A cluster randomized trial of a sex education programme in Belize, Central America.

Background: Concerns about adverse consequences of early childbearing and risk of sexually transmitted diseases (STD) have renewed interest in the sexual behaviour of adolescents in developing countries, where they represent a large proportion of the population and are at highest risk. To date, little is known about the sexual knowledge of adolescents in developing countries. This study's primary objective was to evaluate the effectiveness of a responsible sexuality education programme (RSP) in changing knowledge associated with sex and sexuality; secondary objectives were to evaluate changes in attitudes and behavioural intent.

Methods: A cluster randomized design randomizing high school classes in Belize City. Subjects were 13-19 years old.

Results: Seven schools in Belize City were selected; 8 classrooms were randomized to the intervention arm and 11 classrooms to the control arm (N = 399). The intervention was associated with two more correct answers on the post-test (difference score was 2.22 points, 95% CI = 0.53, 3.91) after adjusting for gender and previous sexual experience. After controlling for gender and previous sexual experience, the intervention was associated with no change in the attitudes (0.06, 95% CI: -2.89, 2.82) or behavioural intent domains (0.84, 95% CI: -1.12, 2.46).

Conclusions: Greater changes in knowledge were observed in the intervention group than in the control group following the intervention. Changes were not observed for the attitude or behavioural intent domains. These results and the results of similar studies may be used to further improve sex education programmes as it is imperative that students have access to the information necessary to make informed decisions regarding their sexual health.