Lets Talk About Sex Baby - Thesis Proposal Example

Let’s Talk About Sex, Baby” Young adults are in a stage vulnerable to a variety of emotions. They belong to a life stage full of new discoveries, challenges and opportunities. Biologically, their bodies undergo a number of changes and their hormones trigger emotions that may be unfamiliar to them making it difficult to handle. Young adulthood is a time when people may need a support system to help them understand many life situations that may be difficult to process. In cases when they are left on their own to resolve their own issues, consequences may be misguided and may lead to worse circumstances. One of this may be mental and emotional anguish that affects a person’s over-all health. A need for a health promotion program for the youth is a necessary step in ensuring their health regardless of their concerns. Establishing a support group for a certain issue of concern would be highly beneficial to the growth and development of adolescents. A good health programme takes into account all dimensions of a person’s development. Ewles & Simnett (2004) summarize the various aspects needed to be addressed in health promotion. It should include the physical or how the body functions; mental or how the person thinks and makes judgments; social or how one maintains relationships; emotional or how a person manages his emotions and how he expresses it appropriately; spiritual or a person’s religious and personal beliefs, principles and ways of being at peace with oneself; sexual or the acceptance of and ability to achieve a satisfactory expression of one’s sexuality; societal or how a person relates to his society in terms of shelter, peace, food, income and his own contribution to society and finally, environmental or his physical environment which includes his housing, transport, sanitation, availability of clean water, pollution control (Ewles & Simnett, 2004). An essential approach to health promotion for the youth should include education and empowerment especially if the issues affect their self-esteem. One concern that may severely affect a young person’s over-all development is engaging in pre-marital sex and a young woman’s teen-age pregnancy. Times have changed in terms of upholding values of chastity. Nowadays, engaging in sexual behaviour has become more commonplace with adolescents and young adults. Such change in values may be caused by media, which highlights sexually promiscuous personalities and eccentric sexual behaviour for the youth to model unconsciously. Since sexual behaviour, which is obviously covert, has become more active with younger people, they run the risk of getting into unfavourable situations considering they engage in it without the proper guidance. Consequently, early and unwanted pregnancies, sexually-transmitted diseases and even the deadly HIV are on the rise. Therefore, an effective health promotion programme should be available to them to educate them on sex. However, most of the current modules in such programs do not suffice in meeting the present youth’s needs. Randomized control trials evaluating the effectiveness of primary intervention strategies within schools have found that in general, they were not successful in delaying sexual initiation, improving contraceptive use nor reducing the number of unwanted pregnancies (DiCenso et al, 2002; Wight et al., 2002). This implies that safer sexual outcomes are not enhanced by the provision of information alone, as done by most available sexual health promotion programmes (Abraham et al., 1991; Mellanby et al., 1992; Helweg-Larsen & Collins, 1994). DiClemente (2001) contends that sexual health promotion programmes for the youth is important in enhancing their knowledge about the prevention of pregnancy and STI and teaching them skills in adopting health-promoting values, attitudes and norms and honing their proficiency in sexual risk reduction skills. Schools are good sources of health information and adololescents’ contraceptive practices and therefore should encourage the improvements in the quality of such sexual health promotion programmes. Other alternatives are community-level programmes, like social/ friendship networks and social institutions like media while simultaneously providing a supportive environment encouraging the adoption and maintenance of sexual-health behaviours (DiClemente, 2001). Self-help support groups may be formed for young women to educate and empower them about sex so that they are ably guided in their decisions. Due to a felt need, concerned citizens came up with a Strategy to Address the Issue of Crisis Pregnancy (2004-2006) that identified the importance of reducing the number of crisis pregnancies through the provision of education, advise and contraceptive services to older children and presexually and sexually active youths. The National Youth Health Programme has developed “Sense and Sexuality”, a support pack and training programme that addresses the issue of sexual health with young people in youth work settings. Abel & Fitzgerald (2006) did a study gathering opinions of adolescents and young adults of the sexual health promotion and sex education programmes available to them. The respondents claimed that the programmes concentrated more on “dangers” and “risks” of sexual intercourse and failed to enhance negotiation skills or consider the contexts in which sex occurred. The participants of the study knew that public health discourses were paramount however, the implications of putting these discourses into practice may hold more potential “risks” in the reality of their daily life. What they meant was their risk to reputation and subjectivity more than risks that may occur through the non-use of contraception. Hence, the study emphasizes the need for sex education programmes to put greater effort into developing young people’s skills of assertiveness, communication and empowerment (Abel & Fitzgerald, 2006) Other models applied for sexual health promotion use Social Cognitive Theory (SCT) or Theory of Reasoned Action (TRA). Social Cognitive Theory (SCT) proposes that people’s actions are informed by their perceptions of social reality and that behavioural intentions will change with changes in social cognitions, which include beliefs, attitudes, self-efficacy and perceptions of social norms (Willig, 1999). Sexual health programmes, which use SCT to inform them, aim to change these cognitions through the provision of information. The Theory of Reasoned Action (TRA), proposes that the immediate determinant of health-related behaviour is the individual’s intention to perform it (Fishbein et al., 1991). However, intentions are not always predictive of behaviour especially when it comes to sex. For example if one has good intentions of using condoms for sexual encounters, these may easily be abandoned when he gets carried away by passion, or convinces himself that his partner is safe, or that the partner does not prefer condom use. This shows that the intention of using a condom may not hold because the decision for condom use is subject to the agreement of both sexual partners at the time of the sexual encounter, and therefore, cannot be predetermined (Abel & Fitzgerald, 2006). More health promotion models may be used in sex health education programmes. The educational approach in health promotion is not only concerned with communicating information to the concerned youth but also fostering the motivation, skills and confidence necessary to take action to improve their health. Following Ewles and Simnett’s model, health education includes the communication of information concerning the underlying social, economic and environmental conditions impacting on health. Risk factors and risk behaviours are likewise discussed. French (1990) defines health education as thus: "Health education is not about behaviour change, and it is not about overt political action to affect the determinants of health. Rather, health education is about enabling – supporting people to set their own health agendas, agendas they can implement in ways decided by themselves collectively or as individuals" Health programmes for the youth should include explanations, open discussions of implications of sexual behaviours so they may understand the consequences related to it such as physical and emotional attachment to their sexual partners, probability of pregnancy or sexually-transmitted diseases. The empowerment approach helps individuals make healthy choices by increasing their control over their physical, social and internal environments. According to Homans and Aggleton (1988), participatory learning techniques help people examine their own values and beliefs and explore the extent to which factors such as past socialization as well as social location affect the choices they make. Participatory learning techniques include group work, problem-solving techniques, client-centered counseling, assertiveness training and social skills training as well as educational drama. The self-empowerment paradigm, with its emphasis upon self-awareness and skills, echoes what Stroebe and Stroebe (1995) refer to as the therapy model of health promotion which uses a wide range of psychological techniques such as cognitive restructuring, skill training and self-conditioning in order to help individuals act upon their intentions to adopt health behaviours. In Abel & Fitzerald’s (2006) study, the students interviewed reported that the most important message they learned from their sex education classes was the theme that sex should occur in a monogamous, heterosexual, ‘committed relationship’, and that initiating sex should be postponed until this ideal relationship was achieved. Such a committed relationship is assumed to be within the bounds of ‘safety’. However, should sex happen outside a committed relationship, then they must be sure they practiced safe sex. However, there were many participants who were not yet sexually active and had difficulty relating to the topics discussed as they were not relevant in their lives. They were even unsure if the information they received would be useful to them in the future when they do become sexually active. The basic ingredient of sex education is information on the reproductive system and the discussion on risks of having sex. Having the same discussion year after year was not appreciated by the participants, making them bored and uninterested in such sexual health education programs. The participants admitted that the current programme lacked discussions on improvement of negotiating skills, strategies and techniques. For example, some participants described the need to talk with a sexual partner before engaging in sex to confirm if they have contracted STI or not in their previous sexual encounters. Practitioners of SCT, TRA and other behavioural change models are advised to add in their modules the context of the situation at hand and the nature of the relationship in negotiating protected sex (Aggleton et al., 1998). Unexpected and opportunistic adolescent sexual encounters have not been taken into account by such models (Bosompra, 2001). If achieving safer sex was merely a process of rational decision-making, negotiating skills would improve with experience. However, Thomas and Holland (1998) suggested that the ability of young people to negotiate safer sex was conditional on the individual encounter or relationship, and that successful negotiation on condom use within one relationship did not imply that, within subsequent relationships, negotiations would be successful (Abel & Fitzerald, 2006). Sex can be a very interesting and relevant topic to adolescents, however, they might be inhibited to ask the questions they need answered. A study by Forrest et al (2004) was successful in unearthing such questions using peer educators and survey questionnaires. This study was done with over four thousand 13/14 year old English adolescents. In sum, the participants expressed their “need for concrete information and advise on issues related to physical development and puberty, transmission of sexually transmitted diseases, accessing condoms and other contraception, using sexual health services, managing relationships and dealing with jealousy, love and sexual attraction; how people have sex; sexual pleasure; masturbation; and homosexuality” (Forrest et al, 2004, p. 337). The study revealed that the adolescents regard for intimate details was actually something they felt necessary to their overall development. Discussions on physical development and puberty validate their awareness about being normal and should focus on the provision of concrete and reassuring information about the rate of physical and sexual development. Knowing about the transmission of STD’s including HIV helps young people evaluate risks that come with engaging with sexual behaviours. Information about contraception should guide the young people in using condoms and the pill. It should also teach them how to manage the situation if contraception failed and how to access emergency contraception. The abovementioned topics in sexual health services may already be in place. The provision of such services should acknowledge young people’s concerns about confidentiality and ensure their awareness of rights to access both condoms and the contraceptive pill and even advice about abortion. Forrest et al’s (2004) study yielded the adolescent’s questions and concerns that were not answered in their current sex education programmes and fail to address their social and sexual realities. These young people desired information about sexual feelings, emotions and relationships. For instance, they needed to know how to form relationships and manage infidelity. They also wanted to know how to identify and deal with jealousy, love and sexual attraction. They also wanted to know how people have sex, particularly oral and anal sex, sexual pleasure/ orgasm, performance, masturbation and homosexuality. These issues are often omitted from or heavily regulated in school-based sex education because of the teachers’ concerns about their own professional competencies (Lawrence et al, 2000). The school may also adopt a more traditional focus on heterosexual biological function (Reiss, 1998). Another reason may be teaching about such details on sexuality may have legal constraints (Douglas et al,1999). Addressing these issues evidently produce tension within the guidance on sex education and promoting stable relationships and marriage. However, such issues also need to be addressed if the goal is to put the youth in a well-guided path. A proposed health education programme that is deemed successful combines the education and empowerment approach which fits Beattie’s Health Promotion Model, specifically, its bottom up approaches named personal counselling for health (PCH) and community development for health (CDH). Such approaches and model seem customized to serve adolescents and young adults in a very confusing stage in their lives. The model aims to increase individual and community empowerment which is essential in helping the youth in the healthy development of their self-concept and self-esteem. The proposed health initiative using Beattie’s PCH model levels with the youth’s position and through a process of active listening and reflection, it empowers the individual in coming up with more genuine and well-thought of decisions. Hence, more than just information being delivered on sexual health, the participants are given several opportunities to voice out their concerns and the facilitators of the programme attempt to answer them to the best of their abilities. Strategies such as discussion of case studies via role-playing and brainstorming on possible options to resolve issues engage the participants to be more interested and hence derive more learning from the programme. This is apart from the basic delivery of information via film showing, lectures from experts and experienced peers, testimonials of risk survivors and victims, etc. Talking about their own issues and concerns regarding sex may be cathartic to adolescents who find relief in unburdening their concerns to someone whom they trust without fear of being judged. Being in a support group encourages participants to think that they are normal after all since everyone else in the group have deep, inner conflicts that are just begging to be heard and understood. Such sharing amongst peers develops camaraderie and strong bonds of friendship. The demeanor of the counselor is also a significant factor that may determine the quality of participation of the group members. A well-trained practitioner who exudes warmth and unconditional acceptance is essential to the success of the programme. Developing a fulfilling relationship with one’s parent or any other significant adult likewise helps an adolescent in developing a healthy awareness of sexual development. The wisdom and guidance of a more mature and experienced adult may indeed help a young person deal with the complexities of sexual issues and concerns. Thomas & Stewart (2003) contend that “A biographical and value clarification approach is employed and works on the understanding that individual(s) have the capacity to make genuine choices. The glaring weakness is that the client may return to an unchanged environment to practice new skills. It could pose difficulties initially at least until skills are transferred to address the new problems”. Thus, such development and honing of such skills are paramount goals of the programme. The success of the proposed Sexual Health Education Programme relies on the outcome of the participants after undergoing it. Their active and relevant participation in all aspects of the programme is one measure of the programme’s effectiveness. Developing a Sex Education Health Promotion Programme is a very sensitive and complicated endeavour requiring utmost care and consideration of several factors. However, the prime beneficiary is the targeted youth, so their needs come first. The programme should be able to balance addressing the youth’s needs with societal norms and the upheld moral values and standards of the participants’ family and culture. The whole Sexual Health Promotion Programme tightly brings together concepts and applications from a variety of disciplines to ensure the mental and emotional health of the target population concerned. It is fondly wished that such a programme be offered to adolescents and young adults from different walks of life and initiatives from the private and public sectors in supporting such a programme be felt and acted upon immediately. If these requirements are met, it is bound to be a overwhelming success. Read More