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The Pedagogy of Pedagogues for Sexual Education in Riobamba, Ecuador: A Pilot Approach to Training Sexual Education Facilitators in a Latin American and Spanish Language Setting

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Title: The Pedagogy of Pedagogues for Sexual Education in Riobamba, Ecuador: A Pilot Approach to Training Sexual Education Facilitators in a Latin American and Spanish Language Setting
Language: English
Authors: Kotkowski, Eithan (ORCID 0000-0002-4947-1343), Realini, Janet, Cisneros, Valeria, Rosenfeld, Jason, Berggren, Ruth, Gafas Gonzalez, Carlos (ORCID 0000-0001-5361-5285), Kneese, Garrett
Source: Sex Education: Sexuality, Society and Learning. 2022 22(3):289-303.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 15
Publication Date: 2022
Sponsoring Agency: National Institutes of Health (NIH) (DHHS)
Contract Number: T32GM113898
Document Type: Journal Articles
Reports - Research
Tests/Questionnaires
Education Level: High Schools
Secondary Education
Descriptors: Foreign Countries, Sex Education, Facilitators (Individuals), Training, Bilingual Teachers, Self Efficacy, Teaching Skills, Culturally Relevant Education, Pregnancy, Prevention, Early Parenthood, English, Spanish, High School Teachers, School Psychologists, High Schools, Program Effectiveness
Geographic Terms: Ecuador
DOI: 10.1080/14681811.2021.1926961
ISSN: 1468-1811
1472-0825
Abstract: Educational efforts to reduce global rates of adolescent pregnancy vary widely with a significant deficiency in the domain of sex education facilitator training. In this study, we sought to establish a pilot approach to comprehensive sex education facilitator training in Riobamba, Ecuador. The approach was aligned with UNESCO recommendations for training facilitators using an adapted version of the U.S.-based Big Decisions curriculum. Four internationally recruited bilingual instructors led a six-day (27-hour) intensive training-of-facilitators programme with twenty trainees using the Big Decisions sex education curriculum. Quantitative and qualitative analyses were conducted using various approaches: anonymised and pre/post-self-assessments, daily feedback surveys of self and instructors, and facilitation practice evaluations. Responses to anonymised surveys indicated improved self-perceived confidence in teaching each curriculum section. More objective pre- and post-teach-back evaluations showed improved ability to teach randomly assigned lessons as assessed by trainers. The pedagogy of facilitator training in comprehensive sex education seeks to combine evidence-informed and culturally appropriate approaches to training facilitators under unique local conditions using adapted assessment tools. This project identified important culturally relevant insights relevant to the future training of comprehensive sex education facilitators working within culturally conservative communities, and Latin America in particular.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1345203
Database: ERIC
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  Value: <anid>AN0156394081;bf401may.22;2022Apr21.04:11;v2.2.500</anid> <title id="AN0156394081-1">The pedagogy of pedagogues for sexual education in Riobamba, Ecuador: a pilot approach to training sexual education facilitators in a Latin American and Spanish language setting </title> <p>Educational efforts to reduce global rates of adolescent pregnancy vary widely with a significant deficiency in the domain of sex education facilitator training. In this study, we sought to establish a pilot approach to comprehensive sex education facilitator training in Riobamba, Ecuador. The approach was aligned with UNESCO recommendations for training facilitators using an adapted version of the U.S.-based Big Decisions curriculum. Four internationally recruited bilingual instructors led a six-day (27-hour) intensive training-of-facilitators programme with twenty trainees using the Big Decisions sex education curriculum. Quantitative and qualitative analyses were conducted using various approaches: anonymised and pre/post-self-assessments, daily feedback surveys of self and instructors, and facilitation practice evaluations. Responses to anonymised surveys indicated improved self-perceived confidence in teaching each curriculum section. More objective pre- and post-teach-back evaluations showed improved ability to teach randomly assigned lessons as assessed by trainers. The pedagogy of facilitator training in comprehensive sex education seeks to combine evidence-informed and culturally appropriate approaches to training facilitators under unique local conditions using adapted assessment tools. This project identified important culturally relevant insights relevant to the future training of comprehensive sex education facilitators working within culturally conservative communities, and Latin America in particular.</p> <p>Keywords: Comprehensive sex education; big decisions; Riosueña; Riobamba; Latin America; Ecuador; medical Spanish</p> <hd id="AN0156394081-2">Introduction</hd> <p>International efforts to reduce adolescent pregnancy and sexually transmitted infections (STIs) through education have resulted in reducing rates of teenage pregnancy (Sedgh et al. [<reflink idref="bib26" id="ref1">26</reflink>]). Worldwide, teenage birth rates have decreased from 65.5 per thousand women aged 15–19 years to 43.9 per thousand since 1990. Adolescent pregnancy – defined as pregnancy between the ages 10 to 19 – is associated with higher a risk of adverse pregnancy outcomes (Ganchimeg et al. [<reflink idref="bib12" id="ref2">12</reflink>]) as compared to post-adolescent mothers, and is also significantly correlated with fewer years of education (Wodon et al. [<reflink idref="bib31" id="ref3">31</reflink>]; Loaiza and Liang [<reflink idref="bib17" id="ref4">17</reflink>]). However, in much of Latin America, including Ecuador, the rate of decline (15%) has been significantly lower. According to 2017 estimates, Latin America has a 68% higher teenage birth rate (73.9 births per thousand women ages 15–19) than worldwide (43.9 births per thousand women ages 15–19) (The World Bank [<reflink idref="bib33" id="ref5">33</reflink>]). More specifically, Ecuador has the second highest fertility rate among young people aged 15–19 years in South America relative to its per-capita spending on health and education systems, lead only by Guyana (World Bank [<reflink idref="bib33" id="ref6">33</reflink>]). Most importantly, according to the most recently available data, teenage pregnancy in Ecuador has been experiencing a 20-year rise (Rodríguez Vignoli [<reflink idref="bib29" id="ref7">29</reflink>]).</p> <p>With a population of just over 17 million (World Bank [<reflink idref="bib35" id="ref8">35</reflink>]), Ecuador is classified as an upper-middle income country with a per-capita GDP of just over 6,000 USD USD (World Bank [<reflink idref="bib36" id="ref9">36</reflink>]). Educational attainment stands at 85% net for secondary-enrolment (World Bank [<reflink idref="bib34" id="ref10">34</reflink>]) and a near 100% literacy rate among individuals aged 15–24 (World Bank [<reflink idref="bib32" id="ref11">32</reflink>]). Sociocultural characteristics of the country include a population that is primarily mestizo (71.9%), with Amerindian, Montubio, Afro-Ecuadorian, and white ethnic groups, each contributing roughly 7%. The religions practised by Ecuadorians are predominantly Roman Catholicism (80.4%) and Protestant Christian denominations (11.3%) (Ecuadorian Institute of Statistics and Censuses [<reflink idref="bib9" id="ref12">9</reflink>]).</p> <p>Several factors have been shown to contribute to decreased teenage pregnancy in developed countries, including: 1) increased economic opportunities for women, 2) increasing gender equality, 3) access to birth control, and 4) widespread comprehensive sex education for young people (Boonstra et al. [<reflink idref="bib4" id="ref13">4</reflink>]). Oddly, although Ecuador has one of the highest rates of government participation by women in Latin America (Women Stats Project [<reflink idref="bib38" id="ref14">38</reflink>]), it experiences one of its highest rates and slowest declines in teenage pregnancy (The World Bank [<reflink idref="bib33" id="ref15">33</reflink>]). Previous work parsing out variables that influence teenage pregnancy rates worldwide has found that in Ecuador, sex education is often limited in scope to abstinence-only messages, which may account for the high rates and slow decline in teenage pregnancy rates (López-Alvarado [<reflink idref="bib18" id="ref16">18</reflink>]). For instance, the promotion of condom use as a component of comprehensive sex education (CSE) is essential to prevent the transmission of HIV and STIs. Abstinence-only and risk avoidance education has the effect of perpetuating negative attitudes towards condom use, leading to less condom use and greater spread of STIs including HIV (Shepherd, Sly, and Girard [<reflink idref="bib27" id="ref17">27</reflink>]). For this reason, CSE approaches have been shown to be effective in reducing adolescent pregnancy, HIV, and STI rates (Chin et al. [<reflink idref="bib7" id="ref18">7</reflink>]).</p> <p>The global importance of CSE in addressing teenage pregnancies and STIs has been noted by the United Nations (UN) which has included universal access to sexual and reproductive health education in its 2030 Sustainable Development Goals (United Nations [<reflink idref="bib30" id="ref19">30</reflink>]). The United Nations Educational, Scientific, and Cultural Organization (UNESCO) is the agency supporting this effort and has updated its international guidelines on school-based sexuality education to provide an evidence-informed approach to the field (UNESCO [<reflink idref="bib28" id="ref20">28</reflink>]). This acknowledges the importance of access to CSE and youth-friendly clinical services, including the provision of condoms and contraceptives. The technical guidelines also highlight the important contribution that school managers and administrators must make, and provide recommendations for the selection, training and support of teachers to facilitate CSE in schools (UNESCO [<reflink idref="bib28" id="ref21">28</reflink>]). A supplementary report to the UNESCO guidance recommends that training be provided by knowledgeable and experienced instructors and emphasises the need for fidelity to the chosen curriculum, a feature that is crucial for the effective use of CSE curricula across settings (Montgomery and Knerr [<reflink idref="bib19" id="ref22">19</reflink>]).</p> <p>Progress has been made in the USA in developing and evaluating transferrable CSE programmes as well transferring curricula across settings (Office of Adolescent Health [<reflink idref="bib20" id="ref23">20</reflink>]; Fonner et al. [<reflink idref="bib11" id="ref24">11</reflink>]; Kirby, Obasi, and Laris [<reflink idref="bib15" id="ref25">15</reflink>]). However, evidence for the success of transferring CSE curricula developed in high-income to low- and middle-income nations with different cultural norms and languages is limited, as is applying US guidelines outside the context of highly resourced settings. By the same token, there are numerous documented challenges to successful CSE implementation in low-income countries including: inadequate weight given to CSE when integrated into other subjects, insufficient adaptation of the curriculum to local circumstances and needs, and limited stakeholder participation in curriculum development (Keogh et al. [<reflink idref="bib14" id="ref26">14</reflink>]). The global health, pedagogy and sexual education literature is also notably lacking in tools and resources to help prepare and train teachers and other professionals to facilitate CSE programmes in Latin America. Herein, we intend to fill part of this gap in the literature, specifically as it relates to the training of CSE facilitators in a middle-income Latin American country.</p> <p>In this study, we tailored facilitator training strategies to certify educators from the city of Riobamba, Ecuador in implementing the Spanish language version of the CSE curriculum Big Decisions. This study constitutes the first stage of an international and inter-institutional collaboration with Ecuadorian national and provincial government support known as <emph>Proyecto Riosueña</emph> to establish evidence-based comprehensive sexual education programmes in public schools residing in the pilot city of Riobamba, Chimborazo Province, Ecuador. This programme meets UNESCO's evidence-informed definition and was originally developed and implemented in the state of Texas. We therefore strongly believe that the <emph>Big Decisions</emph> facilitator training programme originally implemented in the US could be effectively adapted for use in a Latin American and Spanish-language setting using rigorous qualitative and quantitative metrics.</p> <hd id="AN0156394081-3">Methods</hd> <p>In 2018, a consortium of Texan and Ecuadorian organisations and universities (Healthy Futures of Texas, The University of Texas Health Science Center at San Antonio, and the Universidad Nacional de Chimborazo), local Ecuadorian governmental agencies (the Ministries of Education and Public Health and municipal governing authorities), and an Ecuadorian NGO, the Cacha Medical Spanish Institute (Cachamsi), came together to form Proyecto RioSueña. The goal of this youth-development project was to empower youth between the ages of 12–18 to make healthy and informed choices. We hoped to achieve this via a comprehensive sex education (CSE) initiative for public schools in the city of Riobamba, Ecuador using the Big Decisions curriculum. Big Decisions was chosen by Proyecto RioSueña stakeholders for pilot training, testing and implementation because of its widespread use with predominantly Hispanic populations in the USA. We hypothesised that Big Decisions training of facilitators, described below, could be effectively transferred to a Latin American and Spanish-language setting and evaluated quantitatively via standardised facilitation practice (teach-back) scoring methods, and qualitatively via anonymised feedback solicitation of trainees throughout the training process.</p> <p>With English and Spanish versions available, Big Decisions consists of a ten-lesson facilitated educational experience for young people that promotes an inclusive, trauma-informed, and active-learning approach to sex education. The curriculum is culturally and contextually designed to fit the cultural and political milieu of South Texas, which is similar to that of other religious and conservative populations in Central and South America. Among its objectives are ensuring a safe and respectful learning environment; focusing on life goals; recognising the characteristics of healthy and unhealthy relationships; postponing sexual activity; developing refusal skills and respecting others' limits; reducing risks of sexually-transmitted infections; and understanding common contraceptive methods and the importance of planning pregnancy (Realini et al. [<reflink idref="bib23" id="ref27">23</reflink>]). Previous evaluations of the curriculum in Texas have noted improvements in students' attitudes, behavioural intentions and self-efficacy (Realini et al. [<reflink idref="bib24" id="ref28">24</reflink>]), and increased communication with parents (Office of Adolescent Health [<reflink idref="bib21" id="ref29">21</reflink>]). Increased communication with parents is an important metric because the sexual health and sexual decision-making abilities of teenagers and young adults are influenced greatly by parents. Positive open communication can lead to decreased negative sexual health outcomes with longitudinal, nuanced, and bi-directional interaction (Flores and Barroso [<reflink idref="bib10" id="ref30">10</reflink>]). Big Decisions is currently undergoing a US federally funded randomised controlled trial in 20 school districts along the Texas-Mexico border. The curriculum has also been adopted and adapted for use globally by the University of Texas Health Science Center at San Antonio (UTHSA) via the Center for Medical Humanities and Ethics' Global Health programme, to train educators, health providers and community health workers in Haiti (Rosenfeld et al. [<reflink idref="bib25" id="ref31">25</reflink>]), Nicaragua, Guatemala and Uganda (Boozalis et al. [<reflink idref="bib5" id="ref32">5</reflink>]).</p> <p>The Proyecto RioSueña team consists of national and international stakeholders in educational, government, and non-governmental positions. More than a year was spent recruiting the support of local leaders, the Ecuadorian Ministries of Education and Public Health, Riobamba public schools, and the Universidad Nacional de Chimborazo through joint efforts by the project co-directors from the Ecuadorian Cacha Medical Spanish Institute and the University of Texas Health Science Center at San Antonio.</p> <p>Work in anticipation of this project arose within Proyecto RioSueña in 2018 as an inter-institutional CSE research and education initiative between the Ecuadorian Ministries of Education and Public Health with project coordination of UTHSA and the Cachamsi Institute. Teacher educators from local secondary schools and a public university would be responsible for curriculum implementation and subsequent training of future facilitators in Ecuador over time. The project described in this paper is the cornerstone piece of the RioSueña project more generally, as its success has been key in establishing a sustainable and replicable CSE and research initiative.</p> <hd id="AN0156394081-4">Participants</hd> <p>A total of 20 Ecuadorian trainees (age range 21-67 years, median=36 years) representing five public high schools and one public university participated in the facilitator training course. Participants included two high school science teachers and eight school psychologists who would later serve as curriculum facilitators for the implementation of Proyecto Riosueña in the five high schools; four school administrators who would serve as public advocates for the programme; and six psychology students who would serve as future instructors of facilitators. Although health and sex education are not standard practice across the country of Ecuador, it is often school psychologists and counsellors, and science teachers who hold that responsibility. Public-school personnel who participated in this study did so during working-hours with the approval of the district-director of the Ministry of Education. Similarly, university personnel were selected to participate through a practicum as 'continuing education' and for credit.</p> <hd id="AN0156394081-5">Training design</hd> <p>The <emph>t</emph>raining of facilitators programme, as developed in the USA, creates an adult learning group that assimilates and models the Big Decisions programme's foundational principles: 1) use facilitation, rather than lecture, in order to support active learning; 2) create an emotionally safe learning environment that uses a trauma-informed approach (Fava& Bay-Cheng, [<reflink idref="bib37" id="ref33">37</reflink>]); 3) ensure the group is inclusive of all students, including lesbian, gay, bisexual and transgender students; and 4) maintain a values-neutral stance regarding non-universal values, for example, the right age to start dating.</p> <p>To support these principles, trainees are taught ways of establishing a consensus of support, respect and confidentiality. Trainees learn about gender and sexual diversity, including gender identity and expression, sex assigned at birth, and sexual orientation. In addition to the ten lessons, trainees also learn about the need to be 'trauma-informed,' defined as being sensitive to traumatic sexual histories experienced by some students. This includes incorporating a sense of understanding to avoid emotionally triggering language and concepts while opening the door for students to comfortably talk to facilitators and use them as guides for finding and addressing appropriate professional support (Fava& Bay-Cheng, [<reflink idref="bib37" id="ref34">37</reflink>]; Realini et al. [<reflink idref="bib23" id="ref35">23</reflink>]). An outline of the facilitator training schedule is provided in Table 1.</p> <p>Table 1. Overview of lessons</p> <p> <ephtml> <table><thead><tr><td>Day</td><td>Topics Covered</td><td>Teaching Methods Used</td><td>Evaluation Tools Used</td></tr></thead><tbody><tr><td>Day 1</td><td>• Introduction/Overview - Big Decisions - Proyecto RioSueña - Personal Introductions • Activity: Foundational Principles - Facilitation - Values-Neutral - Inclusivity - Trauma-Informed • Emphasising Key Messages • Activity: Ensuring a Safe Learning Environment - Developing ground rules - Understanding Values • Summary of Day's Learning; Evaluations</td><td>• Slide Presentation • Small and Large Group Activities • Group Discussion</td><td>• Pre-Course Evaluation • Post-Class Instructor Evaluation</td></tr><tr><td>Day 2</td><td>• Activity: 'Me at 14' • Lesson 1 Content and Lesson Modelling by Instructors - Rules of the Game • Lessons 2–4 Content and Lesson Modelling in Small Groups - Goals and Dreams - Relationships and Romance - Anatomy • Gender and Sexual Diversity • Practising Inclusive Language • Summary of Day's Learning; Evaluations</td><td>• Slide Presentation • Large-Group Activity • Small-Group Activities • Large Group Discussion</td><td>• Post-Class Instructor Evaluation</td></tr><tr><td>Day 3</td><td>• Lessons 5–7 Content and Lesson Modelling in Small Groups - Abstinence - A CLEAR No - Contraception • Contraception • Consent • Summary of Day's Learning; Evaluations</td><td>• Slide Presentation • Small-Group Activities • Large Group Discussion & Activity</td><td>• Post-Class Instructor Evaluation</td></tr><tr><td>Day 4</td><td>• Lessons 8–10 Content and Lesson Modelling in Small Groups - Sexually Transmitted Infections (STIs) - Staying Healthy and OnTrack - Overcoming Challenges • STIs • Differences between presenting and facilitating • Classroom Management • Overview of Facilitation Practice Activity and Evaluation • Summary of Day's Learning; Evaluations</td><td>• Slide Presentation • Small-Group Activities • Group Discussion</td><td>• Post-Class Instructor Evaluation</td></tr><tr><td>Day 5</td><td>• First Facilitation Practice Activity and Evaluations • Discussion: Facilitation Practice Experience • Challenging Questions & Difficult Topics Part 1 • Sexting, Texting, Social Media and Pornography • Summary of Day's Learning; Evaluations</td><td>• Slide Presentation • Facilitation Practice Small Group Activity • Group Discussion</td><td>• Post-Class Instructor Evaluation • Facilitation Practice Trainee Evaluation</td></tr><tr><td>Day 6</td><td>• Special Presentation: Legal Protocols for Sexual Violence in Ecuador • Second Facilitation Practice Activity and Evaluations • Challenging Questions & Difficult Topics Part 2 • Summary of Day's Learning; Evaluations</td><td>• Slide Presentation • Facilitation Practice Small Group Activity • Group Discussion</td><td>• Post-Class Instructor Evaluation • Facilitation Practice Trainee Evaluation • Post- Course Evaluation</td></tr></tbody></table> </ephtml> </p> <p>We made several adaptations to the Big Decisions training programme. During the training, the trainees and instructors identified knowledge gaps, and trainees recruited local experts to provide training to adequately cover topics such as child abuse and its local reporting requirements. Participants who trained as facilitators did not usually teach sexual education topics. In the Ecuadorian public school system, the Ministry of Health partners with the Ministry of Education to provide sexual education lectures by hosting physician-led lectures to large adolescent student-gatherings. We learned this through consultation and interviews with local health and education experts from Chimborazo province and the consensus appears to be that this approach has not been effective in educating students.</p> <p>Since didactic lecturing is common, we took time to model and practise facilitation techniques. Additional time and attention were invested in educating participants about the efficacy of CSE programmes. We also allocated more time to discussion and analysis of each lesson, with small groups sharing their insights with the rest of the class. We dedicated extensive time to presenting and discussing information about gender and sexual diversity, including how to maintain a non-judgemental attitude and use inclusive language. Lastly, the time spent discussing and sharing strategies to handle challenging questions was also expanded. In the USA, training typically takes two to two-and-a-half days (approximately 14 to 20 hours) to complete. However, our training in Ecuador required 27 hours over six days, with four-and-a-half hours instruction each day. The half-day arrangement served to accommodate trainees' work schedules and comply with continuing education credit standards required by the Ecuadorian government.</p> <hd id="AN0156394081-6">Instructors</hd> <p>The facilitator training design was reviewed and revised to be taught by a team of four instructors trained to effectively communicate the goals, foundational principles and content of the curriculum. The instructors included the curriculum author (a non-native Spanish-speaker with an Inter-Agency Language Roundtable (ILR) score of 2.5 (JR); a local professor of Spanish linguistics (a native Ecuadorian Spanish-speaker, VC); and two trained medical-student instructors from Texas, one a native Mexican Spanish-speaker and Medical Spanish instructor (EK) and the other a non-native Spanish-speaker and leader of <emph>Proyecto Riosueña</emph> with an ILR Scale of 4 (GK) (Adams [<reflink idref="bib1" id="ref36">1</reflink>]). Prior to the study, each instructor had been formally trained to implement the curriculum and to train others on curriculum facilitation by the curriculum author. Further, the non-native instructors were evaluated to be adequate communicators in Spanish by the Ecuadorian linguistic staff.</p> <p>In the weeks leading up to the training, two Proyecto RioSueña directors were tasked with systematically translating the supplementary training resources, presentations and activities from English into Spanish and adjusting role-play and example scenarios to align with Ecuadorian culture. The curriculum itself had been previously translated by Spanish linguistic professionals and used with Spanish-speaking populations in Texas, Nicaragua and Guatemala. Instructors' responsibilities included carrying out tasks such as adaptation of the training, facilitation, presentations, and group-work organisation. When technical matters arose or specific expertise was called for, each instructor was able to contribute based on their individual expertise. Instructors were also tasked with facilitating small-group learning sessions and evaluating trainees during their facilitation practice sessions.</p> <hd id="AN0156394081-7">Measurement tools</hd> <p>We used three tools to evaluate the effectiveness of the course quantitatively and qualitatively: 1) pre- and post-training self-assessments; 2) daily feedback surveys; and 3) trainee facilitation practice evaluations.</p> <p>We assessed the overall efficacy of the training using an anonymised pre- and post-training self-evaluation. This tool comprised ten, five-point Likert scales in which trainees rated their perceived ability to facilitate each of the ten lessons from 1 (no confidence in self to facilitate the lesson) to 5 (very high confidence in self to facilitate the lesson).</p> <p>At the end of each day, participants were instructed to provide anonymous scores and comments on the day's session and provide instructor feedback. Trainees assessed their personal preparedness to facilitate the topics covered on that given day using four-point Likert scales (1 low preparedness and 4 high preparedness). Finally, trainees could provide qualitative feedback via open-ended questions measuring what they liked most about the day's lesson, areas for improvement, and additional comments.</p> <p>For the final assessment, each trainee was evaluated both by an instructor and their peers in two standardised facilitation practice sessions, in which their peers served as the 'students.' Each trainee-directed practice facilitation session was evaluated by one of the four instructors, their peers, and self-assessed by the trainees themselves. A twelve-item questionnaire measured a trainee's ability to perform each item adequately using a 1 (requires a lot of practice) to 5 (expertly performed) Likert rating scale (Table 2). Surveys were anonymised to minimise bias due to the social pressures often encountered in interpersonal settings. Effect sizes measuring how much students improved from the first teach-back to the second based on instructor scores were calculated using Cohen's <emph>d</emph> (Cohen [<reflink idref="bib8" id="ref37">8</reflink>]).</p> <p>Table 2. Facilitation practice evaluation questionnaire</p> <p> <ephtml> <table><thead><tr><td>Facilitation Practice Evaluation Questionnaire</td></tr></thead><tbody><tr><td>1. The class rules and agreements were reviewed adequately before beginning the lesson.</td></tr><tr><td>2. The lesson objectives were outlined adequately at the beginning of the lesson.</td></tr><tr><td>3. The lesson's take-home message was stated verbally and adequately.</td></tr><tr><td>4. The activity instructions were explained and articulated clearly.</td></tr><tr><td>5. The activity's implementation was applied adequately.</td></tr><tr><td>6. The facilitator made the students feel that the classroom environment was safe and comfortable enough to express their opinions.</td></tr><tr><td>7. The facilitator's ability to remain values-neutral was evident.</td></tr><tr><td>8. The facilitator used inclusive vocabulary adequately.</td></tr><tr><td>9. The facilitator used trauma-informed vocabulary adequately.</td></tr><tr><td>10. The tone of voice was adequate: not too loud, not too soft, neutral, and confident.</td></tr><tr><td>11. The facilitator was able to react adequately to an unexpected question.</td></tr><tr><td>12. The facilitator's ability to facilitate the lesson fully was adequate.</td></tr></tbody></table> </ephtml> </p> <p>1 Each question's evaluation was scalar from 1 = 'requires a lot of practice' to 5 = 'expertly performed' (n = 20).</p> <p>Qualitative feedback was anonymous and optional. At the end of each training day, trainees were prompted to answer the following questions anonymously: 1) comments on the effectiveness and communication skills of each of the four main instructors; 2) what the trainee enjoyed the most about the day's training; 3) something the trainee would like to see changed from the day's lesson; and 4) any additional comments.</p> <hd id="AN0156394081-8">Data analysis</hd> <p>All analyses were undertaken using SPSS software (version 25; SPSS Inc., Cary, Chicago, USA). Two-tailed p-values <0.05 were considered statistically significant. We analysed averages on the pre- and post-course self-assessment surveys for the entire training cohort using a two-sampled t-test of independent means. Notably, all participants completed the course in its entirety.</p> <p>We analysed facilitation practice evaluations using a paired two-sample t-test of dependent means. We paired each trainee's data from the first and second facilitation practice assessments and analysed the difference between the first and second evaluation by each source (instructor, peers, and self). Finally, we used a two-sample t-test of independent means to determine the extent to which self- and peer-evaluations matched instructor evaluations.</p> <hd id="AN0156394081-9">Findings</hd> <p></p> <hd id="AN0156394081-10">Quantitative results</hd> <p>Pre/post-training evaluations on self-perceived ability to facilitate each of the curriculum lessons showed a significant improvement between the start of day one and conclusion of day six of the training (Table 3). Before the training, participants reported moderate confidence in their ability to facilitate the ten lessons (average range 2.7 to 3.4), while at the end, average scores increased to a higher level of confidence (average range 4.3 to 4.7). There was a significant improvement in confidence to facilitate all ten lessons, with the greatest increases in confidence documented for lessons 5 'Abstinence' and 9 'Staying Healthy and on Track' and the lowest increase observed for lessons 4 'Anatomy and Reproduction' and 1 'Rules of the Game.'</p> <p>Table 3. Pre- and post-course self-perceived ability to facilitate each of the big decisions curriculum lessons with Middle/High School students</p> <p> <ephtml> <table><thead><tr><td>Lesson Number</td><td>Pre- Course (mean ± SD)</td><td>Post- Course (mean ± SD)</td><td>Two- Sample t-test</td><td><italic>p</italic></td></tr></thead><tbody><tr><td>Lesson 1: Rules of the Game</td><td>3.42 ±.90</td><td>4.68 ±.67</td><td>−4.89</td><td><0.001</td></tr><tr><td>Lesson 2: Goals and Dreams</td><td>3.16 ±.69</td><td>4.79 ±.42</td><td>−8.79</td><td><0.001</td></tr><tr><td>Lesson 3: Relationships and Romance</td><td>3.00 ±.75</td><td>4.68 ±.48</td><td>−8.22</td><td><0.001</td></tr><tr><td>Lesson 4: Anatomy</td><td>3.05 ±.91</td><td>4.26 ±.81</td><td>−4.33</td><td><0.001</td></tr><tr><td>Lesson 5: Abstinence</td><td>2.74 ±.93</td><td>4.79 ±.54</td><td>−8.31</td><td><0.001</td></tr><tr><td>Lesson 6: A CLEAR No</td><td>2.78 ±.88</td><td>4.79 ±.54</td><td>−8.49</td><td><0.001</td></tr><tr><td>Lesson 7: Contraception</td><td>2.78 ±.73</td><td>4.53 ±.61</td><td>−8.02</td><td><0.001</td></tr><tr><td>Lesson 8: STIs</td><td>2.56 ±.92</td><td>4.37 ±.60</td><td>−7.18</td><td><0.001</td></tr><tr><td>Lesson 9: Staying Healthy and on Track</td><td>2.83 ±.79</td><td>4.74 ±.45</td><td>−9.16</td><td><0.001</td></tr><tr><td>Lesson 10: Overcoming Challenges</td><td>3.00 ±.77</td><td>4.63 ±.50</td><td>−7.74</td><td><0.001</td></tr></tbody></table> </ephtml> </p> <p>2 Numbers were scalar, from 1 = no confidence in self-perceived ability to facilitate the lesson to 5 = very high confidence in self-perceived ability to facilitate the lesson (n = 20).</p> <p>Two teach-back sessions during which participants modelled their future roles as facilitators took place over two days. After analysing the self-assessment, peer-assessment, and trainer-assessment data, we found significant differences between the first and second sessions (Table 4). First, self-assessments were significantly lower for the second session than the first (<emph>t</emph> = −5.63, <emph>p</emph> < 0.001), as were peer-assessments (<emph>t</emph> = −6.98, <emph>p</emph> < 0.001). However, instructor evaluations indicated a significant improvement in facilitation practice scores between the first and second days (<emph>t</emph>= 3.74, <emph>p</emph>< 0.001). Using Cohen's <emph>d</emph>, we found an effect size of 0.25, a number that corresponded with a small but statistically significant improvement of 25% of one standard deviation. Further analyses revealed that trainees significantly overestimated their self-assessed performance compared to instructors during their first teach-back session (<emph>t</emph> = 5.89, <emph>p</emph> < 0.001), but significantly underestimated their performance compared to instructors on the second teach-back session (<emph>t</emph> = −2.00, <emph>p</emph> = 0.046).</p> <p>Table 4. Facilitation practice evaluation between day five and day six</p> <p> <ephtml> <table><thead><tr><td>Evaluator</td><td>Raw Average Score</td><td>Paired-Sample Test Statistic (<italic>t</italic>)</td><td>Effect Size</td><td><italic>p</italic></td></tr></thead><tbody><tr><td>Self</td><td>4.49</td><td>−5.63</td><td>0.37</td><td><0.001</td></tr><tr><td>Instructor</td><td>4.04</td><td>3.74</td><td>0.25</td><td><0.001</td></tr><tr><td>Small-Group Peers</td><td>4.47</td><td>−6.98</td><td>0.46</td><td><0.001</td></tr></tbody></table> </ephtml> </p> <p>3 Each question's evaluation was scalar, interpreted as 1 = 'requires a lot of practice' and 5 = 'well done' (n = 226 paired samples). a < 0.05, two-tailed.</p> <hd id="AN0156394081-11">Qualitative results</hd> <p>Qualitative findings were assessed via optional anonymous comments provided by the trainees. Regarding what trainees enjoyed about a given day's training, most expressed satisfaction with the organisation of the daily lessons, the level of 'dynamism' brought to the training, and the quality of interactive activities. Some comments were introspective regarding what they enjoyed most about a specific day's lesson, as shown by the following comment from Day 2: 'Involving myself in the execution of the session, finding my weaknesses and correcting them to avoid making them in front of the teenagers.' Others expressed an appreciation for using Ecuadorian-specific data and resources as seen in the comment: '[I enjoyed Day 3's theme] because it was very focused on the country's problems, tools for young people for the prevention of unwanted pregnancy and STIs.' Still others reported enjoying having learned something new, though culturally sensitive, as expressed in the comment: 'Gender and sexual diversity, since it's something culturally new. Also, getting prepared to reproduce the lesson with students, since they get a lot of information from the internet.' Overall, trainees reported enjoying the small-group activities, discussions and large group activities more than the large-group presentations. A larger selection of comments can be found in a supplemental online file.</p> <p>Improvements that trainees would like to see implemented in future training included better time management and larger classroom size. Specific comments referred to variable arrival times of trainees and sporadic technical difficulties that delayed the start of some sessions. Participants also expressed concern that topics such as reproductive anatomy, contraceptive methods, and answering challenging questions posed by students received too little coverage. Interestingly, these concerns were also reflected in the quantitative data where we see that average confidence scores for anatomy and contraception were lower than for other topics. Additional constructive criticisms included improving the clarity of instructions given for certain group activities.</p> <p>Other comments suggested that some of the role-play scenarios could be perceived as insensitive to dominant cultural norms locally. For example, concerns were raised about a role-playing scenario concerning relationships between 'Chris' and 'Alex', a same-sex couple, regarding its perception by parents and other faculty: 'I think the role-play with the gay couple would be seen as encouraging homosexual behaviour at worst and dismissive of traditional values at best.' Similarly, concerns were also raised regarding the activity's likely perception by students: 'I think this activity might be too distracting for students who will focus too much on homosexuality instead of the actual goal of the lesson.' Although trainees expressed their view that there was nothing inherently wrong with including scenarios to promote inclusivity, they were concerned that the scenario might be misunderstood by students and parents.</p> <hd id="AN0156394081-12">Discussion</hd> <p>The goal of this study was to critically evaluate transfer of the Big Decisions training of facilitators programme to prospective CSE instructors in a Latin American and Spanish-language setting. Overall, the transfer of adapted training can be considered a success, as reflected by the retained knowledge of trainees, the positive ratings and comments for curriculum instruction by the facilitators, and trainees' increased confidence to facilitate each session.</p> <p>Our hope that the Big Decisions training programme could be used in a non-US setting was largely supported. Given the reported levels of confidence for lessons 1 and 4, it is likely that the trainees' lacked familiarity with teaching reproductive anatomy and engaging in a facilitator-centred pedagogical approach. It should be noted that the facilitated teaching style adopted by the programmes is also a relatively new development in the USA where it has shown promise in a variety of settings including health and sex education (Kontak [<reflink idref="bib16" id="ref38">16</reflink>]).</p> <p>The divergence observed between the first and second teach-back evaluations results may be explained by a number of factors, including more difficult topics in the second facilitation practice. Interestingly, the topics covered in the second session were those that teachers showed the lowest levels of self-confidence in teaching at final evaluation. It is also possible that feedback following the first session made participants more aware of expectations and more self-critical of their performance during the second session. Previous sex education training in the USA and Uganda with this curriculum shows similar trends (Realini et al. [<reflink idref="bib23" id="ref39">23</reflink>]).</p> <p>The qualitative instructor feedback was largely positive, but highlighted some important areas for improvement. Accents and phrasing by non-native Spanish-speaking instructors created some confusion at times, and clarification from local instructors was occasionally required. It is crucial for instructors to gain competence in gauging trainees, understanding during the training process to ensure comprehension, especially when linguistic barriers exist.</p> <p>The facilitated approach adopted by our model is warranted given UNESCO guidance stressing the need for young people to engage in CSE as an interactive and group-oriented way (UNESCO [<reflink idref="bib28" id="ref40">28</reflink>]). From a design standpoint, the <emph>Big Decisions</emph> training of facilitators programme provided trainees with a facilitated, interactive, and group-oriented experience they are expected to replicate with students. A similar departure from traditional didactic methodologies was used by the MEMA kwa Vijana (MkV) CSE-training programme in Tanzania (Plummer et al. [<reflink idref="bib22" id="ref41">22</reflink>]). Although the pedagogic literature provides evidence of numerous effective teaching approaches, a lecture-style approach may be more effective in settings where learners exhibit lower levels of knowledge about a given topic of interest (Banning [<reflink idref="bib2" id="ref42">2</reflink>]; Jones et al. [<reflink idref="bib13" id="ref43">13</reflink>]; Berghmans et al. [<reflink idref="bib3" id="ref44">3</reflink>]). For this reason, a mixed methods approach, which combines a didactic approach to address knowledge gaps and an interactive facilitated approach to develop content mastery in a group-oriented setting, may be optimal. This notion aligns with our experience from previous implementation of <emph>Big Decisions</emph> training of facilitators programmes in the USA.</p> <p>When local cultural norms, standards and expectations are breached, entire CSE programmes can be threatened. Fortunately, a training of facilitators programme such as that implemented here can help trainees learn how to navigate such sensitive issues, allowing adaptations to be made to the programme while not threatening its integrity.</p> <hd id="AN0156394081-13">Limitations</hd> <p>Several limitations of this study must be acknowledged. Firstly, competencies learned in a workshop setting may be difficult to apply when working with young people in a real-world educational setting. Second, in this study participant sample size was relatively small, and the heterogeneity of trainees (administrators, teachers, and school psychologists) may have affected our reported results. Third, this trainee evaluation focused on the training, and not on classroom implementation. A gap in knowledge exists regarding the predictive value of training evaluation on future classroom performance. Moreover, the evaluation of performance in training through teach-back sessions was largely formative and subjective. Finally, expectancy bias likely influenced findings, despite efforts to minimise it. Because the instructors developed, implemented and evaluated the training, the reported results may be skewed in favour of success. For this reason, the model of implementation detailed in this paper requires further assessment in other settings using both similar as well as novel metrics.</p> <hd id="AN0156394081-14">Conclusions and recommendations</hd> <p>This training of facilitators programme was largely successful in tailoring US- developed training towards a Latin American community of educators. The training developed was structured but flexible, with each session adapted to address the needs of members of the trainee group. This allowed facilitators to remain faithful to the curriculum, while also taking into account local cultural norms and varying knowledge bases.</p> <p>Successfully adapting evidence-based and evidence-informed programmes for implementation in settings other those in which they were developed is crucial. Often missing from the literature, however, are details of the strategies used for training facilitators and building capacity in a different cultural and linguistic settings (Chandra-Mouli et al. [<reflink idref="bib6" id="ref45">6</reflink>]). This is a gap we attempted to fill in his study. We urge others to publish their methods and experience training educators and transferring CSE curricula from high-income to middle- and low-income countries with differing cultural norms surrounding sex and sexuality education.</p> <p>The process of developing the collaboration between organisations involved in this project created an inter-institutional alliance that played a key role in trainee participation and community momentum towards the implementation of the Big Decisions programme as part of the RioSueña project. While additional research is needed, the overall results are encouraging. Our recommendations include a continued emphasis on the importance of rigorous evaluation of training as a preliminary outcome and as a determinant of success in CSE implementation. We also recommend open dialogue and adaptability in modifying a curriculum training programme to align with local cultural norms.</p> <hd id="AN0156394081-15">Disclosure of potential conflicts of interest</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0156394081-16">Supplementary material</hd> <p>Supplemental data for this article can be accessed https://doi.org/10.1080/14681811.2021.1926961.</p> <ref id="AN0156394081-17"> <title> References </title> <blist> <bibl id="bib1" idref="ref36" type="bt">1</bibl> <bibtext> Adams, M. L. 1980. " Five Co-occurring Factors in Speaking Proficiency." In Measuring Spoken Language Proficiency, edited by J. R. Frith, 1 – 6. Washington, DC : Georgetown University Press.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref42" type="bt">2</bibl> <bibtext> Banning, M. 2005. " Approaches to Teaching: Current Opinions and Related Research." 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DOI 10.1080/14681811.2012.745808.</bibtext> </blist> </ref> <aug> <p>By Eithan Kotkowski; Janet Realini; Valeria Cisneros; Jason Rosenfeld; Ruth Berggren; Carlos Gafas Gonzalez and Garrett Kneese</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib26" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib12" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib31" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib17" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib33" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib29" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib35" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib36" firstref="ref9"></nolink> <nolink nlid="nl9" bibid="bib34" firstref="ref10"></nolink> <nolink nlid="nl10" bibid="bib32" firstref="ref11"></nolink> <nolink nlid="nl11" bibid="bib38" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib18" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib27" firstref="ref17"></nolink> <nolink nlid="nl14" bibid="bib30" firstref="ref19"></nolink> <nolink nlid="nl15" bibid="bib28" firstref="ref20"></nolink> <nolink nlid="nl16" bibid="bib19" firstref="ref22"></nolink> <nolink nlid="nl17" bibid="bib20" firstref="ref23"></nolink> <nolink nlid="nl18" bibid="bib11" firstref="ref24"></nolink> <nolink nlid="nl19" bibid="bib15" firstref="ref25"></nolink> <nolink nlid="nl20" bibid="bib14" firstref="ref26"></nolink> <nolink nlid="nl21" bibid="bib23" firstref="ref27"></nolink> <nolink nlid="nl22" bibid="bib24" firstref="ref28"></nolink> <nolink nlid="nl23" bibid="bib21" firstref="ref29"></nolink> <nolink nlid="nl24" bibid="bib10" firstref="ref30"></nolink> <nolink nlid="nl25" bibid="bib25" firstref="ref31"></nolink> <nolink nlid="nl26" bibid="bib37" firstref="ref33"></nolink> <nolink nlid="nl27" bibid="bib16" firstref="ref38"></nolink> <nolink nlid="nl28" bibid="bib22" firstref="ref41"></nolink> <nolink nlid="nl29" bibid="bib13" firstref="ref43"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Pedagogy of Pedagogues for Sexual Education in Riobamba, Ecuador: A Pilot Approach to Training Sexual Education Facilitators in a Latin American and Spanish Language Setting
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Kotkowski%2C+Eithan%22">Kotkowski, Eithan</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4947-1343">0000-0002-4947-1343</externalLink>)<br /><searchLink fieldCode="AR" term="%22Realini%2C+Janet%22">Realini, Janet</searchLink><br /><searchLink fieldCode="AR" term="%22Cisneros%2C+Valeria%22">Cisneros, Valeria</searchLink><br /><searchLink fieldCode="AR" term="%22Rosenfeld%2C+Jason%22">Rosenfeld, Jason</searchLink><br /><searchLink fieldCode="AR" term="%22Berggren%2C+Ruth%22">Berggren, Ruth</searchLink><br /><searchLink fieldCode="AR" term="%22Gafas+Gonzalez%2C+Carlos%22">Gafas Gonzalez, Carlos</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-5361-5285">0000-0001-5361-5285</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kneese%2C+Garrett%22">Kneese, Garrett</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Sex+Education%3A+Sexuality%2C+Society+and+Learning%22"><i>Sex Education: Sexuality, Society and Learning</i></searchLink>. 2022 22(3):289-303.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institutes of Health (NIH) (DHHS)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: T32GM113898
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Tests/Questionnaires
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22High+Schools%22">High Schools</searchLink><br /><searchLink fieldCode="EL" term="%22Secondary+Education%22">Secondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Facilitators+%28Individuals%29%22">Facilitators (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Bilingual+Teachers%22">Bilingual Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Teaching+Skills%22">Teaching Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Culturally+Relevant+Education%22">Culturally Relevant Education</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Parenthood%22">Early Parenthood</searchLink><br /><searchLink fieldCode="DE" term="%22English%22">English</searchLink><br /><searchLink fieldCode="DE" term="%22Spanish%22">Spanish</searchLink><br /><searchLink fieldCode="DE" term="%22High+School+Teachers%22">High School Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22School+Psychologists%22">School Psychologists</searchLink><br /><searchLink fieldCode="DE" term="%22High+Schools%22">High Schools</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Ecuador%22">Ecuador</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/14681811.2021.1926961
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1468-1811<br />1472-0825
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Educational efforts to reduce global rates of adolescent pregnancy vary widely with a significant deficiency in the domain of sex education facilitator training. In this study, we sought to establish a pilot approach to comprehensive sex education facilitator training in Riobamba, Ecuador. The approach was aligned with UNESCO recommendations for training facilitators using an adapted version of the U.S.-based Big Decisions curriculum. Four internationally recruited bilingual instructors led a six-day (27-hour) intensive training-of-facilitators programme with twenty trainees using the Big Decisions sex education curriculum. Quantitative and qualitative analyses were conducted using various approaches: anonymised and pre/post-self-assessments, daily feedback surveys of self and instructors, and facilitation practice evaluations. Responses to anonymised surveys indicated improved self-perceived confidence in teaching each curriculum section. More objective pre- and post-teach-back evaluations showed improved ability to teach randomly assigned lessons as assessed by trainers. The pedagogy of facilitator training in comprehensive sex education seeks to combine evidence-informed and culturally appropriate approaches to training facilitators under unique local conditions using adapted assessment tools. This project identified important culturally relevant insights relevant to the future training of comprehensive sex education facilitators working within culturally conservative communities, and Latin America in particular.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1345203
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1345203
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/14681811.2021.1926961
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 289
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Sex Education
        Type: general
      – SubjectFull: Facilitators (Individuals)
        Type: general
      – SubjectFull: Training
        Type: general
      – SubjectFull: Bilingual Teachers
        Type: general
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Teaching Skills
        Type: general
      – SubjectFull: Culturally Relevant Education
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Prevention
        Type: general
      – SubjectFull: Early Parenthood
        Type: general
      – SubjectFull: English
        Type: general
      – SubjectFull: Spanish
        Type: general
      – SubjectFull: High School Teachers
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      – SubjectFull: School Psychologists
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      – SubjectFull: High Schools
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Ecuador
        Type: general
    Titles:
      – TitleFull: The Pedagogy of Pedagogues for Sexual Education in Riobamba, Ecuador: A Pilot Approach to Training Sexual Education Facilitators in a Latin American and Spanish Language Setting
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            NameFull: Kotkowski, Eithan
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            NameFull: Realini, Janet
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            NameFull: Berggren, Ruth
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            NameFull: Gafas Gonzalez, Carlos
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            NameFull: Kneese, Garrett
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            – Type: issn-print
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