Peer-led sexual and reproductive health education and risky sexual behavior among adolescent girls and young women in rural Uganda: a quasi-experimental pre-post study

Abstract

Abstract Adolescent girls and young women face significant sexual and reproductive health (SRH) challenges. We assessed the preliminary effectiveness of a community-based, peer-led SRH education intervention on risky sexual behaviors and comprehensive SRH knowledge among adolescent girls and young women aged 15-24 years in Moroto District, northeastern Uganda. From October 2024 to January 2025, we conducted a pre-post quasi-experiment study without a comparison group across six villages. Participants were selected through multi-stage sampling and assessed at baseline. They subsequently received the community-based peer-led SRH education intervention; each participant served as her own control in the absence of a comparison group. Risky sexual behavior was the primary outcome, and comprehensive SRH knowledge was the secondary outcome. The intervention effect was assessed using a generalized estimating equation with a Poisson distribution, log link function, and exchangeable correlation structure. We reported adjusted risk ratios (aRR) with 95% confidence intervals (CI). Of 389 participants who completed both the pre- and post-intervention evaluation, the mean ages were comparable (19.29 ± 2.94 years vs. 19.31 ± 2.91 years; p = 0.922, respectively). After the intervention, there was a significant decline in the proportion of participants who engaged in risky sexual behavior (57.1% before vs. 37.8% after, p<0.001) and a significant improvement in comprehensive SRH knowledge (85.6% before vs. 99.5% after, p<0.001). In cause-effect analysis, there was a 33% reduction in risky sexual behavior (aRR 0.67, 95% CI: 0.57-0.75), and a 16% improvement in comprehensive SRH knowledge (aRR 1.16, 95% CI: 1.12-1.20). A community-based, peer-led SRH education intervention reduces risky sexual behavior and improves comprehensive SRH knowledge. These findings should be considered preliminary, as robust studies are needed, including a need for nuanced strategies to address contextual factors that contribute to risky behavior despite improved comprehensive SRH knowledge.