Doctoral Thesis
The majority of adolescents are currently becoming sexually active before their 18th birthday, hence having to battle with unsafe sexual behaviours, teenage pregnancies, sexually transmitted infections (STIs), and school dropouts. This study designed and tested the effect of integrated reproductive health (RH) lesson materials in a problem-based pedagogy (PBP) to empower adolescents with sexual and reproductive health knowledge, and soft skills for safe sexual behaviours in Tanzania. A sequential mixed-method design was employed. Phenomenological design using the individualized in-depth interview collected qualitative information among 6 experts and 36 research trainers and analysed it using thematic analysis. A Clustered Randomized Controlled Trial (RCT) among 660 randomly selected adolescents and the interviewer-administered structured questionnaires adapted from previous studies were used to collect quantitative data and analysed using Statistical Analysis Software (SAS) version 9.4. Repeated measure Linear Mixed Model (LMM) was used to determine the effect of the interventions between research arms over time. The adolescents’ mean age was 15±1.869 and 57.5% of them were females. Qualitative findings indicated that there was a felt need of facilitating sexual and reproductive health (SRH) learning among adolescents using PBP. The adjusted coefficient of adolescents' SRH knowledge, soft skills, and self-reported sexual behaviours was significantly higher in the Hybrid PBP and pure PBP (β=2.4980, p<0.001) and (β=1.7868, p<0.001); (β=9.0986, p<0.001) and (β=8.7114, p<0.001) and (β=0.30; p<0.001) and (β =0.30, p<0.002) against the control group respectively. The integrated RH lesson materials in a PBP were valid and practical in facilitating SRH learning for adolescents. The Hybrid PBP and pure PBP demonstrated a more significant effect on adolescents’ SRH knowledge, soft skills, and self-reported safe sexual behaviours than pure PBP against the control group though, a Hybrid PBP was significantly effective than the pure PBP. Those wishing to intervene in SRH issues may need to consider integrated RH lesson materials in PBP as a pedagogical guide to teachers and or health workers in facilitating SRH learning among adolescents in Tanzania.