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Try out PMC Labs and tell us what you think. Learn More. In addition, 32 HIV-positive CFSWs were recruited to participate in in-depth interviews 18 participated in both, 14 participated in-depth interviews only to explore reasons for extramarital sexual behaviors and inconsistent condom use.

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Try out PMC Labs and tell us what you think. Learn More. Smart Girlfriend: an interactive web-based sexual health literacy program for safe sex practice in female Chinese university students. Smart Girlfriend Screenshot: information collection of individual risk of sexually transmitted infections STIs and cervical cancer.

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Published on Authors of this article:. Background: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections.

To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. Methods: A multicenter randomized controlled trial was conducted with female university students at 5 universities with dormitories in Hong Kong.

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Participants were randomly ased to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single web of online information about condom use. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the item Multidimensional Condom Attitudes Scale MCAS.

The intention to treat was applied in analyses. MCAS scores at the 3-month follow-up were ificantly higher in the intervention group mean Conclusions: An interactive web-based sexual health literacy program did not ificantly increase the consistency of condom use compared to a single web of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use.

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Future revisions of this Vamos sex women should be personalized and delivered with a proactive approach. Trial Registration: ClinicalTrials. According to the World Health Organization WHOsexual health is a state of physical, mental, and social well-being in relation to sexuality [ 1 ]. Sexually healthy individuals have an absence of sexual or reproductive disease and a positive approach to managing respectful sexual relationships free of coercion and violence, thereby exhibiting safe sexual behaviors.

Sexual health helps prevent sexually transmitted infections STIs and the human papillomavirus HPVthe second leading cause of cancer deaths among women globally [ 2 ], which the WHO proposed as a key global health sector strategy for [ 3 ].

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studies have indicated the important role of health literacy in promoting sexual health [ 4 - 6 ]. Health literacy is a form of empowerment to enhance individuals' capacity to access, understand, communicate, and process health information and services to make appropriate health decisions [ 7 ].

Sexual health literacy is the ability to understand preventive sexual health information to make informed choices, increase safe sex practices eg, promoting condom use, limiting the of sexual partners, avoiding causal sex, and enhancing sexual communication and negotiation skills with Vamos sex women to sex refusal, condom use, and a partner's STI historyand reduce STI risk [ 4 ].

Low sexual health literacy is related to poor sexual health decision-making among university students, Vamos sex women engaging in risky sexual behaviors such as inconsistent condom use and delays or difficulties in seeking care [ 5 ]. Young adults might generally have good health and thus may not fully understand the importance of sexual health assessment in the absence of obvious symptoms, particularly after engaging in risky sexual behaviors [ 6 ]. Due to increasing trends of premarital sex and unsafe sexual behaviors [ 8 ], technologically advanced dating apps [ 910 ], and engagement in compensatory dating and casual sex [ 11 ], the risks of STIs and cervical cancer in female university students is high.

Therefore, it is paramount that female university students have adequate sexual health literacy to facilitate safe sex practices, which yields better sexual health. In this study, we operationalize sexual health literacy as individuals' capacity to understand risk information about unsafe sex practices and communicate with sexual partners to make optimal decisions and maintain sexual health.

sexual health literacy interventions focused on specific groups of people, such as a minute face-to-face interactive class for HIV-positive people [ 12 ] and a hour face-to-face intervention for jailed females to prevent cervical cancer [ 13 ]. However, few interventions targeted young females in the general population to prevent common STIs. Moreover, regarding the intervention content, it has been increasingly recognized that interventions should go beyond biophysical content, such as human development and contraception skills, by also including sociocultural content, such as respectful relationships and sexual coercion [ 14 ].

Research on effective interventions addressing sexual coercion and safe sex is limited, even though freedom from sexual coercion is a key conceptual component of good sexual health [ 15 ]. The internet was the most commonly accessed source for sexual health information in young adults [ 16 ]. A web-based sexual health intervention has some potential advantages over a traditional face-to-face intervention, including the capacity to reach a larger of people in the population with a relatively low cost and facilitating communication with full privacy and confidentiality [ 16 ]. Moreover, a web-based intervention's interactive and anonymous delivery is more acceptable and effective [ 17 ]; a Cochrane meta-analysis evaluating 15 randomized controlled trials RCTs on safe-sex practice interventions found the interactive computer-based interventions to be Vamos sex women effective at improving knowledge about Vamos sex women health [ 18 ].

In this study, we have developed an interactive web-based sexual health literacy intervention to promote safe sex practices.

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The sexual health status of young women in China is generally poor [ 19 ], and Vamos sex women level of sexual health knowledge was poorer than what was reported for young women in Western countries [ 20 ]. Young women are also vulnerable to risky sexual behaviors [ 21 ]. A national survey found that 1.

Sexual health interventions in Hong Kong have lagged far behind that of many other places [ 26 ]. Moreover, sexual health interventions in Hong Kong often focus primarily on physiological knowledge and the dissemination of STI and STI-prevention information; little attention is paid to the effects of gender-power dynamics on sexual health, such as sexual coercion, respectful relationships, and sexual communication and negotiation [ 26 ]. However, a growing body of literature shows that the more sexual communication and negotiation that occurs before sex, the more likely a condom will be used during sex [ 27 ].

Sexual coercion is highly related to unsafe sex practices [ 28 ]. Taken together, these facts emphasize a need to revisit, develop, and evaluate comprehensive sexual health literacy interventions in the Chinese context. This program is an interactive web-based intervention that aims to disseminate knowledge about Vamos sex women and Vamos sex women use, communication and negotiation about condom use, and sexual coercion in daily life to enhance safe sex practices among female university students in Hong Kong.

Our sample size calculation was based on a primary comparison of behavioral change in the consistency with condom use. To conservatively detect a small Cohen effect size of 0. In total, female university students across various disciplines and years of study were screened from 5 universities with dormitory or residential halls in Hong Kong.

Of these, students were recruited. The eligibility criteria were 1 female university students aged 18 years or above who 2 are able to read Chinese or understand Cantonese, 3 are unmarried, 4 have been with intimate partners ie, current and former dating partners or partners in a relationship in the past 12 months, and 5 have not received any sexual health information including formal face-to-face or online education or training courses related to contraceptives and sexually transmitted diseases, from a university, hospital, clinic, or nongovernmental organization in the past 12 months.

The exclusion criteria were 1 an unwillingness to complete the questionnaires at 3 time-points, 2 being pregnant or postnatal, and 3 having a psychiatric illness.

Students were reached via leaflets, campus booths, bulk s, and posters. All interested participants received an invitation to log into the Smart Girlfriend web Multimedia Appendix 1 - 3. Online enrolment was used to screen students for eligibility. For eligible participants, written informed consent was obtained online, followed by a baseline questionnaire. After completing the questionnaire, the recruited participants were randomized to Vamos sex women the intervention group or the control group, according to a list prepared by blocked randomization with blocks of 4with a randomization ratio.

The block size and order of allocation were kept securely in the randomizer to avoid selection bias. The online platform conducted masking and allocation concealment according to the participants' enrolment sequence.

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Participants were automatically guided to the web associated with their allocation and were not aware of the group allocation in advance. The privacy of all participants was ensured. Data collected from all questionnaires were stored in a protected university database.

Therefore, we conducted an intervention to help enhance the awareness of sexual coercion among university students. Sexual issues are typically taboo subjects in Chinese culture; therefore, to minimize embarrassing situations for participants, we implemented the Dating Compassion, Assessment, reFerral, and Education Dating CAFE Ambassador Programme to help Chinese university students with dating violence.

The intervention's development was based on the theory of planned behaviors and was conducted via 3 face-to-face workshops totaling 7. Compared to Vamos sex women in the control group, we found that the students trained to be ambassadors had ificantly enhanced behavioral intentions and control to help peers who were experiencing dating violence, decreased acceptance of dating violence, and increased subjective norms for helping others [ 31 Vamos sex women. Moreover, we learned that discussions about dating issues were attractive and acceptable among university students.

In addition, the face-to-face intervention was labor-intensive, and some students could not be enrolled due to timetable clashes.

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Thus, Vamos sex women web-based intervention could be a more cost-effective and practical approach for reaching as many eligible young people as possible. Smart Girlfriend is deed to be a sexual health literacy intervention empowering female university students with enhanced knowledge, attitudes, norms, and self-efficacy around managing sexual health, particularly condom use for safe sex practice.

In the first phase, participants were able to check their perceived susceptibility and perceived severity for individual STIs. Respondents obtained personalized from their answers, including factors that may increase or reduce their risk of getting STIs and cervical cancer. In the second phase, participants were given knowledge-based information about STIs and cervical cancer in text format, including relevant statistics, development, possible symptoms, and prevention methods. Some scale-based questions were asked to help the students think about the positive and negative features of condom use.

Participants were Vamos sex women to offer personal feedback and were provided with an opportunity to reflect on which benefits or barriers mattered most to them Figure 2. In the second phase, participants were also prompted to take action regarding condom use.

Associated data

Therefore, condom use procedures and tips, as well as web links for local STI testing, cervical screening programs, and HPV vaccination programs, were provided. In addition, participants' self-efficacy in condom use was enhanced by providing information about assertiveness in sexual consent and sexual communication to avoid sexual coercion and casual sex.

Three 5-minute videos were created with narrative stories about STIs and HPV infection based on different scenarios relevant to common situations for university students, about the handling of sexual consent in dormitories, engaging in sexual communication at home, and talking to a friend about worries regarding sex without a condom after a Christmas party Multimedia Appendix 2.

The Continuum of Conflict and Control CCC theory [ 34 ] was used to guide the stories, emphasizing that sexual coercion can occur without physical violence and with minimal fear to strengthen participants' knowledge about sexual coercion, sexual consent pertaining to condom use, and sex refusal. Participants were able to assess their own values and receive feedback on their choices. Textbox 1 shows the perceived benefits of and barriers to condom use featured in the interactive intervention.

In the last phase, a deed to summarize the participants' individual factors for facilitating decision-making about consistent Vamos sex women use in future sexual activities was presented. Participants were asked to rate their level of self-efficacy in terms of knowledge, skills, clarity of information, and perceived support and advice on a scale of If the participant's level of self-efficacy was lowthey were directed to relevant information via Vamos sex women. In the control group, participants received minimal intervention, with only a single web of online information about Vamos sex women and tips for condom use.

The site for the control group had a similar graphic de to the one used for the intervention group, but no self-assessment material or online quiz questions were presented. An inquiry system was created to handle questions from the participants. This system was deed to help participants in both the intervention and control groups if they needed any support or wanted to seek further clarification.

The time spent engaging with the online information was approximately 30 minutes for the intervention group and 10 minutes for the control group.

An interactive web-based sexual health literacy program for safe sex practice for female chinese university students: multicenter randomized controlled trial

All data were collected from the web. Participants were sent a reminder and SMS text message for completing the online questionnaires at 3 time-points: baseline T1 ; 3-months postintervention T2 ; and 6-months postintervention T3.

The primary outcomes were the consistency of condom use with every partner, in accordance with the recommended guidelines of a systematic review of 56 studies [ 35 ], which used the percentage of male condom protected sex with every partner during the past 3 months.

Secondary outcomes were 1 knowledge, attitudes, norms, and self-efficacy of Vamos sex women use, as appraised by the item Multidimensional Condom Attitudes Scale MCAS [ 36 ]; 2 knowledge, attitudes, norms, and self-efficacy of Vamos sex women coercion and sexual consent, as measured by the item Sexual Consent Scale—Revised SCS-R [ 37 ]; and 3 self-efficacy in sexual communication, estimated by the item Sexual Communication Self-efficacy Scale SCSES [ 38 ]. The MCAS items were answered using a 7-point Likert scale, and total scores ranged from 7 to ; a study has shown acceptable validity and reliability in the Chinese population [ 39 ].

The Cronbach alpha in this study was. The SCS-R contained 3 attitudinal subscales positive attitude toward establishing consent, lack of perceived behavioral control, and sexual consent norms and 2 behavioral subscales indirect consent behaviors, and awareness and discussion. With the exception of one of the SCS-R subscales lack of perceived behavioral controlhigh scores on the scales indicated a high level of measured outcomes.

Other outcomes included participant inquiries, participant satisfaction, and participation in the intervention. Participants' inquiries were collected to understand their further needs.

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Satisfaction with the intervention was evaluated by recording the overall satisfaction of the intervention on a scale of In addition, participants were asked which part of the intervention was most memorable. The higher the score, the higher the overall satisfaction with the intervention.