Bridging the Gap Between Family Medicine and Adolescents: Creating Opportunities Through Sex Education.

Introduction: Despite school sex education programs defined by law and a national healthcare service with dedicated family planning appointments, the number of teenage pregnancies in Portugal remains significant. The implementation of these programs has been found lacking and a disconnection between adolescents and primary healthcare has been identified. Adolescents have low literacy in contraception, with males being less involved and informed. With this project, the authors sought to propose an alternative approach to school sex education, aiming to improve the global knowledge and adequate use of contraception methods by teenagers.  Material and Methods: Single-arm prospective interventional study was done to assess the impact of a new model of sexual education learning on adolescents' knowledge and use of contraception methods. A 30-minute lecture was developed by Family Medicine residents focusing on the main aspects of contraception and sexual education, using informal language and slideshow presentations. A form using "Yes/No", "True or False", multiple answer, and Likert scale questions was built to assess attitudes and levels of literacy. Two time points were defined to assess the impact of the intervention, applying the form before and one month after the lecture. Four high schools were invited to enter the study, with 190 students enrolled after personal and guardian authorization. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was used to perform statistical analysis.

Results: A total of 190 participants aged between 14 and 19 years answered both forms. A high 73.7% reported never having had a family planning appointment, with "Not knowing about the possibility" and "Not feeling comfortable with" being the main reasons; 26.3% were sexually active, from which 44% admitted having had intercourse without any kind of protection. Regarding sources of information about contraception, "School," "Internet," and "Friends" were the most prevalent, with only 43% considering the healthcare providers a source. In the contraceptive literacy evaluation, the participants overestimated their knowledge pre-intervention; however, this gap was attenuated in the second evaluation. Moreover, there was a statistically significant improvement in literacy between assessments for all genders. After the intervention, 40.6% reported discussing contraception outside the classroom.  Discussion: The low attendance of the family planning appointments and the low number of participants that considered healthcare services as a source of information in contraception conveys the idea that primary healthcare does not play the desired role in disseminating reliable information on contraception among teenagers. This is concerning considering the overestimated knowledge, low literacy, and risky behaviors identified. The intervention managed to improve the teenagers' literacy while reinforcing the importance of family planning appointments and inciting dialogue among the participants.  Conclusion: This project presents an alternative to current school sex education models and focuses on streamlining communication by resorting to younger communicators, scientific but informal messaging, and short sessions. While extended research comparing against the set models needs to be done, it poses an opportunity to bring adolescents closer to primary healthcare while gathering data to improve clinical practice.