Implementing School-Based Health Education - A Cautionary Tale Aleksandar Štulhofer PhD University of Zagreb Workshop on Implementation Science in HIV Programming Cavtat, Croatia, 17-21June 2013

A Brief History of Sex Education Early 20th century: Social hygiene movement 1930s – sexual adjustment in marriage (T. H. van de Velde) Sweden, – school-based sex education SAD Sex Information and Education Council of the United States (SIECUS) International Planned Parenthood Federation (1952)

Contemporary Sex and Health Education in Europe Main types of sex education: (a) HIV prevention programs; (b) abstinence-only programs; (c) comprehensive sex education Sexuality is usually a part of Health Education curriculum European North vs. South, West vs. East WHO 2010 European Guidelines for Sexuality Education (UNESCO culture-sensitive guidelines for sex education, 2009)

A Brief History of Debates over Sex and Health Education in Croatia* 2005 – MoE committee to evaluate Sex Ed programs 2006 – MoE committee to evaluate Health Ed programs 2007 – Piloting of two HE programs 2008 – MoE final decision 2012 – New initiative and the introduction of Health education curriculum (4th module: Gender Equality and Responsible Sexual Behavior) * Bijelić, N. (2008). Sex education in Croatia: Tensions between secular and religious discourses. European Journal of Women’s Studies, 15, Hodžić, A., Budesa, J., Štulhofer, A., & Irvine, J. (2012). The politics of youth sexuality: Civil society and school-based education in Croatia. Sexualities, 15,

Croatian Health Education Program & Culture Wars August 2012 – MoE announcement The end of 2012 – a culture war erupts (the leaflet; parents protesting in schools; demonization in the media and social networks...) Christmas 2012 – direct engagement of the Croatian Catholic church January 2013 – J. Riesman’s crusade May 2013 – The Constitutional Court decision What next?

Who is Really Opposed – is It a Majority? Public opinion polls Jan 2013

Cont. Institutional support for (the Catholic church, MoE, political parties...) and social mobilization of the protest Internationalization of the issue Mass media and social networks What about teachers? What about young people? (Modrić et al., 2011)

The Mistakes Weak project management Complete absence of implementation strategy (political motives behind the timing)  Potential obstacles ignored or systematically underestimated  No partnerships or alliances forged  Slow response to criticism  Delayed information dissemination Poor handling of public image (PR)

Lessons for the Future: Managing Social Change Importance of change management How to manage (social) change:  Step 1 – Context analysis & situation assessment  Step 2 – Developing action plan (including information dissemination and contingency plans)  Step 3 – Managing the project  Step 4 – Strategic promotion of the project  Step 5 – Close monitoring of public reactions to the project implementation  Step 6 – Continuous assessment; updating/revising Internationalization of the issue should be taken into account!

The Role of Research, Scientific Evidence & Its Communication Informing the public about why the change is needed – an essential part of the action plan Evidence is central for communicating the need for change What if there is a lack of local research and evidence? Communicating evidence can be more important than evidence itself Successful public communication requires strategy, resources, and coordination

Thank you...