Efektivnost programa zdravstvenog vaspitanja o reproduktivnom zdravlju mladih uzrasta 16 godina u Vojvodini

Abstract

Uvod: U Srbiji nema adekvatne edukacije mladih o reproduktivnom zdravlju, a ono je ugroženo u značajnom stepenu. U Vojvodini je tokom tri cikusa primenjen Vannastavni Program edukacije o reproduktivnom zdravlju. Da bi se intervencija prilagodila uticajima demografskih, socijalnoekonomskih i kontekstualnih faktora koji utiču na ponašanja adolescenata i na efektivnost primenjene intervencije, potrebno je ove faktore identifikovati. Cilj ove disertacije je bio da se evaluira primenjeni vannastavni program zdravstvenog vaspitanja o reproduktivnom zdravlju, u uzrastu 16 godina u AP Vojvodini, kroz ishode (znanje, stavove i ponašanja) i procenom efektivnosti putem evaluacionog SERAT instrumenta (UNESCO), kao i da se utvrdi povezanost demografskih, socijalno-ekonomskih i kontekstualnih faktora sa znanjem, stavovima i ponašanjem u vezi sa seksualnim i reproduktivnim zdravljem.Metode: Sprovedena je analiza efektivnosti navedenog programa na osnovu pre- i post- interventnog anonimnog anketiranja učenika drugih razreda srednjih škola i gimnazija u Vojvodini koji učestvuju u programu tokom 3 ciklusa (2013-2016. godina). U prvom ciklusu istraživanja obuhvaćen je 991 učenik pre i 950 učenika posle edukacije. U drugom ciklusu obuhvaćeno je 4.114 učenika pre i 4.790 učenika nakon edukacije. U trećem ciklusu, obuhvaćeno je 5.026 učenika pre, a nakon edukacije 5.230 učenika. U četvrtoj godini, u delu istraživanja koji se odnosi na evaluaciju ciljeva, principa, sadržaja i implementacije programa primenom SERAT upitnika (2016-2017. godina), uzorak je činilo 57 edukatora, donosilaca odluka i autora programa. Rezultati: Postoji značajna razlika u prosečnom skoru na skali znanja o reproduktivnom zdravlju pre i posle edukativne intervencije, tako da je ono više nakon intervencije: prvi ciklus (t=-22,881; p=0,000); drugi ciklus (t=-41,851; p=0,000); treći ciklus (t=-37,437; p=0,000). Znanje je bilo značajno veće kod učenika: ženskog pola; iz urbanih sredina; sa odličnim ili vrlo dobrim školskim uspehom u odnosu na one sa lošijim uspehom; koji pohađaju gimnaziju u odnosu na učenike iz srednjih stručnih škola; koji imaju oca ili majku sa višim nivoom obrazovanja; koji procenjuju svoje materijalno stanje kao prosečno u odnosu na one koji ga procenjuju kao dobro, osim u 2. ciklusu gde nisu uočene razlike u znanju u odnosu na materijalno stanje. U 2. ciklusu je utvrđena i pozitivna korelacija između višeg znanja i većeg broja časova edukacije. Nakon intervencije, u prvom ciklusu istraživanja značajno veći broj učenika je imao poželjan stav da momak otvoreno kaže devojci da ne želi da ima seksualne odnose ukoliko se tako oseća (χ2=9,487; p=0,002) i tražiti od seksualnog partnera/partnerke da ispita da li ima neku seksualno prenosivu infekciju (χ2=7,054; p=0,008). U drugom ciklusu istraživanja značajno veći broj učenika je imao poželjan stav da se devojka (χ2 =14,343; p=0,000) ili momak (χ2=8,563; p=0,003), otvoreno izjasni da ne želi da ima seksualne odnose ako se tako oseća; tražiti od partnera da ispita da li ima neku seksualno prenosivu infekciju ako sumnja u to (χ2=14,454; p=0,000), da se pri seksualnom odnosu zahteva da partner koristi zaštitu (χ2=27,014; p=0,000) i da se devojka (χ2 =101,132; p=0,000) ili momak (χ2=68,203; p=0,000) otvoreno izjasni da želi da ima seksualni odnos. U trećem ciklusu značajno manje učenika je navelo poželjan stav da devojka otvoreno kaže momku da ne želi da ima seksualni odnos ukoliko se tako oseća (χ2=13,568; p=0,000), značajno više učenika je navelo: da je u redu da momak otvoreno kaže devojci da ne želi da ima seksualni odnos (χ2=35,203; p=0,000), da je u redu da devojka (χ2=71,626; p=0,000) ili momak (χ2=34,323; p=0,000) otvoreno kažu da žele da imaju seksualni odnos. Prediktori poželjnih stavova u multivarijantnom modelu u većini slučajeva bili su: ženski pol, bolji uspeh u školi, pohađanje gimnazije i viši nivo samoprocenjenog socioekonomskog statusa. U drugom ciklusu pohađanje većeg broja radionica bilo je značajno povezano sa prisustvom poželjnih stavova (3 od 6 ispitivanih stavova). U odnosu na rizična ponašanja utvrđeno je da nakon intervencije nije došlo do značajne promene u seksualnim ponašanjima, izuzev u 3. ciklusu kada je značajno manji broj učenika stupio u seksualne odnose sa nepoznatim partnerom ili u vezi kraćoj od tri meseca (χ2=18,913; p=0,000). Prediktori protektivnih ponašanja (kasnije stupanje u seksualne odnose, manji broj seksualnih partnera, duže trajanje veze pre stupanje u seksualne odnose, češće korišćenje kontracepcije, ređe iskustvo prinudnog seksualnog odnosa) u multivarijantnom modelu bili su: ženski pol, poreklo učenika iz urbanih sredina, pohađanje gimnazije i viši nivo samoprocenjenog socioekonomskog statusa. Evaluacijom vannastavnog Programa „Zdravstveno vaspitanje o reproduktivnom zdravlju među srednjoškolcima uzrasta 16 godina u AP Vojvodini“ primenom evaluacionog instrumenta – SERAT, dokazali smo efektivnost programskih ciljeva, sadržaja i implementacije. Zaključak: Istraživanjem su obezbeđeni neophodni podaci i prikazana je odgovarajuća efektivnost programa koji bi se mogao primeniti kao zdravstveno-vaspitni program obrazovanja o seksualnom i reproduktivnom zdravlju, uz uvažavanje minimalnih promena imajući u vidu ove rezultate.

Introduction: There is no adequate education of young people in Serbia on reproductive health, and it is significantly endangered. In Vojvodina, the extracurricular Health Education Program about reproductive health was implemented during three cycles. In order to adapt the intervention to the influences of demographic, socio-economic and contextual factors that affect adolescent behavior, it is necessary to identify these factors. The aim of this dissertation was to evaluate extracurricular health education Program: "Health Education on Reproductive Health, at the age of 16 in AP Vojvodina” through outcomes (knowledge, attitudes, and behaviors) and assessment effectiveness through the SERAT instrument (UNESCO), as well as to determine the association of demographic, socio-economic and contextual factors with knowledge, attitudes, and behavior related to sexual and reproductive health. Methods: An analysis of the effectiveness of this program was conducted based on pre- and post-intervention anonymous surveys of students of the high schools in Vojvodina who participated in the program during 3 cycles (2013-2016). The first research cycle included 991 students before and 950 students after education. The second cycle included 4.114 students before and 4.790 students after education. In the third cycle, 5.026 students were included before and 5.230 students after education. In the fourth year, in the part of the research related to the evaluation of goals, principles, content, and implementation of the program using the SERAT questionnaire (2016-2017), the sample consisted of 57 educators, decision-makers, and authors of the program. Results: Results showed that there was a significant difference in the average score on the scale of knowledge before and after the educational intervention, so it was higher after the intervention: first cycle (t=-22.881; p=0.000); second cycle (t=-41.851; p=0.000); third cycle (t=-37.437; p =0.000). Knowledge was significantly higher among students: females; from urban areas; with excellent or very good school performance compared to those with poorer performance; who attend grammar school in relation to students from secondary vocational schools; who have a father or mother with a higher level of education; who assess their material status as average in relation to those who assess it as well, except in the second cycle where differences did not observe in knowledge with regard to material status. In the second cycle, a positive correlation was established between higher knowledge and a larger number of education classes. After the intervention, in the first cycle of research, significantly more students had a desirable attitude - a guy openly tells a girl that he does not want to have sex if he feels that way (χ2=9.487; p=0.002) and asks a partner to examine whether he/she has a sexually transmitted infection (χ2=7.054; p=0.008). In the second cycle of research, a significantly higher number of students had a desirable attitude - a girl (χ2=14.343; p=0.000) or a boy (χ2=8.563; p=0.003) openly declare that he/she does not want to have sex if they feel so; ask their partner to check if he or she has a sexually transmitted infection if he or she suspects it (χ=14.454; p=0.000), ask the partner to use protection during sexual intercourse (χ2 =27.014; p=0.000), and that a girl (χ2=101.132; p=0.000) or a boy (χ2=68.203; p=0.000) openly say that they don’t want to have sex. In the third cycle, significantly fewer students stated a desirable attitude - a girl openly telling a guy that she doesn’t want to have sex if she feels that way (χ2=13.568; p=0.000), significantly more students stated a desirable attitude - a guy openly telling a girl that he does not want to have sex (χ2=35.203; p=0.000), a girl (χ2=71.626; p=0.000) or a guy (χ2=34.323; p=0.000) openly say they want to have sex. Predictors of desirable attitudes in the multivariate model in most case were: female, better school performance, grammar school and a higher level of self-assessed socioeconomic status. In the second cycle, attending a larger number of workshops was significantly associated with the presence of desirable attitudes (3 out of 6 examined attitudes). In relation to risky behaviors, it was determined that there was no significant change in sexual behavior after the intervention, except in the 3rd cycle when a significantly smaller number of students entered into sexual relations with an unknown partner or in a relationship shorter than three months (χ2=18.913; p=0.000). Predictors of protective behaviors (later sexual intercourse, fewer sexual partners, the longer relationship before sexual intercourse, more frequent use of contraception and less frequent experience of unwanted sexual intercourse) in the multivariate model were: female, urban residence, high school attendance and a higher level of self-assessed socioeconomic status. By evaluating the extracurricular program "Health education on reproductive health among high school students aged 16 in AP Vojvodina" using the evaluation instrument - SERAT, the effectiveness of program goals, content, and implementation was determined. Conclusion: The research provided the valuable data and showed the effectiveness of the program that could be applied as a health-educational program on sexual and reproductive health, with respect to minimal changes given these results.