Internet-based Intervention to Prevent Risky Sexual Behaviors in Mexican Adolescents
Condition: Adolescent Behavior
Study type: Interventional

Summary: 
      The objective of this study is to design and evaluate an internet-based educational strategy
      to prevent sexual risk behaviors in Mexican adolescents. Methods: A field trial with one
      intervention and one comparison group, with ex-ante and ex-post measurements will be
      conducted in 2 public secondary schools. Adolescents between 14 and 15 years of age will
      participate. The intervention will be conducted in one school and the other school will serve
      as a comparison group, where investigators will observe the usual sexual education that the
      school provides. The intervention will be delivered through an internet web page; it includes
      four educational sessions that will be provided during a four-week period. The follow up will
      last three-months. The information on the study variables will be obtained through an
      internet-based self-applied questionnaire and collected on three occasions: when the
      adolescents enters to the study (baseline), once intervention is completed (at one month) and
      after three months of follow-up (at fourth month).
    

Detailed description: 
      The conceptual framework for the intervention and educational materials was based on the
      model of the Information-Motivation-and-Behavioral-Skills proposed by Fisher and Fisher,
      2000. This model emphasizes that adequate information regarding risk sexual behavior,
      changing the motivational component and training in behavioral skills can influence
      initiation and maintenance of protective sexual behaviors.

      The research group that was constituted by a pediatrician, a psychologist, and a sociologist,
      designed the educational materials. All the research team members have experience in
      educational interventions. The academic basis to develop the materials were two books titled:
      "You, your life, your dreams" developed by International Family Care (2007) and "Your future
      in freedom, for responsible sexuality and reproductive health" published by the Government of
      the Federal District and the Secretary of Education of the Federal District of Mexico City
      (2008). Investigators also took into account the statistics on the sexually transmitted
      diseases and adolescents' pregnancies of the World Health Organization, 2012 National Health
      and Nutrition survey, the National Register of AIDS cases, and information from the Planned
      Parenthood Federation of America.

      Investigators designed teen-friendly educational materials, to do so, investigators used
      "avatars" from www.bitstrips.com, which are the comics for teenagers. Investigators created
      two central characters a teenage boy and a teenage girl who present the information in the
      form of dialogs and talk about their own and friend's experiences.

      Two experts in the area of adolescents' sexual and reproductive health reviewed the
      educational materials; then, 20 adolescents between 14 and 15 years participated in three
      rounds of pilot testing. Both, the teenagers and their parents accepted to participate in
      this phase through verbal informed consent.

      Investigators used the snowball sampling technique to choose the teenagers that took part in
      the pilot phase, which included ten boys and ten girls, with an average grade point of 8.5
      (range 8.0-9.0). Their families were of different types (nuclear, single-parent, extended),
      and their parents had varying levels of education. Most adolescents (18) had not begun sexual
      activity, and only two reported being sexually active. Experts and teens were asked if the
      educational information was clear, understandable and if it used appropriate language for
      teens, or if it was contradictory, uncomfortable, or boredom. The teens were asked to
      evaluate whether they liked or not each educational session (using a scale of 1 to 3, where 1
      = No, I do not like it, 2 = I like it more or less, 3 = I like it) and to explain why they
      disliked the educational information. The final version of the educational material was
      produced taking into account the comments and suggestions of experts and teens, which rated
      the information highly. Although most adolescents who participated in the pilot testing had
      not started their sexual life, they reported that the information was clear and interesting.

      Description and evaluation of the intervention The study materials are available on the
      Internet web page (http://tu-ssexual.com), which can be accessed with the participant e-mail
      address and a centrally assigned password.

      The intervention will include an introduction and four educational sessions and will last one
      month (one session per week) followed by a three-month follow-up. Teens will be allowed to
      access to a weekly session at any time and as often as he/she likes. However, the sessions
      will be consecutive, so teens cannot be able to access to the next session without finishing
      the previous one. Each session has the duration of one hour on average and ends with overview
      questions. Additionally, at the end of the each session teens will be asked ¿what they like
      and dislike about the session? And the answers will be recorded in the study database.

      Furthermore, during the intervention and follow-up booster e-mail messages will be sent to
      the teens of the intervention group. "Booster messages" will emphasize main points of the
      educational sections and will be sending 2-3 per week from the second week of the
      intervention.

      Information on the study variables will be obtained through the internet-based self-applied
      questionnaire and collected on three occasions: when the adolescents enters into the study
      (baseline), once the intervention is completed (at one month) and after three months of
      follow-up (fourth month).
    

Intervention name(s): Internet-based educational intervention
Intervention type(s): Behavioral
Intervention description(s): The intervention will include four educational sessions about risky sexual behaviors and its prevention. The intervention will last one month (one session per week) followed by a three-month follow-up. Teens will be allowed to access to a weekly session at any time and as often as he/she likes.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: internet-based educational intervention; risky sexual behaviors; prevention