The evidence and effectiveness of a peer-led social media-delivered sexual health promotion

Abstract

The sexual and reproductive health of young people (aged 15-24 years) constitutes a major health concern as they are at risk of contracting unwanted pregnancy or sexually transmitted infections (STIs). Indeed, unsafe sex and the lack of contraception were the second and fourth most common risk factors for cause-specific disability-adjusted life-years for young people globally. Sexual health promotion has long been regarded as an important tool in changing sexual health behaviours. Recent years, more novel ways of sexual health promotion are emerged. Traditionally, sexual health promotion for young people has been delivered through institutional‐based sex education programs, mainly classroom-based and mass media campaigns. The evidence of effectiveness is mixed. On the other hand, both peer-led approach and social media-delivered intervention are new trends in sexual health promotion. However, none of the research has compared its effectiveness with other online channels or in the Asian population. This thesis aims at providing a systematic examination of the effectiveness of the peer-led approach and social media-delivered sexual health interventions targeted young people in Hong Kong. This thesis first systematically reviews peer-led sexual health promotion in more developed countries with a meta-analysis and narrative review. Then it looks into the current situation of sexual health promotion on social media in Hong Kong. Last but not least, it presents a randomised controlled trial (RCT) of a peer-led social media-delivered sexual health promotion targeted Chinese college students. Although both peer-led and social media-delivered approaches are increasingly popular in youth sexual health promotion, evidence of changing sexual health behaviours is lacking. In contrast, these approaches significantly improved the process of sexual health promotion such as students’ satisfaction and leading to more positive learning experiences. The systematic review and meta-analysis revealed that the peer-led approach is effective in changing knowledge and attitude but not behaviours in more developed countries. Focusing in Hong Kong, the scoping review identified a considerable amount of active social media activities promoting sexual health and some of them received high online engagement. A set of social media strategies are recommended. The RCT showed that a peer-led social media-delivered safer sex intervention is feasible and effective in condom use attitude and behavioural skills and is comparable to yet not more effective than a website. At the same time, participants who were randomised in the intervention group have a higher online experience and visiting frequency than these in the control group. Suggestions on the implementation of the peer-led social media delivered sexual health promotion are given and cultural differences are described. This research is the first one to compare different online sexual health interventions in an Asian population. While an increasing number of programmers in youth sexual health promotion adopts the peer-led approach and social media-delivered intervention, it is important to distinguish between components of interventions contributing to successful outcomes in the future. More research may also focus on the long-term effectiveness and cost-effectiveness of these popular approaches as well as the potential cultural differences.