Strategies to support positive sexual behaviour among adolescents attending high schools in Ethiopia

Abstract

The understanding of the patterns of association between positive sexual behaviours and protective factors that have greater impact helps to design appropriate strategies not only on positive sexual behaviour but also for reproductive health outcomes. The purpose of the study was to explore the protective factors and develop strategies to support positive sexual behaviours among high school adolescents. A concurrent mixed method research design was employed to explore the protective factors for positive sexual behaviours. A total of 990 adolescent students attending regular classes were selected using systematic sampling technique for the quantitative study and 33 focus group participants for qualitative study. Pre-tested, self-administered questionnaire was used for the quantitative whereas focus group discussions were employed for the qualitative phase. Protective factors were assessed at family, community/ neighbourhood, school, peer and individual levels. Quantitative data was analyzed using SPSS version 23. Descriptive statistics and binary logistic regression analysis were employed to identify protective factors. Variables with significant association in bivariate analysis were entered into logistic regression to control confounding effects. The qualitative data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations used to illustrate findings. RESULTS: adolescents follow parents' rules about sexual activities [AOR=0.462, 95%CI: 0.285-0.748], authoritative [AOR=0.075, 95%CI: 0.021-0.265] and authoritarian [AOR=0.091, 95%CI:0.025-0.331] parenting styles were protective factors. Adolescents’ communication with parents was more likely to have positive association [AOR=0.56, 95%CI:0.31-0.94] than counterparts. Parental greater monitoring [AOR=0.604, 95%CI:0.38-0.959], clear rules and consequences [AOR=0.378, 95%CI: 0.233-0.613] and need for permission to go anywhere [AOR=0.387; 95%CI: 0.235-0.637] were significantly associated. School performance [AOR=0.141, 95%CI:0.055-0.362], perception that teachers are supportive [AOR=0.447, 95%CI:0.266-0.752], sex education [AOR=0.424, 95%CI: 0.243- 0.742], people approved contraceptive use [AOR=0.319, 95%CI: 0.165-0.619] and discussion with health workers on sexuality AOR=0.545, 95%CI:0.318-0.932] were strongly associated with positive sexual behaviour. Positive sexual behaviour associated with peer influence resulted in preferred later sexual debut [AOR=0.444, 95%CI: 0.248- 0.797] and bonding with peers AOR=0.531, 95%CI: 0.327-0.862].