ABSTRACT Previous trials of whole-school relationships and sexual-health programmes have not reported on fidelity, reach or acceptability, despite the importance of these factors for interpreting outcomes. Our trial of the Positive Choices whole-school relationships and sexual-health programme found limited effectiveness in secondary schools in England. We aimed to understand whether sub-optimal fidelity, reach or acceptability might explain the results. A process evaluation was nested within a parallel-arm, cluster randomised-controlled trial in 49 schools from 2021 to 2025. Using staff log-books, researcher observations, student surveys and staff interviews, we assessed the delivery of the programme in 24 schools and awareness and acceptability among students, including subgroup differences. While most schools delivered lessons, fewer completed ‘whole-school components’, such as school-health promotion councils, sexual-health services reviews and student-led campaigns. No school reached a pre-defined level of ‘good fidelity’ across all components, and only 11 schools achieved ‘adequate fidelity for selected components’. Evidence of programme acceptability and awareness among students was weak, with higher awareness among sexuality- and gender-minority students, and higher acceptability among white students. Findings highlight difficulties implementing whole-school programmes focused on relationships and sexual health. More holistic whole-school programmes addressing multiple health issues, including sexual health, may be more feasible.

ABSTRACT In recent years, research has begun to examine the myriad of ways in which gay, bisexual, and men who have sex with men acquire their sexual health literacy, be that from clinicians, peer groups, or online media. However, little is known about the impact interactions with front-line outreach workers have in informing what GBM know about their own sexual practices and wellbeing, and whether these interactions result in behaviour change. To address this, qualitative data from iCruise, a mixed-method study examining how gay, bisexual, and men who have sex with men in Ontario, Canada, experienced sexual health outreach both in-person and online between July 2017 and January 2018, was examined. Results from 75 interviews indicated that few individuals had ever had interactions with outreach workers, but that outreach was viewed as an important and trusted tool for accessing information about one’s sexual health, specifically for those who were most marginalised within the gay community. These findings suggest that there exists a strong desire among gay, bisexual, and other men who have sex with men to increase their sexual health literacy, but limited avenues to do so, implying the need for more creative, community-based, pathways to sexual health education.

ABSTRACT Engagement with Comprehensive Sexuality Education (CSE) as part of teacher education remains a relatively unexplored field in the Ibero-American context despite broad agreement on the need to prepare qualified professionals. This study examined current trends in CSE implementation by focusing on prevailing attitudes among trainee teachers, instructional strategies, and outstanding challenges in initial teacher education and training contexts. Using a systematic literature review and a systematic mapping approach informed by the PRISMA guidelines, eighteen peer-reviewed articles were identified and analysed. The findings revealed generally positive attitudes among trainee teachers towards the teaching of CSE but stressed the importance of adequate professional preparation. The review concludes that the integration of CSE into initial teacher training programmes is both increasingly valued by trainee teachers and teacher education institutions, although significant challenges remain in equipping trainee teachers with the competencies required to effectively address sexuality education.

ABSTRACT Comprehensive Sexuality Education (CSE) is central to promoting adolescents’ sexual health and rights. In Sweden, CSE is now referred to as Sexuality, Consent and Relationships (SCR) education, following a curriculum revision in 2022. This study explored how upper secondary school students (aged 16–19) experienced SCR education. A digital questionnaire was completed in the classroom by 1378 students (68% response rate) in early 2025, and data were analysed using bi- and multivariate methods. Most participants (61%) reported receiving sufficient education, yet notable gaps and inequalities were evident. Girls and non-heterosexual students were more likely to describe their education as insufficient. One in four students wished SCR contents had been covered more extensively, particularly violence in relationships – a theme viewed as important but often overlooked in teaching. These findings highlight disparities and unmet needs in SCR education, suggesting inequitable access to comprehensive and inclusive teaching relevant to students which may constrain their ability to build informed, respectful, and safe relationships. Strengthening the implementation of Sweden’s SCR curriculum is therefore essential to ensure equitable learning opportunities that reflect young people’s diverse realities.

ABSTRACT Despite recognition that learners with intellectual disabilities face heightened risks of sexual abuse and exploitation, few receive meaningful sexuality education. This article offers a Žižekian critique of this persistent inaction, drawing on qualitative data from teachers, caregivers, religious leaders and policy actors in Kenya. It is argued that institutional paralysis is sustained not by ignorance, but by contradictory fantasies: learners with intellectual disabilities are viewed as simultaneously too vulnerable to ignore and too innocent to educate. Using the concepts of parallax, jouissance, and objet petit a, this contradiction is shown not to be resolved but sustained, because it is enjoyed. Sexuality education becomes a space of moral performance rather than meaningful intervention. Institutions enjoy the failure to act not because they wish harm on learners, but because avoidance allows them to feel morally good, safe, or in control, without having to change anything. Thus, the issue is not whether people care, but how that care is expressed, and whether it leads to action or avoidance. A reframing of policy and practice is needed, one that begins with discomfort, dismantles fantasies of institutional innocence, and affirms disabled learners’ right to sexuality education.

ABSTRACT Despite some progress in creating more inclusive schooling environments, LGBTQ+ individuals still grapple with the persistence of heteronormativity, as reinforced through curricula, policies, and pedagogical practices. This qualitative systematic review synthesises international empirical research on how LGBTQ+ educators experience and navigate heteronormativity in early years, primary and secondary educational settings, utilising minority stress theory as a theoretical framework. Using the Population, Phenomena of Interest, Context (PICo) Framework and PRISMA guidelines, forty studies from ten countries met the inclusion criteria. A thematic synthesis of the data was employed, revealing three main themes: (1) Negotiating Visibility: Disclosure, Silence and Identity Management, (2) Role Modelling and Professional Expectations and (3) Institutional Norms and Schooling Culture. Findings highlight the unique stressors, ongoing identity management and resilience strategies employed by LGBTQ+ individuals within educational settings. This review offers insights into the professional experiences of LGBTQ+ educators as a minority within educational settings, providing recommendations for fostering greater inclusive practice in schools and suggested directions for diversifying future LGBTQ+ research to further include trans, queer and non-binary educators.

ABSTRACT Media is a common source of sexual health information, and scholars have lauded the popular Netflix series Sex Education for its positive approach. This qualitative study explored youth viewpoints about the series as a credible source of information. Six online focus groups were conducted in 2022–2023 (N = 22 US adolescents who had viewed at least two seasons of the show, aged 14–19, 50% cisgender female). Discussion focused on whether participants thought the situations portrayed in the series were realistic and the information provided was trustworthy. Two themes and five subthemes were identified, including 1) realism (subthemes: relatable, awkwardness, dramatised for entertainment) and 2) trustworthiness (subthemes: peer advice, professional advice). Findings indicate that Sex Education presents sexual health content that young people find realistic, relatable and informative, and is a valuable addition to the landscape of sexuality education options. Opportunities for including the show as part of a multipronged approach to sexual health education are discussed.

ABSTRACT Comprehensive sexuality education (CSE), including critical reflection on gender norms and unfavourable power relations, has been theorised to affect various health and social outcomes among adolescents. This systematic review aimed to synthesise evidence on the effectiveness of school-based CSE addressing gender and power topics on adolescents’ sexual and reproductive health (SRH) and relationships outcomes. We screened six databases for evaluations of school-based CSE programmes. We included outcome evaluations of interventions addressing SRH, gender, and power through a critical reflection and empowerment approach. Intervention effects were synthesised in effect direction plots. We identified 12 articles evaluating 11 interventions in four countries. Positive effects were found for most healthy relationships outcomes and for outcomes related to adolescents’ SRH knowledge, attitudes, and intentions. Effects on SRH behaviours were more mixed. CSE programmes addressing gender and power appeared more effective than sexuality education without this content. Gender roles and norms play a crucial role in shaping adolescents’ relationships and should be addressed as part of a comprehensive approach to sexuality education. However, in the light of some inconclusive outcomes, CSE with gender and power content needs to be more rigorously evaluated than hitherto in more diverse social and cultural contexts.

ABSTRACT Parent–adolescent communication about sex has been explored in different contexts, and evidence suggests it can positively impact on adolescents’ and young people’s sexual behaviour. In Uganda, however, there are many misconceptions about discussing sex-related issues with children. This study explored parent–adolescent communication about risky sexual behaviours in Kabira County in Kyotera district of south-central Uganda. Data were collected from young people (aged 10–19 years) and their parents/caregivers by means of focus group discussions (8), in-depth interviews (12) and key informant interviews (15). Interpretive thematic content analysis was used to generate themes from the information provided. Parents acknowledged that talking with adolescents and young people could help reduce risky sexual behaviour. Topics usually talked about included pregnancy, HIV and STIs, sexuality and sex education and personal hygiene. Sexual talks were usually unplanned and happened when triggered by specific incidents. Many such talks were tense, however, with young people perceiving themselves as being scolded by their parents. There is a need for tailored parent–adolescent/young person sex talk guides to assist parents to have more sensitive and productive conversations with adolescents and young people.

ABSTRACT This phenomenological study investigated how Chinese parents seek to support romantic relationship development for adolescents with intellectual disabilities as part of family-based sexuality education. We conducted semi-structured interviews with eight parents (three fathers and five mothers) of adolescents with intellectual disabilities (recruited through Chinese social media platforms across urban China. Thematic analysis identified two main themes: navigating cultural tensions in sexuality education; and building supportive relationship development systems. Parents employed strategies to support their children’s romantic relationship development that sought to reconcile traditional Chinese values with modern educational approaches while creating comprehensive support networks for their children. Our findings highlight the contextual adaptation that parents undertook and their active role in developing educational strategies that maintain cultural authenticity while addressing children’s developmental needs. This study enhances understanding of how families in traditional societies navigate sensitive educational topics, providing insights for culturally responsive support and highlighting the importance of recognising families’ own cultural resources when designing educational programmes for adolescents with intellectual disabilities.