and reproductive health educational program may overcome these barriers, yet no research in China has assessed the effectiveness for senior primary school students. This study aims to evaluate the effectiveness of an online sexual and reproductive health education program for senior primary school students in China, focusing on their adherence to the program and comprehension of its content.

Methods: The efficacy of the program was evaluated through a cluster randomized controlled trial. Participants (mean age 11.21 ± 0.68 years) were recruited from two primary schools in Shangqiu, Henan, with eight classes randomly assigned to either the intervention (n = 4) or control group (n = 4). The intervention group completed a 9-week online sexual and reproductive health education program, while the control group did not receive the program. Data on knowledge, attitudes, and behaviors were collected at baseline, post-intervention, and at 16-week follow-up. The outcomes were analyzed using a generalized estimating equation model.

Results: At baseline, no significant differences were found between groups in sociodemographic or physical development. In the intervention group, 71.4% completed the program with an average test accuracy of 86.6%, indicating good adherence and content comprehension. Compared to the control group, the intervention group had significantly higher sexual and reproductive health knowledge (T1: β = 2.18, T2: β = 1.21, p < 0.001, p = 0.001), attitudes (T1: β = 14.73, T2: β = 6.01, p < 0.001), and behaviours (T1: β = 4.49, T2: β = 5.90, p < 0.001) scores, with improvements sustained at 16 weeks.

Conclusions: The online sexual and reproductive health educational program significantly improved knowledge, attitudes, and behaviours among senior primary students, providing valuable guidance for school health nurses in designing and implementing sexual and reproductive health education programs.

Trial registration: ChiCTR2400083843. [ www.chictr.org.cn ]. 06/05/2024.

Keywords: Adolescent health education; KABP model; Online; Resource; Senior primary school students; Sexual and reproductive health.

Plain language summary

Delivering sexual and reproductive health education to senior primary school students as they transition into adolescence is crucial. However, implementing such programs in low- and middle-income settings, including regions of China, faces challenges such as untrained educators, cultural sensitivities, and limited educational resources. This study assessed the effectiveness of an online sexual and reproductive health education program designed for senior primary school students, as well as their adherence to the program and comprehension of its content.The trial involved students with an average age of 11 from two primary schools in Shangqiu, Henan Province. Students in the intervention group exhibited significantly greater improvements over time in knowledge, attitudes, and behaviours compared with the control group, as reflected by the significant group × time interaction effects in the GEE models.Results showed that most students in the intervention group successfully completed the program, demonstrated high test scores, and showed significant improvements in their knowledge, attitudes, and behaviors compared to the control group. These gains were sustained at the 16-week follow-up.This study highlights the potential of online education programs to address barriers in delivering sexual and reproductive health education. It also provides a scalable approach and valuable guidance for school health nurses in designing and implementing similar programs in resource-constrained contexts.

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Conflict of interest statement

Declarations. Ethics approval and consent to participation: The study received approval from the Life Science Ethics Review Committee of Zhengzhou University (Project No: ZZUIRB2023-308). Consent for publication: Informed consent was obtained from all participating students and their guardians prior to the commencement of the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participants in the study
Fig. 2
Fig. 2
Accuracy rate of test response
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