An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial

Janet Yuen-Ha Wong, Wen Zhang, Yongda Wu, Edmond Pui Hang Choi, Herman Hay Ming Lo, Wendy Wong, Jasmine Hin Man Chio, Hau Lin Cherry Tam, Fei Wan Ngai, Marie Tarrant, Man Ping Wang, Hextan Yuen-Sheung Ngan, Daniel Yee-Tak Fong, Janet Yuen-Ha Wong, Wen Zhang, Yongda Wu, Edmond Pui Hang Choi, Herman Hay Ming Lo, Wendy Wong, Jasmine Hin Man Chio, Hau Lin Cherry Tam, Fei Wan Ngai, Marie Tarrant, Man Ping Wang, Hextan Yuen-Sheung Ngan, Daniel Yee-Tak Fong

Abstract

Background: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China.

Objective: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called "Smart Girlfriend" for female Chinese university students.

Methods: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses.

Results: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI -1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI -5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02).

Conclusions: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach.

Trial registration: ClinicalTrials.gov NCT03695679; https://ichgcp.net/clinical-trials-registry/NCT03695679.

Keywords: eHealth; health literacy; sex education; sexual health; women's health.

Conflict of interest statement

Conflicts of Interest: None declared.

©Janet Yuen-Ha Wong, Wen Zhang, Yongda Wu, Edmond Pui Hang Choi, Herman Hay Ming Lo, Wendy Wong, Jasmine Hin Man Chio, Hau Lin Cherry Tam, Fei Wan Ngai, Marie Tarrant, Man Ping Wang, Hextan Yuen-Sheung Ngan, Daniel Yee-Tak Fong. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.03.2021.

Figures

Figure 1
Figure 1
Conceptual framework of the Smart Girlfriend program based on the Health Belief Model. STIs: sexually transmitted infections.
Figure 2
Figure 2
An example of a scale-based question asked by Smart Girlfriend to help students think about the positive and negative features of condom use and provide an opportunity for feedback and reflection on what matters most to them. STIs: sexually transmitted infections.
Figure 3
Figure 3
CONSORT flow diagram.

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