On-site comprehensive curriculum to teach reproductive health to female adolescents in Kenya

Background: Rates of sexually transmitted infections (STIs) and unplanned pregnancy are high in Kenya, and limited reproductive health education exists in schools. Methods: We designed and implemented a 6-week reproductive health curriculum in Laikipia District, Kenya, in 2011, which included didactic sessions, educational games, and open discussions. We applied a mixed quantitative and qualitative methods to evaluate this curriculum including a comprehensive 35-item survey to assess pre-and post-training knowledge, attitudes, and practices of female teenagers regarding STIs/HIV and family planning using paired t-test as well as complementary focus groups (n=42) and individual interviews (n=20). Results: Average age for 42 female teenagers was 16.5 (±1.31) years. Pre-test questionnaires revealed lack of knowledge about different types of STIs, specifically chlamydia, but adequate knowledge of basic contraception including abstinence and condom use. By the conclusion of the study, we observed improvement in following educational domains: general knowledge of HIV/AIDS (85%±7.5% to 94%±5.6%) (p<0.001); general knowledge of teen pregnancy and STIs (57%±19% to 82%±13%) (p<0.001); and overall scores of knowledge, attitude, and self-efficacy (81%±6.6% to 90%±5%) (p<0.001). Focus group discussions, however, revealed persistent misconceptions and knowledge gaps with themes regarding HIV transmission risk factors, perceived difficulty negotiating condom use, masturbation and its perceived consequences, and issues surrounding female circumcision. Conclusions: Important misconceptions and gaps in reproductive practices were identified and addressed using a mixed methods approach. Despite prior basic knowledge and positive attitudes on STI prevention and family planning, complementary teaching approaches were instrumental in improving overall knowledge of STIs other than HIV as well as family planning. The curriculum was feasible, well received, and achieved its educational goals.