Study Area and Period
The study was conducted among high and preparatory schools in Yaedwha town, East Gojjam zone, Amhara Regional state, which is found 108 kilometers far from Debre Markos the capital city of East Gojam zone, 240 kilometers from Bahir Dar which is the capital city of Amhara region and it is located 283 kilometers from Addis Ababa, the capital of Ethiopia.
When we see the town’s health care facilitates, there is one governmental primary hospital and, 1 health centers and 1 clinic. Yaedwha town: having 1, elementary and 1, secondary and 1 preparatory school. This study was conducted by involving high school and preparatory school students in the town. There are 4734 total students from high school and preparatory school. The study was conducted from March 18, 2019, to March 22, 2019. An institutional-based cross-sectional study with qualitative support was conducted.
Source Population
All students who were studied in grade 9 -12 in Yaedwha town 2018/2019 academic years.
Study Population
Students who were studying in grade 9 -12 and attend class during the data collection and the key informants were: Students (Anti-HIV, women’s and without a club) high school and preparatory school in Yaedwha town.
Inclusion Criteria
All 9 -12-grade students were included in the study.
Sample Size Determination
For quantitative
Sample size(n) for the first specific objective was determined by using single population proportion formula by taking the prevalence of early sexual initiation before their 18 birthday which obtained from research conducted among Jiga high school Northwest Ethiopia in 2014 (3).
Applying the formula:
n= (Zα/2)2 p (1-p) Where,
d2
n= (1.96)20.563(1-0.563) =378
(0.05)2
n= the minimum sample size
z= the desired level of confidence interval 95% (1.96)
P= the proportion of early sexual initiation before their 18 birthday from Jiga high school (56.3%) (3).
d= margin of error 5% (0.05), and single proportion formula for sample size
k= anticipated rate of non-response, 15%
nf= final sample size
= 378 by adding non-response rate 15%
n = 435
Finally, by adding 15% non-response rate the estimated sample size was 435.
For the qualitative:
Five focus group discussion was conducted each group contains 10 participants.
Sampling Procedure
For the quantitative:
There are 1 high school and 1 preparatory school in Yaedwha town. Both of them were included by stratified sampling technique and then proportionally allocated. The K value was determining (K= 5 )Then the sample was picked each grade their own interval from the class register. The first cases were selected by lottery method.
For the Qualitative:
Five focus group discussions were undertaken among student’s female (3 groups), and males (2 groups). Study participants were selected purposively after communicating the school director, anti-HIV/AIDS, women’s clubs and without of clubs. They were briefed on the study objectives before selecting the participants. Homogeneity of participants based on sex within the group was maintained.
Dependent Variable
Risk sexual behaviors
Independent Variables
Socio-demographic characteristics: Sex, Age, religion, marital status, education level, and Ethnicity.
Individual factors: Alcohol use, Substance Use, Exposure to pornographic films, Knowledge of HIV/STD and Risk Perception.
Family And Peer Discussion On Sexuality: Communication on sexual behavior, with family, peer, teacher and partner, Peer pressure and Families Education, Families employment.
Operational and terms of definitions
Risky sexual behaviors: is defined as sexually active school students who have at least one of the following multiple sexual partners (having more than one sexual partner before the data collection period), sexual initiation before the age 18, inconsistent use of condom and sexual intercourse with commercial sex workers (3).
Sexually active: Study subjects who claimed to have engaged in a sexual act at least once prior to
the study.
Inconsistent use of condom: Incorrect use of condom or failure to use a condom at least once during sexual intercourse (3).
Knowledge of HIV/STD: Respondents who answered/score more than the mean of correct answers for HIV/STD-related questions were categorized to have good knowledge, while those who responded below the mean of correct answer were classified as having poor knowledge towards HIV/STDs(3).
Risk perception: Students view the risk of sexual behavior.
Alcohol drinkers: Use of alcohol at least once a week among those who had ever drunk alcohol in the previous 12 months.
Data Collection Tools
A structured questionnaire was used to collect data from sample respondents regarding the extent of risky sexual behaviors and associated factors. The questionnaire had 44 items adapted from different literature (3, 7, 9, 14) was administered with the form of self-administered and focus group discussion guide was used for a qualitative study.
Data Collection Procedures
The questionnaire was first prepared in English language and then translated to Amharic and then retranslated to English by language experts for consistency. The pretest was done on 22 subjects in Bichena high school and preparatory school to check the consistency and appropriateness, and then necessary correction was taken before the actual data collection was started. The data was collected by four diploma Nurses and two BSc Nurses were selected as supervisors and were contacted and trained as to how to supervise.
An open-ended question was prepared to guide the focus group discussions which were conducted in a quiet and comfortable room. The discussion was moderated by one BSc and one journal who speak the Amharic language together with the principal investigator. Respondents discussed on various issues regarding risk sexual behaviors. The ideas raised by discussants were translated to the principal investigator by the immediate moderators at the same time being recorded for further transcription.
The principal investigator provided guidance by communicating with the discussants through the immediate moderators to further probe and steer through the discussion points. All focus group discussions were recorded after consent is sought from the participants. Then, tape-recorded version was transcribed, and translated into Amharic then to English.
Data Quality Assurance
Data collectors and supervisors were trained for one day before and after pretest on the content of the questionnaire, purpose of the study and how to approach and maintain the confidentiality of the interviewees. The way of questionnaire administration was taken during pretest that the respondents need a separate class. Data collectors were also supervised by two BSc Nurses and the principal investigator. During data collection, the questionnaire was daily checked for consistency and completeness by supervisors and principal investigator to maintain the quality of data.
The discussion was conducted using the local Amharic language to help them to express their feeling without any difficulties. All Focused Grouped Discussion (FGD were written in note form, captured by radio cassette and careful attention was given for the expressions of the ideas that the discussants used to describe their opinions to the specific discussion points. A decision to stop at four was based on the fact there was a repetition of emerging views. Every focus group discussion was also transcribed and translated on the same day of collection.
Data Processing and Analysis
After data collection, filled questionnaires were coded. The data were entered using Epi data version 3.1 and analyzed using SPSS version 25 statistical software’s. Binary and multiple logistic regression analysis was used to ascertain the association between explanatory variables and the outcome variable. Variables with the significant association in the bivariate analysis (variables which had p values less than 0.25) were entered into multivariate analysis to determine the independent associated factor of risky sexual behaviors. Variables with P value less than 0.05 were considered as statistically significant. Finally, the results were presented in texts, tables, and charts.
After the collection of qualitative data using the guidelines, the information obtained was analyzed manually using predetermined themes after recording, transcribing and translating all discussion points. This data was used to supplement the results obtained using the quantitative method.