An Evaluated Curriculum Teaching about Contraception and Safer Sex
Most publications by the Center for Sex Education are teaching manuals, with lesson plans galore, enabling teachers to pick and choose the lessons most appropriate for their audiences. All Together Now is a 5-lesson evaluated curriculum, intended to be taught from start to finish to teach students about contraception and safer sex. The curriculum includes 5 updated classic lessons, a summary of the evaluation research, and pre- and post-test surveys to replicate the impact of the curriculum on your audience.
The lessons in All Together Now: Teaching About Contraception and Safer Sex are derived from curricula developed by the Center for Sex Education (CSE), within Planned Parenthood ® of Central and Greater Northern New Jersey (PPCGNNJ). Lessons from CSE’s popular resources, Positive Images: Teaching Abstinence, Contraception, and Sexual Health, and Teaching Safer Sex, have been replicated and adapted by sexuality educators worldwide. Lessons such as “The Condom Lineup,” “Don’t Pass It Along,” and “Choices and Consequences” have been used to teach generations of young people about contraception and safer sex. Other lessons, such as “All Together Now,” have been used to respond to political and classroom realities while acknowledging the very limited amount of time that teachers often have to teach these subjects. “It’s Your Right” is used to address teen self-advocacy and helps young people learn how to access reproductive health care.
The lessons taken from Teaching Safer Sex that appear in All Together Now were evaluated when they first appeared in the popular curricula Be Proud! Be Responsible! and Making Proud Choices. Evaluation revealed that these lessons, coupled with other safer sex lessons, resulted in:
• more consistent and more frequent condom use and less unprotected sex among participants in the experimental group in the months after the intervention, compared with participants in the control group
• increased knowledge, self efficacy, and development of positive attitudes regarding condoms
The five lessons in this curriculum each emphasize a distinct aspect of safer sex and pregnancy prevention while they also complement and reinforce each other.
The initial evaluation of All Together Now measured the curriculum’s effect on change in participants’ attitudes and knowledge regarding contraception and safer sex. The evaluation was conducted by Susan Philliber, Donna Johnson, and the expert team of Philliber Research Associates.
Participants in the All Together Now lessons were 182 young people from four programs. The first program was for public high school students in a blue-collar, racially and ethnically mixed area. The other three programs were for youth in psychiatric and juvenile justice facilities. The evaluation of the lessons was done in a pre and post-test format, with questions pertaining to each of the five lessons. The questionnaire was designed by PPCGNNJ staff in consultation with the Philliber research team, and the findings were independently analyzed by Philliber Research Associates. The survey used for this research can be found on page 41. Eighty-eight sets of pre and post-test data were matched, a rate that the Philliber team reported as typical for this type of study.
The Philliber team found statistically significant improvements in the following:
• overall contraceptive knowledge
• knowing that the contraceptive patch is a good method for people who forget to take the pill
• knowing that outercourse is a good choice for a teen who does not want a pregnancy or sexually transmitted infection
• knowing to hold the rim of the condom when pulling out
• refuting the perception that condoms break too easily
• refuting the perception that emergency contraception works only the day after unprotected sexual intercourse
• stating that they would go to a family planning clinic to get condoms.
We were pleased to find that overall correct contraceptive knowledge went up a statistically significant eight percent (p>.001), from 66 to 74 percent after the series of lessons. Knowledge about STIs improved as well, but because the participants already knew quite a bit about STI prevention when they began, the percentage of correct answers went up only three percentage points, from 74 to 77 percent.
It is worth noting that the percentage of participants who were able to identify both condoms and abstinence as the two best methods to protect against both pregnancy and sexually transmitted infections/HIV increased among three of the four groups . (At the juvenile justice facility, knowledge remained the same — 86 percent — on this point.) While these increases did not reach the threshold of statistical significance, we were pleased to see change in a positive direction.
In other areas, the Philliber research team did not find statistically significant changes. Many of these non-changes are understandable — for example, before the program began, 100 percent of teens in a resident juvenile justice facility already knew to check the expiration date of a condom before using it. There was no room for statistically measured improvement, and so it was no surprise that the same 100 percent knew this fact after the program! In another instance, 94 percent of participants agreed that condoms were a good choice for a teen who didn’t want a pregnancy or STI, and 95 percent agreed in the post-test. The problem of high baseline levels of knowledge and desired attitudes repeated itself in many other places.
One question demonstrated significant decline. The Philliber research team explained that this could have been related to the wording of the question, since it required disagreeing with a negative statement and may have caused some confusion among respondents. This question has been reworked in the instrument published here. Other cases where the lessons did not achieve statistically significant outcomes helped us to make important improvements. For example, after the lessons, a significant number of participants would go to a family clinic for condoms, and one group (juvenile justice residents) would feel substantially more comfortable using a clinic for contraception. However, we were disappointed to learn that there were no other significant changes with respect to attitudes about family planning centers. We responded by adding a short, but important, activity in the “It’s Your Right” called “To Go or Not to Go.” This activity will enable educators to spend more time acknowledging and addressing the anxiety young people may feel about accessing sexual health care.
Long-term users of Positive Images and Teaching Safer Sex will observe other changes in these lessons. Language adjustments were made throughout the curriculum, to help ensure clarity of the procedural steps for educators and understanding on the part of participants. When we tested the “Condom Lineup,” for example, we found that young people did not know what we meant by “savor the afterglow” as a final step for using condoms. Other noteworthy changes in this All Together Now curriculum include a new Contraceptive Options Chart, updated incidence and prevalence charts for STIs, an updated STI summary sheet, an additional teen profile situation, and more.
In summary, the evaluation process has been invaluable to PPCGNNJ and our Planned Parenthood colleagues in beginning to assess the impact of these classic lessons on contraceptive and safer sex knowledge and attitudes when they are taught as a curriculum. Nevertheless, we also remain cognizant of the fact that these initial findings represent but a first step in understanding long-term effects. We look forward to continued examination of these and other excellent contraceptive and safer sex lessons.
Bill Taverner, Linda Potter,
Melissa DiGioia, and Sue Montfort
All Together Now Preventing Unplanned Pregnancy and Sexually Transmitted Infections
emphasizes the importance of learning about contraception and safer sex concurrently, rather than as independent subjects. This title lesson serves as an introductory module for the full curriculum.
Don’t Pass It Along An overview of sexually transmitted infections, illustrating how quickly they can spread, and how to prevent them.
The Condom Lineup Teaches the steps for effective condom use, and a skills-based follow up to the “Don’t Pass It Along” lesson.
Choices and Consequences Making Decisions About Contraception
introduces the concept of a decision tree, empowering young people to make active decisions to help them avoid unplanned pregnancy and STIs. Case studies allow participants to review and assess the many contraceptive options available today.
It’s Your Right: Accessing Sexual Health Services
helps young people become advocates for their own reproductive health, as they identify situations in which they might need care and practice accessing services. The lesson’s “teen profile cards” allow the participants to think through how they would handle specific situations involving unplanned pregnancy and STIs.
Pre- and Post-Test Surveys Sexual Health Questions