A quasi-experimental study on the effectiveness of a standardized comprehensive sexuality education curriculum for primary school students

Although the importance of sexuality education has been recognized, Chinese rural students have limited access to sexual and reproductive information. This study aims to evaluate the effectiveness of a standardized comprehensive sexuality education curriculum package featuring cartoon animation on sexuality-related knowledge and skills, attitudes, and practices of primary school students. This quasi-experimental study recruited 1725 students in grades 4-6 (aged 9-13) from eight primary schools sampled as school clusters in 2020 in China. Internet-based questionnaires from three intervention schools' participants were collected after trained schoolteachers had conducted six 45-min sexuality education sessions. We performed optimal full matching and treatment effects were estimated in the matched sample by outcome regression models that further adjusted the covariates. Compared with the control group, intervention group students achieved significantly higher scores by 3.35 out of 38 and 2.02 out of 34 in knowledge- and skill-based tests and attitudinal tests, respectively. For the five self-reported practices on genital care, the experimental group showed significantly better performance than the control group in genital hygiene, by 6.92%, 22.45%, and 30.66% higher rates in the overall prevalence of three proper practices of genital hygiene, with effect sizes larger for boys than girls. Our sexuality education package effectively improved primary school students' sexuality-related knowledge, skills, attitudes, and hygiene practices. Our study suggests that the standardized curriculum package could be a promising approach to improving the quality and accessibility of sexuality education in underdeveloped rural China.