https://doi.org/10.37955/cs.v6i3.275
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 173 - 184
eISSN: 2600-5743
Adolescent development and sexual
health in the curriculum of health
science careers
Desarrollo del adolescente y la salud sexual en el
currículo carreras ciencias de la salud
Martha Yolanda Morocho Mazón
University of Guayaquil. Faculty of Medical Sciences. martha.morochom@ug.educ.ec
https://orcid.org/0000-0002-5207-4824
Rocío María Verduga Monar
University of Guayaquil Faculty of Medical Sciences rocio.verdugam@ug.edu.ec
https://orcid.org/0000-0003-4663-5733 https://orcid.org/0000-0003-4663-5733
James Edward Neira Borja.
University of Guayaquil Faculty of Medical Sciences. OmniHospital.
jneiraborja@yahoo.es https://orcid.org/0000-0003-2046-6572
Myrian Giselle Rosero Castro
University of Guayaquil Faculty of Medical Sciences myriam.roseroc@ug.edu.ec
https://orcid.org/0000-0001-6641-4343 https://orcid.org/0000-0001-6641-4343
ABSTRACT
Adolescence is one of the most complex, profound and transitional
stages of the life cycle, a time of interconnection in the biological,
psychological, emotional, social, behavioral and cognitive dimensions
until reaching maximum maturity; in response to this, society
demands health professionals to contribute to the community in
activities to promote health and prevent disease. In this sense, this
study arises with the intention of determining the sexual health
culture in sexually active adolescents. For this purpose, a qualitative,
phenomenological type of research was carried out, in which
interviews were conducted with previously structured open-ended
questions to 4 adolescents who met the inclusion and exclusion
criteria. After collecting the information, the results were subjected to
analysis and interpretation through the process of categorization and
coding, having obtained that: sexually active adolescents have little
Centro Sur Vol. 6 No. 4- October - December -Revista Centro Sur- eISSN: 2600-5743
170
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
information on sexual health, sexual practice is generally
monogamous, early onset, product of peer and acquaintance pressure,
coupled with curiosity; there is condom use; however, the
information comes from various sources and scarcely from the health
unit.
RESUMEN
La adolescencia es una de las etapas del ciclo vital muy compleja,
profunda y de transición, de interconexión en las dimensiones
biológica, psicológica, emocional, social, conductual y cognitiva hasta
llegar a la máxima madurez; en respuesta aquello, la sociedad
demanda del profesional de salud que aporte dentro de la comunidad
en actividades de fomento de la salud y evitar enfermedades. En tal
sentido, surge este estudio con la intención de determinar la cultura de
salud sexual en adolescentes sexualmente activas. Para lo que, se
realiza una investigación cualitativa, de tipo fenomenológico, en la cual se
realiza entrevistas con preguntas abiertas previamente estructuradas a 4
adolescentes que cumplen criterios de inclusión y exclusión. Posterior a
recolectar la información se somete a análisis e interpretación los
resultados mediante el proceso de categorización y codificación,
habiendo obtenido que: los adolescentes sexualmente activas tienen
escasa información sobre la salud sexual, la práctica sexual
generalmente es monógama, de inicio precoz, producto de la presión
de compañeros y conocidos, aunado a la curiosidad; existe el uso de
preservativos; no obstante, la información surge de varias fuentes y
escasamente de la unidad de salud.
Keywords / Keywords
Adolescente-salud sexual-currículo
Adolescent-sexual health-curriculum
Introduction
Referring to the conglomerate of adolescents means thinking of 20%
of the total population of the planet, with the particularity that 85%
of these are found in countries in a situation of progress; that is, in
these geographies the largest population of this age range is found. In
Latin America, the adolescent population between 10 and 19 years of
age increased 138% during the 30 years since 1960, and by 1990 the
group of 10 to 24 year olds reached 155 million, constituting
171
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
approximately one third of the population of Latin America and the
Caribbean. (Mori, 2018).
According to INEC for 2017 in Ecuador there are approximately six
million children and adolescents aged 0 to 17 years, which means
35% of the total population, a decade ago the demographic group in
Ecuador represented children under 18 years old, today they
represent 28% and 33% corresponds to the age of 12 to 17 years old
(Ecuador, 2018).
The World Health Organization (WHO) conceives the stage of
adolescence as a cycle of human growth and development after
childhood and before adulthood, which lasts from 10 to 19 years; time
that includes 3 chronological moments known as early, middle and late
adolescence; the first from 10 to 13 years, followed by 14 and 16 years
known as middle and the last from 17 to 19 years. This cycle is
determined by the increase in independence and marked autonomy, self-
esteem, self-worth and personal identity. Particularly in the early stage
the first physical characteristics stand out, in the subsequent intermediate
stage the sexual alignment develops progressively, while in the late
stage there is important cognitive, emotional and behavioral maturity;
which together with the social sphere are determinants of behavior.
In this sense; identifying the needs in this life cycle requires
decisively to capture in the educational units most of this age group;
it is in these places where according to Blanco there are difficulties
related to risky sexual activity, high incidence of drug use, alcohol
consumption, unhealthy habits caused by social coercion or lack of
information on health issues, situations that most of the time are
minimized at this age due to an apparent self control. (Blanco Pereira,
2011).
Regarding sexual activity at risk, one of its consequences is
pregnancy in adolescents, which is diagnosed as a public health
problem. Adolescents have early sexual relations and with it multiple
complications and risks according to the Paladinez study, which
sought to determine the sociodemographic conditions and
complications that increased the rate of adolescent pregnancies, in
which it was observed that 57.65% of pregnant women belong to
middle adolescence, 37.65% correspond to the late adolescence stage.
However, 4.71% of the adolescents are in the early stage, which
indicates a high risk of maternal and neonatal morbidity and
mortality. (Paladinez, 2020).
172
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
The World Health Organization (WHO), orients sexuality as a vertical
axis of the human being, since 1974 it was closely contemplated by
some psychologists such as Freud, Kolbert, and Piaget who related it
to psychological, social, cognitive, language development; which are
in tune with ethical and social values as an expression of sexual and
reproductive behavior; which is more marked in adolescence
compared to the other life cycles.
The cases of sexually transmitted infections or STIs have been on the
rise in recent years according to the study of Reyes, who argues as
causes of that the beginning of early sexual activity, dragging with it
the possibility of the association with the greater number of sexual
partners. The 94% of infected women are located in undeveloped
countries, about 275,000 of the deaths are due to HIV, therefore, they
are among the main causes of maternal deaths. (Reyes A. , 2017)
In this context, dealing with the problems of adolescence, according to the
study by Gonzàlez, whose objective was to analyze the reality of a group of
adolescents in the intermediate stage with the possible intention of
designing a Pediatric Nursing program that gathers specific
competences and contributes to their development, he found that
young adolescents anticipate situations such as the consumption of
narcotics, conditions concerning sexuality, experiences during their
lifetime, the permutations that have occurred, the relationship with
their peers and family members. (González Zúñiga, 2015).
In this sense, Primary Care professionals play a crucial role in the
early detection and prevention of the problems mentioned in the
previous paragraph, since they work at the gateway to the healthcare
system. According to Lopez, in the study aimed at raising awareness
of the need for health education intervention in adolescents in the
school setting, particularly on issues related to sexuality, he
concludes that the school nurse is a key figure in the context of
training and plays a decisive role in health care and health promotion,
and that the lack of information on the subject of adolescence, its
changes and needs is one of the determining factors in risky behavior.
(López, 2019)
In the study on "Experience of nursing care to children and
adolescents in risk centers to know the experience of nursing care,
unveiling the motivations and values to care for children and
adolescents in these centers in the Araucanía-Camaguey Chile
region", the codes presented are: incentive to work in the center,
173
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
beginning and evolution of nursing care;, identification, performance
and experience of institutional values, professionals in the care. The
codes of care activities were focused on drug administration and drug
management, administrative activities with institutional goals,
emotional charge and containment, both oriented to the
characteristics of the population, attention to vulnerable groups such
as the child population, performance values such as responsibility,
dedication, ethics, patience, empathy, scarce scientific production on
the subject, children who have been violated, values such as ethics,
tolerance, empathy and dedication, as well as disciplinary
responsibility. Lack of research on the nurse's work. (Mercado-
Elgueta, 2020) . In this context, all the efforts made by academia to
contribute to adolescent health still leave a bias in society, which calls
on higher education institutions to reassess what is really happening in
society and intervene in it by means of links.
According to Mori's study, in which he seeks to analyze the attributes of
the nurse's competencies in the care of schoolchildren as seen by
managers of educational institutions, he presented the following empirical
categories: The nurse in the promotion of the health of the
educational community; The nurse in the prevention of disease in the
educational community; The school nurse articulating health-
education in the everyday life of these (Mori F. M., 2018) . In this
sense, considering what the WHO indicates, about sexuality in man,
regarding the influence that this has biological, psychological, social,
religious, spiritual, political, economic, legal, ethical, historical
aspects, allows inferring that it is a state that has multidimensional
influences whose commitment is deep in adolescence and puberty,
requires intimacy, autonomy, responsibility, its impact will be the
product of the sexual thoughts lived (Mullinax and Mathur, 2017).
According to Sanchez's study, which aims to evaluate a Health
Education (HE) experience in adolescents on health topics chosen by
them, using Instagram. A change in their knowledge, attitudes, as
well as their satisfaction and adherence to the activity is assessed.
Satisfaction with the overall program has been high, which shows
that the vast majority liked this new way of learning. Add that this
great majority of participants think that Instagram can be a good tool
to promote health. The good reception of social networks as tools for
Health Education is also the result of studies with similar
interventions (Sanchez, 2021) . In this sense, technology and its
computer applications are a good current channel to address the
needs and issues in adolescents, i.e. inadequate nutrition or physical
174
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
activity, substance use and abuse, sexual activity leading to unwanted
pregnancy or possible infections, and behaviors that contribute to
violence and unintentional injuries (suicide/homicide). It is through
the School Health Programs (PSE) that interventions on healthy
habits will be carried out. The exchange of knowledge and
information, promoting safety and improving the quality of life of
young people.
In this sense, this group is the one that in a short time makes up the
economically active population, they are the ones who are
responsible for family, political, social, educational, productive and
demographic life; promptly identifying the problems that involve
them from a preventive and promotional philosophy constitutes a
hope and better prognosis for society, addressing better living
conditions for each one of them.
With this background, what can be done in the training of health
professionals, involves taking a look at the ways of teaching and learning;
according to Algarra, the nurse is trained with solid theory that he/she
applies in practice, initially guided by teachers, depending on the real
experiences to which he/she has access during this phase, the future
professional acquires the necessary competencies for his/her job
performance (Algarra, 2018).
In this context, the health of the schoolchild is conditioned to social,
educational, didactic dimensions, conglomerates such as the family,
nucleus of society that demands observation, which leaves said
Cardenas, in the study "Analysis of nursing situation: caring for the
family from Roy's model of adaptation" which states that there is a
lack of effective dialogue within the family, insecure scenarios due to
adverse events or situations that surround it, which determines
alterations in coping and accommodation, which directly impacts on
reflected in negative changes in the self-concept and interdependence
relationships in families. (Cárdenas-Martínez, 2019)..
Materials and Methods
For this study a qualitative research of phenomenological, non-
experimental, field, interpretative type is carried out. It uses
theoretical methods, synthesis analysis, induction, deduction,
historical-logical, and interview. A questionnaire of previously
175
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
structured questions in which sex education in sexually active
adolescents is examined, for which it is diagnosed what sexually
active adolescents think about sex education and the factors that
condition it are identified. The sample consisted of 4 adolescents who
attended the consultation at the San Francisco de Asis CS in the
Guayaquil Canton, who signed the informed consent for their
participation.
The analysis of the data begins with the execution of relationships,
dispersion in clusters in which characters are included for the design
of the interview data package, the codes are those identified as the
most significant from the information obtained from the respondents,
i.e. the adolescents; then, comparisons and links are made to locate
the various categories and sub-categories, assembling a systematized
information table that serves as a basis for an approach to the
hypotheses.
The questions asked are: What do you think about sex education during
adolescence? What opinion can you give about how your first sexual
experience occurred? What do you think about actions to prevent
sexually transmitted infections and pregnancy during adolescence?
What do you think about sex education provided by the nursing staff
of the health unit?
Table 1. Categories, subcategories and codes
Category
Codes
Approval
Physical and emotional
well-being
Reasoning
Attention
Mutual assent
Programming the family
Corporeal sexual activity
Possibility of STIs
Health
Protection methods
Safe sex
adolescent development
and sexual health in the
curriculum - health
science careers
Access to health units
Contraceptive methods
Information on methods
and reproduction within
the family
176
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
Values: Trust
Disinformation and
curiosity
Sexually transmitted
diseases
Loyalty
Partner- and peer-
induced behavior
Early onset
Monogamy
Mutual consent
Family planning
Reproduction and fertility
Values: Respect,
Responsibility
Risk of contagion
Insecurity, fear, doubts,
embarrassment
Educational talks
Disinformation
Motivation for nursing
students
State of emergency due to
COVID 19
Contraceptive methods
Scarce information issued
177
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
by health unit
Specialized personnel
Results
The variables studied are: sexual health in adolescence and the
nursing curriculum. Regarding what adolescents think about sex
education, the following codes were obtained: approval, physical and
emotional wellbeing, reasoning, attention, mutual consent, family
planning, sexual activity, possible sexually transmitted infections,
health, protection methods, safe sex; some of which coincide with the
study by Ibarra, in which 19.04% of pregnant women who receive
consultation have co-morbidity such as diabetes, overweight; however,
they attend for control, this being the opportunity to develop health
promotion and disease prevention activities. (Ibarra, 2021).
In this context, the study by Rojas, for "Knowledge and Experience of the
Nursing student in their care practices" yielded categories such as:
successful didactics, care learning process, professional competencies,
teaching role and pedagogical relationships. The highest levels of
evidence are found in the studies on didactics, however, the trends
and challenges of this review are oriented towards professional
competence because it becomes the transversal concept in nursing
education, which denotes the need for an important theoretical basis
of how to learn and how to teach in such a way that the didactic
competences are evidenced in practice. (Rojas Reyes, 2018).
With regard to the conditioning factors of sexual behavior, the
categories obtained correspond to access to health units,
contraceptive methods, information on contraceptive methods and
human reproduction, values of trust, respect, responsibility, loyalty,
misinformation and curiosity, sexually transmitted diseases, behavior
induced by peers and partners, early onset, monogamy, mutual
consent, insecurity, fear, doubt and shame. Coinciding with this
study, the research by Gonzàlez, S., on "The adolescent and his or her
experience during the intermediate stage", prioritizes problems at
this age, addictions, sexuality and their concerns, experiences,
transformations occurring during this stage, interaction with peers
and family. (González Zúñiga, 2015)In this sense, this phenomenon is
conditioned by personal and contextual factors that can bring with
178
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
them, in addition to sexual problems, other problems that will mark
their lives in adulthood.
According to Freitas, nursing practice in countries such as London,
France, Germany, Scotland, Switzerland and Sweden, is diverse and
different from that of the United States and Spain with regard to
adolescent health management, the school nurse is an established
figure and aims to strengthen prevention and health promotion
activities in schools. In the United States, the school nurse has a dual
role (in the school and in the health service) and carries out
consultations with students, parents and educational professionals
both in the school and in the health service. However, they agree on
the need to address issues (chronic diseases, emergencies and first
aid) and on health promotion (educational activities: healthy eating,
cardiopulmonary resuscitation techniques (CPR), environmental health
and sex education, etc.) in the various groups in which there are
subjects in this life cycle. (Freitas Matos, 2020)
Conclusions
The full development of the adolescent is conditioned by universal
principles; participation, accessibility, autonomy, justice and equity
involving the family, groups, health units, education, health,
economy and political sectors are determining factors in the
promotion and fostering of health.
Addressing the social dimension in adolescents is an important basis
for achieving their identity and responsible behavior in such a way
that they are free of risks with regard to subsequent diseases, as a
determinant of their purpose in life and future. Diagnosing the health
situation of adolescents, based on the holistic approach, is a real
precedent that makes it possible to include in the curriculum of
health science courses as a response to social needs, whether for
undergraduate or postgraduate training, in order to train
professionals with new competencies and profiles for the
requirements of young people with contemporary problems.
Adolescents spend most of their time at school, which is why schools
have a duty to provide a health-promoting framework. The health
179
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
education provided by the school nurse lays the foundations for the
healthy development of the individual in adolescence and throughout
his or her life. The first contact with the young adolescent and giving
the necessary confidence is a way of achieving rapprochement, being
a tutorial figure and accompanying him/her throughout the cycle of
health education.
References
Algarra, A. J. (2018). Application of Patricia Benner's Philosophy for
nursing education. Cuban Journal of Nursing, 34(2, 421-432.
Blanco Pereira, M. E. (2011). Comprehensive adolescent health
education through peer promoters. Revista Médica Electrónica, 33(3),
349-359.
Cardenas-Martinez, F. J.-O. (2019). Nursing situation analysis: Caring for
the family from Roy's adaptive model. cuidarte journal 10(1).
Ecuador, O. S. (2018). Situation of children and adolescents in
Ecuador; a look through the SDGs.
González Zúñiga, S. &. (2015). The adolescent person and his
experience during the intermediate stage. Enfemerìa actual de
Costa Rica (29) , 1-14.
López, C. G. (2019). Perception of Primary Care Nursing
professionals on their training for addressing child and
adolescent suicide in Spain. Revista Iberoamericana de
Enfermería Comunitaria: RIdEC, 12(2), , 11-17.
Mercado-Elgueta, C. G.-S.-S.-L.-C.-D. (2020). Nursing care
experience in children's centers . Revista Archivo Médico de
Camagüey, 24(4).
Mori, F. M. (2018). Nursing competencies in educational institutions:.
Revista Gaúcha de Enfermagem, 39.
Mori, F. M. (2018). Nursing competencies in educational institutions:
a view from educational managers. Gaucha.
Paladinez, D. E. (2020). Nursing performance and complications
associated with adolescent pregnancy in a hospital in El Oro. .
Revista científico-profesional, 5(8), 653-672.
Ramirez Cardesin M., P. M. (2020; 19). Nursing care in the .
RECIEN. , 40-57.
180
Received: December 13, 2021 / Approved: January 18, 2022 Pages: 169 - 179
eISSN: 2600-5743
Reyes, A. (2017). Sexually transmitted infections. A public health
problem in the world and in Venezuela. Obtenido de
http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-
32932016000200008
Sánchez, A. E. (2021). Experience of Health Education in adolescents
through Instagram. OSAGRAM (Osasuna Instagram). RIdEC
14(1), 26-35.