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812 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
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Afr. J. Biomed. Res. Vol. 28(2s) (February 2025); 812-820
Research Article
Effect Of A Structured Health Education Program On Secondary
School Students' Knowledge Of Risky-Sexual-Behaviors In Warri,
Delta State Nigeria
Judith Njideka Esievo1*, Ijeoma Ehiemere2, Taiwo Funmilola Okusanya3, Obataze
Josephine Akpoyovwere4, Obehi Favour5, Chinemerem Eleke6
1*,2,6Department of Nursing Sciences, University of Nigeria, Enugu Campus, Nigeria
3Department of Nursing Science, Federal University of Allied Health Science Enugu
4Deparment of Nursing Sciences, Edo State University, Uzairue
5Department of Nursing Science Delta State University, Abraka Delta State
*Corresponding Author: Judith Njideka Esievo
*Department of Nursing Sciences, University of Nigeria, Enugu Campus, Nigeria.
Email: judithnjideka5@gmail.com
ABSTRACT
Adolescents are at increased risk of engaging in risky sexual behaviours, due to limited knowledge of their consequences.
This study evaluated the effectiveness of the Universal Design for Learning (UDL), a student-centred approach, compared
to the lecture method, a teacher-centred approach, in improving adolescents' knowledge of risky sexual behaviours. A
controlled quasi-experimental design was employed in two selected secondary schools in Warri, Delta State, Nigeria.
Ekpan Secondary School was exposed to the lecture method, while Ugbomro Secondary School received UDL tutelage.
A total of 558 students (279 in each group) were recruited through simple random sampling. Data were collected using a
self-structured questionnaire on "Knowledge of Risky Sexual Behaviour and Consequences", administered as a self-report
questionnaire. Descriptive statistics (mean, standard deviation, frequency, percentage) and inferential statistics (chi-
squared and Odd Ratio) were used to analyze the data at a significance level of p < 0.05. Results showed that before the
intervention, both groups demonstrated similar levels of knowledge (p = 0.552). Post-intervention, the UDL group
demonstrated significantly greater improvement in knowledge of risky sexual behaviours compared to the Lecture group
(97.9 vs. 91.0%, χ² = 12.33, p = 0.001). The UDL approach improved knowledge of risky sexual behaviours 8 times post-
intervention (OR = 8.52, 95%CI = 3.57-20.35) compared to the non-significant change in the lecture group. In conclusion,
the UDL approach significantly improved knowledge of risky sexual behaviours compared to the lecture method in
enhancing adolescents' knowledge of risky sexual behaviours. Nurse educators, teachers, and policymakers should
integrate UDL-based teaching strategies into sexual health education programs to improve knowledge outcomes among
adolescents.
Keywords: Adolescents, Lecture method, Nigeria, Nurse educators, Risky sexual behaviours, Sexual health education,
Student-centred approach
*Author of correspondence: Email: judithnjideka5@gmail.com
Received: 10/01/2025, Accepted: 07/02/2025
DOI: https://doi.org/10.53555/AJBR.v28i2S.6558
© 2025 The Author(s).
This article has been published under the terms of Creative Commons Attribution-Noncommercial 4.0 International
License (CC BY-NC 4.0), which permits noncommercial unrestricted use, distribution, and reproduction in any medium,
Effect Of A Structured Health Education Program On Secondary School Students' Knowledge Of Risky-Sexual-
Behaviors In Warri, Delta State Nigeria
813 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
provided that the following statement is provided. “This article has been published in the African Journal of Biomedical
Research”
INTRODUCTION
Risky sexual behaviors among adolescents have
emerged as a significant public health concern globally,
with far-reaching consequences for both individual and
societal well-being (Ene-Bongilli & Peter-Kio, 2021).
Efrati et al. (2024) noted that the behaviours which
include early initiation of sexual activity, unprotected
sex, and multiple sexual partners, are strongly associated
with unintended pregnancies, sexually transmitted
infections (STIs), and human immunodeficiency virus
(HIV) transmission. Adolescents in developing
countries, including Nigeria, are particularly vulnerable
due to limited access to comprehensive sexual health
education, cultural taboos surrounding discussions of
sexuality, and inadequate healthcare services tailored to
their needs (Ene-Bongilli & Peter-Kio, 2021; Osadolor
et al., 2022).
Nigeria, with its high prevalence of HIV/AIDS and other
STIs, faces unique challenges in addressing adolescent
sexual health (Badejo et al., 2024). According to
Olofinbiyi (2024), a significant proportion of Nigerian
adolescents engage in risky sexual behaviors, often due
to a lack of accurate knowledge and awareness. This
situation is further compounded by societal stigma,
economic hardships, and peer pressure, all of which
contribute to an environment where misinformation and
risky behaviors thrive (Osayi et al., 2024). Warri, a
major city in Delta State, exemplifies these challenges,
as it experiences high rates of adolescent pregnancies
and STIs, highlighting an urgent need for targeted
interventions (Yesufu & Boyi, 2024).
Structured health education programs have been
recognized as effective tools in addressing risky sexual
behaviors among adolescents (Dickson et al., 2024).
Such programs are designed to provide accurate
information, build critical thinking skills, and promote
positive behavioral changes through interactive and
culturally relevant approaches (Hendriks et al., 2024).
By equipping students with the knowledge and skills
necessary to make informed decisions about their sexual
health, structured health education programs have the
potential to significantly reduce the prevalence of risky
sexual behaviours and their associated consequences.
Identifying the best approach or method to delivering the
educational instruction is vital.
The lecture method is the most traditional and widely
used approach in many educational institutions (Nchia et
al., 2017). It is largely a one-way communication route
(Bickford & Warren, 2020). The lecture technique is a
process by which lecturers impart knowledge to students
in the classroom setting. Students' participation in this
teaching method is limited to listening, taking notes and
organising knowledge (Miller, 2012). Several factors,
such as student grade level, subject, and academic goals,
must be considered when using the lecture method
effectively (Lawless & Yea-Wen, 2019). The lecture
method has both benefits and drawbacks. One advantage
is that multiple topics can be covered in a single class
hour (Aham-Chiabuotu & Aja, 2017). The technique
does not necessitate the use of any specialised
equipment, such as a laboratory (Mitra et al., 2020). The
students' listening skills are enhanced. It also assists
pupils in developing linguistic abilities (Muhamad et al.,
2020). Nonetheless, one of the downsides is that the
teacher gives the lesson to all students without taking
into account their individual learning peculiarities
(Lammers et al., 2022). The lecture method places less
emphasis on student involvement (Shqaidef et al., 2021).
The Universal Design for Learning (UDL) method is a
student-centred approach that is proactive in learning,
teaching, and assessment (Marvin et al., 2021). It
provides a framework for educators, students, and
educational institutions to reimagine teaching and
learning in new ways that incorporate new evidence and
address significant challenges (Davis et al., 2022). It
addresses the diverse identities, abilities, learning
strengths, and needs of every student in the learning
environment (Diaz-Vega et al., 2020). The UDL
encourages student involvement and independence by
providing a range of choice options and flexibility for
learning (James, 2018). Flood and Banks (2021) noted
that at the heart of UDL are three principles that
educators must address and they include (1) multiple
ways for students to engage in their learning such as
face-to-face and online lecture and drama narratives
(Principle of Engagement); (2) multiple means of
concept presentation to provide students with equitable
access to the learning content such as take-home fliers,
wall posters, pin-ups, and wrist bands (Principle of
Representation); and (3) multiple ways for students to
demonstrate and experiment with their learning such as
role play and pen on paper assessments (Principle of
Action and Expression). There is increasing interest
among health researchers in the efficacy of applying
UDL in Health Education and its knowledge outcomes
(Davis et al., 2022).
Despite the documented benefits of health education
programs, their implementation in Nigerian secondary
schools remains inconsistent, often hindered by
inadequate resources, insufficient training of educators,
and resistance from stakeholders. There is, therefore, a
pressing need for evidence-based studies that evaluate
the effectiveness of such programs in improving
adolescents' knowledge and attitudes toward risky
sexual behaviours. Such research can provide valuable
insights for policymakers, educators, public health and
child health nurse practitioners, enabling them to design
and implement more effective interventions.
This study assessed the effect of a structured health
education programs employing the UDL versus the
Lecture method on secondary school students'
knowledge of risky sexual behaviors in Warri, Nigeria.
By evaluating the program’s impact, this study
contributes to the growing body of evidence on
adolescent sexual health education and informs
Effect Of A Structured Health Education Program On Secondary School Students' Knowledge Of Risky-Sexual-
Behaviors In Warri, Delta State Nigeria
814 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
strategies for addressing the sexual health challenges
faced by Nigerian adolescents.
METHODS
Ethical Consideration and Approval: This study adhered
strictly to with the Helsinki Declaration of 1975, as
revised in 2013. The study was approved by the
University of Nigeria IRB.
Design: A non-randomized controlled quasi-
experimental design was adopted for this study. This
design was chosen to evaluate the impact of the
structured health education program on students'
knowledge of risky sexual behaviors.
Study Area: The study was conducted in two selected
secondary schools in Warri, Delta State, Nigeria. Delta
State, situated in the Niger Delta region of southern
Nigeria, is known for its diverse population and
educational challenges. Warri municipal hosts numerous
secondary schools, among which Ekpan Secondary
School and Ugbomro Secondary School were purposely
selected for this study. These schools were chosen due
to their status as the oldest public secondary schools in
the area and their relatively large student populations.
Population: The total student population of Ugbomro
Secondary School was 279, while Ekpan Secondary
School had a population of 506. These two schools
formed the basis of the study population.
Sample Size: A total sample size of 558 students was
determined for the study, with 279 students assigned to
the treatment group and 279 to the control group. The
sample size was calculated using Cohen’s power
analysis formula for paired sample designs (Polit &
Beck, 2021):
n = ((Zα/2 + Zβ)2 x 2 x δ2 ) ÷ d2.
Where n = Required sample size, Zβ = Z-score for the
desired statistical power (e.g., 0.84 for 80% power), Zα/2
= Z-score for the desired significance level (e.g., 1.96 for
α = 0.05), σ² = Variance of the difference of paired
scores (best guess for moderate effect = 4.0), d = Effect
size (conventional value = 0.5). The minimum
calculated sample size was increased by 10% to account
for potential attrition and dropout, ensuring the study
maintained adequate power.
Sampling Technique: Simple random sampling was
employed to select participants from the target
population. Inclusion criteria were: (1) Students aged
10-19 years and (2) Enrolled and actively attending one
of the selected secondary schools. Exclusion criteria
included: (1) Mental and/or physical instability and (2)
Visual impairment preventing independent reading of
text without assistance.
Intervention: The structured health education involved
the Universal Design for Learning (UDL) approach. The
UDL method involves presenting educational content
through diverse approaches to enhance learning
outcomes (Fornauf & Erickson, 2020). The intervention
took place weekly for four weeks. The UDL intervention
was a 1-hour program conducted in three stages: lecture,
drama, and ribbon pin-up reminder.
The Lecture (30 minutes) session began with a lecture
covering the definition of risky sexual behaviors and
related topics. These included: Definition and
characteristics of adolescence, Types of risky sexual
behaviors, Factors predisposing individuals to risky
sexual behaviors, Types of sexual harms and
consequences of risky behaviors, Available choices to
mitigate risky sexual behaviours, and Discussion of
sexual issues and prevention techniques.
In the Drama/Role Play (20 minutes) session, students
were divided into four groups, each tasked with planning
and performing a 5-minute drama or role play, focusing
on preventive choices against risky sexual behaviours.
This interactive activity encouraged active participation
and practical application of the concepts learned during
the lecture.
At the Ribbon Pin-Up Reminders (10 minutes) session,
students were given red ribbons to pin on their school
uniforms as a visual reminder of the sexual health
education received. The ribbons served to reinforce the
key messages on risky sexual behaviors and their
consequences.
Control: The comparison involved the Lecture Method.
The lecture method is a traditional approach to
instruction, involves delivering information through an
oral presentation (Hafeez, 2021). The lecture only
condition was provided weekly for four weeks. In this
study, the lecture method was implemented over 1 hour
and comprised the following components: actual lecture,
verbal evaluation, and question and answer sessions.
The Lecture (30 minutes) was similar to that of the UDL
method, covering topics such as the definition of risky
sexual behaviors, factors contributing to these behaviors,
their consequences, and prevention strategies. The
Verbal Evaluation (15 minutes) followed the lecture and
the researcher posed verbal leading questions to the
participants to assess their understanding of the material.
The Question-and-Answer Session (15 minutes) had
participants asking questions, which were addressed by
the researcher to clarify any doubts and reinforce key
concepts.
Both the intervention and comparison conditions were
designed to provide comprehensive sexual health
education, with the UDL method incorporating a more
interactive and multi-faceted approach compared to the
traditional lecture method.
Instrumentation for Data Collection: Data were
collected using a 29-item self-structured questionnaire
on "Knowledge of Risky Sexual Behaviour and
Consequences", administered as a self-report
questionnaire with a reported reliability coefficient of
0.91. The instrument comprised two sections. Section A:
This section consisted of 4 items designed to capture the
socio-demographic profile of participants. Information
collected included age, gender, grade/class, and country
of origin. Section B: This section assessed participants'
knowledge of risky sexual behaviors and their
consequences using 25 items. Knowledge-related items
were numbered 1-6, 9-13, 17-20, and 23-25, while
consequence-related items were numbered 7-8, 14-16,
and 21-22. Most items in this section were structured as
True/False questions, except item 9, which was a single-
best-answer multiple-choice question. Each correct
Effect Of A Structured Health Education Program On Secondary School Students' Knowledge Of Risky-Sexual-
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815 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
response was awarded 1 point, while incorrect responses
scored 0. The total possible score ranged from 0 to 25.
Scores were categorized as follows: 0-8: Poor
knowledge, 9-17: Fair knowledge, 18-25: Good
knowledge.
Data Analysis: The study collected both categorical.
Categorical socio-demographic data from Section A and
B were summarized using descriptive statistics such as
frequencies and percentages. To evaluate the
intervention's effectiveness in improving knowledge of
risky sexual behaviors and consequences was assessed
using odds ratio inferential statistics at a 95% confidence
interval. All statistical analyses were performed using
IBM SPSS software version 25 (IBM SPSS, Armonk,
USA).
RESULTS Table 1: Socio-demographic characteristics of the respondents (n = 558)
UDL treatment group
(n = 279), f (%)
Lecture control group
(n = 279), f (%)
p value
Age
0.735
10-14
144 (51.61)
148 (53.05)
15-19
135 (48.39)
131 (46.95)
Gender
0.931
Female
113 (40.50)
114 (40.86)
Male
166 (59.50)
165 (59.14)
Class of study
0.985
Junior secondary 1
64 (22.94)
61 (21.86)
Junior secondary 2
80 (28.67)
79 (28.32)
Senior secondary 1
64 (22.94)
67 (24.01)
Senior secondary 2
71 (25.45)
72 (25.81)
Who respondent lives with
0.991
Both parents
193 (69.18)
191 (68.46)
Mother only
38 (13.62)
42 (15.05)
Relation (Aunty/Uncle)
36 (12.90)
35 (12.54)
Foster parent (Step father or mother)
12 (4.30)
11 (3.94)
Chi-squared test was used for comparison, p < 005 is significant, f = frequency, % = percent, n =
sample size
Table 1 summarizes the socio-demographic characteristics of the respondents and revealed that there was no significant
difference between the UDL treatment group and the lecture group (p > 0.050). Majority of the respondents were aged
10-14 years, female, in senior secondary 1, and lived with both parents.
Figure 1: Baseline Knowledge of Risky Sexual Behavior and Consequences
Figure 1 summarises the baseline Knowledge of Risky Sexual Behavior and Consequences and showed that there was no
significant difference between the UDL treatment group and the lecture group (p = 0.552).
n = 44 (15.8%) n = 39 (14.0%)
n = 235 (84.2%)
n = 240 (86.0%)
0
50
100
150
200
250
300
Treatment (UDL) Comparison (Lecture)
Poor knowledge (score 0-8)
Fair Knowledge (score 9-17)
Chi squared = 0.354
P value = 0.552
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816 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
Figure 2: Post-intervention Knowledge of Risky Sexual Behavior and Consequences
Figure 2 summarises the post-intervention Knowledge of Risky Sexual Behavior and Consequences and revealed a
significant difference between the UDL treatment group and the lecture group (p = <0.001).
Table 2: Effectiveness of the UDL compared to Lecture in improving Knowledge of Risky Sexual Behavior and
Consequences
Study groups
Baseline knowledge
level
Post-intervention
knowledge level
Chi squared
P value
OR (95% CI)
Poor
Fair
Poor
Fair
UDL (n = 279)
44
235
6
273
31.723
<0.001
8.52 (3.57 – 20.35)
Lecture (n = 279)
39
240
25
254
3.459
0.063
1.65 (0.97 – 2.81)
OR = odds ratio, CI = confidence interval, n = sample size, p < 0.05 is significant
Table 2 summarises the effectiveness of the UDL compared to Lecture in improving Knowledge of Risky Sexual Behavior
and Consequences and demonstrated that UDL intervention increased knowledge by up to 8.5 times from baseline. Lecture
methods increased knowledge by 1.65 but did not reach the level of significance.
DISCUSSION
The pre-intervention findings revealed that both the
UDL treatment group and the lecture control group
exhibited similar levels of knowledge regarding risky
sexual behaviours and their choice-consequences.
Statistical analysis confirmed no significant differences
between the groups prior to the intervention. This
equivalence in baseline knowledge establishes a
balanced starting point for evaluating the effects of the
interventions. By controlling for initial knowledge
disparities, the study ensures that post-intervention
differences in outcomes can be directly attributed to the
instructional strategies employed, rather than pre-
existing variations in knowledge or understanding.
One primary reason for this finding is the fact that the
respondents were drawn from the socio-cultural
environment and had access to similar sources of
information and exposure to health education before the
study. Schools in the same geographic area often follow
comparable curricula, and students may have received
basic sexual health education from teachers, parents, or
media, contributing to a shared baseline of knowledge.
Additionally, the homogeneity in baseline knowledge
might reflect limited prior exposure to comprehensive or
targeted sexual health education across the population.
This uniformity suggests that any prior education about
risky sexual behaviours was general and not
differentiated by the type of group (e.g., UDL or lecture),
thus resulting in similar knowledge levels across both
groups.
These findings align with the design of rigorous
experimental studies, which often seek to minimize
baseline differences to ensure the validity of
comparative analyses. The homogeneity in pre-
intervention knowledge suggests that both groups shared
similar exposures, experiences, or educational inputs
before the study, thereby making them suitable for
evaluating the relative effectiveness of the UDL and
lecture approaches.
When comparing these results with previous studies,
similarities emerge. For instance, studies by Osadolor et
al. (2022) found a similar level of baseline knowledge
level (95%) among respondents in similar educational
contexts among 10-19 years old children. The lack of
significant pre-intervention differences in this study
strengthens its conclusions by ensuring that observed
post-intervention effects are genuine and not
confounded by pre-existing knowledge gaps. The
n = 6 (2.1%)
n =25 (9.0%)
n = 273 (97.9%)
n = 254 (91.0%)
0
50
100
150
200
250
300
Treatment (UDL) Comparison (Lecture)
Poor knowledge (score 0-8)
Fair Knowledge (score 9-17)
Chi squared = 12.330
P value = <0.001
Effect Of A Structured Health Education Program On Secondary School Students' Knowledge Of Risky-Sexual-
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817 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
finding emphasizes the importance of establishing a
level playing field to accurately measure the impact of
health education interventions.
The post-intervention findings of this study
demonstrated found that the UDL group achieved
markedly greater improvements, with nearly all
participants attaining good knowledge of risky sexual
behaviours. In contrast, the lecture group not only
showed a slight increase in the number of participants
with fair knowledge. The stark contrast in post-
intervention outcomes can be attributed to the different
teaching methods employed. The UDL approach is
inherently interactive, learner-centred, and adaptable,
engaging students through multiple means of
representation, expression, and engagement. This
method likely fostered deeper understanding and
retention of information, empowering participants to
connect the material to their own experiences and apply
it practically. Conversely, the traditional lecture method
relies heavily on one-way communication, which may
not accommodate diverse learning styles and often leads
to lower levels of engagement and retention. This
pedagogical gap likely contributed to the superior
performance of the UDL group.
These findings align with previous research highlighting
the efficacy of interactive and participatory learning
strategies over traditional lecture-based methods in
health education. Studies by Ene-Bongilli and Peter-Kio
(2021) and Gomez-Lugo et al. (2022) have shown that
comprehensive, student-centred interventions
significantly enhance knowledge related to sexual and
reproductive health. For instance, a study by Farahani et
al. (2020) reported that adolescents exposed to
interactive, multimedia-based sexual education
programs demonstrated improved knowledge and
reduced engagement in risky behaviours compared to
peers who received lecture-based instruction.
Furthermore, the minimal improvement observed in the
lecture group mirrors findings from previous studies,
such as that by Scull et al. (2022), which noted that
traditional lecture methods often fail to significantly
impact knowledge retention. The slight decline in the
lecture group’s performance could reflect
disengagement or the inability of participants to retain
information presented in a passive format.
The findings of this study highlight the superior
effectiveness of the Universal Design for Learning
(UDL) approach in enhancing adolescents' knowledge of
risky sexual behaviors and their choice-consequences.
The UDL group consistently demonstrated significantly
greater knowledge improvements than the lecture group,
with knowledge of risky sexual behaviors increasing by
approximately eight times from the baseline. This robust
improvement indicates the transformative impact of
UDL in fostering a deeper understanding and retention
of critical sexual health information. In contrast, the
lecture method showed far less improvement,
underscoring the limitations of traditional teaching
methods in addressing complex, behavior-related topics.
The remarkable success of the UDL intervention can be
attributed to its inclusive, flexible, and engaging nature.
UDL employs a variety of teaching strategies to
accommodate diverse learning styles, including
interactive activities, multimedia resources, and
opportunities for active participation. This multi-modal
approach likely enabled learners to connect with the
content more effectively, fostering both comprehension
and application. Additionally, UDL emphasizes
relevance and adaptability, which are critical for
engaging adolescents in discussions about sensitive
topics like sexual health. The lecture method, by
contrast, relies primarily on passive learning and lacks
the interactive elements needed to sustain interest or
deepen understanding, resulting in lower levels of
improvement.
These findings are consistent with earlier research
emphasizing the advantages of interactive and inclusive
learning strategies in health education. For example, a
study by Gomez-Lugo et al. (2022) found that
participatory and learner-centred approaches were
significantly more effective than traditional methods in
improving knowledge and reducing risky sexual
behaviours among adolescents. Similarly, Farahani et al.
(2020) noted that interactive programs that engage
students actively lead to better outcomes in sexual health
education compared to lecture-based approaches.
The eight-fold increase in knowledge observed in the
UDL group also aligns with studies that have
demonstrated the power of tailored, adaptive teaching
methods. For instance, a study by Ene-Bongilli and
Peter-Kio (2021) found that using interactive tools and
diverse teaching modalities led to substantial
improvements in adolescents' understanding of health-
related topics. By comparison, the modest gains in the
lecture group reflect findings from Constantine et al.
(2015), which showed that traditional lecture methods
often fail to achieve significant knowledge retention or
behavioural change due to their lack of engagement and
personalization.
Limitation
The post-intervention knowledge assessments were
conducted shortly after the educational intervention,
which does not account for the long-term retention of
knowledge. Future studies with follow-up assessments
over extended periods are needed to determine whether
the observed improvements in knowledge are sustained
over time.
Conclusion
The Universal Design for Learning (UDL) approach is
significantly more effective than traditional lecture-
based teaching in enhancing adolescents' knowledge of
risky sexual behaviours and their choice-consequences.
The UDL method achieved a substantial increase in the
proportion of participants with fair knowledge. The
lecture-based approach yielded minimal improvements,
highlighting its limitations in fostering comprehensive
understanding in this critical area of health education.
Effect Of A Structured Health Education Program On Secondary School Students' Knowledge Of Risky-Sexual-
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818 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
Based on the findings of this study, school health
educators should integrate the UDL approach into their
teaching practices to address the diverse learning needs
of students. By providing multiple means of
engagement, representation, and expression, educators
can create an inclusive learning environment that
ensures all learners, regardless of their abilities or
backgrounds, gain a comprehensive understanding of
complex topics such as risky sexual behaviours and their
consequences.
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Appendix A: Questionnaire
Section A: Socio-demographic profile
Response
Age
10-14
15-19
Gender
Female
Male
Class of study
Junior secondary 1
Junior secondary 2
Senior secondary 1
Senior secondary 2
Who respondent lives with
Both parents
Mother only
Relation (Aunty/Uncle)
Foster parent (Step father or mother)
Section B: Knowledge of Risky Sexual Behaviour and
Consequences Survey
1
Adolescent are involved in risks sexual behaviours
[ ] True
[ ] False
2
Factors that predispose one to sexual risks include substance
and use and drug abuse
[ ] True
[ ] False
3
Engaging in unprotected sexual activities at a time earlier than
marriage is a risky behaviour
[ ] True
[ ] False
4
When people are behaving inappropriately in a sexual manner
towards me, i will discuss the situation with my parents?
[ ] True
[ ] False
5
One can get information concerning sexual health issues at the
health centre or maternity
[ ] True
[ ] False
6
Abstinence is the right choice to make concerning premarital
sex
[ ] True
[ ] False
Effect Of A Structured Health Education Program On Secondary School Students' Knowledge Of Risky-Sexual-
Behaviors In Warri, Delta State Nigeria
820 Afr. J. Biomed. Res. Vol. 28, No.2s (February) 2025 Mrs. Njideka Judith Esievo et al.
Knowledge items = 1, 2, 3, 4, 5, 6, 9, 10, 11, 12, 13, 17, 18, 19, 20, 23, 24, and 25
Consequence items = 7, 8, 14, 15, 16, 21, 22.
7
Unwanted pregnancy is a consequence of risky sexual
behaviour
[ ] True
[ ] False
8
STI is a consequence of premarital sex
[ ] True
[ ] False
9
What does STI stand for?
[ ] Sexually Transmitted illness
[ ] Sexually Transmitted infection
[ ] Sexual Toxic Infections
10
One can tell if someone has an STI by looking at them
[ ] True
[ ] False
11
Condoms protect one from catching an STI
[ ] True
[ ] False
12
Hormonal contraception such as the implant can protect
women against STI?
[ ] True
[ ] False
13
One can have multiple STIs at once?
[ ] True
[ ] False
14
Genital warts and Genital Herpes can be caught via skin to skin
contact
[ ] True
[ ] False
15
HIV can be passed on through oral sex and sex toys?
[ ] True
[ ] False
16
HIV can be passed on through French kissing
[ ] True
[ ] False
17
If an HIV positive person is not on effective treatment for HIV,
they can pass the virus
[ ] True
[ ] False
18
If someone has HIV it means they will get AIDS
[ ] True
[ ] False
19
The private area is a part of the body that people should not
touch
[ ] True
[ ] False
20
Some methods of emergency contraception can be taken up to
5 days after unprotected sex
[ ] True
[ ] False
21
Drinking alcohol with people can result in rape
[ ] True
[ ] False
22
Having unintended pregnancy may make students drop out
from school
[ ] True
[ ] False
23
Touching someone inappropriately defines rape
[ ] True
[ ] False
24
To prevent sexual violation, I must not visit anyone alone
[ ] True
[ ] False
25
It is recommended to seek immediate medical attention if one
is sexually violated
[ ] True
[ ] False
