Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE (Open Access)

Perceived knowledge gained from school-based sexuality education – results from a national population-based survey among young people in Sweden

Anna ChuChu Schindele https://orcid.org/0000-0002-2901-6861 A B * , Henrik Källberg C , Kristina Areskoug Josefsson D E and Malin Lindroth A E
+ Author Affiliations
- Author Affiliations

A Faculty of Health and Society, Institution for Social Work, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden.

B Unit for Sexual Health and HIV Prevention, Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden.

C Unit for Analysis, Department of Public Health Analysis and Data Management, The Public Health Agency of Sweden, Stockholm, Sweden.

D Department of Health Sciences, University West, Trollhättan, Sweden.

E Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway.

* Correspondence to: anna-chuchu.schindele@mau.se

Handling Editor: Anthony Smith

Sexual Health - https://doi.org/10.1071/SH23093
Submitted: 8 May 2023  Accepted: 13 October 2023   Published online: 6 November 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

School-based sexuality education is a core component of securing young people’s right to attain health equity regarding sexual and reproductive health and rights. This paper aims to explore how perceived knowledge (sufficient or insufficient) of taking care of one’s sexual health is associated with knowledge gained from school-based sexuality education and social determinants.

Methods

The data material is drawn from a population-based survey conducted in Sweden in 2015. The survey had 7755 respondents and a response rate of 26%. To explore the aim descriptive statistics and logistic regression models were used.

Results

Our results show that perceived insufficient knowledge from school-based sexuality education was associated with higher odds of reporting not being able to take care of one’s sexual health. The highest significant excess risk for insufficient knowledge was found among young people from sexual minorities.

Conclusions

Young people in Sweden do not have equal abilities to receive knowledge needed to take care of their sexual health and thus attain sexual health literacy. There is an unequal distribution of perceived knowledge, and LGBTQI+ youth particularly face barriers in using school-based sexuality education as a resource for sexual health literacy.

Keywords: Agenda 2030, health equity, health promotion, intersections, public health, school-based sexuality education, sexual and reproductive health and rights (SRHR), sexual health literacy.

References

Ezer P, Kerr L, Fisher CM, Heywood W, Lucke J. Australian students’ experiences of sexuality education at school. Sex Educ 2019; 19(5): 597-613.
| Crossref | Google Scholar |

Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet 2018; 391: 2642-2692.
| Crossref | Google Scholar |

Vongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JEW, Sychareun V, Essink DR. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS ONE 2019; 14(1): e0209675.
| Crossref | Google Scholar | PubMed |

Engel DMC, Paul M, Chalasani S, Gonsalves L, Ross DA, Chandra-Mouli V, Cole CB, de Carvalho Eriksson C, Hayes B, Philipose A, Beadle S, Ferguson BJ. A package of sexual and reproductive health and rights interventions—what does it mean for adolescents? J Adolesc Health 2019; 65(6): S41-S50.
| Crossref | Google Scholar |

UN. Transforming our world: the 2030 Agenda for sustainable development. 2015. Available at https://sustainabledevelopment.un.org/post2015/transformingourworld/publication

CRC. General comment No. 4 (2003): adolescent health and development in the context of the convention on the rights of the child (CRC/GC/2003/4, Issue). CRC; 2003.

CRC. General comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24)*. CRC; 2013. Available at https://www.refworld.org/docid/51ef9e134.html

Hurtado Murillo F, Pérez Conchillo M, Rubio-Aurioles E, Coates R, Coleman E, Corona Vargas E, Horno Goicoechea P. Science-based sexuality education: Madrid consensus paper: recommendations of an international expert group. Madrid: Spanish Association of Sexology Specialists, the Spanish Academy of Sexology and Sexual Medicine, and the Institute of Sexology and Psychotherapy. 2012. p. 230.

Kågesten A, van Reeuwijk M. Healthy sexuality development in adolescence: proposing a competency-based framework to inform programmes and research. Sex Reprod Health Matters 2021; 29(1): 1996116.
| Crossref | Google Scholar | PubMed |

10  UNESCO. International technical guidance on sexuality education: an evidence-informed approach. 2018. Available at https://unesdoc.unesco.org/ark:/48223/pf0000260770

11  Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000; 15(3): 259-267.
| Crossref | Google Scholar |

12  Nutbeam D. The evolving concept of health literacy. Soc Sci Med 2008; 67(12): 2072-2078.
| Crossref | Google Scholar | PubMed |

13  Ringsberg KC, Olander E, Tillgren P. Health literacy: Teori och praktik i hälsofrämjande arbete. Studentlitteratur AB; 2020.

14  Frederiksen N, Wångdahl J. Health literacy in the Nordic countries – not only a determinant of health, but also a tool for health promotion. 2022. Available at https://nordicwelfare.org/en/publikationer/health-literacy-in-the-nordic-countries-not-only-a-determinant-of-health-but-also-a-tool-for-health-promotion/

15  McDaid L, Flowers P, Ferlatte O, Young I, Patterson S, Gilbert M. Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research. Cult Health Sex 2021; 23(2): 207-223.
| Crossref | Google Scholar | PubMed |

16  Lopez LM, Bernholc A, Chen M, Tolley EE. School-based interventions for improving contraceptive use in adolescents. Cochrane Database Syst Rev 2016; 2016(6): CD012249.
| Crossref | Google Scholar |

17  Mason-Jones AJ, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database Syst Rev 2016; 11(11): CD006417.
| Crossref | Google Scholar |

18  Reinisch J, Beasley R. America fails sex information test. In: Reinisch JM, Beasley R, Kent D, editors. The Kinsey Institute new report on sex: what you must know to be sexually literate. St Martin’s Press; 1990. pp. 1–26.

19  Graf AS, Patrick JH. Foundations of life-long sexual health literacy. Health Educ 2015; 115: 56-70.
| Crossref | Google Scholar |

20  Jamali B, Maasoumi R, Tavousi M, Haeri Mehrizi AA. Women’s sexual health literacy and related factors: a population-based study from Iran. Int J Sex Health 2020; 32(4): 433-442.
| Crossref | Google Scholar |

21  Martin SP. Young people’s sexual health literacy: seeking, understanding, and evaluating online sexual health information. PhD thesis, University of Glasgow; 2017.

22  Bengtsson J, Bolander E. Strategies for inclusion and equality–‘norm-critical’ sex education in Sweden. Sex Educ 2020; 20(2): 154-169.
| Crossref | Google Scholar |

23  The National Agency for Education. Sex education – gender equality, sexuality and human relationships in the Swedish Curricula. 2014. Available at https://www.skolverket.se/download/18.6bfaca41169863e6a65bd27/1553966490106/pdf3580.pdf

24  The Swedish Schools Inspectorate. Sexuality education – thematic quality review 2018. 2018. Available at https://www.skolinspektionen.se/beslut-rapporter-statistik/publikationer/kvalitetsgranskning/2018/sex--och-samlevnadsundervisning/

25  Beaumont K, Maguire M. Policies for sexuality education in the European Union. 2013. Available at https://policycommons.net/artifacts/1333478/policies-for-sexuality-education-in-the-european-union/1937994/

26  Bäckman M. Gender and feeling: cohabitation education and young people’s thoughts about sexuality [Kön och känsla: samlevnadsundervisning och ungdomars tankar om sexualitet]. Makadam: Stockholm University; 2003.

27  Lukkerz J. Sex the right way: young people, sexuality and Swedish contemporary views on sexuality [Sex på rätt sätt: Unga, sexualitet och svensk samtida sexualsyn]. Sweden: Örebro University; 2023.

28  The National Agency for Education. Curriculum for primary school, pre-school and after-school activities – Lgr22. 2022. Available at https://www.skolverket.se/publikationsserier/styrdokument/2022/laroplan-for-grundskolan-forskoleklassen-och-fritidshemmet---lgr22

29  The National Agency for Education. Curriculum for upper secondary school (gymnasium) SKOLFS 2022:13. 2022. Available at https://shop.nj.se/products/skolfs-20228-15-6dfw2

30  Mark K, Corona-Vargas E, Cruz M. Integrating sexual pleasure for quality & inclusive comprehensive sexuality education. Int J Sex Health 2021; 33(4): 555-564.
| Crossref | Google Scholar |

31  Goldfarb ES, Lieberman LD. Three decades of research: the case for comprehensive sex education. J Adolesc Health 2021; 68(1): 13-27.
| Crossref | Google Scholar | PubMed |

32  Mitchell A, Smith A, Carman M, Schlichthorst M, Walsh J, Pitts M. Sexuality education in Australia in 2011. Melbourne: Australian Research Centre in Sex, Health & Society, La Trobe University; 2011.

33  Currin JM, Hubach RD, Croff JM. Sex-ed without the stigma: what gay and bisexual men would like offered in school based sex education. J Homosex 2020; 67(13): 1779-1797.
| Crossref | Google Scholar | PubMed |

34  Hillier L, Jones T, Monagle M, Overton N, Gahan L, Blackman J, Mitchell A. Writing themselves in 3: the third national study on the sexual health and wellbeing of same sex attracted and gender questioning young people. Melbourne: Australian Research Centre in Sex Health and Society, La Trobe University; 2010.

35  Paschen-Wolff MM, Greene MZ, Hughes TL. Sexual minority women’s sexual and reproductive health literacy: a qualitative descriptive study. Health Educ Behav 2020; 47(5): 728-739.
| Crossref | Google Scholar | PubMed |

36  Bowleg L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health 2012; 102(7): 1267-1273.
| Crossref | Google Scholar | PubMed |

37  Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Review 1991; 43(6): 1241-1299.
| Crossref | Google Scholar |

38  Trygg Fagrell N. Knowledge diversification in public health through intersectionality. Umeå University; 2022.

39  Wemrell M, Karlsson N, Vicente RP, Merlo J. An intersectional analysis providing more precise information on inequities in self-rated health. Int J Equity Health 2021; 20(1): 54.
| Crossref | Google Scholar |

40  Kapilashrami A, Hankivsky O. Intersectionality and why it matters to global health. Lancet 2018; 391(10140): 2589-2591.
| Crossref | Google Scholar |

41  Schindele AC, Areskoug Josefsson K, Lindroth M. Vulnerability Analysis in Sexual and Reproductive Health and Rights (SRHR)—indications of intersecting vulnerable positions in a national survey among young people in Sweden. Sex Res Soc Policy 2022; 19: 1034-1045.
| Crossref | Google Scholar |

43  Statistics Sweden. Technical report. A description of implementation and methods. Young people’s sexual health. Statistics Sweden; 2015.

44  Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med 2014; 110: 10-17.
| Crossref | Google Scholar | PubMed |

45  Bauer GR, Mahendran M, Walwyn C, Shokoohi M. Latent variable and clustering methods in intersectionality research: systematic review of methods applications. Soc Psychiatr Psychiatr Epidemiol 2022; 57: 221-237.
| Crossref | Google Scholar |

46  McCall L. The complexity of intersectionality. Signs: J Women Cult Soc 2005; 30(3): 1771-1800.
| Crossref | Google Scholar |

47  Spierings N. The inclusion of quantitative techniques and diversity in the mainstream of feminist research. Eur J Women’s Stud 2012; 19(3): 331-347.
| Crossref | Google Scholar |

48  Marmot M. Achieving health equity: from root causes to fair outcomes. Lancet 2007; 370(9593): 1153-1163.
| Crossref | Google Scholar |

49  Plamondon KM. A tool to assess alignment between knowledge and action for health equity. BMC Public Health 2020; 20(1): 224.
| Crossref | Google Scholar | PubMed |

50  Bauer GR, Churchill SM, Mahendran M, Walwyn C, Lizotte D, Villa-Rueda AA. Intersectionality in quantitative research: a systematic review of its emergence and applications of theory and methods. SSM Popul Health 2021; 14: 100798.
| Crossref | Google Scholar | PubMed |

51  Bauer GR, Scheim AI. Methods for analytic intercategorical intersectionality in quantitative research: discrimination as a mediator of health inequalities. Soc Sci Med 2019; 226: 236-245.
| Crossref | Google Scholar | PubMed |

52  Bowleg L, Bauer G. Invited reflection: quantifying intersectionality. Psychol Women Q 2016; 40: 337-341.
| Crossref | Google Scholar |

53  Formby E, Donovan C. Sex and relationships education for LGBT+ young people: lessons from UK youth work. Sexualities 2020; 23(7): 1155-1178.
| Crossref | Google Scholar |

54  Shannon B. Comprehensive for who? Neoliberal directives in Australian ‘comprehensive’ sexuality education and the erasure of GLBTIQ identity. Sex Educ 2016; 16(6): 573-585.
| Crossref | Google Scholar |

55  Andersson I, Liljefors Persson B, Olsson H. The knowledge area of school-based sexuality education in teacher education. A mapping of course plans and reasoning about content. 2020. Available at https://mau.diva-portal.org/smash/get/diva2:1591280/FULLTEXT01.pdf

56  Areskoug-Josefsson K, Schindele AC, Deogan C, Lindroth M. Education for sexual and reproductive health and rights (SRHR): a mapping of SRHR-related content in higher education in health care, police, law and social work in Sweden. Sex Educ 2019; 19(6): 720-729.
| Crossref | Google Scholar |

57  Schindele AC, Lindroth M. Sexual and reproductive health and rights (SRHR) among young people in secure state care and their non-incarcerated peers–a qualitative, descriptive and comparative study. Eur J Soc Work 2021; 24(4): 657-670.
| Crossref | Google Scholar |