School nurse-involved sexual and reproductive health educational interventions can effectively enhance adolescents' SRH knowledge (SMD=1.36), but show no significant changes in attitudes or behaviours, with effective programs relying on active learning, consistent education, and interdisciplinary collaboration.
School nurse-involved SRH interventions significantly improved adolescents' knowledge compared to control groups.
School nurse-involved SRH interventions showed no significant changes in adolescents' attitudes or behaviours.
The majority of included quantitative studies had a high risk of bias.
Key facilitators of effective school nurse-involved SRH education included school nurses' expertise, trust, and active learning approaches.
Key barriers to school nurse-involved SRH education included limited time, lack of materials, passive parents, and rigid policies.
Integrated mixed-methods findings indicated that effective school nurse-involved SRH education relies on active learning, consistent education, and cross-disciplinary collaboration.
This research synthesized evidence from 19 studies (12 quantitative and 7 qualitative) conducted in high-income countries to understand how school nurse-led sexual and reproductive health (SRH) education affects teenagers. The analysis found that when school nurses deliver or are involved in SRH education programs, students' knowledge about sexual and reproductive health improves substantially. However, these programs did not appear to change students' attitudes toward SRH topics or their actual health-related behaviors in measurable ways. It is worth noting that three-quarters of the quantitative studies included had a high risk of bias, and the results showed very high variability between studies, which means the knowledge findings should be interpreted with some caution. The qualitative portion of the review revealed that school nurses bring unique advantages to SRH education, including established trust with students and relevant health expertise. Programs that used interactive, active learning methods rather than passive instruction were seen as more effective. However, school nurses and programs face real-world obstacles including not having enough time, insufficient educational materials, parents who are not engaged, and school or government policies that restrict what can be taught. This research suggests that school nurses can play a meaningful role in improving what adolescents know about sexual and reproductive health, but that translating knowledge into changed attitudes and behaviors likely requires more comprehensive approaches—including consistent, ongoing education and collaboration among teachers, health professionals, families, and policymakers. Addressing structural barriers like policy rigidity and resource limitations may be important for making these programs more effective in practice.
Choi Y, Seo H, Lee S, Park E, Yoon J, Noh S. (2025). School nurse-involved sexual and reproductive health education for adolescents' students in high-income countries: a mixed-methods systematic review.. Health education research. https://doi.org/10.1093/her/cyaf050