Sexual Assertiveness Skills and Sexual Decision-Making in Adolescent Girls: Randomized Controlled Trial of an Online Program

Am J Public Health. 2018 Jan;108(1):96-102. doi: 10.2105/AJPH.2017.304106. Epub 2017 Nov 21.


Objectives: To evaluate the efficacy of an interactive, Web-based sexual health program (Health Education and Relationship Training [HEART]) for developing sexual assertiveness skills and enhancing sexual decision-making in adolescent girls.

Methods: Participants were 222 tenth-grade girls (mean age = 15.2; 38% White, 29% Hispanic, 25% Black) in the Southeastern United States who were randomized in fall 2015 to the HEART intervention or an attention-matched control. We assessed participants at pretest, immediate posttest, and 4-month follow-up.

Results: Both groups had similar demographic and sexual behavior characteristics at pretest. At immediate posttest, girls who completed the HEART program demonstrated better sexual assertiveness skills measured with a behavioral task, higher self-reported assertiveness, intentions to communicate about sexual health, knowledge regarding HIV and other sexually transmitted diseases (STDs), safer sex norms and attitudes, and condom self-efficacy compared with the control condition. At 4-month follow-up, group differences remained in knowledge regarding HIV and other STDs, condom attitudes, and condom self-efficacy.

Conclusions: This brief online sexual health program can improve short-term outcomes among adolescent girls and offers an exciting new option in the growing array of digital health interventions available to youths.

Trial registration number: NCT02579135.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Assertiveness*
  • Communication
  • Condoms / statistics & numerical data
  • Decision Making*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Promotion
  • Humans
  • Intention
  • Motivation
  • Self Efficacy
  • Sex Education / methods*
  • Sexual Behavior / psychology*
  • Sexual Health
  • Sexually Transmitted Diseases / prevention & control
  • Social Norms
  • Socioeconomic Factors
  • Southeastern United States

Associated data