Knowledge about safe sex and the needs on providing information on reproductive health among students at the high school number 2 Hiep Hoa district, Bac Giang province in 2015

LIT LIEN HUONGKNOWLEDGE ABOUT SAFE SEXAND THE NEEDS ON PROVIDING INFORMATION ON RE PROD VC TIM HEALTHAMONG STI DENTS AT THE HIGH SCHOOL NUMBER 2.HIEP HOA DISTRICT.. 34 Table 3.9: The pro

LIT LIEN HUONG

KNOWLEDGE ABOUT SAFE SEXAND THE NEEDS ON

PROVIDING INFORMATION ON RE PROD VC TIM HEALTHAMONG STI DENTS AT THE HIGH SCHOOL NUMBER 2.HIEP HOA DISTRICT BAC GIANGPROVINCE IN 2015

GRADUATION THESIS OF MEDICALBACHELOR

Course: 2011 - 2015Supervisor: Ass Prof NGUYENTHITHUY HANH

HANOI 2015

ACKNOWLEDG FA IENTForenrost I would like to thank the Boards of Hanoi Medical Universityand Institute for Preventive Medicine and Public Health as well as theteachers in the Department of Demography for supporting me to do this graduationthesis in the most convenientconditions.

I would like to express my respectful gratitude to my supervisor Ass Prof Nguyen T1Ũ Thuy Hanli forgiving me an opportunity working with herand having the experiences, for many valuable lessons, not only inprofessional knowledge but also in life skills

I am grateful tothe students and also fortheir enthusiasm inanswering the questionnaire, also to the Boards of tire high school number 2 Hiep Hoadistrict Bac Giang province fortheir cooperation during field work

I would like to thank my friends for helping me in the progress ofstudying and completing my graduation thesis

Last but not least I would like to give many thanks to my family, especially my mother, for Iter encouragement to me instudy process as well

as support me toovercome many challengesin my life

Luu Lien Huong

TheBoards ofTraining- Hanoi Medical University

- The Boards of Training Health Research and International Collaboration - Institute forPreventive Medicine and Public Health TheDepartment of Demography

- The BoardsofDissertation Assessment

I guarantee that this is my own thesis The data and results presented in this thesis are to the best of my knowledge, true and accurate The workcontained in this study has notbeen submitted elsewhere, as panof any other degree or assignment I contend that the work presented in this thesis is my own except in instances where due references have been made to other referenced material

The author of thesisLuu Lien Huong

Human Immunodeficiency Virus infectionand AcquiredImmune Deficiency Syndrome

TheSurveyAssessment ofVietnamese YouthSexual Transmined Disease(s)

TheUnited NanonChildren's FundWorld Health Organization

1.1 Definitions and concepts • eaaaaaaaaaaa

1.1.1.Definition of adolescence

1.1.2.Definition ofreproductive health

1.1.3 Definition ofcontraceptive methods

1.1.4 Definition of safe sex

1.1.5.Contents of reproductive health education among adolescents

1.2 The situation aboutreproductive healthamong adolescents

1.2.1 In the world

1.2.2.In Vietnam

1.3 Knowledgeof adolescents aboutsafe sex

1.3.1 In the world • •••••••••a •••••••••••••••••••••••••••••••••••••••••••••••••••••••• •■•••••••••

1.3.2.In Vietnam

1.4 Information about reproductivehealth among adolescents

1.4.1 In the world • • •«••«•••••••••«•••• I«••••••••«•••• I•••••• (I •••••«••••••• •aaaaaaaeaaaaae aaaa

1.4.2 In Vietnam «•«« aw a«««*r aa ■•«« aaaa««*raa •««••• at «««faaa«(««*veat*t«aa«i««* at a««f«a >«••«»•••

1.5 The situation of education about reproductivehealth at the high

number 2of Hi ep Hoa District

CHAPTER 2 RESEARCH METHODS

2.1 Stud}’setting • •••• •••••••••• •••••••••••a

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2.4.1 Studydesign

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2.5 Variables ••••■••••••••••■••••••••••••••••••••••a* • •••a • •• aa a • •••••• ■••• 182.6 Data collection process • ••••••• • • •• a •••••• ••••• «■ ■212.6.1 Data collection tools V • •••• • • ••a••• • •• •21

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2.6.3 Data management and analysis

2.7 Bias and controlling

2.8 Ethical considerations •• 'a

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23CHAPTER 3 RESULTS•aa a»a I* 1«

3.1 Characteristics of study subjects ••••a • ••• • •••

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3.1.1.Quantitative research a a ••

3.2 Knowledge about safe sex among students

3.2.1 Knowledge about fertility andcontraceptive methods

3.2.2 Knowledgeabout safe sex and consequences of unsafesex

3.3 Theneedsofproviding information aboutreproductive health

2732343.3.1 The situation of providing information about reproductive health

3.3.2 The needs of providing information about reproductive healthamong students ••••••»• f f f w t Í t ••• «••«««••39CHAPTER 4 DISCUSSION

4.1 Lack of knowledge about safesexamong students 454.1.1 Knowledge about fertility and contraception 454.1.2 Knowledge about safesex and theconsequences ofunsafe sex 484.2 The need of providing information on reproductiveheal til 494.2.1 The limitation ofaccessing information about reproductive health

4.2.2 Tire needs ofproviding information on reproductivehealth 524.3 Limitationsof thestudy 55

APPENDIX

LIST OF TABLES

Table 3.1: Characteristic ofrespondents in quantitative study 24

Table 3.2:Characteristics of students in qualitative study 25

Table 3.3:Characteristics of interviewedteachers 26

Table 3.4: Knowledge ofstudents about fertility 27

Table 3.5: Knowledge of students about contraceptive methods 28

Table 3.6: Knowledge of students about emergency contraceptive pill (ECP) Table 3.7: Knowledge of students about safe sex and the consequences of unsafe sex 32

Table 3.8: The situation of finding ARHinformationamongstudents 34

Table 3.9: The providing of reproductive health information atschool 37

Table 3.10: The contents that students want to be informed 39

Table 3.11: The needs of providing information at school among students 42

LIST OF FIGURES Figure 3.1: The number of student thought that abortion is a contraceptive method

Figure 3.2: The knowledgeof students about STDs 33

Figure 3.3: Evaluate about knowledge of students 34

Figure3.4: The contents of reproductive health that studentsreceived 36

Figure3.5 : The information sources that students received 36

Figure3.6: The information sources that students want to receive 41

Adolescence is a transition stage between childhood and adulthood.According to World Health Organization (WHO) adolescents are youngpeople between the ages of 10 and 19 years It is characterized by tile physical, social and emotional changes in puberty The mostimportant change

of adolescents at this stage is the change of reproductive system,which makes them moresexually active than before Therefore, there is a significant rise ofthe need to be informed about reproductive health especially about safe sex among adolescents [1] However, providing information aboutthis content toadolescents is still neglected in many countries of the worlds, and Vietnamis one of them These may lead to serious consequences such as unexpectedpregnancy, contracted toSTDsor abortion if adolescents have sex

According to Survey Population and Family planning in 2013, the proportion of adolescents in Vietnam is 15.6% much higher than many other developing countries [2J Adolescents inVietnam have faced many problems

as those from many parts ofthe world Singula: mean age atsex in Vietnam is decreasing, from 19.6 in SAVY I to 18.1 in SAVY II aid the proportion of adolescents having intercourse before marriage is increasing, from 7.6% inSAVY 1 to 9.5°/« in SAVY II [3], Although the percentage of abortion in Vietnam is decreasing in recent 10 years, this percentage of adolescent tends

to be increasing, with about 20% of the total abortion cases This rate is highest in Southeast Asia and the fifth highest in the world [4], Abortion atteenager may cause some consequences, such as infection, miscaniage nexttime, secondary infertility and mental disorders [5] The proportion of adolescents contracting to HIV/AIDS was 1.8% with under 13 years old groups 4.11% with 13 to 19 years old group [6] To reduce all of these

Therefore, investigating knowledge and the needs of providinginfornntion about reproductive health among adolescents is essential toprovide them with suitable forms and contents Furthermore, there liasbeen

no research in Hiep Hoa Bac Giang a rural area about this issue Because of all reasons above, athesis named “Knowledge about safe sex and the needs

on providing information on reproductive health among students at thehigh school number 2 Hiep Hoa district Bac Giang province in 2015”was carried out withtwo main objectives:

1 To describe knowledge of students aboui safe sex at the high school number 2 ofHiep Hoa Disrrict, Bac Giang province in 2015.

CHAPTER 1 LITERATURE REMEW

1.1 Definitions and concepts

of tlieir egos and they are also affected much by the peer group opinions.Therefore, they may have many physical, mental and social problems if theyare not oriented by tire adults

UNICEF has divided adolescenceinto2 groups [8]:

Tlte early adolescence (from 10 to 14 years old): Early adolescence beginswith the rapid growth of physicalchanges and followedby tlie development ofsexorgans and reproductive characteristics

- Tlte late adolescence (from 15 to 19 years old): At this part, the body

is still developing, with a slower speed while the capacity of analyticaland reflective thought is strongly enhanced

Therefore, the ages of high school children belong to the group of late adolescence, at which the physical condition is stable, but the psychology changes strongly

1.1 J Definition of reproductive health

The definition of WHO about ‘Health” is “A state of complete physical,social and mental well-being, and not merely the absence of disease or infirmity” [9]

Following that in 1994 the International Conference of Population and Development in Cairo Egypt gave a definition of “Reproductive health" According to the 1CPD reproductive health is "A state of complete physical,mental and social well- being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and to its functionprocess Reproductive health, therefore, implies that people are able to have satisfying and safe sex life and that they have the capacity to reproduceand the freedom to decide if when and how often to do so Implicit in the last conditionare the rights of men and women to be informed and haveaccess tosafe, effective, affordable andacceptable methods of family planning of theirchoices, as well as other methods of their choice for regulation of fertility which are not against the law the right ofaccess to appropriate health care senice that women will able to go safety' through pregnancy and childbirth and provide couples with tire best chance of having a healthy infant" [10].With this definition, reproductive health consists of 3 mainaspects [11]: Physical condition: A normal reproductive system and a healthy reproductive function process

- Mental condition; Satisfying and do not worry about the reproductivesystem

- Social condition: To be respected and behaved fairly about the rights

of sex andreproduction

In Vietnam reproductivehealthcare had 10 contents They are;

- Safe motherhood

- Sexual health and education about sex

- Information, educationand communication about reproductive health

Contraceptive methods are methods usedto control fertility andto avoid unexpected pregnancy It consists of modern contraceptive methods and traditional contraceptive methods Some popular modern contraceptivemethods are condom contraceptive pill (daily and emergency), diaphragm,vasectomy andtubal ligation Some popular traditional contraceptivemethods areovulation calculator, withdrawal and lactation antenorrhea

Safe sex is tire sexual acts having protected methods to avoid unexpectedpregnancyand STDs, including HIV.AIDS[12]

Unsafe sex is the sexual acts not having protected methods, leading tounintended pregnancy andcontracted to STDs [13]

Reproductive health education among adolescents consists of severalcontents They are:

- Education aboutpubertyandmenstruation

Education about fertility and contraceptive methods, about conditionand signs of pregnancy

1.2.The situation about reproductive health amongadolescents

Over the world, in 2014 there were about 2.5 billton adolescents (under

15 years old), making up about 35% of world population [14] The situation about reproductive health among adolescents varies between countries and religions

According to a survey conducted in Europe and Uniled Nations, tire proportion ofteenagers who had ever been pregnant were 39.1/1000 womenages 15-19 in United States (2009) This figure in France (2007) was 7.1/1000, in Germany (2007) was 9.6 1000 and in Netherlands (2006) was5.3/1000 Also in this survey, in 2007 14.8/1000 youngwomen from 15-19 years old in United States had abortions [15]

According to UNICEF, among the developing countries (except China), therewere 11% of femalesand 6% of males from 15 to 19 years old.whohadsex before 15 Latin America and the Caribbean was the area that had the highest proportion of female adolescents having sex before 15 years old(22%) Thelowest rate belongedto Asia (15% for both male and female) [8]

In Nairobi, 11% of female students and 50% of male students were sexually experienced with a significant Jjroportion of students reportingmultiple sexual partnerships About 40% of sexually experienced female

srudenis and 65% of sexually experienced male students reportedhavingmore than one sexual partner with 26% of male students having more than five partners [16].

A research in two universities in Tanzania showed that the majority (70.4%) of respondents liad sexual intercourse Among them, more thanone-third started sexually activities when they were in secondaryschool or in the university and 15.8% of the respondents have had pregnancies and about half

of them had induced abortions [17],

In Thailand, astudy showedthat 36.5% offemale students and 40.7% of male students had sexual intercourse Among the 58 female adolescents whohad sexual intercourse 28 became pregnant (48.3%) Among this number.50% reported having been pregnant more than once Fourteen of the 28female studentswho got pregnant resorted toabortion (50%) [I8J

1.2.2 III t Jet II am

In Vietnam, with the decreasing in tire population growth rate and increasing inthe lifeexpectancy, the proportion of peoplefrom 10 to 19 years old fellslightly, comparing toyears ago from 18.7%in 2009 [19] to 15.6%in

2013 [14] However, reproductive health matters of adolescents in Vietnam tend to increase

The Survey Assessment of Vietnamese Youth Round 2 ($AVY H) showed that 9.5% of respondents reported that they had ever had sex before marriage, which increased 1.9% comparing to SAVY I The average age of first sex tended to decline from 19.6 years old inSAVYI to 18.1 years old inSAVY II while the singular mean age at marriage tended to increase [3] (20].Tliese results obviously demonstrated the number of adolescents having sex before marriage increased

According to Department of Maternal and Child Health, from 2010 theproportion of adolescents who are pregnant has rose This rate in 2010 2011and 2012 were 2.9%, 3.1% and 3.2% respectively Following this, tire propotlion of abortion among this ages were 2.2% (2010) 2.4% (2011) and 2.3% (2012) Although the percentage of abortion inVietnam is decreasingin recent 10 years, tins percentage of adolescent tends to be increasing, with about 20% ofthe total abortioncases This rate was highest in Southeast Asia and the fifth highest in the world [4] The proportion of adolescents contracting to HTV/AIDS was 1.8% with under 13 years old groups 4.11% with 13 to 19years old group [6],

1.3 Knowledge of adolescentsabout safe sex

1.3J In the world

Mans' researches demonstrated that knowledge about safe sex amongadolescents in theworld is still limited, especially in the developing countries [11(21]

From a research among 253 students in Tanzania, only24.3%of studentshad ever heard about condom, 16.8%had ever heard about contraceptive pill and 16.5% had everheardinjectable contraceptive method [17],

According to another studs’ among 1440 students from class 6 to 12 in India, only one-third of male students and one-fourth of female students hades'er heard about different types of contraception Two-thirds of respondents had es’er heaid about HIV AIDS, and only half of them knew exactly variouswaysof transmission HIV [22]

A studs' in Bangladesh, which was conducted in 4 secondary schools,pointed out that female and male students had poorknowledge about STDs Amajority of girl only had heard about “sexual diseases”, but did not knowanythingabout that All of the respondents recognizedAIDS as an STD [23]

In Tehran, therewere nearly 70% of female students who knew that a girl can bepregnant after havingsex for the first time This rate in males was only40.6% Nearly 69% of female students were awareof the protective role ofcondoms against HIV and 95% of the adolescent males had heard about STDsandHIV/AIDS however, misperceptionswerewidespreadamong males [24].From a study conducted in the slums in Thailand, about 63% of femaleadolescents knew about contraceptive pill, whereas 70.3% of maleadolescents did not know about them Only 4.4% to 39% of female adolescents, compared to only 0.8% to 18.6 % of males, knew aboutemergency birthcontrol pill, contraceptive injections, implant contraceptives,intrauterine devices, misoprostol, the fertility awareness method, coitusinterrupts, or vaginal douche [18].

1.3 J In Vietnam

Knowledge about reproductive health among adolescentsin Vietnam hasbeen limited They still lack basic knowledge about reproductive health issues [3|

Most ofthe adolescents do not know about the time that a girl is easy to

be pregnant According to SAW II the percentage of male and femaleadolescents who knew exactly about this time was only 7% and 18% respectively [3] This rate inBac Can province was low only 8.4% of malesand 3.8% of females know about this [25] From a research among 976students in Thai Nguyen province 66 2% of them did not know about thetime that is easy to be pregnant [26Ị This rate in Ha Nam was lower than 10% for both males and females [27] Students have mans misconceptionsabout fer tility For example, in Bac Can more than a half of respondents saidthat "Cannot bepregnant ifwe just have sex once” [25].Even in the centreof Hanoi, there were 36.5% of students had the same opinion [28]

About different types ofcontraception, the most common methods that adolescents knew is condom Most of the student knew 3 basic methods of contraception that are condom (93%) contraceptive (91%) and coitusinterrupts (76%) [29] In a stud}’ carried out in Hoai Due Hanoi, of 576 high school students, nearly 70% of them knew about condom, only 59% knewcontraceptive pill and only 39% knew about diaphragm [30] In Dong Da District, these rates were74.2%,61.s% and 16.6% respectively [28] In somestudies, knowledge about contraception among adolescents was under average In Ho Chi MinhCity, about 50% of respondents had right knowledgeabout contraception [31] This rate among students in a universityin Hue was only 42.8% [32] According to SAW n only 82% of young people claimed that we shoulduse contraception if we did not want to be pregnant [3]

The number of students answering correctly about the definition of safesex varied, from 64.7% in Hanoi to 15.9% in Bac Can [25], [28] About tlie consequences of unsafe sex, 83.3% of students knew about unexpectedpregnancy 74.3% knew about contracted to STDs and 75.6% knew aboutsuffering from Hl V/AIDS [28]

The knowledge of adolescents about STDs is quite good Three mostpopular diseases that they knew were gonorrhea (78%) syphilis (81.6%) andHIX "AIDS (91.6%) [26], A lower result was found in other research of Nguyen ThuyNga About 78.5% of students knew HIX’AIDS only 50.9% knew about syphilis and only29% knew about gonorrhea [28], Students have best knowledge about HIV with 95% of respondents couldlist all the modes

of transmission HIV [3J However,they still misconceived about the way totransmit HIX7 Particular!}', tliere were 26% ofstudents whothought tliat one

of the transmissions of HIV was through mosquito bites and 13% of them thinkingthat HIX' couldưansmitted by breathing [3]

Il is seen that there have been “holes” in the knowledge of students aboutsafe sex Therefore, they need to be informed about these issues sufficientlyand correctly.

1.4.Information about reproductive health among adolescents

Í.4./ ĨII the world.

Due to the differences of tradition and religion, adolescents in western areas aremore opened to talk about reproductiveto others than adolesceiUs in other areas, especially in eastern areas and religious areas However, whether they discussed this topic or not they still found information ofit fromseveralsources and by themselves [33]

In Egypt, the adolescents were restricted from reproductive health education Most of them received little accurate information aboutreproductive health According to a research did in 2009 less than 15% ofmales and 5% of females received enough information about the puberty atschool Tire main sources of reproductive health information that theyreceived were from mother (about 60% of female), friends (nearly 50% of males and 25% of female) and relatives (less than 10% of male students) [21Ị

A research fromNigeria showedtliat more than 73%female students had ever used the Internet to find the information about reproductive health.Except the Internet parents and teachers were two main sources of information with the in-school girls, with 66.22% and 56.15% respectively.With the out-of-school girls, the main sources of information were friends (63.18%) [33]

From a study in India, the information sources that adolescents receivedmost ofinformation about reproductive health were books in school (64.4%) television (63.8%), teachers (57.3%) The information sources that theyreceived least information were medical staff(35J%) and radio (21.3%)[22]

According to a study in New York, half (49%) of adolescents got infornntion about reproductive health on the Internet The topics most oftendiscussed were about sex (42.1%) fitness and exercise (41.6%) and sexual transmitted diseases (37%) (34]

Ỉ.4.2 Ill ỉĩetiiiun

Vietnam is aneastern country so the discussion about reproductive health among adolescents and adults is still limited In recent years, the education and communication about reproductive health among adolescents has been morepopular

According to a research in 2012 only 26.1% of female students talked totheir father about the puberty andgender 18.4% talked to fathers about STDs, 11% talked about sex, and only 7.2% of them talked about contraceptivemethods Ulis figure in males were 33.6% 25.5%, 12.3%, and 8.9% respectively [35]

Another research in Ha Tay demonstrated that the mam sources ofinformation about reproductive health that adolescents can access were books-'document (70.7%), from school (58.6%) television'movie (41.1%) Only 33.1%of adolescents received the information from parents and 11.2%

of adolescents received it from medical staff [36] In Hoai Due District, themultimedia (television, magazines,radio, theInternet) was the main source of information about reproductive health, with more than 85% of adolescentscan access The second source was from medical staff (more than 45% ofadolescents can access) andthe last was frail family and friends (more than 20%)[30]

In Ho Chi Minh City, most of adolescents(49.5%)discussed with friendsabout reproductivehealth, love and sex 36.2% of adolescents discussedwith

parans 32.4% of Them discovered by themselves Only 11.3% talked tocounselor and 43% talked to teachers [37].

When being asked about the need to be informed about reproductivehealth, contraception and safe sex 65.8%ofadolescents had demand for this People they wantedtoshare about tinsissue were parents (34.3%) counselors(33.1%) and friends (31.1%) (37) In Phu Tho province, three main sources that adolescents wanted to receive information from were medical staff(47.1%), friends (42%) and mother (36.1%) [38] In another study, the topicsthat adolescents wanted to be informed most were HIX’-AIDS (57.6%) STDs(51.2%), love and marriage (44.5%) [36] Thehigher proportionwas found in

a research did in Hanoi, with 71.6% of students wanted to be providedinfornntion about reproductive health Among many topics, they wanted toknow more about love/friendship (58.8%), safe sex (55.9%x STDs (52.4%),solutions to unexpected pregnancy(50.6%) and contraception (48.9%) [28].Withall tlie results above, there wasa high need of providing information

on reproductive health amongadolescents Investigating how this need should

be addressed from perspectives of students and their teachers will helpstakeholders to provide exactly what students want Having correctinformation can protect themselves not only in adolescence but also in tlieiradulthood

1.5.The situation of education about reproductive health at the high school number 2 ofHiep Iloa District

Hiep Hoa District is a midland region in the south - west of Bac Giang Province Hiep Hoa is 30 kilometres from Bac Giang city and 50 kilometres from Hanoi It is 201 square kilometres in area, with the population in 2009 was213.200 people

The high school number 2 of Hiep Hoa district is one offour high schools

ofHiep Hoa District,which is located in ThangTown Hiep Hoa District Bac Giang province It lias 36 classes with more than 1500 students and neatly

100 teachers Recent years, one of the most importaid missions of this school

is to educate about reproductive health but tins mission have not been completed due to many difficulties Because of this reason, a research aboutknowledge about safe sex and the need to providing information onreproductive healthamong students is a necessary and important work that isencouraged by all of teachers ofthis school

CHAPTER2 RESEARCH METHODS2.1 Study setting

The research was carried out at the high school number 2 of Hiep HoaDistrict BacGiang Province

The studyapplied quantitative andqualitative research methods

- Quantitative study: A cross-sectional study, using self-administered questionnaire

- Qualitative study: In-depth interviews and focus group discussions were held after carrying out quantitative study

2.4 J Sample size

With: n: Sample size

d=0.06: /Xbsolute precisionrequired (1-a): Confident level (95%) -»z = 1.96p: Anticipated population proponionAccordingtoprevious studies:

The proportion of adolescents who had adequate knowledge (including good and moderate knowledge) about safe sex was 42% [30 31 [ -> 11 =

The number of students involved in in-depth interviews was increasinguntil there wasnot new information anymore.In reality, there was 10 studentsjoined in-depth interview

The number ofteacher participating in-depth interviews were 4 teachersand the number offocus group discussion were 4 groups

2.43 Sampling method

Using multi-stage sampling method

- Stage 1: Choosing classes: Using clustersampling method

+ Step 1: List all classes

According to the board of president of the high school number 2 ofHiep Hoa district, there are 42 classes in the school, each grad? has 14 classes, thenumber of students in each class ranged from 31 to 45 students

The average students in each class are 35 students To have enough students, the number of classes is 520:35= 14.8 classes (consider as 15classes)

4- Step 2: Chooseclasses

Randomly choose 5 classes ineach grade from the list

- Stage 2: Choose students

In each class, choosing all students attending class, having enough inclusion criteria andagree tojoin the study

In reality, a number of students in 15 classes were 642 students

Using quotapurposed sampling method

- For in-depth interviews:

4- Choosing 10 students (5 males and 5 females), who joined the quantitativestudy before

+ Choosing 4 teachers who are teaching Biology and Ethic subject,which are related toreproductive health issues

For sycup discussion: 8 students ineach group:

+ 2 gr oups ofgrade 10(1 maleand I femalegroup)

+ 2 groups of grade 11 (1 male and I female group)

4- Because time of the study was close to the final semester examination, students at grade 12 did not join the focus group discussion

In total, there were 32 studentsinvolved in group discussion

4 Rating proficiency ill studying

4- Information about boy/girlfriend and close friend

Knowledge ofsafe sex:

4- Knowledge about fertility

4- Knowledge about typesof contraception

4- Knowledge aboutsafe sex

4- Knowledge aboutdie consequences of unsafe sex

- The situationof providing reproductive health informati on:

4- The sources that students received information

4- The contents that students received information

4- Difficulties in not findingreproductive healthinformation

4- The situation of providingreproductive health at school

- The need ofinformation about reproductive health

4 The informationsources which students wantto access

4- Tin?contents that students want to be informed

4- The way studentswant to be informedat school

previous study of Nguyen Thuy Nga[28] witheach right answer,theygained

1 point With the questions that haw more than one right answer, they gained

1 point for eachright answer This isthe way to evaluate:

point

Adequate point

Using contraceptive method to avoid

unexpectedpregnancy and STDs: 1 point

Others: 0 point

B18a List I to 3 correct method(s): 1 point

List more than 3 correct methods: 2 points

B19b Within72 hours after having sex: 1 point

The sooner thebetter: 2 point 2

l/l

Others: 0 point

B19c

Shouldnot have unprotected sex after

taking ECP: 1 point

Reduce contraceptive effectiveness: I point

Menstrua] disorders: 1 point

Unexpected piegnancy: 1 point

Contracted to HIV: 1 point

Through blood, frommo tiler to child and

having unsafe sex: 1 point7 choice

Themaximum pointofknowledge was27 points.If:

Students gained>“21 points:good knowledge

Students gained from 14 to 20 points: moder ate knowledge

Students gained less titan 14 points: not good knowledge

2.6.Data collection process

For quantitative studs: Using self-administered questionnaire designed based on the objectives of study and previous research

Forqualitative study: Using guide for in-depth interview and focus group discussion

- contact and meet wi ththe Rectorboard ofthe school toget permission forthe study,

- Prepare time schedule for data collection with people in charge of theschool

- After the investigators asked for permission to come in the class, theypresented about the study and tire objectives of the study Then they introduced students to fill 111 the questionnaire and answered students'questions if the} had Students had 20 minutes to fill in the questionnaire During Ulis time, there were 2 investigators in the class to supervise studentsand answer their questions

Quantitative stud}" Data was entered by Epldata 3.1 Software andanalyzed bySPSS 16.0 Software

Qualitative study: applied content analysis method

+ Qualitative data was collected bytaking note or recording (with the permission of the interviewees) Then the transcriptions of the interviews were typed by Microsoft Office Word software

4 Based on these transcriptions, the sam? contents was coded by samecolors and gatheredina matrix table

4 Making summary and conclusions for the analyzed data

2.7 Bias andcontrolling

Biases that may happen inthis research:

With quantitativestudy:

- Bias due to unrepresentativesample

- Response bias (because of lying and recall bias)

- Bias because of datacollection, data enterand data analysis

Controlling:

- Building questionnaire based onprevious studies, withsimple and easy understanding contents

- Training investigators beforeconducting data collecting process

- Pre- test before collecting data

Explaining for respondents about objectives of research and the importance of exact information

Check 10°«of data after entering

Withqualitative studs':

- Untrustworthy of information: Safe sex is sensitive content so biasmight happen because of lying and unreal information

Controlling:

Training investigators before conducting data collecting process

- Explaining for respondents about objectives of research and the importanceofexact information

- Making a comfortable and privacy space for in-depth interviews andfocusgroup discussions

- Checking information through different informants and differentmethods of collecting data

2.8.Ethical considerations

The research was conducted with the agreement of Department of Demography Hanoi Medical University about science aspect and ethicalissue The research was also done with the permission ofthe Rectorboard of the high school number 2 of Hiep Hoa District

The respondents were informed clearly about the aim of research and they were only involved in the research if they had agreed The information of respondents was kept in secret and only be used for the objectives of research.Tire results of tins research will be feedback to the school arid may be reported to tire stakeholders

CHAPTER 3 RESITTS3.1 Characteristics ofstuds subjects

Mother’sjob Government staff 14

Table 3.1 showed the characteristics of students in the quantitative study.About60% among 642 students were female The numberof students in each gradewas quite balance Most of the students lived with parents(92.7%) Thejobs of students' parents were fanners (nearly 80%) Around 70% of studentshad at least one close friend to share everything There were 287 (44.7%)students said that they had had lover(s) The average age that students hadlover was 15.6 years old.

interview

FGD(8students/group)

Gender

MaleFemale

55

1616

>3

3

32

Did not ask

There were 4 focus group discussions (2 male groups and 2 female groups) with 32 students at grade 10 and grade 11 involved There were 10students (5 males and 5 females) participated in tire in-depth interviews.Grade 10 and grade 11 each grade had 4 students (2 males and 2 females),grade 12had 2 students (1 male and 1 female) There were 8/10 students had

orhave liad lovers, among them, three students loved for tire first time, three students loved twice of the three times, the others loved more than three times All students lived with parents

Ot her Leader ofLi fe skills consult!nggroup 1

responsibilities Member ofLifeskills consultinggroup 2

I n thesell ool Secretary of YouthUnion 1

Interviewed teachers were 1 Biology teacher 2 Etilic teachers and ISecretary of Youth Union Tile youngest teaclier was 28 years old and the oldest was 43 years old Among 4 teachers 3 of them were members ofLife skills consult!Jiggroup in the school

3.2 Knowledge about safe sex among students.

Sexual intercourse may leadtopregnancy 223 85 1 320 84.2 543 84 6Having sex only once may lead to

The time easy to be pregnant is in the

Loss of menses is the most important sign

Table 3.4 showed the knowledge of students about fertility Most of the students (84.6%) knew that having sex may lead to pregnancy, but only50.8% of them knew that having sex only once can be pregnant Only 7.2%

of students knew about thetime that easy tobe pregnant About half (45.5%)

of students knew tliatloss of metises is the most important sign of pregnancy

In qualitative study, some students still thought that a girl cannot be pregnant if having sex onlyonce Some others thoughtthat many factors have effects onpregnancy after having sex only once, such as time, age and a girl herself

’7 think it is difficult to have pregnancy because we just have sex one time."

system IS sensitive " (Female FGD grade 11)

Most of the interviewed students did not know when a girl is easy to be pregnant If tliey knew about that time, they could not explain why It was in

the middle of menstnial cycle or they had some misconceptions about that time

Table3.5 showed The knowledge of students aboutcontraceptivemethods.Tl»e most popular method tliat students knew was contraceptive pill (53.3%),followed by condom (47.7%) The other methods were known with low propotlion (lessthan 10%).About one-third ofstudents did not know any of contraception methods About 43% thought tiiat condom was the best and safest method Around 10.4% tliought that thebest method was contraceptivepill.

In qualitative study, most of the students thought that condom is better and safer than contraceptive pillbecause condom does notaffect childbirth in future while contraceptivepilldoes Among them, few students mentioned theadvantage of avoiding STDs of condom A small number of students thoughtthat contraceptive pill is better than condom

contraceptive pill IS better And in my opinion, contraceptive pill IS better."

method

Most ofthe students (68.4%) knew that abortion was not a contraceptivemethod There were still 14.3% of them who thought that abortion was a contraceptive method About 17.3% of them did not know whether it was a contraceptive methodor not

The same result was found in qualitativestudy Most of the students knewthat abortion is not a contraceptive method However, some of them hadopposite opinions

'7 think II is not a contraception method Because contraception method is a

abortion IS a way to avoid pregnancy." (Female FGD grade Ji)

Studentsalsoknew about some consequences ofabortion It demonstrated that students were awareof the importantof avoiding pregnancy at theirages

as well as the risks iftheyare pregnant and have an abortion

Table 3.6: Knowledge of students about emergency' contraceptive pill (ECPf

In qualitative stud)', most of the students reported that they only heard about ECP name and did not know anything else about it But they can list some consequences of using contraceptive pill in general It showed that lack

of knowledge about ECPwaspopular among students

"If we lake too much, we may be infertility In the future, when we get

Using contraceptive methods to

avoid unexpected pregnancy and

STDs

146 55.7 179 47.6 325 50.9

Table 3.7 showed that almost half ($0.9%)of students knew that safe sex was using contraceptive methods to avoid unexpected pregnanes' and STDs.About rise consequences of unsafe sex 86.4% knew that we may suffer fromHIV'AIDS 80.9% knew that we mayhave unexpected pregnanes and 75.4% knew that we may suffer fromSTDs

Unexpected pregnancy 166 81.4 249 80.6 415 80.9Suffering fromSTDs 169 82.8 275 89.0 387 75.4Suffering fromHIV.'AIDS 156 76.5 230 74.4 443 86.4

The qualitative studyshowed some different results Students had variousopinions about safe sex but a fewofthem liad a rightknowledge

effectively to avoid STDs such as syphilis or HIV" UDI female student, grade

10}