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Canadian Guidelines for

Sexual Health

Education

Our mission is to promote and protect the health of Canadians through
leadership, partnership, innovation and action in public health
...

Revised Edition of the 2003 Canadian Guidelines for
Sexual Health Education
This publication can be made available in alternative formats upon
request, and can also be found on the Internet at the following
address: www
...
gc
...
gc
...
1
Acknowledgements
...
2
Goals and Objectives of the Guidelines
...
2
Individuals and Organizations Who May Benefit from the Guidelines
...
4
Health
...
4
Health Education
...
5
Sexual Health
...
5
Sexual Rights
...
7
The Social Construction of Sexual Health
...
8
Recognizing and Meeting Diverse Needs in Sexual Health Education
...
11
Philosophy
...
14
Figure 1
...
15
Knowledge Acquisition and Understanding
...
16
Skills that Support Sexual Health
...
17

Guiding Principles
...
18
Principle 2:
Comprehensiveness of sexual health education
...
24
Principle 4:
Training and Administrative Support
...
32

Theory and Research in Sexual Health Education
...
34
Integrating Theory into Practice: Utilizing the IMB Model
...
The IMB Model
...
45
Appendix A
...
46

Appendix B
...
51

References
...
Both editions of the Guidelines were
developed with the expertise of professionals
in various areas of sexual health, including
education, public health, women’s issues,
health promotion, medicine, nursing, social
work, and psychology
...


The Canadian Guidelines for Sexual Health
Education, 2008 Edition, is based on the
2003 Edition, however, comments from
a national evaluation survey that was
undertaken in Fall 2007 as well as input from
external reviewers have been incorporated
...


Acknowledgements
The Canadian Guidelines for Sexual Health
Education would not exist without the efforts,
knowledge and expertise of those involved
in the development of the 1994 and 2003
editions
...
publichealth
...
ca/sti
...


The revisions to this document were made
possible through the valuable input provided
by experts working in the field of sexual health
education and promotion across Canada,
including the members of the Sexual Health
Working Group of the Joint Consortium for
School Health
...


1

Introduction
Goals and Objectives
of the Guidelines
Sexual health is a key aspect of personal
health and social welfare that influences
individuals across their lifespan
...


2

One goal of the Guidelines is to guide the
efforts of professionals working in the area
of sexual health education and promotion
...

A second goal of the Guidelines is to offer
clear direction to assist local, regional and
national groups and government bodies
concerned with education and health to
develop and improve sexual health education
policies, programs and curricula which
address the diverse needs of all Canadians
...
Assist professionals concerned with the
development and implementation of
new and effective programs, services and
interventions that reinforce behaviours
that support sexual health and personal
well-being
...
Provide a detailed framework for
evaluating existing sexual health education
programs, policies and related services
available to Canadians
...
Offer educators and administrators
a broader understanding of the goals
and objectives of broadly based sexual
health education
...

This document provides a framework that
outlines principles for the development and
evaluation of comprehensive evidence-based
sexual health education
...

Readers should begin by reviewing the
section on Key Concepts
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

The Exploring Sexual Health and Sexual
Health Education section discusses and
recognizes diverse viewpoints concerning the
concept of sexual health, defines the goals
of sexual health education and highlights
the need to recognize and meet the diverse
sexual health needs of various populations
...
The
principles and strategies provided suggest
steps that may be used for current and future
program planning and policy development
...
Action plans developed
from such reviews can help identify gaps in
services in order to improve the sexual health
of Canadians
...

This section also demonstrates that curricula
and programs based on well-tested theoretical
models, such as the Information, Motivation
and Behavioural Skills (IMB) Model, are most
likely to achieve their intended outcomes
...


Individuals and Organizations
Who May Benefit from the
Guidelines
At the individual level, those who may
benefit from using the Guidelines include:
health and educational policy-makers,
curriculum developers, education
researchers, teachers, school administrators,
health care professionals, social workers,
counsellors, therapists, community and
public health personnel, parents, clergy, and
all other individuals who are involved in the
planning, delivery and evaluation of broadly
based sexual health education
...


Overall, the Guidelines discuss in detail
the elements of an effective sexual health
education program (see Figure 1, on page 15)
...
This document recognizes and
embraces these differences which can arise
from diversity in cultural, environmental
and community norms and values
...


Health

4

As defined by the World Health Organization,
“health is a state of complete physical,
mental and social well-being and not merely
the absence of disease or infirmity
...
”2
Research demonstrates that factors outside
the health care system can significantly
affect an individual’s health and sense of
wellness
...
3 Sexual health is an often
overlooked, yet vitally important aspect
of an individual’s sense of health and
personal wellness
...
” 4
“Health promotion has emerged as a
cornerstone of contemporary public health
that aims to advance the physical, social,
[sexual, reproductive], and mental health
of the wider community
...
” 6

Health Education
“Health education is not only concerned
with the communication of information, but
also with fostering the motivation, skills and
confidence (self-efficacy) necessary to take
action to improve health
...
” 6

CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

Sexuality
“Sexuality is a central aspect of being
human throughout life and encompasses
sex, gender identities and roles, sexual
orientation, eroticism, pleasure, intimacy
and reproduction
...
While
sexuality can include all of these dimensions,
not all of them are always experienced or
expressed
...
” 7
As a result of these multiple influences,
sexuality is best understood as a complex,
fluid and dynamic set of forces that are
an integral aspect of an individual’s
sense of identity, social well-being and
personal health
...
Sexual health
requires a positive and respectful approach
to sexuality and sexual relationships, as well
as the possibility of having pleasurable and
safe sexual experiences, free of coercion,
discrimination and violence
...
” 7

“Sexual health is influenced by a complex
web of factors ranging from sexual behaviour,
attitudes and societal factors, to biological risk
and genetic predisposition
...
Sexual health can also
be influenced by mental health, acute and
chronic illnesses, and violence
...

Sexual health education is a broadly based,
community-supported process that requires
the full participation of educational, medical,
public health, social welfare and legal
institutions in our society
...

Effective sexual health education maintains
an open and nondiscriminatory dialogue that
respects individual beliefs
...


KEY CONCEPTS

5

Sexual Rights
“Sexual rights embrace human rights that
are already recognized in national laws,
international human rights documents and
other consensus statements
...

The responsible exercise of human rights
requires that all persons respect the rights
of others
...

Access to timely, broadly based sexual health
education plays a significant role in ensuring
an individual’s sexual health rights
...

Despite the appeal that is associated with
this definition, users should remain aware
that there is no single, universal definition
for sexual health
...
No
single definition of sexual health will fully
represent this diversity
...
” 9
Individuals or groups that suggest a particular
definition of sexual health are likely to appear
to have good reasons for their selection
...
In this context it has been argued
that “we cannot step outside of these
cultural processes to develop a universally

applicable concept of sexuality”10 and this
document acknowledges that the same is
true for the concept of sexual health
...
As a result, the
term “sexual health” may be misunderstood
to express approval or disapproval of specific
behaviours or individuals under the guise of
“medical truth”
...

There are three different approaches that can
be considered when defining sexual health:
i
...
11,12
According to this approach, developing
a definition of sexual health for use
in education programs may result in
the transmission of powerful messages
indicating what is to be considered
“proper” or “normal” sexuality or sexual
behaviour
...
From this
perspective, education programs addressing
sexuality should avoid making direct
references to definitions of sexual health
...
Define and use the term with caution
...
13
This approach recognizes that beliefs about
sexual health vary from one individual to
another and can change over time and in
different cultural or faith-based contexts
...
Therefore, when
professionals use terms such as “sexual
health”, they should do so with caution
...

iii
...
14
8

With this approach, the term sexual
health is used to provide a range of
“sexual health indicators” that suggest a
preferred or ideal set of nonjudgmental
sexual attitudes and behaviours
...

Before applying any of the above approaches,
professionals working in this area should
be aware of and challenge their own values
and standards as well as the values and
standards of the organization they work for
...
Finally, they must
remain cognizant of the different meanings
and understandings associated with the term
“sexual health”
...
Sexual
health education should be available to all
Canadians as an important element of health
promotion programs and services
...
to help people achieve positive outcomes
(e
...
, self-esteem, respect for self and
others, non-exploitive sexual relations,
rewarding human relationships, informed
reproductive choices); and
ii
...
g
...


Recognizing and Meeting
Diverse Needs in Sexual Health
Education
All Canadians have a right to sexual health
education that is relevant to their needs
...

Correspondingly, it is important that sexual
health educators and service providers give
particular attention to the kinds of programs
and resources that support the sexual health
and personal well being of these individuals
across their lifespan
...
The selected
examples that follow are representative of
this larger principle
...
15 Due to
a complex combination of circumstances
(e
...
, cultural and religious background;
geographic location; peer pressure, etc
...
For
example, a survey of 1358 Canadian youth
(ages 13-29) found that while 3
...
5% of the
heterosexual youth surveyed acknowledged
experimenting sexually with members of
the same sex
...
This
realization has important implications for
educators and health care professionals
when engaging in sexual health education
and promotion for diverse populations
...
Rather, awareness that
all youth [and adults] are not heterosexual,
sensitivity in conducting routine interviews,
and understanding the stressors that affect
[LGBTTQ youth and adults] will enable
providers to assess and address their needs
...
18 Inclusive and
affirming supports are critical and should be

provided for all youth and adults, regardless
of their sexual orientation and gender identity
...

See Appendix B, page 51, for Sexual
Orientation and Gender Identity Terms
and Definitions
...
Aging brings about natural changes,
both physically and mentally, which can
affect sexual intimacy and response
...
Having
safe sexual relationships is also important, as
STIs do not respect age
...
Sexual health education and
awareness of individual needs is important
for both seniors and health care professionals
in this context
...
Although the sexual

EXPLORING SEXUAL HEALTH AND SEXUAL HEALTH EDUCATION

9

health education and service needs of
people with disabilities are receiving more
attention than in the past, for many, the kind
of education that supports expression of their
sexuality is often insufficient
...
20 The specific needs of
individuals with disabilities vary greatly from
one individual to another and this should
be taken into account when developing
programs or curricula
...
”21

10

Accessibility and comprehensiveness of
sexual health education are two important
principles of effective sexual health education
articulated in the Guidelines
...

Awareness of these distinct needs can foster
the inclusive, nonjudgmental, broadly based
sexual health education to which all people,
including youth, should have access
...

However, for youth who are living on
the streets and who have dropped out or
been expelled from school, there is often
no access to broadly based sexual health
education
...
Street-involved
youth often do not have the benefit of
supportive family or school settings and, as
such, they are among the most vulnerable
populations in Canada
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

Developing a Broad Framework
for Sexual Health Education
The Guidelines have been conceptualized
and integrated within a broad framework
for sexual health education
...


Philosophy
The expression of human sexuality and its
integration in an individual’s life involves a
dynamic interplay between:

Helps individuals to become more
sensitive and aware of the impact their
behaviours and actions may have on
others and society
...

Integrates the positive, life-enhancing and
rewarding aspects of human sexuality
while also seeking to prevent and reduce
negative sexual health outcomes
...

Effective sexual health education should
be provided in an age-appropriate,
culturally sensitive manner that is
respectful of individual sexual diversity,
abilities and choices
...

Focuses on the self-worth, respect and
dignity of the individual
...

Is structured so that changes in behaviour
and confidence is developed as a result
of nonjudgmental and informed
decision making
...
It recognizes
the dynamic nature of gender roles,
power and privilege and the impact
of gender-related issues in society
...


DEVELOPING A BROAD FRAMEWORK FOR SEXUAL HEALTH EDUCATION

11

Challenges the broader and often invisible
dynamics of society that privilege certain
groups (e
...
, heterosexuals) and identifies
those dynamics which marginalize
or disadvantage others (e
...
, sexual
minorities, people with disabilities,
street-involved youth)
...


12

Recognizes and responds to the specific
sexual health education needs of particular
groups, such as seniors, new immigrants,
First Nations, Inuit and Métis communities,
youth, including ‘hard to reach’ youth
(e
...
, street-involved, incarcerated), sexual
minorities (e
...
, lesbian, gay, bisexual,
trans-identified, two-spirited, intersex and
queer) and individuals with physical or
developmental disabilities, or who have
experienced sexual coercion or abuse
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

A CHECKLIST FOR
ASSESSING PROGRAMS
IN RELATION TO THE
Philosophy of Sexual Health
Education Reflected in the
Guidelines…
...


EXPECTED CHARACTERISTICS:

NOTES:

The sexual health education program emphasizes
the self-worth and dignity of the individual
...

The sexual health education program reflects a
balanced approach to sexual health enhancement
and the prevention of negative outcomes
...

The sexual health education program assists
behavioural change through informed
individual choice
...

The sexual health education program counters
misunderstanding and reduces discrimination
based on the characteristics previously mentioned
...

14

Research consistently demonstrates that
positive sexual health outcomes are most
likely to occur when sexual health education
integrates understanding, motivation and
skill-building opportunities and occurs in
environments conducive to sexual health
(see the Theory and Research in Sexual Health
Education section for more information)
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

Figure 1
...


Motivation and Personal Insight
This element helps individuals to:
develop positive personal attitudes
towards attainment of sexual health
and performance of sexual health
promoting actions;

raise their awareness of the personal
benefits of taking action to enhance
sexual health and to prevent and/or
reduce negative sexual health outcomes
...
g
...


Skills that Support Sexual Health
This element helps individuals to:
acquire developmentally appropriate
skills that are necessary to achieve
personal sexual health goals
...
For example,
individuals would learn how to negotiate
and set sexual limits, including choosing
not to take part in particular sexual
activities; how to articulate their concerns
and to negotiate and consistently use
safer sex practices; how to avoid, or safely
leave a situation in which personal and
sexual health is placed at risk; and how
to work toward nurturing, affectionate
and respectful relationships;

CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

learn to identify possible health
challenges, evaluate the potential
outcomes of their sexual health
practices and to modify their
behaviours as necessary;
learn how to use materials and access
resources that can promote sexual health,
such as using condoms/barrier protection,
getting tested regularly for STI/HIV and
seeking counselling and professional
support in the face of sexual assault
or coercion;
feel confident about their potential to
achieve positive sexual health outcomes
...
The intent is to encourage the
development of a consistent practice of
behaviours that will enhance sexual health
and help individuals to learn appropriate
ways of communicating their sexual health
goals
...
They may also
have the confidence to self-evaluate
their relationship or situation and seek
professional help to access care, treatment
and support to improve their situation
...


This element helps individuals to:
develop an awareness of the ways in
which the environment can help or
hinder individual efforts to achieve
and maintain sexual health;

DEVELOPING A BROAD FRAMEWORK FOR SEXUAL HEALTH EDUCATION

17

Guiding Principles
evaluated on program outcomes and
participant feedback;

The philosophy of sexual health education
used in this document gives rise to five
principles that characterize effective sexual
health education programming
...

COMPREHENSIVENESS – Sexual health
education should address diverse sexual
health promotion and illness prevention
objectives and should be a coordinated
effort of individuals, organizations,
agencies and governments
...

TRAINING AND ADMINISTRATIVE
SUPPORT – Sexual health education
should be presented by confident,
well-trained, knowledgeable and
nonjudgmental individuals who
receive strong administrative support
from their agency or organization
...


Principle 1:
Accessible sexual health education
for all Canadians
Effective sexual health education is
accessible to diverse groups and takes into
account different needs for information,
motivation and skills development
...


Guidelines
This section addresses the general principle
of accessibility as it applies to effective
sexual health education
...
Access to effective
sexual health education requires ongoing
support in both formal settings, such as
schools, community groups, health and
social service agencies and in informal
settings where sexual health education
is provided by parents, caregivers, peers
and others
...

For example, youth, seniors, sexual
minorities, First Nations, Inuit and
Métis people, ethno-cultural minorities,
individuals with disabilities (e
...
, physical,
mental or developmental), individuals
who live in geographically isolated areas,
economically marginalized individuals
and incarcerated individuals are among
the groups that require improved and
nonjudgmental access to sexual
health education
...

They can be a major pathway to ensure
that youth have access to effective and
inclusive sexual health education
...


19

GUIDING PRINCIPLES

A CHECKLIST FOR
PRINCIPLE 1 : Access to
sexual health education for all
The sexual health education activity, program
or policy promotes accessibility for all, as
suggested by the Guidelines
...

Programs and policies embody the key elements
of sexual health education as identified in
the Guidelines
...

This approach also considers sexual health
education to be the shared responsibility of
parents, peers, schools, health care systems,
governments, media and a variety of other
social institutions and agencies
...

INTEGRATED – Learning in formal
settings, such as schools, communities,
health care systems and social service
agencies is complemented and
reinforced by education acquired in
informal settings through parents,
families, friends, media and other
sources of influence
...


Guidelines
This section elaborates on the principle of
comprehensiveness as it applies to effective
sexual health education
...

Accordingly, it is linked to related
curriculum areas that address sexuality,
relationships and personal development
...
These programs take
into account the resources required
to support individual efforts that will
enhance sexual health and prevent
negative sexual health outcomes
...

Comprehensiveness in effective sexual
health education focuses on the needs of
different groups and considers the various
issues relevant to the sexual health of
individuals within any group
...
It should be provided in schools
as an integral element of a broadly based
sexual health education program, and
continue beyond school through the
coordinated interaction of community
agencies and services that adults are likely
to encounter throughout their lifespan
...
Sexuality is a central and
positive part of the total well-being
of young people and, as a result,
comprehensiveness of sexual health
education for children, adolescents
and young adults involves far more
than the prevention of unintended
pregnancy and STI/HIV education
...
g
...

22

Effective sexual health education provides
information and opportunities to develop
personal insight, motivation and skills
that are relevant to an individual’s current
and future development of sexual
health in a safe, caring, inclusive,
and nonjudgmental environment
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

A CHECKLIST
FOR PRINCIPLE 2:
Comprehensiveness of sexual
health education: Integration,
coordination and breadth
Is the sexual health education activity,
program or policy sufficiently comprehensive
in terms of the integration, coordination and
breadth suggested by the Guidelines?

EXPECTED CHARACTERISTICS:

NOTES:

The sexual health education program or policy
is sufficiently broad in content and meets the
information, motivational support and skills
development needs of diverse groups and
individuals seeking to achieve and maintain
sexual health
...

Sexual health education is offered in specific
programs dedicated to this topic
...

Sexual health education programs are coordinated
to facilitate access to clinical and social services
...


GUIDING PRINCIPLES

Principle 3:
Effectiveness of educational
approaches and methods
Effective sexual health education increases
the knowledge, understanding, personal
insight, motivation and skills needed to
achieve sexual health
...


Guidelines
This section describes the characteristics of
educational approaches and methods that
create effective sexual health education
...
knowledge acquisition and
understanding;
ii
...
skills that support sexual health; and
iv
...

For an in-depth description on the
elements of sexual health education and
the effects of environments conducive
to sexual health education, refer to the
section on Theory and Research in
Sexual Health Education
...


Effective sexual health education
programs require financial and
administrative support to develop,
implement and evaluate age-appropriate
and socially relevant programs
...
However, new and
different approaches are needed to
reach youth who are street-involved,
have dropped out of school, or are
living in institutional or care-related
settings
...

Effective sexual health education provides
opportunities for individuals to explore,
question and challenge the attitudes,
feelings, values and customs that may
influence their choices about sexual
health
...

Effective sexual health education
programs ensure access to clinical health
and social services that can help people
address their counselling and health care
needs related to sexual health
...

Effective sexual health education
recognizes that responsible individuals
may choose a variety of paths to achieve
sexual health
...

Effective sexual health education supports
informed decision-making by providing
individuals with the opportunity to
develop the knowledge, personal insight,
motivation and behavioural skills that are
consistent with each individual’s personal
values and choices
...


conducive to assisting all individuals,
including those who have been sexually
abused and/or traumatized
...

Effective sexual health education
encourages and strengthens the role of
peer education and support
...


25

Since the media plays a major role in
the sexual education of individuals,
effective sexual health education provides
training in critical media literacies to
help individuals identify and deconstruct
hidden and overt sexual messages and
stereotypes
...

Effective sexual health education identifies
and assists, through referral and support,
individuals who have experienced the
trauma of child sexual abuse, sexual
coersion and sexual assault, violence and
exploitation
...


EXPECTED CHARACTERISTICS:
Approaches and methods effectively integrate
the four key elements of sexual health education
featured in Figure 1: knowledge acquisition
and understanding, motivation and personal
insight, skills that support sexual health and
environments conducive to sexual health
...

Sexual health education policies provide financial
and administrative support for approaches that
target specific audiences
...

The sexual education program provides access
to clinical and social services that support
counselling and health care needs related to
sexual health
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

NOTES:

The sexual health education program provides
training in critical media literacies relevant to
sexual health
...

The sexual health education activity or program
encourages informed parent and caregiver
support to strengthen positive parent-child
communication about sexual health issues
...


27

GUIDING PRINCIPLES

Principle 4:
Training and Administrative Support
Effective sexual health education involves
institutional and administrative commitment
and support
...


Guidelines
This section outlines the training and
administrative supports that are important for
providing effective sexual health education
...

The requirements for individuals delivering
sexual health education in formal settings,
such as schools, public health units, clinics
or group homes, should be mandated
by the educational and administrative
authorities that govern their professions
...

In the case of educators, for example,
these skills would be reflected in
their ability to provide students with
information as well as opportunities to
develop personal insight, confidences,
motivation and self-esteem, and to
facilitate the acquisition of skills
necessary to achieve optimal
sexual health;
ability to identify and understand
the diverse beliefs and values of
individual students, clients or groups
...
This
sensitivity often involves the ability
to address issues surrounding conflict
management and resolution;
deconstructing personal assumptions
and biases in order to work towards a
nonjudgmental learning environment;
understanding of contemporary and
historical issues surrounding sexual
orientation and gender identity and
the skills to provide effective and
inclusive education in this area;
sensitivity to gender-related issues as
they pertain to both the practice and
content of sexual health education;
teaching strategies that help people
to effectively address sensitive and
controversial issues
...
g
...

Effective sexual health education
requires administrative support and
sufficient time for educators to meet
professional and academic development
needs
...
g
...


Effective sexual health education gives
parents, guardians and primary caregivers
access to a variety of opportunities to
learn about sexuality and sexual health,
which in turn provides them with the
knowledge, skills and confidence
necessary to support them in speaking
effectively to their children about
healthy sexuality
...

This makes parents, guardians and
primary caregivers important sources of
positive sexual health education
...

Effective sexual health education
encourages training and educational
opportunities for persons engaged
in peer education, counselling and
advocacy in all areas related to sexual
health education
...
The
organizations and agencies involved
should coordinate such training to
provide formal, informal and non-formal
mechanisms for communication,
information sharing and education
...


EXPECTED CHARACTERISTICS:
There are mandated professional requirements for
those who provide sexual health education
...


30

Those training sexual health educators receive
strong administrative support
...
;
the skills and confidences to act as
effective sexual health educators in
their professional setting;

CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

NOTES:

the ability to understand and acknowledge
the needs of people of diverse backgrounds,
sexual orientation, and varied sexual
health education;
the ability to sensitively affirm sexual feelings
as a natural part of life;
the ability to recognize the effect that
religious, ethno-cultural and other variables
may have on an individual’s values and
beliefs about sexuality;
the ability to sensitively address and resolve
conflicts that may arise as a result of differing
values and beliefs surrounding sexual health
and sexuality;
specific understanding about issues related
to sexual orientation and gender identity and
skills to provide inclusive and nonjudgmental
sexual health education in this area;
sensitivity to gender-related issues relevant
to sexual health; and
media literacy relevant to sexual health
...

Peer educators, counsellors or advocates receive
training, supervision and opportunities for
continuing education
...


Guidelines
This section summarizes the principles of
planning, evaluation, and updating and
social development that contribute to
effective sexual health education
...
This process involves
collaboration with persons for whom the
programs are intended to be delivered
...

Evaluation
Effective sexual health education
programs are evaluated on a regular basis
...

Careful program evaluation ensures that
learning outcomes are clearly defined
from the outset and are being met over
time, which in turn can guide program
delivery and modification
...

Individuals who receive effective sexual
health education are given regular
opportunities to assess the usefulness and
relevance of such programs
...

Updating and social development
Objectives for effective sexual health
education programs are guided by a
realistic awareness that education is
one of a number of factors that contribute
to health-related knowledge, attitudes
and behaviour
...

For example, the media represents a
powerful influence on how individuals
perceive themselves, others and the world
around them
...
Such
images can be unrealistic in terms of the
expectations communicated about sexual
attractiveness and performance
...

Correspondingly, organizations and
individuals should be encouraged to
support media and social marketing
efforts designed to help individuals
enhance sexual health and avoid
negative sexual health outcomes
...


EXPECTED CHARACTERISTICS:

NOTES:

Sexual health education programs are based on
a careful needs assessment that includes input
from community, educators and the scientific/
research sector
...

33

Participant feedback is used to assess program
effectiveness and to detect additional outcomes
other than specific stated program objectives
...

The sexual health education program helps
individuals to recognize environmental factors
affecting sexual health and creates environments
conducive to sexual health
...
While
most forms of sexual health education have
potential benefits, many are still missing the
main elements needed to effectively address
the diverse sexual health needs that may be
relevant to Canadians
...
The
approach to sexual health education
presented in the Canadian Guidelines for
Sexual Health Education is supported by such
research
...

Programs that are exclusively directed at
increasing the knowledge of an individual are
often successful in reaching this objective
...

While an individual exposed to this type
of educational programming may possess
a high level of sexual health knowledge,
it is unclear whether that knowledge will
translate into behaviours that can enhance
sexual health
...
In the case of STI/HIV prevention,
one of the characteristics of nearly all
effective interventions is the incorporation
of theoretical models that are well supported
by a body of research and that effectively
encourage sexual health promotion and
behavioural change
...

Several theoretical models meet these
standards and can be used to develop
programs consistent with the Canadian
Guidelines for Sexual Health Education
...
A brief summary of these
models is provided on the following pages
...
24-28
The Social Cognitive Theory29 states that
people learn from one another by observation,
imitation and modelling
...
It identifies
human behaviour as an interaction of:
personal factors (e
...
, knowledge,
understanding, expectations,
attitudes, confidences),
behavioural factors (e
...
, skills,
practice, self-efficacy), and
environmental factors (e
...
, social
norms, access in community,
influence of others)
...

For example, a recent study applied SCT in
an HIV prevention program for fathers and
their sons
...
The program
included relevant and current information
about listening and communication skills,
adolescent development, puberty, and HIV
and STI risk-reduction practices
...
27

The Transtheoretical Model has also
provided the basis for effective STI/HIV
interventions
...
According to the model, individuals
participating in behaviour change
interventions should be guided through
a five-stage continuum33:
i
...
Contemplation: intention to change
behaviour in the near future (e
...
, within
the next 6 months);
iii
...
g
...
Action: engaging in the health behaviour
within the past 6 months; and
v
...
g
...

The transtheoretical model has been shown
to have promise for use at an adolescent
sexual health and STI/HIV clinic
...
It was also noted that the
transtheoretical model helped clinic staff to
structure and personalize their counselling
sessions
...
35-37
The Theory of Reasoned Action38,39 is
a theory that focuses on an individual’s
intention to behave a certain way
...


36

SUBJECTIVE NORM – associated
with the behaviour
...

The Theory of Planned Behaviour 40 is an
extension of the Theory of Reasoned Action,
which additionally considers that behavioural
intention is a function of attitudes toward
a behaviour, subjective norms toward that
behaviour and perceived behavioural control,
or the feeling that the individual can indeed
perform the behaviour in question
...
The study found that
students had greater intentions of using
condoms when the educational intervention
focused on: (1) positive attitudes towards
condom use and their protective effect
against STIs, including HIV, and also
(2) students’ perceptions that their sexual
partner(s) and peers were likely to approve
of condom use
...
41 Information, motivation and
behavioural skills are basic concepts that
are easily understood by educators and
program audiences
...
42-44

Integrating Theory into Practice:
Utilizing the IMB Model
While there are a number of very good
theoretical models that can be used in the
development of sexual health education
curriculum and programming, the Guidelines
are based on the IMB model because there
is significant empirical evidence which
demonstrates the model’s effectiveness
...
48 Furthermore, a
meta-analysis strongly supports the need to
include elements of information, motivation
and behavioural skills in interventions that
target sexual risk behavioural change
...
The IMB Model50
SEXUAL AND
REPRODUCTIVE
HEALTH INFORMATION

SEXUAL AND
REPRODUCTIVE
HEALTH MOTIVATION

SEXUAL AND
REPRODUCTIVE
HEALTH BEHAVIOUR
SKILLS

SEXUAL AND
REPRODUCTIVE
HEALTH BEHAVIOUR

Note: Adapted from Fisher, W
...
, & Fisher, J
...
(1998)
...
Annual Review of Sex Research, 9,39-76
...
Using the IMB model, sexual health
education programs are based on the three
essential elements:
Information – helps individuals
to become better informed and to
understand information that is relevant
to their sexual health promotion needs
and is easily translated into action;

The IMB model can help individuals to
reduce risk behaviours, prevent negative
sexual health outcomes and guide
individuals in enhancing sexual health
...


Motivation – motivates individuals to
use their knowledge and understanding
to avoid negative risk behaviours and
maintain consistent, healthy practices
and confidences; and
Behavioural skills – assists individuals
to acquire the relevant behavioural
skills that will contribute to the
reduction of negative outcomes
and, in turn, enhance sexual health
...

Example: Programs targeting groups
with diverse backgrounds must provide
information that is clear, practical and
situated within the social context and
environment experienced by the target
population
...


INFORMATION – For sexual health
education programs to be effective,
they need to provide evidence-based
information that is relevant and easy
to translate into behaviours that can
help individuals to enhance sexual
health and avoid negative sexual
health outcomes
...


Directly linked to the desired
behavioural outcome and will result
in the enhancement of sexual health
and/or the avoidence of negative sexual
health outcomes
...
Acquiring
such information may be directly
linked to reducing cases of
unintended pregnancies
...

Example: Creating a directory of
all local, easily accessible sexual
and reproductive health centres
may translate into a desired positive
behaviour when it results in individuals
identifying accessible, appropriate,
user-friendly sexual health care
resources and visiting such a health
centre or clinic more frequently
...

Example: Programs targeting
prevention of STI/HIV risk
behaviours among adolescents
with disabilities must take into
account their unique needs
...
Accordingly, in order for
sexual health education programs to
achieve their goals, planners should
address the motivational factors
that are needed to bring about
behavioural change
...

Example: Men who have negative
emotional responses to sexuality
may be less likely to benefit from
educational programs designed
to encourage them to undertake
a testicular self-examination
...

Example: An individual who has strong
negative feelings about a method of
contraception (“condoms are awful
because they reduce feeling,” “the pill
is bad because it will make me gain
weight”) are unlikely to adopt the
method of contraception in question,
unless they come to accept offsetting
positive beliefs that alter their
negative attitudes
...


Example: Individuals who are
questioning their sexual orientation
are more likely to seek out and speak
openly in an environment they feel is
supportive of all sexual orientations
...

BEHAVIOURAL SKILLS – Individuals
should be aware of and acquire
practice enacting the specific
behavioural skills that are needed
to help them adopt and perform
behaviours that support sexual health
...
This is why sexual and reproductive
health skills training are key elements of
effective sexual health education programs
...
The practical skills for performing
the behaviour (e
...
, knowing how
to negotiate); and
ii
...
g
...

Example: An individual who has been
given information on how to use a
condom, and is motivated to use it,
must also have the technical skills to
properly put it on, and the negotiation
skills to get their partner to agree to
use or to support the use of one
...
g
...
g
...

Behavioural skills for self-reinforcement and
for partner-reinforcement for maintaining
sexual health promoting behaviour over
time is also critical in the long run
...
To
assess this information, conduct focus
groups, interviews or administer a survey
questionnaire to a representative
sub-sample of the target population
...


INTERVENTION
Develop and implement relevant
and appropriate sexual health
education programs

EVALUATION
Measure the effectiveness of the
program in relation to its stated
objectives and identify areas that
require modification

Make evidence-based decisions for
program planning based on the current
research, other program evaluations as
well as assessment of need
...
There are several
types of program evaluation, both in the
program planning and implementation
stages
...
Information from a
needs analysis and a feasibility study will
provide planners with information on the

CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

type of programming that is required, and
if the program is appropriate in terms of
timing, resources and audience
...
The purpose of process
evaluation is to improve the operation
of an existing program, and focuses on
what the program does and for whom
...

The plan for process and outcome
evaluation should be built into the overall
program plan, prior to its actual launch
...
In order to determine whether
a program made a difference or not,
there needs to be an understanding of
how things were before the program was
implemented (e
...
, knowledge, attitudes,
beliefs, etc)
...

For each target group, address where
gaps exist in information, motivation
and behavioural skills in relation to
the program objectives and needs
of the individual
...
These assets should
be used to reach program objectives
...
This could fill knowledge
gaps among the target group
(Information), reinforce the group’s
personal views about condom use
and help them to personalize the
risks of teen pregnancy and/or STI/
HIV (Motivation) and incorporate role
playing exercises to help individuals
learn how to negotiate condom
use with sexual partners while also
teaching them where to access free
condoms (Behavioural skills)
...
Evaluation research
enables program planners to identify
strengths and weaknesses in the program
so that, if necessary, modifications may
be made to increase the program’s
effectiveness
...
Such
unintended outcomes may also identify
particular strengths and weaknesses in
the program that are not revealed by an
analysis of just the stated objectives
...
When possible,
the evaluation should include a control
group to ensure that observed changes

THEORY AND RESEARCH IN SEXUAL HEALTH EDUCATION

41

are actually the result of the program
and not the result of external influences
...

Example: The evaluation phase of
a sexual health education program
focusing on cervical cancer
prevention and screening might
include the following steps:

42

As part of the evaluation process,
re-administer the questionnaire to
both groups after the program has
been completed to measure the
degree of effectiveness
...


At the beginning of the program,
have participants fill out a
questionnaire that assesses their
knowledge of the prevalence,
causes and preventive measures
associated with cervical cancer
(Information), their personal
attitudes towards taking the
necessary precautions to reduce
their risk of cervical cancer
(Motivation) and their perceived
ability and skills to change risk
behaviours and seek screening/
vaccination services to reduce
the risk of cervical cancer
(Behavioural skills)
...
In
this case, the questionnaire would
determine the participant’s level of
behavioural risk for cervical cancer,
whether the individual has received
an HPV vaccine and whether they
have been screened for cervical
cancer and, if so, how frequently
...


Environments Conducive
to Sexual Health
The Guidelines identify “Environments
Conducive to Sexual Health” as a fourth
key element of sexual health education
...
These include:
social and economic circumstances
(e
...
, income, education, employment,
social status and social supports);
access to/knowledge of health
services; and
community norms, values and
expectations related to sexuality,
gender identity, sexual orientation
and reproduction
...
However,
these programs must also address the
influence of environmental factors on
individual efforts to acquire and apply the
knowledge, motivation and skills needed
to maintain or enhance sexual health
...
The rate of teen births
was over 13 times higher in the low
socioeconomic status (SES) areas when
compared to the high SES areas
...
56 Income and access
to services are only two of the many
examples of the different ways in
which the social environment, and
particularly social inequality, can
affect sexual health
...
An in-depth
international comparative study of
adolescent sexual and reproductive
health in five developed countries
(Canada, United States, France,
Great Britain and Sweden) has provided
convincing evidence of the role of
environmental factors in influencing
sexual health
...
Data collected
for the Canadian component of the
study suggested that in Canada, for
both early teen pregnancies and STIs,
rates vary by geographic region and
economic status
...
58-60

In the United States a comprehensive
review of research on teenage
pregnancy found that environmental
factors such as community
disadvantage and disorganization,
family structure and economic
situation, as well as peer, partner and
family attitudes towards sexuality and
contraception are directly linked to
determinants of adolescent sexual
behaviour, use of contraception,
pregnancy and attitudes toward
childbearing
...
The media, including television,
movies, music, magazines and the
Internet, have become an increasingly
powerful force in communicating norms
about sexuality and sexual behaviour
...

Example: Several studies have
suggested that exposure to sexual
content in the media is one of the
many factors that may influence
the timing of onset of sexual
behaviours
...

Critical evaluation of the impact of
the media, and of the environment
that such information creates, should
also be a key part of sexual health
education in both the public and
not-for-profit sectors
...

Research on program evaluation
illustrates how sexual health education
programs that are culturally appropriate
and sensitive to community needs are
more likely to be effective
...
This can also
be done by identifying and using
organizers within the housing
developments as educators and by
using housing development events
as opportunities to provide effective
sexual health education
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

Conclusion
The aim of these Guidelines is to unite
and guide professionals working in the
area of sexual health education and health
promotion, with a particular emphasis on
curriculum and program planners, policymakers, educators (in and out of school
settings) and health professionals
...
Developing curricula and
programs related to sexual health education
can add another level of complexity as a
result of the sensitivities associated with
discussions of sexuality
...


3
...

Check to ensure that this mechanism is
able to evaluate the intended goals and
identifies areas that need to be addressed
and changed to achieve the desired
results
...


45

While this document presents a great deal
of information, there are three keys points
that provide the critical foundation for the
Guidelines
...
Inclusivity – sexual health education
must be inclusive of the population
it is targeting
...

Account for intra-group diversity and
differing health needs
...
Evidence-based – Sexual health
education should be grounded in a
theoretical model that is applicable to
the subject and target population being
served
...


CONCLUSION

Appendix A
The information provided below offers
sample criteria that can be used in
assessing or revising programs consistent
with the Guidelines
...

Example:

46

Work with individuals to assess their personal and primary needs where sexual health
and sexuality are concerned
...

Understand the central underlying issues associated with the above factors in order to
assist program planners, policy-makers and educators in creating and implementing
effective, targeted programs and services that will help to prevent negative outcomes
and bring about positive behavioural change
...

Example:
Work in partnership and form linkages with federal, provincial, territorial and
community organizations to pool funds and resources in order to ensure the coordinated
development of effective, targeted sexual health education programs, policies or
activities
...

Build up the systems of supporters and users of the Guidelines and develop
discussion papers that will be the subject of national debate on the future of
sexual health education
...
g
...

Educate practitioners on how to understand and use the Guidelines to ensure that the
target population benefits from its key messaging
...

Example:
Comprehensiveness refers to the information, motivation, and behavioural skills content
of sexual heath education
...

Determine where sexual health education overlaps with related programs and
integrate sexual health education into these areas
...
These programs can be targeted and delivered at the primary, secondary
and post-secondary levels
...

APPENDIX A

47

PRINCIPLE 3:
EFFECTIVENESS AND SENSITIVITY OF EDUCATIONAL APPROACHES
AND METHODS
The sexual health education activity, program or policy incorporates effective and
sensitive educational approaches and methods as suggested in the Guidelines
...

Collaborate with provinces, territories and community organizations to identify the
key elements/topics of the program area
...
Encourage their input to ensure that programs and services
in this area are tailored to meet their needs
...
Also work
in concert with community leaders and sexual health experts, as well as provincial and
territorial officials to address any controversy that may arise from this issue
...

Example:
Provide a comprehensive orientation guide for those who provide sexual health
education
...

Ensure that job descriptions within the organization have clearly defined statements of
qualifications which will help guide staff selection, interviewing and hiring processes
to ensure that the selected person has a specific level of knowledge, skills and ability
to provide sexual health education services
...

Include as part of the annual budget, funds to support on-going professional
development and in-service training for those providing sexual health education
...

Include sexual health education as part of curriculum
...
The curricula should be based upon, and evaluated
according to the framework outlined in the Guidelines
...

Example:
Engage and influence policy-makers in the developmental and evaluation processes
...

Synthesize and share best practice models (nationally and internationally) for the
development of effective sexual health education programs, simultaneously integrating
research with policy and practice
...

Create an Advisory Committee composed of members from the community,
non-governmental organizations and from all levels of government to monitor
and evaluate sexual health education programs on a regular basis to ensure that
they are meeting the needs of the target audiences
...


CANADIAN GUIDELINES FOR SEXUAL HEALTH EDUCATION

Appendix B
Sexual Orientation and Gender
Identity Terms and Definitions65-67
This glossary of terms is a resource for
individuals working in sexual health
education and promotion
...


BISEXUAL: A person who is attracted
physically and emotionally to both
males and females
...
g
...

GAY: A person who is physically and
emotionally attracted to someone of the
same sex
...

GENDER IDENTITY: A person’s internal
sense or feeling of being male or female,
which may or may not be the same as
one’s biological sex
...
Also commonly referred
to as straight
...


INTERNALIZED HOMOPHOBIA: A
diminished sense of personal self-worth
or esteem felt by an individual as a result
of the experienced or presumed homophobia
of others
...
For example,
some intersexed individuals are born with
the reproductive organs of both males and
females or ambiguous genitalia
...

LGBTTQ: A commonly used acronym for
the constellation of lesbian, gay, bisexual,
trans-identified, transsexual, two-spirited,
and queer identities
...

LESBIAN: A female who is attracted physically
and emotionally to other females
...
More recently, the LGBTTQ
community has reclaimed the word and
uses it as a positive way to refer to itself
...

TRANSGENDER/ TRANS-IDENTIFIED:
A person whose gender identity, outward
appearance, expression and/or anatomy
does not fit into conventional expectations
of male or female
...
g
...

TWO-SPIRITED: Some Aboriginal people
identify themselves as two-spirited rather
than as bisexual, gay, lesbian or transgender
...
Before colonization,
two-spirited persons were often accorded
special status based upon their unique
abilities to understand both male and
female perspectives
...
World Health Organization
...
Constitution of the World Health Organization, Geneva
...
Green L
...
, & Kreuter, M
...
(1991)
...

In Health Promotion Planning: An Education and Environmental Approach
...

Mountain View: Mayfield Publishing Co
...
Public Health Agency of Canada (PHAC)
...
Population Health Approach
...
Accessed on December 6, 2007: http://www
...
gc
...
html
...
World Health Organization (WHO)
...
The Ottawa Charter for Health Promotion
...
World Health Organization (WHO)
...
Education for Health Promotion: Report of an
Intercountry Expert Committee Meeting
...
World Health Organization (WHO)
...
Health Promotion Glossary
...
World Health Organization (WHO)
...
Accessed on January 18, 2008: http://www
...
int/
reproductive-health/gender/sexualhealth
...

8
...
G
...
A
...
Sexual Health: A Useful Public Health Paradigm
or a Moral Imperative? Archives of Sexual Behavior, 33, 181-187
...
Giami, A
...
Sexual Health: The Emergence, Development, and Diversity of a Concept
...

10
...
, & Theis, J
...
The construction of sexuality: implications for sex education and
therapy
...

11
...
(1987)
...
In Concepts of Sexual Health:
Report of a Working Group
...

(EUR/ICP/MCH 521)
...
Naus, P
...
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...

13
...
L
...
A social work perspective on sexual health
...

14
...
S
...
Promoting healthy adolescent sexuality
...

15
...
, & Risdon, C
...
Caring for lesbian and gay people: A clinical guide
...

16
...
(2006)
...
Ottawa, ON: The Canadian Teachers’ Federation
...
Ryan, C
...
(1998)
...
New York:
Columbia University Press
...
Russell, S
...
(2005)
...
Journal of Gay
& Lesbian Issues in Education, 2, 5-18
...
Health Canada
...
It’s Your Health: Seniors and Aging – Sexual Activity
...
Servais, L
...
Sexual Health Care in Persons with Intellectual Disabilities
...

21
...
(2003)
...
The Canadian Journal of Human Sexuality, 12, 53-68
...
Poulin, C
...
, Bernier, F
...
(2001)
...
Sexually Transmitted Diseases, 28, 437-443
...
Public Health Agency of Canada
...
Street Youth in Canada: Findings from Enhanced
Surveillance of Canadian Street Youth, 1999-2003
...
Kamb, M
...
, Douglas, J
...
(1998)
...

Journal of the American Medical Association, 280, 1161-1167
...
Koniak-Griffin, D
...
A
...
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in a human immunodeficiency virus prevention program
...

26
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...
, Applewhite, J
...
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...
AIDS Patient Care
and STDs, 21, 306-320
...
Dilorio, C
...
, & Denzmore, P
...
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mediators of father-son communication about sex
...


54

28
...
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...
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...

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(1986)
...
Englewood
Cliffs, NJ: Prentice-Hall
...
CDC, Centers for Disease Control and Prevention
...
(1999)
...
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...
Naar-King, S
...
, Parsons, J
...
, et al
...
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HIV-positive youths
...

32
...
, Brown, E
...
, & Dodds, D
...
Applying a transtheoretical behavioral
change model to HIV/STD and pregnancy prevention in adolescent clinics
...

33
...
O
...
F
...
The transtheoretical model of health behavior change
...

34
...
B
...
S
...
T
...
Abstinence and safer-sex HIV risk-reduction
interventions for African American adolescents: a randomized controlled trial
...

35
...
(2001)
...
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...
Albarracin, D
...
T
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...
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Muñoz-Silva, A
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...
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...
Ajzen, I
...
(1980)
...

Englewood Cliffs, New Jersey: Prentice-Hall
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Fishbein, M
...
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...
Reading, MA: Addison-Wesley
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Ajzen, I
...
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...
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perceived behavioral control
...

41
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D
...
A
...
Theoretical approaches to individual level change in HIV risk
behavior
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Peteson, & R
...
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3-55
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Albarracin, D
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...
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Johnson, B
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...
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of AIDS Impact, Brighton, England, United Kingdom
...
Fisher, J
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...
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...
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...

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among HIV-infected patients
...

45
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A
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...
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...
AIDS and Behavior,
12, 412-418
...
Anderson, E
...
, Wagstaff, D
...
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...
, et al
...
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in low-income housing
...

47
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, Kalichman, S
...
, et al
...
A randomized trial of a brief HIV risk
reduction counselling intervention for women
...

48
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D
...
A
...
D
...
J
...
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skills model-based HIV risk behavior change intervention for inner-city high school youth
...

49
...
L
...
T
...
P
...
Conducting meta-analyses of HIV prevention
literatures from a theory-testing perspective
...

50
...
A
...
D
...
Understanding and promoting sexual and reproductive health
behavior: theory and method
...

51
...
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...
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...
(1996)
...
Health Psychology, 15, 114-123
...
Fisher, W
...
, Fisher, J
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...

In Suls, J
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(Eds
...

United Kingdom: Blackwell Publishers
...
Fisher, W
...
(1997)
...
The Canadian Journal of Human Sexuality, 6, 105-112
...
Boyce, W
...
, Fortin, C
...
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...
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...
Manitoba Child Health Atlas
...
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Community, Education and Health Care
...

cpe
...
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Hardwick, D
...
(1999) Geographic mapping demonstrates the association between
social inequality, teen births and STDs among youth
...

57
...
E
...
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...
, et al
...
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Developed Countries: Can More Progress be Made? Occasional Report
...

58
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, McKay, A
...
(2001)
...
Occasional Report
...

59
...
, Barrett, M
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(2000)
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The Canadian Journal of Human Sexuality, 9, 41-65
...
Maticka-Tyndale, E
...
Sexual health and Canadian youth: how do we measure up?
The Canadian Journal of Human Sexuality, 10, 1-17
...
Kirby, D
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L
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Brown, J
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