Youth’s Perceptions on the Delivery Approaches, Enablers and Barriers of Learning, Participating, and Delivering the Out-of-School Comprehensive Sexuality Education Program in Karongi, Nyamasheke, and Rusizi-Western Rwanda

Background:
Out-of-school Comprehensive Sexuality Education (CSE) plays a vital role in educating, empowering, and equipping out-of-school youth with evidence-based information, needed to make healthier decisions for their health and well-being. There are no studies that explored youth’s lived experiences with out-of-school CSE interventions in Rwanda, highlighting barriers and enablers influencing the learning experience of the out-of-school youth. This research is tailored to inform program implementers and policy makers on effective implementation and delivery approaches, using human-centered design. This study aimed at exploring youth’s perceptions on the delivery approaches, enablers and barriers of learning, participating and delivering the out-of-school CSE pilot program in three districts in the western province of Rwanda and propose recommendations by August 2024.

Methods:
This was a qualitative research study to explore youth's lived experiences with delivery approaches, enablers and barriers in learning, participating and delivering out-of-school CSE pilot program implemented by AfriYAN Rwanda in Karongi, Nyamasheke, and Rusizi districts, in western Rwanda. With informed consent from youth study participants, six focus group discussions with groups of male and female youth learners separately and six key informant interviews with male and female peer educators of the program were conducted using semi-structured interview guides. Interviews were conducted and recorded in Kinyarwanda and transcribed. One transcript was discarded due to ethical considerations as a minor below 18 years of age attended the interview. The transcripts were openly read in detail followed by the development of a codebook. The coding of the Kinyarwanda transcripts was done using Dedoose software version (Dedoose 8.3.35), codes were categorized, interview excerpts were translated in English by the principal investigators and emerging themes and their corresponding sub- themes were identified.

Results:
The study findings indicated four themes to understanding the youth’s lived experiences with delivery approaches, enablers and barriers encountered during the out-of-school CSE program: (1) a structured and youth-friendly out-of-school CSE program that included real-life applications and associated emotional experiences for knowledge retention and enhanced engagement was emphasized by study participants; (2) the importance of tailoring content and delivery approaches to different age groups and ensuring gender sensitivity was highlighted by study participants as key to fostering a supportive and diverse learning environment during the program; (3) delivery, socio-cultural, and inclusion barriers significantly impacted the program's implementation, hindering participation and limiting its reach, and (4) recommendations of program continuation and a consistent and supportive program implementation framework were highlighted by study participants as measures to address gaps and create more effective delivery approaches. The findings from this study can be used to inform further program design, scaling of the piloted program and policies on out-of-school CSE interventions.

Conclusion:
The research study’s findings provide valuable insights and information for policy makers and CSE program implementers to scale and improve out-of-school CSE programs. The findings can further be used as evidence to highlight the importance of youth-friendly, evidence-based and learner- centered designed out-of-school CSE programs.