A Systematic Review and Meta‑analysis of Gamified Affective Sexual Health Interventions in Schools

Abstract

Abstract Introduction Adolescent sexual education targets risk reduction in STIs, pregnancies, and gender inequality. Inadequacies in traditional methods drive exploration of innovative approaches. This systematic review aims to synthesise, compare, and evaluate gamified affective sexual health interventions for adolescents within the school. Methods A systematic literature review was conducted across five databases from March 2022, with an update in December 2023, including PubMed, Scopus, PsycINFO, WOS, and EMBASE. Experimental studies of gamified interventions in schoolbased affective sexual health for adolescents aged 10–19 years were included. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies by the Effective Public Health Practice Project. The selected articles were conducted primarily in the USA, encompassing 13 randomised controlled trials, two quasi-experimental studies, and one clinical trial. A subsequent meta-analysis was conducted using the random-effects model to calculate combined effect sizes and 95% confidence intervals (CI). Results Interventions yielded positive short and long-term impacts, improving attitudes, knowledge, and behaviours, and delaying sexual initiation. Studies revealed a statistically significant effect in follow-ups of less than six months, with 81% of outcomes showing positive impacts on delaying the initiation of any sexual activity and 50% on contraceptive use, knowledge, and improved attitudes. In follow-ups exceeding six months, a consistently positive and significant effect was maintained, ranging between 19% and 62.5%, for the delay in sexual initiation, contraceptive use, knowledge, and attitudes. The results from the meta-analysis indicate that gamified interventions are effective in delaying sexual initiation among adolescents, achieving an 15% reduction in the probability of initiating sexual relationships. Conclusions To enhance affective sexual health, a recommended methodological framework standardizes the design of universal interventions, enabling comprehensive effectiveness analysis. Emphasizing the encouragement of early initiation of interventions, adopting technological advances to enhance traditional education and address contemporary challenges in adolescent sexual health is highlighted. Policy Implications Sex education is essential to prevent risky behaviours, unwanted pregnancies, and STIs. This requires effective educational programmes that improve knowledge, skills, attitudes, and behaviours in a standardised way that is accessible to all adolescents.