Single and Multi-message Sexuality Education: Improving Implementation and Evaluation of Group-based Programs

Objective: In this study, we isolated primary messaging strategies of sexuality education curricula to improve tailored delivery of group-based interventions. Specifically, our aim was to define single-message programs (eg, messaging about avoiding sexual risk or messaging about reducing sexual risk) and multiple-message programs (eg, avoiding sexual risk and reducing sexual risk), and to investigate their comparative effectiveness. Methods: We used a descriptive approach with publicly available data from US Department of Health and Human Services-funded teen pregnancy prevention programs to categorize 16 different curricula as single-message or multiple-message. We coded primary messages using a curriculum mapping rubric and scoring that was evaluated by a panel of experts for content validity. Forest plots compared behavioral outcomes. Results: Scores for primary messages achieved inter-rater reliability of 91%-100%; curricula were scored on 20 items within each category to calculate mean scores. Spearman correlations for items ranged from .43 to .93. Conclusions: No outcome differences were observed between single- or multi-message programs. Effective delivery of primary messaging may rely more on identifying moderators of classroom climate typically underrepresented in evaluations of school-based programs.