Interpersonal Barriers and Facilitators to Sexual and Reproductive Health Education in the Southern US Público
Hultman, Chloe (Spring 2023)
Abstract
Background: This exploratory qualitative study examines the major barriers and facilitators to sexual and reproductive health (SRH) education in the Southern US, defined topographically and socio-culturally as comprising 11 states/regions: Eastern Texas, Eastern Oklahoma, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Northern Florida, Georgia, South Carolina, and North Carolina. AIM: This study was conducted to answer the research question: “What barriers or gaps did participants face in meeting their SRH educational needs, and what facilitated having these needs met?” Methods: Participants were SRH professionals and undergraduate and graduate students interested in the SRH field. Participants were all purposively sampled adults who resided in Southern states and were recruited through snowball sampling in social networks and online. A team of four researchers conducted semi-structured in-depth interviews (N=16; 50% SRH professionals and 50% students) via videoconference software Zoom. Audio was transcribed verbatim using HappyScribe™ and transcripts were de-identified. The thematic analysis was conducted with MAXQDA using deductive and inductive codes. Results: Major barriers to SRH education were identified including emotional activation in pivotal experiences and social norms and external barriers, such as lack of educational spaces and logistics of continuing education. Major facilitators included supplementary resources, formal professional training, organized and facilitated educational interventions, and reflexivity of personal beliefs. Conclusion: Formal education and experiential learning were found to be significant in the SRH profession, and inclusive, evidence-based, and comprehensive SRH education is essential for the general public. This research study emphasizes the need for personalized, curated community spaces – online or in person – that include diverse identities, foster open dialogue, and are free of judgment, shame, and stigma. Future research should investigate the impacts of shame, fear, social scripts, and ostracization in SRH education. Future intervention recommendations include reevaluating laws and policies on sexual education curriculum, and developing online educational interventions for both SRH professionals and the general public that is free, inclusive, comprehensive, and evidence-based. Moreover, funds and workforce should be allocated to monitor and evaluate the efficacy and impact of these interventions and improve them regularly.
Table of Contents
Introduction.......................................................................................................................................................................1
Literature Review.................................................................................................................................................................2
Methods..............................................................................................................................................................................3
Results................................................................................................................................................................................4
Barriers...............................................................................................................................................................................4
Facilitators..........................................................................................................................................................................4
Conclusion..........................................................................................................................................................................4
Literature Review...............................................................................................................................................................5
Defining the Southern US.....................................................................................................................................................5
Figure 1. Census Regions and Divisions of the United States....................................................................................................6
Figure 2. The United States “Bible Belt” .................................................................................................................................7
Sexual and Reproductive Health in the Southern US..............................................................................................................7
How Sex “Became” Immoral: Evangelical Purity Movement in the United States.....................................................................9
Sexual Health Educational Curriculums in the US................................................................................................................11
Impact of Abstinence Only Education vs Comprehensive Sexual Education............................................................................12
Out-Of-School SRH Education............................................................................................................................................14
Impact of SRH Education....................................................................................................................................................15
Methods............................................................................................................................................................................16
Setting of Researchers.........................................................................................................................................................16
Positionality of Researchers................................................................................................................................................17
Study Population and Setting..............................................................................................................................................17
Study Design, Sampling, and Participant Recruitment..........................................................................................................18
Tools, Data Collection, and Data Storage............................................................................................................................19
Analysis.............................................................................................................................................................................21
Theoretical Frameworks.....................................................................................................................................................21
Figure 3. The Systems Health Equity Lens (SHEL) .................................................................................................................22
Figure 4. ETR’s Health Equity Framework.............................................................................................................................23
Institutional Review and Ethics...........................................................................................................................................23
Results..............................................................................................................................................................................24
Barriers to Education..........................................................................................................................................................24
Interpersonal Barriers to SRH Education...............................................................................................................................24
Interpersonal Barrier to SRH Education #1: Emotional Activation and Pivotal Experiences.............................................................24
Interpersonal Barrier to SRH Education #2: Social Norms..........................................................................................................29
External Barriers to Education: Lacking in Educational Spaces + Further Education.................................................................32
External Barrier to SRH Education #1: Lacking Educational Spaces.............................................................................................32
External Barrier to SRH Education #2: Logistics of Continuing Education.....................................................................................33
Facilitators to SRH Education: New Ways of Getting Education........................................................................................34
Education Facilitator #1: Supplementary Resources: Media, The Internet, & Online Community Spaces....................................34
Education Facilitator #2: Formal Training: Comprehensive, Evidenced-Based, & Experiential...................................................37
Education Facilitator #3: Organized and Facilitated Educational Interventions........................................................................38
Education Facilitator #4: SRH-positive Dialogue: Undoing Early Fear and Shame.....................................................................39
Education Facilitator #5: Reflexivity of Beliefs.......................................................................................................................41
Discussion..........................................................................................................................................................................43
Public Health Implications...................................................................................................................................................46
Strengths............................................................................................................................................................................48
Limitations.........................................................................................................................................................................49
Conclusion.........................................................................................................................................................................50
References.........................................................................................................................................................................52
Appendix A. Stratification of Quantified Resource Type, Resource by Educational Purpose, & Formality of Resources...59
Appendix B. Student Key Informant Interview Guide........................................................................................................59
Appendix C. Non-Student Key Informant Interview Guide................................................................................................62
About this Master's Thesis
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