Study design and setting
A quasi-experimental study was conducted among first-year students of Arba Minch University.
Population
All first-year students of Arba Minch University in regular programs were the source population whereas all first-year students in selected departments who attend regular programs and full fill inclusion criteria in both intervention and control groups were study population
Inclusion and Exclusion Criterion (Eligibility Criteria)
The study included all first-year students whose ages between 15–24 years, but those students who had previous exposure for comprehensive sexuality education and those who have unable to respond due to severe illness were excluded from the study.
Sample size determination
The required sample size for the number of students needed for this study was calculated by Open Statcalc based on the following assumptions: Based on the study done in Lusaka, Zambia, the proportion of students who used condom consistently and correctly with casual partner last time among control group was 59.1% and among intervention group was 71.4% [13]. At a 95% confidence interval for a two-sided test, power of 80%, a minimum detectable alternative of ± 5%. Accordingly, the calculated sample size was 504 participants. Assuming a study refusal rate of 10% and a design effect of 1.5, a total minimum sample size needed for this study was 504* 0.1+ 504 = 554*1.5= 832 individuals.
Sampling technique
The sampling procedure used in this study was cluster sampling techniques. The sampling frame used for this study was obtained from Arba Minch University registrar office. Arba Minch University geographical located in two towns administrative of zone. The Arba Minch and sawla town. Those towns used as clusters. To select the samples of departments, departments were stratified into two clusters and samples of students were selected independently in each cluster in two stages. In the first stage, a total of 16 departments (8 from each cluster) were selected with purposively and with independent selection in each sampling stratum. In the second stage of selection, a fixed number of 832 (416 per cluster) were selected using simple random sampling techniques using a computer-generated random table. (Figure1)
Sampling Procedure
Measurement
Knowledge towards condoms was measured using four items developed after reviewing previously done literature. The scale is comprised of the following question, having heard about the male and female condom, condoms are an effective method to prevent unwanted pregnancy, HIV/AIDS and sexually transmitted infection (STI). The correct answers were coded "1" and wrong answers "0"[14].
Attitude towards condoms was measured using thirty Likert scale items developed after reviewing previously done pieces of literature[14-16]. Respondents were presented with the following statements. Response categories included: 1 = agree, 2 = not sure and 3 = disagree.
Intention to use a condom was measured based on the study subjects responses to the question asked on regardless of their past sexual experience the students were assessed for their intention to use a condom in their next sexual encounter, using the following item: "I intend to use a condom at the next sexual intercourse." Responses were arranged from strongly agree to strongly disagree on a 5-point scale. This variable will be treated as continuous and each variable coded as "1" or Have great intention to use condoms If the study subject responded as he/she intend to use a condom at the next sexual intercourse and "0" or student don't have an intention to use condoms[3,17].
Data Collection Procedure
Data were collected using a self-administered questionnaire. The questionnaire was initially adopted from the WHO knowledge, attitudes, beliefs, and practices survey instrument and further modified based on available literatures[14,18-20]. At the pre-intervention stage, the baseline information for respondents was obtained from two groups (intervention and control group) one week before starting an educational intervention. The unique confidential identification number was assigned to each student to allow for matching their responses across time points. This was followed by an intervention stage in which a series of sixteen-week education sessions for students in the intervention group which was designed to equip students with knowledge, skills, and attitudes needed to prevent SRH problems and bring positive behavioral changes on sexual and reproductive issues. The education was delivered using brainstorming, lectures, case study, discussion and demonstrations methods. Immediately, after the last education session before the final exam, the post-intervention stage, the same questionnaire that used in the pre-intervention stage was administered to the same students who were selected at the pre-intervention stage in both the intervention and the control groups.
Data Quality Control
To data quality control training was given for data collectors and data clerk personnel. Intensive supervision was done by investigators during data collection. A pre-test was conducted at Arba Minch Health Science College that was equivalent to 5% of the study participants to check the accuracy and consistency of the data collection tools. All the data were cleaned double entered and cross-checked for their completeness and linkage to the unique identification number before analysis. The database was checked for incorrect or out of range data entry.
Data Analysis
The completeness and consistency of the data were checked, coded and double entered into Epi-data 3.1 and exported to STATA version 14.0 statistical software for further analysis. Descriptive statistics were performed. Pearson’s chi-squared test was used to compare categorical outcome variables before and after intervention as well as between the intervention and control group. Furthermore, to compare continuous outcome variables before and after the intervention was tested using paired t-tests while differences between the control group and the intervention groups were tested using the independent t-test. To see the effect of intervention we used an Inverse Probability Weighted (IPW) analysis.