Implementation of The World Starts With Me, a comprehensive rights-based sex education programme in Uganda

This article presents a process evaluation of the implementation of the sex education programme the World Starts With Me (WSWM) for second-ary school students in Uganda. The purpose of this mixed-methods study was to examine factors associatedwith dose delivered (number of lessons implemented) and fidelity of implementation (im-plementation according to themanual), as well as to identify the main barriers and facilitators of implementation. Teachers ’ confidence in teach-ing WSWM was negatively associated with dose delivered. Confidence in educating and discuss-ing sexuality issues in class was positively asso-ciated with fidelity of implementation, whereas the importance teachers attached to open sex education showed a negative association with fi-delity. Main barriers for implementing WSWM were lack of time, unavailability of computers, lack of student manuals and lack of financial sup-port and rewards. Other barriers for successful implementation were related to high turnover of staff and insufficient training and guidance of teachers. Teachers ’ beliefs/attitudes towards sexuality of adolescents, condom use and sex edu-cationwere found to be important socio-cognitive factors intervening with full fidelity of implemen-tation. These findings can be used to improve the intervention implementation and to better plan for large-scale dissemination of school-based sex education programmes in sub-Saharan Africa