Development of a computer-assisted instructional package for life skills to prevent risky sexual behaviors in early adolescents, Bangkok, Thailand

Ethical considerations

This Research and Development Project was approved by the Institutional Review Board, Kuakarun Faculty of Nursing, Navamindradhiraj University (approval number KFN-IRB2018-19 and KFN 22/2019). Information about the study was explained to the students; objectives, data collection steps, timing of research study, and benefits of participation in the research project were given to the students, their guardians and teachers prior to conducting the study. Written informed consent to participate in the study was signed and obtained from the students and their legal guardians. They were paid for participation in this research project, as approved by the Research Fund Board of the University. Upon completing the interview, each participant received 300-baht cash incentive for their participation.

Study design

The research project was divided into two phases; phase 1 developed the computer-assisted instructional package for life skills (herein ‘the CAIFLS’). In phase 1, the CAIFLS was validated using pilot testing. In phase 2, the efficacy of CAIFLS was tested in a group of secondary school students using a questionnaire. In phase 2, student satisfaction with CAIFLS was also evaluated.

Phase 1

Development of CAIFLS package

To understand life skills (LS) in preventing sexual risky behaviors in Thai early adolescences, the CAIFLS and a questionnaire were systematically developed by the researchers. First, background information was synthesized by reviewing textbooks, research studies, articles. After the researchers reviewed and synthesized the theory of LS and related research, a group of participants in a school in Bangkok were sampled to participate in interviews for a situation analysis of current risky sexual behaviors in the school.

The participants in the interviews were purposively sampled from two target groups of participants, i.e. students and teachers. Five students were selected based on the criterion of differences in their academic achievements (GPA) (1 high-, 2 moderate-, and 2 low-GPA students) and gender (3 females and 2 males). The second group consisted of 5 teachers who were responsible for guidance, advisory teacher, Health-Physical Health Education and administration. Two sessions of group interviews with teachers and students were conducted to gather information about current high-risk sexual behaviors in school students (Extended data (Neranon & Thongsong, 2021b)). Then the researchers analyzed the collected data from the group interviews and the contents, including life skills needed to prevent or reduce the sexual risk behaviors in early adolescents, guidelines for promoting life skills in preventing early adolescent sexual risk behaviors, and the characteristics of preferred teaching materials. After the data analysis, the researchers developed a series of computer-assisted lesson activities to promote life skills in preventing sexually risky behaviors for early adolescents in four main aspects: 1) relationship building skills; 2) communication–denial skills; 3) self-esteem skills; and 4) self-awareness skills.

CAI lesson series entitled ‘Adolescents and life skills on sexual self-prevention’

The CAI was divided into three steps (Alessi S. M & Trollip S.R., 1985): 1) planning step: comprised of define the scope, cost the project, produce a planning document; 2) design step: comprised of develop initial content ideas, conduct task and concept analyses, preliminary program description, prepare a prototype, create flowcharts, storyboards and prepare scripts; 3) development step: write program code, create the graphics, produce audio and video, test and make revisions.

The final version was developed in the form of Adobe Flash Player. It features two-choice pre- and post-tests to measure life skills to prevent sexual risky behaviors in early adolescents. Once the students complete the tests, they can see the scores they have achieved. For the post-tests, the students can see the correct answers of all items. Students’ pre- and post-test scores are recorded in the program. The program was created and designed using still images and animations with vivid colors, voiceover, and subtitles. Four lessons were developed based on situations that students encounter in everyday life. The series of CAI included: 1) relationship building skills; 2) communication–denial skills; 3) self-esteem skills; and 4) self-awareness skills.

The stories are based on situations students encountered in their daily lives. Each lesson contains the following objectives:

Lesson 1: Relationship building Skills. This story is based on a simulation. Its objective is to create the ability to build good relationships between them and understand 3 stages of a relationship: The 1st stage is friendship; the 2nd stage is love, and the 3rd stage is sexual relationship and can maintain a long-lasting platonic relationship.

Lesson 2: Communication–denial Skills. This story is based on a simulation. Its objective is to develop the ability to use words to communicate one’s own feelings and thoughts appropriate to cultures and situations that includes giving comments, expressing needs, negotiating, and refusing without damaging the relationship and tendency to sex.

Lesson 3: Self-esteem Skills. This story is based on a simulation. Its objectives include improving self-esteem, unprovocative dress code for women, and refraining from going with a heterosexual friend alone and staying with a heterosexual friend in private, — all of which can lead to sexual intercourse.

Lesson 4: Self-awareness Skills. This story is based on a simulation. Its objectives are to create the ability to learn and to be aware of one’s advantages and disadvantages and what one needs or does not need. In addition, reading erotic books, watching porns, hugging, kissing, fondling, physical touching, and drinking alcoholic beverages are extremely inappropriate behaviors. If any of these happens, sexual intercourse may be inevitable.

The four lessons

The lesson plans included activity topics, learning objectives, tools/materials used, worksheets, the duration of each activity, and leaning assessments. The worksheets for each activity are as follows and copies in Thai are provided in the Extended data (Neranon & Thongsong, 2021b):

Validation of CAIFLS

Five experts in the field of preventing risky sexual behaviors in children and adolescents and educational technology were approached to validate the CAIFLS. All experts used a 39-item evaluation checklist of 5-point Likert scale developed by the researchers to assess the quality of CAIFLS in terms of content (10 items), functionality (19 items), as well as lesson plans and worksheets (10 items). It was found that the CAI content was of quality at a very good level (M = 4.44, SD = 0.206), the CAI functionality was at a very good level (M = 4.86, SD = 0.328), and the quality of the activity plans and worksheets of activities for preventing risky sexual behaviors for early adolescents was also at a very good level (M = 4.42, SD = 0.175). The researchers then improved the quality of the CAIFLS based on the suggestions given by the experts.

A pilot test of CAIFLS was performed with students in Bangkok having the same characteristics as the target participants, which were students aged 12–13 years studying in Grades 7 students in schools of Bangkok. The efficiency of the CAIFLS was examined by the students using the E1/E2 formula as follow. The findings of efficiency analysis of the CAIFLS activity package based on 80/80 criteria (or the E₁/E₂ formula) showed the efficiency values; the first try out with individuals (three students) gave results of 65.0/61.5, which were lower than the set criteria. Misspelled words in CAIFLS were corrected and the questionnaires were reordered. The second try out with a small group (10 students) gave results of 75.0/78.0, which were also lower than the criteria. The language used in the questions were revised for appropriateness for the students. The final try out with a larger group (30 students) gave results of 81.0/82.5, which were higher than the criteria (Figure 1).

Figure 1. Phase 1: Development of the CAIFLS.

Phase 2

Participants

Sample size was determined by the effect size of 0.55. The power analysis was set at 0.8 at the 0.05 level of significance (Cohen, 1988) and tested with one-tailed test by using G*power to obtain 42 sample size for each group. In order to avoid losing cases, 5% of the sample (n = 3), were included into each group (Faul et al., 2007). Therefore, the sample size was 45 participants for each group. They were assigned into the experimental and control group.

Purposive sampling of one secondary school in Bangkok was conducted. This school has been reported by teachers as having a problem with risky sex behavior. Simple random sampling was then used to select two classrooms. One classroom was the experimental group, with 44 students, and one classroom was the control group, with 43 students. The participants of the present study had a total 87 students.

Inclusion criteria: secondary school students aged 12–13 years studying in Grades 7 in schools of Bangkok, with the ability to read, write, and communicate.

Development of the assessment questionnaires

Two questionnaires were developed to analyze if the objectives of CAIFLS were successful (questionnaire 1) and to see student satisfaction with the CAIFLS (questionnaire 2) (Extended data (Neranon & Thongsong, 2021b)).

Questionnaire 1: A two section questionnaire. Section one contained a checklist to obtain general demographic information; section two consisted of 33 items included the following sections:

Questionnaire 2: Consisted of 10 items with rating scale 1-5 (5 = mostly satisfied, 4 = more satisfied, 3 = moderately satisfied, 2 = less satisfied, 1 = not satisfied).

Validation of questionnaires

Content validity of the questionnaires were evaluated by five experts in the field of preventing risky sexual behaviors in children and adolescents. All of the experts worked as child health specialists in Bangkok, including two child health and behavior specialists, two school health nurse, and one educational technology. The five experts assessed the items of the two questionnaires using the Index of Item Objective Congruence (IOC). The assessment of the questionnaire items showed that most of the items were at a high level of item-objective congruence (IOC ≥ 0.5), except only one item (IOC = 0.4) of questionnaire 1. Subsequently, the researchers revised the questionnaire items based on the experts’ feedback in terms of content, language use, and appropriate context representation for children aged 12–13 years in Bangkok.

A pilot test was performed with 30 secondary school students in Bangkok having the same characteristics as the target participants, which were students aged 12–13 years studying in Grades 7 students in schools of Bangkok, with the ability to read, write, and communicate with normal, Reliability was analyzed using Cronbach’s alpha. It was found that the reliability values of the two questionnaires were greater than 0.80, which is at a good level. The revised version of the instruments were then used for data compilation (Figure 1).

Data collection

After obtaining consent from the students and their legal parents, a group of trained research assistants coordinated with the teacher coordinators of the schools. Then the researchers and research assistants went to the participants’ schools to collect data. Before starting compiling data, the researchers and research assistants gave self-introduction, expressed the purpose of the research clearly, and clarified the data collection details to each of the participants.

After having understood all the research-related information, each participant was given questionnaire 1 to complete (Pre-test) (generally 30 to complete).

The group of 44 participants assigned to the experimental group received the CAIFLS program. The participants of this group received a total of 4 lessons, 60 minutes each. The group of 43 participants assigned to the control group received no CAIFLS.

The 1st Round. The experimental group was taught through CAIFLS at the school’s computer room. The researcher explained the purpose of doing activity, duration of the activity, and learning methods according to the CAI manual. In this round, the experimental group had to do a pretest first and started learning about Lesson 1: Relationship building Skills for 20 minutes. After the lesson, the experimental group was divided into 10-11 member groups to cooperate in completing the 1st worksheet “What stage is it ?” and the 2nd worksheet “Is it appropriate?” This activity requires the students to role play base on situation of both appropriate and in appropriate relationship building in class in a 40-minute duration. Overall, this activity took 60 minutes. The researchers assessed with an observational assessment form while students role play.

The 2nd Round. The experimental group was taught through CAIFLS at the school’s computer lab. The researcher explained the purpose of doing activity and duration of the activity. Later, the experimental group learned Lesson 2: Communication–denial Skills for 20 minutes. After the lesson, the experimental group was divided into 10-11 member groups to cooperate in completing the worksheet “What would you say”. The students were also asked to discuss and make a presentation in class, allowing the students to complete or incomplete conversation using refusal skills for various situations. in a 40-minute duration. Overall, this activity took 60 minutes. The researchers assessed with read worksheet and observational form while students role play.

The 3rd Round. The experimental group was taught through CAIFLS at the school’s computer lab. The researcher explained the purpose of doing activity and duration of the activity. Later, the experimental group learned Lesson 3: Self-esteem Skills for 20 minutes. After the lesson, the experimental group was divided into 10-11 member groups to cooperate in completing the worksheet “I’m proud of myself”. The students were also asked to discuss and make a presentation in class about why they would or would not perform such behaviors given in each situation in a 40-minute duration. Overall, this activity took 60 minutes. The researchers assessed the students’ responses given in the worksheet.

The 4th Round. The experimental group was taught through CAIFLS at the school’s computer lab. The researcher explained the purpose of doing activity and duration of the activity. Later, the experimental group learned Lesson 4: Self-awareness Skills for 20 minutes. After the lesson, the experimental group was divided into 10-11 member groups to cooperate in completing the 1st worksheet “This is right!” and the 2nd worksheet “What’s happening?”. The students were also asked to discuss and make a presentation in class about causes and provide solutions for each problem in a 30-minute duration. The researchers assessed the students’ responses given in the worksheet. Afterward, the students did a posttest on CAI for 10 minutes. Overall, this activity took 60 minutes.

All participants in both groups completed questionnaire 1 after the CAIFLS intervention had been completed (post-test) (Figure 2). Students then completed questionnaire 2.

Figure 2. Phase 2: The CAIFLS was conducted on an experimental group.

Statistical analysis

Descriptive statistics were utilized for data analysis of demographic information (section 1, questionnaire 1), and the level of student satisfaction on CAIFLS (questionnaire 2).

For questionnaire 1 (section 2), frequency distribution testing was done using the Kolmogorove-Smirnov Test formula, and normal curve distribution was confirmed. Therefore, a t-test at.05 level of statistically different significance was used to evaluate the effect of the CAIFLS. All statistical analyses of the present study were conducted using SPSS software version 26 (IBM Corp., 2019).

Demographic characteristics of the sample

The participants were 87 students who were early adolescents studying in Grade 7, in Bangkok. A total of 44 students (males 47.75%, females 52.3%) were assigned as the experimental group, and 43 students (Males 48.8%, females 51.2%) were in the control group. Their average age was 12 years. The average academic achievement (GPA) was between 2.50 and 2.99.

Validation of CAIFLS

The efficiency (E1/E2) analysis of the CAIFLS based on 80/80 criteria with the experimental group (44 students) was 80.2/82.5, which was higher than the criteria.

Efficacy of CAIFLS (questionnaire 1)

To test for differences before and after the intervention, mean scores of the four variables (i.e., relationship building skills, communication-denial skills, self-esteem skills and self-awareness skills) were evaluated.

Mean scores of the experimental group were as follows: for Relationship building, the pre-test was ($\overline{\mathrm{X}}$ = 28.16, SD = 3.12) and the post-test was ($\overline{\mathrm{X}}$ = 30.38, SD = 2.63), for Communication-denial, the pre-test was ($\overline{\mathrm{X}}$ = 2.25, SD = 0.94 ) and the post-test was ($\overline{\mathrm{X}}$ = 3.79, SD = 0.90), for Self-esteem, the pre-test was ($\overline{\mathrm{X}}$ = 22.54, SD = 2.86) and the post-test was ($\overline{\mathrm{X}}$ = 24.16, SD = 2.64), for Self-awareness, the pre-test was ($\overline{\mathrm{X}}$ = 28.16, SD = 2.79) and the post-test was ($\overline{\mathrm{X}}$ = 30.82, SD = 2.59), for LSRSB, the pre-test was ($\overline{\mathrm{X}}$ = 81.11, SD = 4.96) and the post-test was ($\overline{\mathrm{X}}$ = 89.16, SD = 4.06). When comparing the difference of the mean scores between the pre-test and the post-test, the mean post-test score of the experimental group was significantly higher than the mean pre-test score (p < .05). Within the control group no significant differences were found in the mean values of the four variables between pre-test and post-test scores (p > .05) (Table 1).

At the end of the experiment, the mean scores between the control group and the experimental group, were compared, mean score on Relationship building of the control group was ($\overline{\mathrm{X}}$ = 29.21, SD = 2.95) and that of the experimental group was ($\overline{\mathrm{X}}$ = 30.38, SD = 2.62), mean score on Communication-denial of the control group was ($\overline{\mathrm{X}}$ = 2.20, SD = 0.91) and that of the experimental group was ($\overline{\mathrm{X}}$ = 3.79, SD = 0.90), mean score on Self-esteem of the control group was ($\overline{\mathrm{X}}$ = 22.53, SD = 2.87) and that of the experimental group was ($\overline{\mathrm{X}}$ = 24.16, SD = 2.65), mean score on Self-awareness of the control group was ($\overline{\mathrm{X}}$ = 29.25, SD = 2.89) and that of the experimental group was ($\overline{\mathrm{X}}$ = 30.82, SD = 2.59). When the mean post-test scores between two groups were compared, the post-test scores of the experimental group were higher than those of the control group with a statistical significance level (p < .05) (Table 2).

Satisfaction with the CAIFLS (questionnaire 2)

Table 3 presents the satisfaction of the experimental group with the CAIFLS package after finishing the intervention. The CAIFLS satisfaction of the experimental group was found at the level of ‘more satisfied’.

Recommendations for future research

This study evaluated the effectiveness of the CAIFLS learning package with Grade 7 students in only one school in a Bangkok district. This CAIFLS learning package should be further used in other districts and in more schools.

Although the CAIFLS learning package can be adopted to promote life skills for risky sexual behavior prevention, teachers that intend to use this learning package are encouraged to be trained how to use this learning package effectively before use in their classrooms.

Underlying data

Underlying data cannot be shared as the ethical committee that approved this study states that only aggregated data can be shared openly. In addition, the consent form that guardians/children signed explicitly stated that the data resulting from the study would not be openly shared. Researchers interested in accessing the data will need to submit an official letter of request for the data to Navamindradhiraj University, and will be asked to confirm that they will not violate the ethical standards of the ethical committee and protect the anonymity of the participants. Researchers can contact the corresponding author, who can facilitate this process.

Extended data

Open Science Framework: Development of activity package computer assisted instruction for life skills to prevent risky sexual behaviors on early adolescents, Bangkok, Thailand, https://doi.org/10.17605/OSF.IO/24XPY (Neranon & Thongsong, 2021b).

This project contains the following extended data:

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).