The strategies used by the school health team during the delivery of sexual health information to unmarried adolescents in Malaysia


school health team
sexual and reproductive health
unmarried adolescents
scare tactics

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Abdul Hamid, S. H., & Fallon, D. (2022). The strategies used by the school health team during the delivery of sexual health information to unmarried adolescents in Malaysia . Belitung Nursing Journal, 8(5), 438–445.
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Accepted for publication: 2022-10-08
Peer reviewed: Yes

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Background: Adolescents’ sexual health is vital to overall health and well-being to achieve sustainable development goals. Yet, research on the strategies used by Malaysian school health teams regarding their experiences of providing sexual health information to adolescents is sparse.  

Objective: This study was conducted to explore the experiences of school health teams in Malaysia who provide unmarried adolescents with sexual health information either during school health visits or at health clinics, with a particular interest in the strategies they use to educate these young people. 

Methods: This qualitative study used semi-structured interview data from twenty participants from four multidisciplinary school health teams. The participants included staff nurses, medical officers, and family medicine specialists. The transcripts were analysed for common themes.

Results: Four main themes were identified: discourse on risk, being selective, using scare tactics and maintaining own honour. The findings indicate that the interactions between school health teams and unmarried adolescents were not always ‘adolescent friendly’. The school health teams tended to use discourses of ‘risk’ or scare tactics to encourage abstinence in the adolescents they advised. Staff were also selective about the information they gave, prioritising notions of ‘maintaining honour’ over ‘safer sex’ messages. 

Conclusion: This study revealed how school health teams perceived sexual health education to be about moral issues and social attitudes. Influenced by both culture and religion, the sexual health services provided were underpinned by a ‘moral’ approach and promoted abstinence. However, most of the nurses in this study held the belief that sexual health knowledge acts as an encouragement for sexual activity. Thus, as part of school health teams, nurses need to embrace evidence that improved sexual health education may delay sexual initiation and prevent unintended pregnancy and HIV/STDs.

Supporting Agencies

This research was supported Malaysia Ministry of Education (MOE) through Fundamental Research Grant Scheme (FRGS/1/2022/SKK06/UIAM/02/2)


Copyright (c) 2022 Siti Hazariah Abdul Hamid, Debbie Fallon

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declare there is no conflict of interest.


The authors sincerely thank the school health team who generously spent their time for the interview, shared their experiences, and provided valuable input that was essential to improve adolescents’ sexual health services in Malaysia.

Authors’ Contributions

All authors contributed equally to the study concept, design, definition of intellectual content, literature search, data acquisition, data analysis, and manuscript preparation. SHAH also contributed to manuscript editing, and DF reviewed the manuscript. All authors were accountable in each stage of the study and approved the final version of the article to be published.

Data Availability

Research data is kept at the corresponding author’s university and will be released upon request if related.


Aronson, J. (1995). A pragmatic view of thematic analysis. The Qualitative Report, 2(1), 1-3.

Bellamy, K., Ostini, R., Martini, N., & Kairuz, T. (2016). Seeking to understand: Using generic qualitative research to explore access to medicines and pharmacy services among resettled refugees. International Journal of Clinical Pharmacy, 38(3), 671-675.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in Psychology, 3(2), 77-101.

Canan, S. N., & Jozkowski, K. N. (2017). Sexual health education topics in schools: Inclusion and timing preferences of a sample of southern US college students. Sexuality Research and Social Policy, 14(2), 143-156.

Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitative inquiry. Theory Into Practice, 39(3), 124-130.

DeSantis, L., & Ugarriza, D. N. (2000). The concept of theme as used in qualitative nursing research. Western Journal of Nursing Research, 22(3), 351-372.

Dobson, A. S., & Ringrose, J. (2016). Sext education: pedagogies of sex, gender and shame in the schoolyards of Tagged and Exposed. Sex Education, 16(1), 8-21.

Hamid, S. H. A. (2018). Exploring the views and experiences of primary healthcare professionals who deliver Sexual and Reproductive Health services to unmarried adolescents in Malaysia [Doctoral thesis, University of Manchester ]. United Kingdom.

Hamid, S. H. A., & Fallon, D. (2020). Healthcare professionals’ perspectives on the provision of sexual and reproductive health to young people in Malaysia. International Journal of Care Scholars, 3(1), 3-10.

Hazariah, A. H. S., Fallon, D., & Callery, P. (2021). An overview of adolescents sexual and reproductive health services provision in Malaysia. Comprehensive Child and Adolescent Nursing, 44(2), 144-160.

Kocsis, T. (2017). A critical analysis of sexuality education in the United States: Toward an inclusive curriculum for social justice [Dissertation, Loyola Marymount University]. Los Angeles.

Lederer, A. (2017). Why the use of scare tactics to promote sexual health for youth may backfire.

Lim, H. M. (2010). Country profile on universal access to sexual and reproductive health: Malaysia. Selangor, Malaysia: Federation of Reproductive Health Associations.

Marks, D. F., & Yardley, L. (2004). Research methods for clinical and health psychology. London: Sage.

Ministry of Health Malaysia. (2015). National adolescent health plan of action (Vol. 73). Malaysia: Ministry of Health

Mori, A. T., Kampata, L., Musonda, P., Johansson, K. A., Robberstad, B., & Sandøy, I. (2017). Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: Study protocol for a cluster randomized controlled trial. Trials, 18(1), 1-10.

Olsson, H. (2015). Openness and opposition: Sexuality education in Europe. In J. James J. Ponzetti (Ed.), Evidence-based Approaches to Sexuality Education (1st ed., pp. 316-338). Routledge.

Ormston, R., Spencer, L., Barnard, M., & Snape, D. (2014). The foundations of qualitative research. In K. Metzler (Ed.), Qualitative research practice: A guide for social science students and researchers (Vol. 2, pp. 52-55). Sage.

Patton, M. Q. (1999). Enhancing the quality and credibility of qualitative analysis. Health Services Research, 34(5 Pt 2), 1189-1208.

Pound, P., Denford, S., Shucksmith, J., Tanton, C., Johnson, A. M., Owen, J., Hutten, R., Mohan, L., Bonell, C., & Abraham, C. (2017). What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views. BMJ Open, 7(5), e014791.

Pound, P., Langford, R., & Campbell, R. (2016). What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences. BMJ Open, 6(9), e011329.

Raworth, K. (2007). Adapting to Climate Change: What's needed in poor countries, and who should pay. Kenya: Oxfam International.

Santelli, J. S., Kantor, L. M., Grilo, S. A., Speizer, I. S., Lindberg, L. D., Heitel, J., Schalet, A. T., Lyon, M. E., Mason-Jones, A. J., & McGovern, T. (2017). Abstinence-only-until-marriage: An updated review of US policies and programs and their impact. Journal of Adolescent Health, 61(3), 273-280.

Shackleton, N., Jamal, F., Viner, R. M., Dickson, K., Patton, G., & Bonell, C. (2016). School-based interventions going beyond health education to promote adolescent health: Systematic review of reviews. Journal of Adolescent Health, 58(4), 382-396.

Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63-75.

Talib, J., Mamat, M., Ibrahim, M., & Mohamad, Z. (2012). Analysis on sex education in schools across Malaysia. Procedia-Social and Behavioral Sciences, 59, 340-348.

Temin, M., & Levine, R. (2009). Start with a girl: a new agenda for global health. Issues in Science and Technology, 26(3), 33-40.

Tylee, A., Haller, D. M., Graham, T., Churchill, R., & Sanci, L. A. (2007). Youth-friendly primary-care services: how are we doing and what more needs to be done? The Lancet, 369(9572), 1565-1573.

Wannarit, L.-O. (2022). Sexual abstinence as a reproductive health-promoting behavior for women: A perspective. Belitung Nursing Journal, 8(4), 372-377.

Wilson, K. L., Wiley, D. C., & Rosen, B. (2012). Texas sexuality education instruction: Shame and fear-based methodology. Journal of Health Education Teaching, 3(1), 1-10.

Wood, K., & Rk, J. (2011). Barriers and scolding nurses : to blood blockages use in South Africa adolescent contraceptive. Reproductive Health Matters, 14(27), 109-118.

World Health, O. (2020). Sexual, reproductive, maternal, newborn, child and adolescent health: policy survey, 2018-2019: Summary report (9240004092).

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