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Effect of Comprehensive Sexuality Education on Sexual Health Decision-Making Knowledge among Secondary School Students in Nigeria

Abstract

Comprehensive sexuality education is an important component of adolescent health promotion because it can provide young people with age-appropriate, scientifically accurate, culturally responsive, and rights-based information about sexual and reproductive health. Secondary school students in Nigeria may face challenges related to limited access to reliable sexuality information, peer pressure, misinformation from social media and the internet, cultural taboos, inadequate parent–adolescent communication, and misconceptions about sexual and reproductive health. These challenges may affect students' ability to make informed decisions concerning relationships, sexual health, contraception, sexually transmitted infections, consent, personal boundaries, and healthcare-seeking. Comprehensive sexuality education provides an opportunity to strengthen students' knowledge and decision-making capacity by providing structured information and opportunities to discuss sexual and reproductive health issues in an appropriate educational setting. Against this background, this study investigates the effect of comprehensive sexuality education on sexual health decision-making knowledge among secondary school students in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Social Cognitive Theory. The Health Belief Model explains how students' perceptions of susceptibility to sexually transmitted infections and unintended pregnancy, perceived severity of sexual health consequences, perceived benefits of preventive behaviours, perceived barriers, self-efficacy, and cues to action may influence their sexual health decisions. The Theory of Planned Behavior emphasizes attitudes, subjective norms, perceived behavioural control, and behavioural intentions in shaping students' sexual health-related decisions. Social Cognitive Theory emphasizes observational learning, social modelling, self-efficacy, reinforcement, peer influence, and environmental factors in developing students' understanding and responses to sexual health issues. Collectively, these theoretical perspectives provide a suitable framework for explaining how comprehensive sexuality education may influence sexual health decision-making knowledge among secondary school students in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise students aged approximately 12–19 years enrolled in selected public and private secondary schools across Nigeria, with the specific age range determined according to the approved study protocol and ethical requirements. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, schools, classes, and eligible students. Comprehensive sexuality education will be assessed using indicators such as exposure to structured sexuality education sessions, frequency and duration of education, knowledge of puberty and reproductive development, healthy relationships, personal boundaries, consent, sexual and reproductive rights, contraception, sexually transmitted infections, HIV prevention, pregnancy prevention, condom use, abstinence, sexual coercion and violence, online sexual risks, healthcare-seeking, and available adolescent-friendly health services. Sexual health decision-making knowledge will be assessed using indicators such as students' ability to identify factors that should be considered before making sexual health decisions, recognize risks associated with unprotected sexual activity, identify appropriate methods of pregnancy and sexually transmitted infection prevention, understand consent and personal boundaries, distinguish reliable sexual health information from misinformation, identify situations involving sexual coercion or unsafe relationships, recognize when professional healthcare should be sought, and identify appropriate sources of sexual and reproductive health information and services. Data will be collected using structured questionnaires, standardized sexuality-education knowledge assessment tools, age-appropriate scenario-based questions, school health programme records where available, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize students' demographic and educational characteristics, exposure to sexuality education, sources of sexual-health information, and sexual health decision-making knowledge. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of comprehensive sexuality education on sexual health decision-making knowledge. Where a quasi-experimental design is adopted, knowledge scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that comprehensive sexuality education has a significant positive effect on sexual health decision-making knowledge among secondary school students in Nigeria. Students exposed to structured, age-appropriate, scientifically accurate, culturally responsive, and participatory sexuality education are expected to demonstrate greater knowledge relevant to informed sexual health decision-making than students without comparable exposure. Education may improve students' understanding of puberty, consent, personal boundaries, pregnancy prevention, sexually transmitted infections, HIV prevention, healthy relationships, sexual coercion, and appropriate healthcare-seeking. It may also improve students' ability to distinguish reliable sexual health information from misinformation obtained through peers, social media, or other informal sources. Scenario-based learning may further strengthen students' ability to apply knowledge to common sexual health situations and identify safer and more appropriate responses. However, cultural sensitivities, parental concerns, peer influence, misinformation, stigma, limited teacher training, inadequate instructional materials, and restricted access to adolescent-friendly health services may reduce the effectiveness of comprehensive sexuality education alone. The study therefore expects appropriately designed, age-sensitive, culturally responsive, sustained, and evidence-based comprehensive sexuality education to contribute significantly to improved sexual health decision-making knowledge among secondary school students in Nigeria. The study is expected to contribute to the literature on comprehensive sexuality education, adolescent sexual and reproductive health, sexual health knowledge, health education, reproductive-health literacy, adolescent decision-making, sexually transmitted infection prevention, pregnancy prevention, healthy relationships, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, National Primary Health Care Development Agency, state ministries of health and education, secondary schools, teachers, school health personnel, healthcare professionals, adolescent-health organizations, development partners, parents, and policymakers regarding strategies for strengthening adolescent sexual and reproductive health education. The study will also provide evidence-based recommendations for integrating appropriate comprehensive sexuality education into school health programmes, strengthening teacher capacity and instructional resources, improving adolescent access to reliable sexual-health information, promoting effective parent–adolescent communication, strengthening adolescent-friendly health services, addressing sexual-health misinformation, and developing sustainable interventions that promote informed sexual health decision-making among secondary school students across Nigeria.

Keywords: Comprehensive sexuality education, sexual health decision-making knowledge, secondary school students, adolescent sexual and reproductive health, health education, reproductive-health literacy, pregnancy prevention, sexually transmitted infections, healthy relationships, Nigeria, public health.