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Effects of a life skills-based sexuality education program on Korean early adolescents.

Puberty is a turning point in life when children transition to adolescence and experience dramatic physical, mental, and emotional changes (Patton & Viner, 2007). Positive adaptation to these changes plays a critical role in the individual's lifetime health and well-being, further ensuring the reproductive health of the next generation (Patton & Viner, 2007; United Nations Educational, Scientific and Cultural Organization [UNESCO], 2018).

Sexuality education is particularly important for children in upper elementary school grades as they are entering puberty, facing physiological maturity of their reproductive system, and beginning to explore and design their own lives (Yang, Jeong, Kim, Lee, & Baek, 2002). During this period, perceptions about sexual intercourse are formed and the motivation for learning is strong; thus, sexuality education is expected to have temporal efficiency and greater long-term effects on upper elementary school-aged children compared to learners who have already graduated from high school (Im & Park, 2014). Providing appropriate sexuality education for elementary school students is, therefore, essential in maintaining their sexual health as members of society (UNESCO, 2018).

However, currently, sexuality education taught in Korean elementary schools does not reflect the developmental stage of young adolescents and the changes in their social environment. The main problem is that it is not systematic or professional, nor does it fulfill the needs of the learner (G. Y. Lee, 2015; Yoon, Jeon, & Park, 2009); thus, Korean teenagers' satisfaction with sexuality education in school is low. According to H. J. Lee (2013), the satisfaction score of Korean elementary school students regarding sexuality education was 3.31 out of 5 and their perception of the helpfulness of sexuality education programs was 3.41 out of 5. In addition, 31.3% of them cited "poor content of the textbook" as a reason for their dissatisfaction, followed by "unprofessional instructors" (3.0%). One barrier to providing appropriate sexuality education is that in the Confucian culture, discourse around sexuality within the education system has long been forbidden. Although existing sexuality education programs are claimed to be comprehensive, the current method of delivering only biological information chosen by the standards of the older generation, or presented from teacher to learner, is inconsistent with the needs of learners (G. Y. Lee, 2015).

As a solution to these deficiencies, G. Y. Lee (2016) developed a learner-centered sexuality education program based on life skills, which was published by Chung-Ang University. UNESCO (2018), which has developed worldwide sexuality education guidelines, revised its existing guidelines in 2018 and highlighted that the lifestyle-based approach to sexuality education is effective in addressing adolescent smoking, problems arising from drinking alcohol, illicit drug taking, and sexual health. The World Health Organization (WHO, 2003) defined life skills as "abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life" (p. 3). Life skills-based education is a form of learner-centered education that allows participants to develop their capacity to grow through active and autonomous participation in the process of constructing high-level knowledge, applying problem solving, taking part in discussion and debate, completing projects, and learning through collaborative strategies (Bastable, Gramet, Sopczyk, Jacobs, & Braungart, 2019).

Many scholars have reported that learner-centered life skills-based programs are particularly effective in increasing learners' knowledge and changing their perspectives and attitudes during sexuality-related education, in regard to topics such as human immunodeficiency virus (HIV) prevention (Boler & Aggleton, 2005; Clarke, Yankah, & Aggleton, 2015; United Nations Children's Fund [UNICEF], 2012; Yankah & Aggleton, 2008). Life skills-based education helps to promote self-esteem, self-efficacy, and motivation (UNICEF, 2012) through developing psychosocial skills, such as self-awareness, along with interpersonal problem-solving and critical-thinking skills that determine appropriate behavior (WHO, 2003).

However, sexuality education in Korea has mainly comprised sexuality-related information delivered via a teacher-centered program. Further, research on sexuality education for Korean adolescents has been mainly focused on conducting surveys to establish the demand for sexuality education (Kim & Lee, 2001; G. Y. Lee, 2015; H. J. Lee, 2013), comparing media for sexuality education (K.-O. Lee, Yang, & Im, 1998; Lim & Park, 2003), and the development of sexuality education content (Cho, Kim, Lee, & Woo, 2001; Yoon et al., 2009). Therefore, as has been done for middle school students, it is necessary to develop a practical sexuality education program that will meet the needs of early adolescents, help to solve practical problems related to sexual intercourse, and include testing the program's effectiveness by applying it in the classroom.

In this study we sought to confirm whether a sexuality education program based on life skills, including self-esteem, interpersonal skills, communication skills, problem-solving skills, decision-making skills, and critical-thinking skills, can have a positive influence on Korean upper elementary grade students' knowledge and attitudes about sexual risk behaviors. Our specific aims were as follows: (a) to explore the application of a life skills-based sexuality education program among upper elementary grade students and (b) to obtain initial estimates of intervention efficacy using a one-group pretest--posttest design.

Hypothesis 1: The life skills-based sexuality education program will increase students' life skills.

Hypothesis 2: The life skills-based sexuality education program will increase students' sexuality knowledge.

Hypothesis 3: The life skills-based sexuality education program will increase students' sexual attitude.

Method

Participants

Participants were 72 students from four sixth-grade classes at one elementary school located in Seoul, South Korea. The required minimum number of participants was calculated as 44 by using the G*Power 3.1.9.2 program with significance level [alpha] = .05, test power (1 - [beta]) = .90, and effect size = .50. However, to prevent inequality in the benefits of sexuality education among the students, all 72 students in the sixth grade were included in the study. After excluding four questionnaires that were carelessly completed, the data of 68 students were used in the analysis.

Procedure

All the participants in this study completed a pre-education survey and took part in an 8-week life skills-based sexuality education program. After program completion, they completed a posteducation survey, including a measure of satisfaction with the program. We recruited a teacher who completed 30 hours of training to obtain necessary teaching skills and knowledge of the educational content before teaching the life skills-based sexuality education program.

This study was approved by the Bioethics Review Committee of Chung-Ang University (Institutional Review Board approval number: 1041078-201806-****-132-01) to verify the ethical and scientific validity. As an ethical consideration, the program teacher explained the study's purpose and method to the participants. The students completed the pre- and posteducation program surveys only after an explanatory letter describing the purpose of the study was sent to their parents, and the accompanying consent forms were completed and returned to us. Students and their parents were informed that there would be no benefits or disadvantages to participating in the study, although school supplies valued at around US$5.00, including highlighters, were offered as an incentive for participation.

To ensure the reliability of responses, the survey forms were placed in individual envelopes. After completion, the forms were returned to the envelopes, sealed with tape, and submitted to the program teacher, who mailed the sealed envelopes to us. The pre-education questionnaires were collected from August 27 to August 30, 2018, and the posteducation questionnaires from November 8 to November 14, 2018, 1 week after the program's completion.

Intervention Description

The life skills-based sexuality education program used in this study is based on the theoretical and conceptual frameworks of social learning theory (Bandura, 1977) and problem behavior theory (Jessor & Jessor, 1977). We analyzed the life skills training program developed by Botvin (2014), Japan's life-skills-based sexuality education program (Japan Know Your Body, 2009), and the Korean Ministry of Education's (2015) sexuality education standards, then developed a life skills-based sexuality education program that included examples specific to Korean adolescents' circumstances.

Life skills-based sexuality education programs are independent of gender and feature a learner-centered interactive teaching and learning method. All classes were structured such that the learners could participate directly in the class through activities such as group work, brainstorming, role playing, storytelling, discussion, and debate. In this program that consisted of 16 sessions (40 minutes per session), the life skills concepts to be taught in each session were predefined to provide precise knowledge and information related to performance; raise decision-making awareness on human relations, appropriate values, and sexual self-determination; and promote critical thinking about the information provided in the program. We sought, in particular, to link our school sexuality education program with the respondents' home and community (see Table 1).

This program was applied experimentally in three schools, with a 6-month process of revising the program based on feedback from teachers and students. Before the program was finalized, a committee composed of 10 experts, including a nursing professor, education professor, health teacher, and school inspector responsible for sexuality education, reviewed the program and provided advice.

Measures

Life skills. The life skills measured in this study comprised self-esteem, interpersonal skills, communication skills, problem-solving skills, decision-making skills, and critical-thinking skills. We translated the original text of the measurement items into Korean, then the translation was reviewed by a nursing professor, an education professor, and a health teacher who had experience in developing instruments and who were familiar with English. The content validity was measured on a 4-point Likert scale ranging from 1 (extremely invalid) to 4 (extremely valid). The content validity index (CVI) was over .80 for all items used in this study. The developed instrument for life skills measurement was pilot tested with 15 students in the sixth grade who were the same age and at the same academic level as our participants. Cronbach's alpha reliability for the overall measure was .82 in this study. We used the following tools to measure life skills:

Self-esteem. Ten items from the Rosenberg Self-Esteem Scale (Rosenberg, 1965). A sample item is "On the whole, I am satisfied with myself." Cronbach's alpha reliability was .92 in the original study and .88 in this study.

Interpersonal relationships/Communication. The 20-item communications subscale from the Youth Life Skills Evaluation System (Barkman & Machtmes, 2002). A sample item is "I try to watch other people's body language to help me understand what they are trying to say." Cronbach's alpha reliability was .79 in the original study and .81 in this study.

Problem solving/Decision making. Twenty items from the Solving Problems Survey developed by Barkman and Machtmes (2002). A sample item is "I try to get all the facts before trying to solve a problem." Cronbach's alpha reliability was .86 for the original instrument and .70 for the current instrument.

Critical thinking. Eighteen items from the Critical Thinking in Everyday Life Scale (Perkins & Mincemoyer, 2002). A sample item is "I am able to give reasons for my opinions." Cronbach's alpha reliability was .75 in the original study and .88 in this study.

Sexuality knowledge. We developed a 25-item sexuality knowledge instrument based on the content of the life skills-based sexuality education program. The developed items were verified by a nursing professor who had experience in developing tools, a pedagogy professor, and three elementary school health teachers. The yielded CVI was over .80 for all items. Examples of the items are "Pubertal body changes differ between individuals" and "The faster the body and mind reaches puberty, the better." Three response options (right = 1 point, wrong = 0 points, do not know = 0 points) were presented. A higher score indicates more knowledge about sexuality.

Sexual attitude. We developed a sexual attitude instrument based on the Korean Gender Awareness Scale developed by the Korean Institute for Gender Equality Promotion and Education (2008), a measurement instrument for adolescent sexual culture used by Seoul Aha Sexuality Education and Counseling Center for Youth (2013), and the sexual attitude instrument used by Park (2018). The items were reviewed by five experts using the same procedure as above, and the yielded CVI was over .80 for all items. This instrument comprises 24 items across four dimensions: nine items on positive sexual awareness (e.g., "I am glad that my body is changing to become an adult"), four items on sexual subjectivity (e.g., "I am uncomfortable with talking about sexuality-related issues"), five items on prevention of risky sexual behaviors (e.g., "The best way to prevent sexual risk behaviors is for me to protect myself"), and six items on sexual equality (e.g., "It is more important for men to make money and success in life than for women"). Each item is rated on a 4-point Likert scale ranging from 1 = strongly disagree to 4 = strongly agree. A higher score indicates a more positive and more appropriate sexual attitude. Cronbach's alpha reliability in this study was .76.

Satisfaction with the program. The measurement instrument for satisfaction with the program comprised nine items, including one open-ended item, and dealt with the following themes: the validity and helpfulness of the program (e.g., "The lessons helped with real-life situations"), intention to participate again in the program (e.g., "I would like the sexuality education classes to continue"), and the helpfulness of the group activity (e.g., "It is good that the classes provided many opportunities for active participation and presentations"). Each item, excluding the open-ended one, was answered using a 5-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. A higher score indicates greater satisfaction with the program. Cronbach's alpha reliability in this study was .89.

Data Analysis

Analysis was carried out using SPSS 25.0 and two-sided tests of significance with the level set at .25. Descriptive statistics were used to investigate the general characteristics of the students. To measure the effectiveness of the proposed program, the Wilcoxon signed-rank test was used for assessing scale outcomes and McNemar's test for homogeneity was used for dichotomous outcomes to determine if there were significant changes for each of the pre- and posteducation measures.

Results

Sexuality-Related Characteristics of the Participants

The participants' sexuality-related characteristics are shown in Table 2.

Effectiveness of Life Skills-Based Sexuality Education Program

Students' scores for life skills before the program increased after they had completed it, but the difference did not reach statistical significance. However, the increase in interpersonal relationship/communication skill scores after completing the program was statistically significant. Self-esteem, problem-solving/decision-making skills, and critical thinking scores all decreased slightly in the postprogram test compared with the pretest scores; however, these decreases did not reach statistical significance (see Table 3).

The increase in students' sexuality knowledge scores between pretest and posttest was statistically significant. Further, after they had completed the education program, students' sexual attitude became slightly positive compared with before the education program; however, the change did not reach statistical significance. Scores for satisfaction with the life skills-based sexuality education program indicated general satisfaction. Satisfaction levels were particularly high for the following items: "The sexuality education classes were fun and beneficial," "The lessons helped with real-life situations," and "It is good that the classes provided many opportunities for active participation and presentations."

Discussion

Implementing measures to promote the healthy behaviors of adolescents during puberty and protect them from sexual health risks is very important in preventing health problems during adulthood and ensuring the future health and development of the human resources of the country (UNESCO, 2018; WHO, 2003). Sexuality education presented in school is one of the most effective ways to reduce risky sexual behavior in adolescents (Clarke et al., 2015). Following the global trend toward using rational- and practice-based sexuality education programs with young people (Haberland & Rogow, 2015), in this study we developed and implemented an evidence-based and practice-centered sexuality education program for young people in Korea at the stage of early adolescence, and sought to determine its effectiveness.

The life skills-based sexuality education program developed and used in this study proved to be effective for learners in acquiring life skills and sexuality knowledge. Our results are consistent with those of previous researchers who found that sexuality education is useful to prevent learners' risky sexual behaviors through educating them with accurate information and knowledge (Im & Park, 2014; Yoon et al., 2009). Knowledge acquisition is a critical outcome for life skills-based education in which learner-centered discussions or problem-solving learning methods are applied, rather than lectures or memorization of educational materials provided in a traditional classroom setting (Clarke et al., 2015; Sun, Miu, Wong, Tucker, & Wong, 2017). As our results show, it is possible to acquire accurate information and sexuality knowledge through interaction with fellow learners, which suggests that the existing rigid sexuality education format used in the Korean school system should be replaced with a learner participation format.

Given the short study period, the information learned had an immediate effect on the students' interpersonal/communication skills. Typically, a long period of time is required for a significant change to appear for learning skills that are helpful in real life and have a psychosocial motivator, such as self-esteem, critical thinking, decision making, and interpersonal skills (Clarke et al., 2015; Pick, Givaudan, Sirkin, & Ortega, 2007). This makes it difficult to measure the immediate effects. Students must strive to improve their motivation and achieve positive thinking and values through active participation, learning experiences, and conversation, rather than through passive classroom learning (G. Y. Lee & Lee, 2019; Ryu, Kim, & Kim, 2012). Our results indicate that the lifelong skills of learners can be improved by avoiding unilateral knowledge transfer and instead allowing them to participate in appropriately organized experiential sexuality education activities.

The ultimate purpose of sexuality education is to develop adolescents' ability to think carefully about engaging in sexual intercourse and to teach them accurate sexual information, thus allowing them to engage in healthy and responsible sexual behaviors (Choi & Song, 2006; G. Y. Lee & Lee, 2019; UNICEF, 2012). To teach elementary school students healthy sexual values and responsibility for their own sexual behaviors, sexuality education should have specific goals, such as education on contraception, sexual health, and values. To achieve these goals, life skills-based sexuality education programs such as the one we have developed in this study should be applied in the classroom setting.

The study findings should be interpreted in light of the following limitations: First, in the case of girls and boys at the stage of early adolescence who are undergoing physical and emotional development, even though life skills such as self-esteem and interpersonal skills can be acquired effectively through learning (Pick et al., 2007), these skills can also be affected by external environmental factors. Unlike the acquisition of knowledge, acquisition of life skills and attitude formation may be influenced by various factors in everyday life other than education programs (Clarke et al., 2015), meaning that it is necessary to be careful in interpreting the results of this study.

Second, the generalizability of our results is limited because we tested the effectiveness of the program with students in just one elementary school in Seoul, South Korea. Program performance and effectiveness may vary according to school policies and student characteristics; therefore, further studies should be conducted with participants of various age groups and cultural characteristics. In addition, pre- and posttests were performed only for a single group. To compensate for these limitations, studies should be conducted to verify the differences between the sexuality education program tested in this study and existing sexuality education.

Acknowledgements

This work was supported by the National Research Foundation of Korea grant funded by the Korean government (NRF-2017R1A2A2A05001108) and Chung-Ang University research grants in 2019.

References

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Gyu-Young Lee (1), Da Ye Lee (1)

(1) Red Cross College of Nursing, Chung-Ang University, Republic of Korea

CORRESPONDENCE Da Ye Lee, Red Cross College of Nursing, Chung-Ang University, 102-705, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea. Email: dayelees@gmail.com

https://doi.org/10.2224/sbp.8600
Table 1. Content Outline of the Life Skills-Based Sexuality Education
Program

Sector         Session  Subject

Increase       1        How puberty changes
self-esteem             the body and mind
Manage         2/3      Learning about
sexual health           women's and men's
                        reproductive organs
               4        Pregnancy and birth
               5        Keeping the
                        reproductive system
                        healthy
Develop self-  6        Obtaining appropriate
assertiveness           sexual health
and good                information
interpersonal
relationships
               7        Avoiding high-risk
                        sexual behaviors
               8        Refusing propositions

Sector         Lesson goal

Increase       * Orientation.
self-esteem    * Understanding life skills.
               * Students can ask questions about
                 anything regarding how puberty
                 changes the body and mind.
Manage         * Students should learn names of
sexual health    organs and their functions and can
                 describe secondary sex characteristics
                 and how to manage the
                 associated changes.
               * By understanding pregnancy and
                 making better decisions, students
                 can be prepared to be healthy
                 parents in the future.
               * Various gender issues can
                 be predicted and negotiated
                 according to the situation.
                 Students should learn to correctly
                 address such situations by
                 applying life skills.
Develop self-  * The teacher should describe the
assertiveness    advantages and disadvantages of
and good         various sources of information
interpersonal    regarding the body and mind,
relationships    and teach students how to select
                 and use reliable sources of
                 information.
               * Students should learn appropriate
                 decision-making steps (stop-
                 think-go method) and apply these
                 steps in a variety of situations
                 relating to their friends.
               * Students should practice
                 self-assertive communication
                 skills through role-playing
                 activities that involve refusing
                 health-related temptation.

Sector         Educational activities          Key life skills

Increase       * Group discussion using a      * Self-esteem
self-esteem      nominal group technique       * Stress coping skills
                                               * Self-assertiveness
                                               * Interpersonal skills
Manage         * Learn organs' names and       * Self-management skills
sexual health    functions                     * Self-esteem
               * Match secondary sex
                 characteristics and the
                 appropriate changes
               * Watch a video about           * Self-management skills
                 fertilization and             * Self-esteem
                 implantation
               * Draw a picture of their
                 future family and leave
                 a message to their future
                 baby
               * Problem-based learning        * Critical thinking
                 (read a specific situation    * Problem-solving skills
                 and discuss the solution)     * Decision-making skills
               * Group discussion and
                 presentation
Develop self-  * Consider reliable sources     * Decision-making skills
assertiveness    of information through        * Critical thinking
and good         brainstorming and group       * Self-esteem
interpersonal    discussion
relationships
               * After reading the situation,  * Decision-making skills
                 discuss as a group            * Critical thinking
               * Applying the stop-think-go
                 method
               * Role playing                  * Critical thinking
                                               * Refusal skills

Table 2. Sexuality-Related Characteristics of Research Participants

Variables                        Categories               n   (%)

Gender                           Boys                     30  (44.1)
                                 Girls                    38  (55.9)
Experience with school-provided  Yes                      64  (94.1)
sexuality education              No                        4   (5.9)
Whether school-provided          Very helpful             19  (28.8)
sexuality education is helpful   Average                  42  (63.6)
                                 Not helpful               5   (7.6)
How sexuality knowledge is       School sexuality         47  (70.0)
obtained                         education classes
                                 Parents                   2   (3.0)
                                 Online content            6   (9.0)
                                 Friends                   5   (7.5)
                                 Television or magazines   1   (1.5)
                                 Textbooks in sexuality    4   (6.0)
                                 education classes
                                 Others                    2   (3.0)
Experience with sexual content   Yes                       3   (4.4)
(i.e., pornography)              No                       65  (95.6)

Note. N = 68.

Table 3. Comparison of Pre- and Posttest Results for Life Skills,
Sexuality Knowledge, and Sexual Attitudes

Variables                                    Pretest
                                             M[+ or -]SD

Total life skills score                       3.04 [+ or -] 0.28
  Self-esteem                                 3.20 [+ or -] 0.55
  Interpersonal relationships/Communication   2.92 [+ or -] 0.25
  Problem solving/Decision making             2.99 [+ or -] 0.24
  Critical thinking                           3.07 [+ or -] 0.35
Sexuality knowledge                          15.20 [+ or -] 5.02
Sexual attitudes                              3.06 [+ or -] 0.29

Variables                                    Posttest
                                             M[+ or -]SD          t

Total life skills score                       3.06 [+ or -] 0.33  -0.50
  Self-esteem                                 3.15 [+ or -] 0.48   1.17
  Interpersonal relationships/Communication   3.09 [+ or -] 0.36  -5.09
  Problem solving/Decision making             2.94 [+ or -] 0.31   1.45
  Critical thinking                           3.05 [+ or -] 0.41   0.46
Sexuality knowledge                          18.23 [+ or -] 5.92  -4.27
Sexual attitudes                              3.12 [+ or -] 0.29  -1.96

Variables
                                             P

Total life skills score                       .616
  Self-esteem                                 .245
  Interpersonal relationships/Communication  <.001
  Problem solving/Decision making             .151
  Critical thinking                           .645
Sexuality knowledge                          <.001
Sexual attitudes                              .055

Note. N = 68.

Table 4. Satisfaction With the Life Skills-Based Sexuality Education
Program

Variables                                      M[+ or -]SD

Total satisfaction score                       3.60 [+ or -] 0.78
The sexuality education classes were           3.93 [+ or -] 0.90
fun and beneficial.
I would like the sexuality education           3.60 [+ or -] 0.97
classes to continue.
The lessons answered my sexuality-related      3.71 [+ or -] 0.97
questions and curiosity
The lessons helped with real-life situations.  3.82 [+ or -] 0.94
I have shared knowledge I learned in class     2.59 [+ or -] 1.22
with friends and family.
Sexuality education is a must for young        3.75 [+ or -] 1.05
people like us.
It is good that the classes provided many      3.84 [+ or -] 0.97
opportunities for active participation and
presentations.

Note. N = 68.
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Author:Lee, Gyu-Young; Lee, Da Ye
Publication:Social Behavior and Personality: An International Journal
Geographic Code:9SOUT
Date:Dec 1, 2019
Words:5077
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