Table 3 Characteristics of the studies included in the systematic review

1

Le Mat et al. (2021) [20]

Ethiopia

Qualitative study (content analysis)

Total 56 participants, included 12 teachers

To improve understanding of the ways in which teachers enact and re-contextualise CSE policy, and their reasons for doing so

To understand teacher enactment, we attend not only to what teachers do, but also to teachers’ interpretations of the policy

The paper highlights that while CSE teachers were typically conceptualised as ‘facilitators’ of the CSE initiative presented here, in practice teachers seemed to perform what might be understood as ‘activist’ roles within and beyond the classroom and school

2

Ocran. (2021) [21]

Ghana

Qualitative case study

Total 13 participants; included Municipal School Health Education Coordinator, head teachers, school-based coordinators, and students at junior high schools

To investigate the training and support offered to teachers on the delivery of sex education in three contrasting Junior High Schools in Ghana, the attitudes and approaches to the delivery of sex education, and the response of students to teacher delivery of sex education

Findings suggest that students underwent training sessions in sex education through classroom-based learning, and extracurricular activities such as school health clubs, talks by nurses, and also talks by teachers during early morning school worship

Findings also show that although teachers in all schools underwent the same level of training for sex education, they exhibited different attitudes to teaching

3

De Hass and Hutter. (2019) [22]

Uganda

Qualitative study (grounded theory)

40 sexuality education teachers from 16 secondary schools

To obtain a better understanding of teachers’ cultural values and beliefs, the conflicts they may experience, and how these relate to their experienced level of comfort teaching comprehensive sexuality education within the Ugandan context

This study partly confirms those findings but also shows that teachers can feel conflicted about the type of messages their students need and can feel vulnerable to adopting more comprehensive approaches within a school system that expects the to teach abstinence-only

4

Achora et al. (2018) [23]

Uganda

Grounded theory design

11 teachers participated in individual interviews  in four rural primary schools

To explore the experiences and perceptions of teachers and adolescents (12–16 years) of school-based sexuality education in rural primary schools in Uganda

Findings from the study have shown that adolescents received abstinence-only information as a method to protect themselves against STIs/HIV and to continue attending school

The findings also demonstrated that sexuality education was taught selectively, since it was considered not to be relevant for children at primary level

5

De Hass and Hutter. (2020) [24]

Uganda

Qualitative study (grounded theory)

40 sexuality education teachers from 16 secondary public (n=7) and private (n=9) schools

To gain a better understanding of teachers’ professional identities in the context of providing school-based sexuality education in Uganda, and of how these identities motivate teachers to provide school-based sexuality education

Five cultural schemas of professional identity were found: (i) upholder of ethics and regulations; (ii) authority figure; (iii) counsellor and guide; (iv) role model; and (v) guardian

Teachers’ cultural schemas of professional identity motivated them to adhere to moral discourses of abstinence and sexual innocence

6

Louw. (2017)

[25]

South Africa

Qualitative study (thematic analysis)

Total 78 participants; included 68 teachers and 10 school staffs at special needs schools

To focus specifically on teachers and school staff employed at Special Needs Schools in the Western Cape Province to explore their perspectives and views on teaching sexuality and HIV and AIDS education to learners with disabilities

This study holds that the impact of environmental factors as it relates to societal attitudes towards youth with disabilities and their sexuality is potentially harmful to developing a positive sexuality

7

Håkansson et al. (2020) [26]

Kenya

Mixed methods study

15 teachers at a secondary school

To explore attitudes related to abortion and contraceptive use among secondary school teachers and student peer-counsellors in a low-resource setting in western Kenya

This study showed that adolescent girls associated with abortion and contraceptive use face social judgements and discrimination by secondary school teachers and fellow students in Kenya

8

Rijsdijk et al. (2014) [27]

Uganda

Mixed methods study

Of the 24 teachers from the intervention schools, eight were selected for in-depth interviews

The purpose of this mixed-methods study was to examine factors associated with dose delivered (number of lessons implemented) and fidelity of implementation (implementation according to the manual), as well as to identify the main barriers and facilitators of implementation

Teachers’ beliefs/attitudes towards sexuality of adolescents, condom use and sex education were found to be important socio-cognitive factors intervening with full fidelity of implementation

9

De Hass and Hutter. (2022) [28]

Uganda

Qualitative study (grounded theory)

40 sexuality education teachers from 16 secondary schools

Cultural schema theory was used to explore teachers’ personal experience of the onset of sexual activity and explain how sexuality education teaching is influenced by such experiences

Findings show that while teachers’ personal experience of sexual initiation did not directly align with the content of their messages, due to the centrality and evocative function of these schemas these experiences strengthened teachers’ motivation to teach sexuality education because they enabled them to empathise with students

10

Plaza-Del-Pino et al. (2021) [29]

Spain

Descriptive Qualitative study

15 active primary school teachers in  four public primary schools

To explore the perspective of primary school teachers regarding Sexual Education in schools in Spain

Primary school teachers conclude that SE in schools has an excessively preventative approach

Nonetheless, they recognise an attempt to implement a more comprehensive SE that includes affective sexual education and sexuality as a human right

11

Zulu et al. (2019) [30]

Zambia

Case study

18 teachers from six schools in Nyimba district

To investigate teachers' experiences with the implementation of the CSE curriculum in the Zambian context

This study’s findings revealed that the lack of clarity in the CSE framework, on how to integrate CSE teaching into existing subjects, coupled with contextual challenges, left teachers involved in CSE with a great room for discretion