ReReki: The Effectiveness of a Gamified Sexual and Reproductive Health Education in Malaysian Adolescent Boys
Main Article Content
Abstract
Introduction: About one-third of Malaysian adolescents are engaged in sexual activities before the age of 14 that could negatively affect their health. This study aimed to evaluate the effectiveness of a gamified sexual and reproductive health education (ReReki) to mitigate early sexual activities amongst Malaysian adolescent boys. Materials and methods: A gamified ReReki module was developed by using the Analysis, Design, Development, Implementation and Evaluation model, along with the Theory of Planned Behaviour. An experimental study was subsequently conducted with 257 adolescent boys, who were assigned to either an experimental (n=130) and control (n=127) groups. The experimental group was exposed to five gamified ReReki modules. Sexual intention (SI) towards pre-marital sex, self-efficacy (SE) on performing sexual activity, social norms (SN) on pre-marital sex, permissive attitude (PA) towards pre-marital sex and knowledge (KN) on SRH were assessed at baseline (P1), immediately after the intervention (P2) and 10 weeks after the intervention (P3). Results: The gamified ReReki module showed significant reduction in the SI score from P2 to P3, with a small effect (ηp2 =0.037, p<0.013), SE score reduced from P1, P2 to P3 with large effect (ηp2 =0.210, p<0.010). The SN score reduced from P1, P2 to P3, also with a large effect (ηp2 =0.104, p<0.010) and the PA score reduced from P2 to P3 with a small effect (ηp2 =0.048, p<0.002). Conclusion: The gamified ReReki module was found to reduce the risk factors such as SI, SE, SN and PA it may be useful in SRH education for adolescent boys in various settings.
Downloads
Article Details
References
Kaplan DL, Jones EJ, Olson EC, Yunzal-Butler CB. Early age of first sex and health risk in an urban adolescent Population. Journal of School Health [Internet]. 2013 Mar 21 [cited 2021 Mar 27];83(5):350–6. Available from: https://pubmed.ncbi. nlm.nih.gov /18048793/ doi: 10.1111/josh.12038. PMID: 23517003.
Sandfort TGM, Orr M, Hirsch JS, Santelli J. Long-term health correlates of timing of sexual debut: Results from a National US study. American Journal of Public Health [Internet]. 2008 Jan [cited 2024 Jan 12];98(1):155–61. Available from: https://pubmed. ncbi.nlm.nih.gov/18048793/ doi: 10.2105/AJPH.2006.097444. Epub 2007 Nov 29. PMID: 18048793; PMCID: PMC2156059.
Garofoli M. Adolescent substance abuse. Primary Care: Clinics in Office Practice [Internet]. 2020 Feb [cited 2024 Jan 12];47(2):383–94. Available from: https://pubmed.ncbi.nlm.nih.gov/32423721/ doi:10.1016/j.pop.2020.02.013. Epub 2020 Feb 21. PMID: 32423721.
Slater C, Robinson AJ. Sexual health in adolescents. Clinics in Dermatology [Internet]. 2014 Mar [cited 2024 Jan 12];32(2):189–95. Available from: https://www.cidjournal. com/article/S0738-081X(13)00152-1/fulltext doi:10.1016/j.clindermatol.2013.08. 002. PMID: 24559553.
World Health Organization. Sexually transmitted infections (STIs) [Internet]. Who.international. World Health Organization: WHO; 2023 [cited 2024 Feb 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted- infections-(stis)
Society for Adolescent Health and Medicine. Improving outcomes for adolescents and young adults living with HIV. Journal of adolescent health [Internet]. 2023 Sep 1 [cited 2024 Feb 11];73(3):605–9. Available from: https://www.jahonline.org/article/S1054-139X(23)00265-3/fulltext https://doi.org/10.1016/j.jadohealth.2023.05.006
Mason-Jones AJ, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database of Systematic Reviews [Internet]. 2016 Nov 8 [cited 2024 Feb 22];11(11):1–69. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles /PMC5461872/ https://doi.org/10.1002%2F14651858.CD006417.pub3
Ministry of Health Malaysia. The Global AIDS Monitoring Report 2022. Country progress report- Malaysia [Internet]. Ministry of Health Malaysia. Putrajaya, Malaysia: Disease Control Division, Ministry of Health Malaysia; 2022 May [cited 2024 Mar 22] p. 1–34. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/ Umum/ MYS_country_report_2021.pdf
Park E, Kwon M. Health-related internet use by children and adolescents: Systematic review. Journal of Medical Internet Research [Internet]. 2018 Apr 3 [cited 2024 Feb 24];20(4):e120. Available from: https://www.jmir.org/2018/4/e120/ doi: 10.2196/jmir.7731. PMID: 29615385; PMCID: PMC5904452.
Brown JD. Mass media influences on sexuality. Journal of Sex Research [Internet]. 2002 Feb [cited 2024 Feb 13];39(1):42–5. Available from: https://www.jstor.org/ stable/3813422 doi: 10.1080/00224490209552118. PMID: 12476255.
Talib J, Mamat M, Ibrahim M, Mohamad Z. Analysis on sex education in schools across Malaysia. Procedia - Social and Behavioral Sciences [Internet]. 2012 Oct [cited 2024 Apr 12];59(2012):340–8. Available from: https://core.ac.uk/download/pdf/81122559 .pdf.doi.org/10.1016/j.sbspro.2012.09.284
Sirait EM, Sitorus E. The effect of sexual ethics education on adolescents at SMP Negeri 1 Pematang Bandar. Edunesia Jurnal Ilmiah Pendidikan [Internet]. 2023 Feb 26 [cited 2024 Jan 16];4(2):508–20. Available from: https://edunesia.org/ index.php/edu/article/view/390 doi:https://doi.org/10.51276/edu.v4i2.390
Wahid R. Keberkesanan pembelajaran berasaskan permainan dalam kalangan pelajar institusi pengajian tinggi. Journal of Education and Social Science [Internet]. 2020 Oct [cited 2024 Feb 23];16(1):9–13. Available from: https://www.jesoc.com/wp-content/uploads/2020/12/JESOC16-007.pdf
Dahalan F, Alias N, Shaharom MSN. Gamification and game based learning for vocational education and training: A systematic literature review. Education and Information Technologies [Internet]. 2023 Jan 12 [cited 2024 Dec 12];29(12):1–39. Available from: https://pubmed.ncbi.nlm.nih.gov/36688221/ https://doi.org/10.1007/ s10639-022-11548-w
Patchen L, Ellis L, Ma TX, Ott C, Chang KH, Araya B, et al. Engaging african american youth in the development of a serious mobile game for sexual health Education: Mixed methods study. JMIR Serious Games [Internet]. 2020 Jan 26 [cited 2024 Jan 13];8(1):e16254. Available from: https://pubmed.ncbi.nlm.nih.gov/32012041/ doi: 10.2196/16254. PMID: 32012041; PMCID: PMC7055799.
Hossein Taghdisi M, Babazadeh T, Moradi F, Shariat F. Effect of Educational Intervention on the Fruit and Vegetables Consumption among the Students: Applying Theory of Planned Behavior ARTICLE INFORMATION ABSTRACT. JRHS Journal of Research in Health Sciences Res Health Sci [Internet]. 2016;16(4):195–9. Available from: www.umsha.ac.ir/jrhs. PMID: 28087851; PMCID: PMC7189921.
Baudouin BS, Wongsawat P, Sudnongbua S. Factors affecting the preventive intention on premarital sexual behaviours among junior high school students in lower-northern region of Thailand. International Journal of Adolescence and Youth [Internet]. 2020 Feb 24 [cited 2023 Oct 18];25(1):712–24. Available from: https://web.archive.org/web/ 20200229160148id_/https://www.tandfonline. com/doi/pdf /10.1080/02673 843.2020. 1728560?need Access=true&
Raingruber B. Health Promotion Theories [Internet]. Vol. 2. Massachusetts: Jones & Bartlett Learning; 2014 [cited 2024 Mar 24]. Available from: https://samples.jbpub.com/9781449697211/28123_CH03_Pass2.pdf
Rossett A. Training needs assessment. Englewood Cliffs, N.J.: Educational Technology Publications (Techniques in Training and Performance Development Series); 1987.
Ajzen I. From intentions to actions. Poland: Springer series in social psychology; 1985.
Siraj S, Alias N, Dewitt D, Hussin Z. Design and developmental research: Emergent trends in educational research. 1st ed. Kuala Lumpur: Pearson Malaysia Sdn Bhd; 2013.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods [Internet]. 2007 [cited 2024 Feb 20];39(2):175–91. Available from: https://pubmed.ncbi.nlm.nih.gov/17695343/ doi: 10.3758/bf03193146. PMID: 17695343.
National Population and Family Development Board. Modul PEKERTI. 1st ed. Kuala Lumpur: National Population and Family Development Board; 2009.
Muhammad NA, Shamsuddin K, Mohd Amin R, Omar K, Thurasamy R. Questionnaire development and validity to measure sexual intention among youth in Malaysia. BMC Public Health [Internet]. 2017 Feb 2 [cited 2022 May 23];17(1):1–10. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3949-1. doi.org/10.1186/s12889-016-3949-1
Chua S. Fatimah: STD cases on downtrend last year [Internet]. Borneo Post Online. 2022 [cited 2024 Feb 13]. Available from: https://www.theborneopost.com/2022/03/22/fatimah-std-cases-on-downtrend-last-year/
World Health Organization. Adolescent health [Internet]. World Health Organization. 2023 [cited 2024 Feb 22]. Available from: https://www.who.int/health-topics/adolescent-health
National Population and Family Development Board. Laporan kajian kekeluargaan dan pelajar sekolah menengah semenanjung Malaysia 1994/95. Penemuan penting [Internet]. National Population and Family Development Board. Kuala Lumpur: National Population and Family Development Board; 1994 Nov [cited 2024 Jan 2]. Available from: https://mprh.lppkn.gov.my/books/laporan-kajian-kekeluargaan-dan-pelajar-sekolah-menengah-semenanjung-malaysia-1994-95/
Institute of Public Health. National Health and Morbidity Study 1996 [Internet]. Institute of Public Health. Kuala Lumpur: Institute of Public Health; 1996 [cited 2024 Feb 11]. Available from: https://iku.nih.gov.my/nhms-1996
Ministry of Health Malaysia. Global school-based student health survey 2012 [Internet]. Institut Kesihatan Umum. Putrajaya: Kementerian Kesihatan Malaysia; 2012 [cited 2024 Mar 22]. Available from: https://iku.moh.gov.my/images/IKU/Document /REPORT/NHMS2012-GlobalSchoolBasedStudentHealthSurvey.pdf
Institute for Public Health. National health and morbidity survey 2017 adolescent health survey 2017. [Internet]. Institute for Public Health. Kuala Lumpur: Institute for Public Health; 2017 [cited 2024 Jan 12]. Available from: https://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2017/NHMS2017Infographic.pdf
Panting AJ, Abdullah H, Ariff Ismail I, Roslan S. Information-seeking behaviour on sexual and reproductive health among rural adolescents in Sarawak, Malaysia. Vol. 5, International Journal of Public Health and Clinical Sciences. Kuala Lumpur; 2018.
Nik Farid ND, Che’ Rus S, Dahlui M, Al-Sadat N, Abdul Aziz N. Predictors of sexual risk behaviour among adolescents from welfare institutions in Malaysia: a cross sectional study. BMC Public Health [Internet]. 2014 [cited 2024 Feb 22];14((Suppl 3)):2–8. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/ 1471-2458-14-S3-S9 https://doi.org/10.1186/1471-2458-14-S3-S9
Ahmad N, Awaluddin SM, Ismail H, Samad R, NikAbdRashid N. Sexual activity among Malaysian school-going adolescents. Asia Pacific Journal of Public Health [Internet]. 2014 Jul 28 [cited 2024 Jan 12];26(5_suppl):44S52S. Available from: https://pubmed.ncbi.nlm.nih.gov/25070693/ doi: 10.1177/1010539514544700. Epub 2014 Jul 28. PMID: 25070693.
Qomariah NL, Pamungkasari EP, Budihastuti UR. Determinantsof premarital sex behavior: Application of theory of planned behavior and social cognitive theory. Journal of Health Promotion and Behavior [Internet]. 2020 [cited 2024 Mar 23];5(4):272–83. Available from: https://thejhpb.com/index.php/thejhpb/article/ view/281/169
Attila FL, Akpadago J, Agyei-Sarpong K, Eshun E, Inkoom D, Asamoah-Gyawu J. Adolescent curiosity as a predictor of sexual behaviours. International Journal of Rehabilitation and Special Education (IJRSE) [Internet]. 2022 Sep 25 [cited 2024 May 22];2(2):99–107. Available from: https://acspublisher.com/journals/index.php/ijrse/ article/view/2236 doi.org/10.48165/ijrse.2022.2.2.5
Shek DTL. Sexual behavior and intention to engage in sexual behavior in junior secondary school students in Hong Kong. J Pediatr Adolesc Gynecol. 2013;26(3 SUPPL). doi: 10.1016/j.jpag.2013.03.013. PMID: 23683825
Simak VF, Rekawaty E, Rahmadiyah DC. The effectiveness of “PEKA BERAKSI” programs in improving self-efficacy to prevent the risky sexual behavior in adolescents. International Journal of Public Health Science (IJPHS) [Internet]. 2022 Mar 1 [cited 2022 Oct 20];11(1):54. Available from: https://scholar.ui.ac.id/en/publications/the-effectiveness-of-peka-beraksi-programs-in-improving-self-effi. http://doi.org/10.11591 /ijphs.v11i1.20960
Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad MS, Yidana A. Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial. Reproductive Health [Internet]. 2019 Aug 15 [cited 2024 Feb 25];16(1):1–12. Available from: https://reproductive-health-journal.biomedcentral.com/articles/ 10.1186/s12978-019-0784-8 doi: 10.1186/s12978-019-0784-8. PMID: 31416450; PMCID: PMC6694566.
Ott MA, Pfeiffer EJ. “That’s Nasty” to curiosity: Early adolescent cognitions about sexual abstinence. Journal of Adolescent Health [Internet]. 2009 Jun [cited 2024 May 22];44(6):575–81. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2974623/ doi: 10.1016/j.yhbeh.2013.03.007
Zakaria M, Karim F, Mazumder S, Cheng F, Xu J. Knowledge on, attitude towards, and practice of sexual and reproductive health among older adolescent girls in Bangladesh: An institution-based cross-sectional study. International Journal of Environmental Research and Public Health [Internet]. 2020 Oct 22 [cited 2021 Mar 20];17(21):7720. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672593/ doi: 10.3390/ijerph17217720
Ab. Rahman A, Ab. Rahman R, Ibrahim MI, Salleh H, Ismail SB, Ali SH, et al. Knowledge of sexual and reproductive health among adolescents attending school in Kelantan, Malaysia. The Southeast Asian Journal of Tropical Medicine and Public Health [Internet]. 2011 May [cited 2024 Mar 11];42(3):717–25. Available from: https://pubmed.ncbi.nlm. nih.gov/21706952/ PMID: 21706952.
Rohrbach LA, Donatello RA, Moulton BD, Afifi AA, Meyer KI, De Rosa CJ. Effectiveness evaluation of It’s your game: Keep it real, a middle school HIV/sexually transmitted infection/pregnancy prevention program. Journal of Adolescent Health [Internet]. 2019 Mar [cited 2024 Feb 22];64(3):382–9. Available from: https://pubmed.ncbi.nlm.nih.gov/ 30509768/ doi: 10.1016/j.jadohealth.2018.09.021. Epub 2018 Nov 30. PMID: 30509768.
Yustika E, Isnaeni W, Indriyanti DR, Marianti A. Development of sex education model as An extracurricular activity in high school to improve understanding and attitude of care for reproductive health. Journal of Innovative Science Education/Journal of innovative science education [Internet]. 2023 Aug 31 [cited 2024 Jun 27];12(2):229–36. Available from: https://journal.unnes.ac.id/sju/jise/article/view/72349
Masonbrink A, Hurley EA, Schuetz N, Rodean J, Rupe ER, Lewis K, et al. Sexual behaviors, contraception use and barriers among adolescents and young adults in rural Haiti. BMC Women’s Health [Internet]. 2023 Mar 27 [cited 2024 Feb 23];23(1):1–10. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905 -023-02268-5https://doi.org/10.1186/s12905-023-02268-5