Community psychology final report 2016

Evaluation of
thebodyshop Toolkit
Presented by:
Alice Bledsoe
Patrice DeLeon
Kristen Haddad
Angelica Hardee
David Kovalchick
Danni Lanaway
Taylor Lovett
Caravella McCuistian
Katelyn Schloemer
Amaha Sellassie
Teresa Smith
Kristen Welker
Jenny Zhen-Duan
April 18, 2016

Evaluation of the Body Shop Toolkit
Page 2
ACKNOWLEDGMENTS
Dr. Farrah Jacquez, Dr. Jennifer Mooney, Aalap Bommaraju, and University of Cincinnati spring
2016 Community Psychology class would like to thank the following participants in our research
study:
Churches Active in Northside (CAIN)
North Presbyterian Church
New Prospect Baptist Church
City Gospel Mission
Winton Terrace Community Center with special thanks for Ms. Nikki Steele
Crossroads Center

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EXECUTIVE SUMMARY
thebodyshop Toolkit
With a consideration of the lack of robust sexual health
education in the area, and with the knowledge of short-
and long-term effects of STIs and unwanted pregnancies
in mind, the Cincinnati Health Department’s Reproductive
Health and Wellness Program has developed their own
comprehensive sexual health education program, called
thebodyshop Toolkit. This reproductive health education
tool is designed for multifaceted use. It can be used to
teach teens and adults about reproductive health, to
supplement previous sexual health education
experiences, or to introduce new topics to those who
have not experienced a comprehensive sexual health
program.
Sections of thebodyshop Toolkit
The current study sought to receive community feedback on thebodyshop Toolkit sexual health
education program used by the Cincinnati Health Department.
______________________________________________________________________
KEY FINDINGS
Demographics
A total of 58 participants completed thebodyshop Toolkit program, 29 female and 29 male.
Participants ranged in age from 18 years-old to 61 years-old with the mean age of 39.4. Participants
with no partner relationship accounted for 43% of the sample, while 32.8% had a steady partner and
are unmarried, 13.8% had a steady partner that they are married to, and 8.6% had multiple partners.
Income ranged ranged from zero to $60,000 with a mean of $11,095. The sample was equally divided
by religious affiliation, as 50% of participants reported being affiliated with some type of religion
while 48.3% reported no religious affiliation. Of note, 80% of participants have previously received
sexual health education
Teen Health
Reproductive Life Planning
Birth Control Methods
Sexually Transmitted Infections
Healthy Bodies/Health Homes
Resources/Referrals
24%
14%
7%
41%
14%
Location
CAIN
Winton Terrace
Crossroads
City Gospel
Mission
New Prospect
Church
63%
30%
2%3% 2%Race
Black
White
Hispanic/Latino
Native American/
Alaskan
Biracial

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Overall Satisfaction of thebodyshop Toolkit
87% would recommend this program to someone else
86% like the way the toolkit looks
85% like the way the toolkit was presented
82% found this course was informative for them
70% found this information applies to their life
Overall Toolkit Effects Group Differences in Toolkit Effects
ü thebodyshop Toolkit was found to be
effective for all participants.
ü Pre and post test results show
significant improvements in 1) self-
efficacy for birth control use; 2)
intention to use reproductive life
planning; 3) intention to use birth
control; 4) intention to protect against
STIs; 5) intention to communicate about
sex.
ü There were significant gender differences for
intention to use reproductive life planning, in
which women were more likely to use
reproductive life planning after the toolkit.
ü After the toolkit, those who have had sexual
health education before had significantly
higher scores of intention to use birth control
than those participants who have not received
previous sexual health education.
CONCLUSIONS
Results of our study demonstrate thebodyshop toolkit to have a positive impact in improving self-
efficacy and intention to use birth control, and intention to use reproductive life planning, to use
condoms to protect against STIs, and to communicate about sex. Overall, the toolkit benefits
everyone regardless of gender, race, age partner status, income, religious affiliation or prior
sexual health education, thus supporting the effectiveness of the Toolkit within a diverse
community. These results present strong evidence of the benefits of thebodyshop’s feasible, low-cost
comprehensive sexual and reproductive health education in the Cincinnati area.

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INTRODUCTION
Cincinnati, Ohio has some of the highest rates of gonorrhea, chlamydia, syphilis, and teen
birth the state of Ohio (Ohio Department of Health [ODH], 2015). The rates per 100,000 people in
Cincinnati for 2014 were sometimes five times higher than national rates (ODH, 2015; Centers for
Disease Control and Prevention, 2015a). Specifically, Cincinnati saw a rate (per 100,000 people) of
756.3 for gonorrhea (compare to a rate of 138.6 for Ohio and 110.7 nationally), 2138.4 for chlamydia
(compared to 469.3 for Ohio and 456.1 nationally) and 95.8 for syphilis (compared to 10.5 for Ohio
and 11.6 nationally). With this data, it is safe to say that Cincinnati has a significant problem with
sexually transmitted infections. Not helping in the search for a solution is Cincinnati’s lack of
coherent educational policies on sexual and reproductive health (FOX 19, 2015). Research has shown
that communities that provide comprehensive sexual education have lower incidences of STIs and
teen births (Kohler, Manhart, and Lafferty, 2008). In order to respond to the sexual and reproductive
health environment in Cincinnati, the Cincinnati Health Department’s Reproductive Health and
Wellness program has developed a reproductive health intervention called thebodyshop Toolkit. We
evaluated the efficacy of this intervention in improving the knowledge of sexual and reproductive
health issues of Cincinnatians.
The Importance of Comprehensive Sexual Health Education
Sexual and reproductive health are overlooked health topics in the United States. Despite
being critically important to the health and well-being of people throughout the life course, we often
avoid talking about sexual and reproductive health because of the stigma associated with talking
about sex. But sex happens -- a lot. And so do other things, like sexually transmitted infections (STIs)
and unwanted pregnancies.
Each year, there are nearly 20 million new documented cases of sexually transmitted
infections (STIs), carrying an estimated $16 billion in associated medical costs (CDC, 2014).
Contracting an STI compromises an individual’s immediate and long-term health and well-being
(CDC, 2014a). Having an STI increases an individual’s likelihood of contracting another STI or human
immunodeficiency virus (HIV; CDC, 2014b). Additionally, undiagnosed STIs cause roughly 24,000
women to become infertile each year, and lead to a variety of birth defects in children born to STI
infected mothers. While the growth rate of new STIs is less than it was in years past (CDC, 2015a), the
rate is still high and warrants national attention.
Unwanted births also happen as a result of people having sex. Having an unwanted birth is a
serious outcome for people of all reproductive ages. Studies have shown that having unwanted
births seriously impacts people’s later physical and emotional health (Roberts and Foster, 2014;
Harris, et al. 2014). Given the restricted nature of abortion access in the United States, the effects of
unwanted birth are also attributable to unwanted pregnancy (Herd et al., 2016; Kost and Lindberg,
2015). Data from the National Vital Statistics Report on births (Martin, Hamilton, Osterman, Curtin &
Mathews, 2015) indicate that around 273,000 babies were born to mothers ages 15-20, and it is

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estimated that the overwhelming majority of these pregnancies are unplanned (Finer & Henshaw,
2006).
With an understanding of both short and long-term effects associated with contracting an
STI or having an unwanted pregnancy, comprehensive sexual health education programs have been
developed to address these issues. Comprehensive sexual health education programs are a proven
way to reduce an individual’s susceptibility to the negative health consequences of unplanned
pregnancies and STIs (Future of Sex Education Strategic Plan [FoSE], 2015; Wilson, Wiley, Houseman,
McNeil & Rosen, 2015). Comprehensive sexual health education programs typically include
information on a variety of topics, including (but not limited to): body development, puberty, human
reproduction, methods of contraception, male and female condom use, abstinence, sexually
transmitted infections (and methods to prevent them), identifying healthy sexual relationships,
locating and securing sexual health resources (e.g., finding a women’s clinic, obtaining
condoms/birth control) and communication and decision-making regarding sex (FoSE, 2015). Those
comprehensive sexual health programs that deliver accurate, complete and developmentally
appropriate information have been found effective in delaying the onset of sexual intercourse in
young people and in encouraging condom and birth control use (FoSE, 2015). These are important
methods that prevent STIs and unwanted pregnancies.
Comprehensive sexual health education is effective in reducing high-risk sexual behaviors.
Chin and colleagues (2012) conducted a meta-analysis of 66 comprehensive risk reduction programs
(i.e., sexual health programs that promote behaviors that prevent or reduce the risk of pregnancy
and HIV and other STIs, while identifying abstinence as the “best” method) and found favorable
evidence in support for these programs in reducing adolescent pregnancy, HIV and other STIs. In
contrast, however, Chin and colleagues also reviewed 23 sexual health programs which used
exclusively abstinence-only messaging and found mixed results regarding the effectiveness of these
programs on pregnancy and STI reduction. This supports the argument for comprehensive sexual
health education programming versus abstinence-only messaging. Further, researchers using the
National Survey of Family Growth found that teens who received comprehensive sexual health
education programming were 50% less likely to get pregnant than those students who received
abstinence only programming (FoSE, 2012), Stanger-Hall and Hall (2011) found that states requiring
comprehensive sexual health education had lower teen pregnancy rates than those states who
employed abstinence only programming.
Despite the compelling evidence in support of comprehensive sexual health education,
many state boards of education have eliminated health education requirements and many states
rely strictly on abstinence-only programs (National Council of State Legislatures, 2016). Just 33 of 50
states and the District of Columbia require that public schools provide students with education on
HIV. Only 20 states and the District of Columbia mandate sex education and HIV education. Less than
half of all states (19) require medically accurate sexual health education, and the definition of
medically accurate varies from state to state. Locally, Ohio has pending legislation that will require
for medically accurate information to be provided for STIs. This legislation urges educators to “stress

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abstinence but shall not exclude other instruction and materials on contraceptive methods and
infection reduction measures” (Senate Bill 101). Within the Cincinnati area specifically, there is a large
number of private (primarily founded in the Christian faith) schools and schools that believe
abstinence only education to be the best way to approach the subject of sexual education. These
restrictive education policies prevent teens and adults from obtaining a full awareness of the
consequences of unprotected sex. They also are not being provided with the knowledge they need
to prevent STIs and unwanted pregnancies.
thebodyshop Toolkit
With a consideration of the lack of robust sexual health education in the area, and with the
knowledge of short- and long-term effects of STIs and unwanted pregnancies in mind, the Cincinnati
Health Department’s Reproductive Health and Wellness Program has developed their own
comprehensive sexual health education program, called thebodyshop Toolkit. This reproductive
health education tool is designed for multifaceted use. It can be used to teach teens and adults
about reproductive health, to supplement previous sexual health education experiences, or to
introduce new topics to those who have not experienced a comprehensive sexual health program
thebodyshop Toolkit was originally designed to teach men and women of reproductive age
about reproductive health and wellness. The Toolkit is a flip-book presentation or PowerPoint
presentation that includes the following sections: teen health, reproductive life planning, birth
control methods, sexually transmitted infections, healthy bodies, healthy homes, and resources and
referrals. Descriptions of the sections are found in Table 1.
Table 1. Descriptions of Sections in thebodyshop Toolkit
Section Description
Teen Health The teen health section goes over the following topics: “Are you ready for
sex?”, pregnancy getting birth control, talking to your parents, talking to your
partner, what to do to get a doctor’s appointment, what to talk about in a
doctor’s appointment, and pelvic exams.
Reproductive Life
Planning
The reproductive life planning section discusses healthy relationships, what a
reproductive life plan is, pregnancy spacing, and unintended pregnancy.
Birth Control
Methods
The birth control methods section details the following topics: what is birth
control, variations and how to choose, effectiveness, condoms, the pill, the
patch, the ring, the shot, the implant, IUDs, and birth control while breast
feeding.
Sexually
Transmitted
Infections
The sexually transmitted infections (STIs) section discusses the following
topics: what are STIs, Gonorrhea, Chlamydia, Genital Herpes, HPV and
vaccinations, Syphilis, Hepatitis B and C, testing and protecting yourself, HIV,
and a sexual exposure chart.
Healthy
Bodies/Healthy
Homes
The healthy bodies, healthy homes section goes over healthy eating, safe sleep
for your baby, personal hygiene, smoke free homes, and smoke alarm safety.
Resources/Referrals
The resources and referrals section is a separate document given to the client
that includes information about primary care, mental health services, domestic
violence shelters, substance abuse treatment, abortion, adoption, and
pregnancy care, home health, nutrition (WIC), men’s health, and pediatric care.

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The Toolkit is usually presented in a one-on-one meeting between a community health
worker and a client. The community health worker flips through each page of the Toolkit, going over
the information and asking if the client has any questions. Since CHD is interested in expanding the
scope of use for the Toolkit, our evaluation tested presentation of the Toolkit in group settings.
Although some of the information in the Toolkit may, at face value, appear to be common
knowledge, the state of Ohio does not have any health education standards; this allows many
schools in the city of Cincinnati to pick and choose what reproductive health and wellness
information they provide to children and teens. Many teens in the state of Ohio and the city of
Cincinnati leave high school without having learned about proper birth control techniques, what a
reproductive life plan is, or how to prevent STIs. The CHD has chosen the list of topics included in the
Toolkit because they feel that these items are the backbone of reproductive health and wellness
education.
Purpose
The current study sought to receive community feedback on thebodyshop Toolkit sexual
health education program used by the Cincinnati Health Department. The purposes of this study
were twofold: (1) to assess changes in self-efficacy (i.e., a person’s belief in their ability to perform an
action) and intentions (i.e., the likelihood of an individual performing a specific action) to use and
discuss reproductive life planning, condoms to prevent STIs, and condoms and various
contraception methods to prevent pregnancy; and (2) to determine the levels of satisfaction and
relevance of various elements of the program for study participants.
Our specific hypotheses are listed below:
• Participation in the health education program using thebodyshop Toolkit can change an
individual’s self-efficacy to use effective birth control.
individual’s self-efficacy to prevent STIs.
individual's self-efficacy to discuss reproductive health with their partner(s).
individual’s intention to use reproductive life planning.
individual’s intention to use effective birth control.
individual’s intention to prevent STIs.
• Participation in the health education program using thebodyshop Toolkit can change the way an
individual discusses reproductive health.

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METHOD
Research Team
The research team is comprised of Farrah Jacquez, a University of Cincinnati (UC) professor in
Psychology, Jennifer Mooney, the Director of Maternal and Infant Health at the Cincinnati Health
Department, a graduate teaching assistant, and 14 undergraduate, masters, and doctorate level
students studying psychology, sociology, health education, and/or health promotion. We
collaborated together through a graduate-level Community Psychology course. This course was
developed by Dr. Jacquez in collaboration with Dr. Mooney as part of the UC Forward initiative at the
University of Cincinnati. UC Forward is a grant program that supports trans-disciplinary teaching,
learning, and research by pairing students with experts and community partners to solve real world
problems.
Measures
As a class, we developed pre and post-test self-assessments. These self-assessments
accompanied the delivery of the Toolkit to test for overall effectiveness. After careful consideration
of the goals and desired outcomes of the project, the team settled on the several main research
questions: We wanted to find out if participation in a group education session using thebodyshop
Toolkit changed an individual’s: (1) self-efficacy to use effective birth control, (2) self-efficacy to
prevent STIs, (3) self-efficacy to discuss reproductive health with partner(s), (4) intention to use
effective birth control, (5) intention to prevent STI’s, (6) intention to use reproductive life planning,
and (7) intention to discuss reproductive health with partner(s). We also wanted to know if (8)
participants were satisfied with the education provided in the Toolkit. We developed questions to
assess changes in these domains. Our evaluation tool is found in Appendix A.
Self-efficacy to Use Birth Control. The pre and post-tests included items that measured self-efficacy to
use birth control. Participants responded on a 7-point Likert scale, 1 being “Not Confident” and 7
being “Confident.”
Table 2. Descriptions of Questions for Self-efficacy to Use Birth Control
Test Questions
Pre & Post How confident are you that you or your partner can use birth control methods
(other than a condom) to prevent pregnancy?
Pre & Post How confident are you that you or your partner can use a condom to prevent
pregnancy?
Pre & Post How confident are you that you can insist on using a condom during sex, even
if your partner does not want to use a condom?
Pre & Post How confident are you that you or your partner can use a condom every time
that you have sex?

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Self-efficacy to Prevent STIs. Similarly, pre and post-test items were used to measure self-efficacy to
prevent STI’s. Participants responded on a 7-point Likert scale, 1 being “Not Confident” and 7 being
“Confident.”
Table 3. Description of Questions for Self-efficacy to Prevent STIs
Test Questions
Pre & Post How confident are you that you or your partner can use a condom to prevent
sexually transmitted infections?
Pre & Post How confident are you that you know when to get tested for sexually
transmitted infections?
Self-efficacy to Discuss Reproductive Health with Partner(s). Survey items were included to assess
participants’ self-efficacy to discuss their reproductive health with their partner(s). Participants
responded on a 7-point Likert scale ranging from 1 (Not Confident) to 7 (Confident).
Table 4. Description of Questions for Self-efficacy to Discuss Reproductive Health with Partner(s)
Test Questions
Pre & Post How confident are you that you can talk to your partner about having sex?
Pre & Post
Pre & Post
How confident are you that you can talk to your partner about a plan to
prevent unwanted pregnancy?
How confident are you that you can talk to your partner about STIs?
Intention to Use Effective Birth Control. Participants responded to questions, using a 7-point Likert
scale ranging from 1 (False) to 7 (True).
Table 5. Description of Questions for Intention to Use Effective Birth Control
Test Questions
Pre I use birth control methods (other than a condom) to prevent pregnancy.
Pre
Post
Post
I use a condom to prevent pregnancy.
I will use birth control methods (other than a condom) to prevent pregnancy.
I will use a condom to prevent pregnancy.
Intention to Prevent STIs. Participants responded to questions, using a 7-point Likert scale ranging
from 1 (False) to 7 (True).
Table 6. Description of Questions for Intention to Prevent STIs
Test Questions
Pre I use a condom to prevent STIs.
Pre
Post
Post
I talk to my partner about using a condom to prevent STIs.
I will use a condom to prevent STIs.
I will talk to my partner about using a condom to prevent STIs.
Intention to Use Reproductive Life Planning. Participants responded to questions, using a 7-point Likert
scale ranging from 1 (False) to 7 (True).

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Table 7. Description of Questions for Intention to Use Reproductive Life Planning
Test Questions
Pre I talk to my partner about having sex.
Pre
Pre
Pre
Post
Post
Post
Post
I have a plan to prevent unwanted pregnancies.
I have a plan to prevent STIs.
I have a plan about whether or not I want to have a child.
I will talk to my partner about having sex.
I will make a plan to prevent unwanted pregnancies.
I will make a plan to prevent STIs.
I will make a plan about whether or not I want to have a child.
Intention to Discuss Reproductive Health with Partner(s). Participants responded to questions, using a
7-point Likert scale ranging from 1 (False) to 7 (True).
Table 8. Description of Questions for Intention to Discuss Reproductive Health with Partner(s)
Test Questions
Pre I talk to my partner about using birth control methods (other than a condom)
to prevent pregnancy.
Pre
Post
Post
I talk to my partner about using a condom to prevent pregnancy.
I will talk to my partner about using birth control methods (other than a
condom) to prevent pregnancy.
I will talk to my partner about using a condom to prevent pregnancy.
Satisfaction. This measure was included in the post-test only, because participants were administered
the Toolkit after the pre-test. Participants rated the below statements using a 7-point Likert scale
ranging from 1 (Disagree) to 7 (Agree).
Table 9. Description of Questions for Satisfaction
Test Questions
Post I would recommend this course to someone else.
Post
Post
Post
Post
Post
Post
Post
Post
This course was informative for me.
I like the way the Toolkit looks.
I like the way the Toolkit was presented.
This information applies to my life.
If this information applies to your life, why?
If this information DOES NOT apply to your life, why?
At what age should people learn this information?
What would you change about this presentation?
Demographics. At the very end of the post-test, participants were asked demographic questions.
These responses ranged from open, yes/no, and Likert-type responses.
Table 10. Description of Questions for Demographics
Test Questions
Post Have you ever thought about having children?
Post Are you interested in having a child in the next 12 months?

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Post
Post
Post
Post
Post
Post
Post
Post
Have you had a sex education course before this one?
Do you consider yourself as belonging to any particular religion or
denomination?
If “yes”, which religion or denomination?
How old are you?
What gender do you see yourself as?
What is your race or ethnicity?
What was your total household income in the past year from all legal sources
before taxes?
How many people, including you, depend on your household income?
What kind of sexual relationships do you have?
Participants
Participants were recruited from several community centers including Churches Active in
Northside (CAIN), North Presbyterian Church, New Prospect Baptist Church, City Gospel Mission,
Winton Terrace, and Crossroads Health Center. Participants from locations such as CAIN, North
Presbyterian Church, City Gospel Mission, Winton Terrace, and Crossroads Health Center were
recruited by announcements made during community meetings and flyers hung in community
areas. Interested community members called a recruitment line managed by members of the
research team. At New Prospect Baptist Church, however, facilitators from the research team simply
notified church-goers of the sexual health education program before and after sermon. Those who
were interested in participating stayed after sermon and attended the facilitation. All participants of
this study were offered $20 Kroger gift cards for their participation.
Facilitation and Procedure
Facilitators were chosen on a volunteer basis; 10 students from our class offered to facilitate
the Toolkit program and did so at the community locations. Facilitators administered the self-
assessments and Toolkit in private spaces made available by the community centers for ease of
access and child-care service. The Toolkit was delivered on a laptop in groups of separated men and
women, ranging from two to 24. In one instance, the Toolkit was administered to one peer outside of
our class. The group at City Gospel Mission was presented with the Toolkit using a projector. The
delivery of the Toolkit became quite interactive, with participants asking questions and providing
input during the facilitation sessions. The facilitations lasted roughly an hour, with 10 minutes at the
beginning devoted to pre-tests and 10 minutes at the end for post-tests.
Statistical Analysis
We looked to see if people scores changed for pre and post-tests. We also looked to identify if
change scores differed by gender or race. Change scores were computed by finding the difference in
post and pre-test mean scores. Variables with change scores included: self-efficacy for birth control,
self-efficacy for STI prevention, self-efficacy for communication with partner, intention to use
reproductive life planning, intention to use birth control, intention to prevent STI’s, intention to
communicate with partner, and satisfaction. Once all change scores for each variable were

Page 13
calculated, an independent sample t-test was employed with each of the change scores as the
dependent variable and gender as the independent variable. The same procedure was used for the
independent variable of race.
We also assessed differences in change scores by religion and partnership status. Change
scores were calculated using the same procedure as seen above. An independent sample t-test was
employed with change scores as the dependent variable and religion as the independent variable.
Next, partnered and non-partnered responses were split into dichotomous variables. An
independent sample t-test was conducted with each of the change scores as the dependent variable
and partner status as the independent variable. Significant mean changes for each group were
recorded.
Differences in change scores between those who have had prior sex education and those
who have not, as well as those were are interested in having kids in the next year and those who
were not interested were assessed. Change scores were calculated using the same procedures as
discussed above. An independent sample t-test was conducted with each of the change scores as
the dependent variable and prior sex education as the independent variable. Another independent
sample t-test was employed with the “interested in having kids in the next year” response as the
independent variable. Significant mean changes were recorded for each group.
Finally, we analyzed qualitative, open-response data for emergent themes. Responses were
considered carefully, and together, the group identified recurring themes in responses and coded
those responses into themed subsets.
RESULTS
Demographics
A total of 60 participants completed thebodyshop Toolkit program. Two participants did not
complete the post-test portion of our assessment, leaving 58 participants whose data was analyzed.
14% of participants were from New Prospect Church (2 male, 5 female), 41% from City Gospel
Mission (24 male), 24% from CAIN (3 male, 11 female), 14% from Winton Terrace (8 female), and 7%
from Crossroads (4 female). Study participants were 50% males (n = 29) and 50% females (n = 29).
Participants ranged in age from 18 years-old to 61 years-old with the mean age of 39.4. The mean
age for female participants was 31.96 while the mean age for males was 47.11. Participants with no
partner relationship accounted for 43% of the sample, while 32.8% have a steady partner and are
unmarried, 13.8% have a steady partner that they are married to, and 8.6% have multiple partners.
Participants had a mean income of $11,095 and ranged from $0 to $60,000. Income was collected
using the question: "What was your total household income in the past year from all legal sources
before taxes?" The integer value of the respondent's answer was used unless they specified their
monthly income. In these cases, their reported income value was multiplied by 12 to determine
annual income numbers. Individuals who did not report a numeric value were coded as missing. In
terms of previous sexual health education, 80% of participants had received prior sex education

Page 14
63%
30%
2%3% 2%Race
Black
White
Hispanic/Latino
Native American/
Alaskan
Biracial
while 20% had not. Lastly, the sample was equally divided by religious affiliation, as 50% of
participants reported being affiliated with some type of religion.
Overall Toolkit Effects
We found that the Toolkit was effective in changing both self-efficacy and intention on six
research domains. To assess significant differences between pre- and post-test scores, total scores
were computed for each of the six research questions at the pre and post-test time points. To
compute these scores, survey items for each research question were scored and summed to create
one score reflecting the pre-test responses and one score reflecting the post-test scores. Once pre-
and post-test total scores were created, paired samples t-tests were conducted to determine
significant differences between scores. Results of these tests show significant improvements in
scores for five of the study’s domains: self-efficacy for birth control use, t(55) = -3.05, p = 0.003,
intention to use reproductive life planning, t(56) = -4.13, p = 0.0001, intention to use birth control,
t(53) = -4.78, p = 0.0001, intention to protect against STIs, t(57) = -3.28, p = 0.002, and intention to
communicate about sex, t(57) = -3.09, p = 0.003.
Group Differences in Toolkit Effects
We looked at differences in the effect of the Toolkit across demographic groups. A change
score was computed by subtracting the calculated pre-test total score from the calculated post-test
total score for each research question. Independent samples t-tests were used to determine
significant differences across demographic groups. There were no significant differences found
across race, religious affiliation, age, or income level on any question, p > .05. There were significant
differences between males (M=2.32, SD=4.11) and females (M=2.64, SD=3.29) for only one research
question: intention to use reproductive life planning, t(54) = -1.25, p = 0.03.
With respect to the domain of intention to use birth control, independent samples t-tests
reflect significant differences with respect to previous sexual health education; t(49) = 1.69, p = 0.014.
Those who have had sexual health education (M=2.56, SD=3.53) before had significantly higher
scores than those participants who have not received previous sexual health education (M=.60,
SD=1.65).
24%
14%
7%
41%
14%
Location
CAIN
Winton Terrace
Crossroads
City Gospel
Mission
New Prospect
Church

Page 15
Satisfaction with the Toolkit
Participants were asked to review the Toolkit and provide feedback on their experiences.
Most participants strongly agreed with recommending this program to someone else (M=6.46,
SD=1.16). Participants also thought the course was informative (M=6.32, SD=1.32), liked the way the
Toolkit looks (M=6.26, SD=1.26), and that they liked the way the Toolkit was presented (M=6.29,
SD=1.25). The evaluation item that saw the lowest mean score was that question asking if the
information applied to the life of the participants. This item received a mean score of 5.89 (1.66).
Overall Satisfaction of thebodyshop Toolkit
87% would recommend this program to someone else
86% like the way the toolkit looks
85% like the way the toolkit was presented
82% found this course was informative for them
70% found this information applies to their life
Open-Ended Questions
Participants were asked three open ended questions in the post-assessment: “If this
information applies to your life, why?”, “If this information does not apply to your life, why?”, and
“What would you change about this presentation?” There were 43 participants that replied when
asked if the information from this program applied to their life. Those who responded felt the Toolkit
applied to their life because they were sexually active (20%), they found it to be helpful and/or useful
information (18%), they felt it was information that people should know (14%), or they wanted to
know more about birth control methods (14%). One respondent wrote, “Yes because I am sexually
active and am actually considering a birth control method.” Additional responses can be found in
Table 11.
When asked why the Toolkit may not apply to their lives, 25 participants responded.
Responses indicate participants said that the Toolkit did not apply to their lives because they were
not sexually active (23%), too old (15%), or were not in a sexual relationship (12%). For example,
several respondents wrote, “Not having sex” as their reason for the program not being applicable for
them.
Table 11. Responses to the Question “If this information applies to your life, why?”
“Because these are some things I needed to hear and learned. Especially different methods.”
“Yes because I learned more and I can talk to my daughters about sex and birth controls.”
“To help plan for if I would like more children and how to plan for such things.”

Page 16
“Yes because I am sexually active and am actually considering a birth control method.”
“Because I've had multiple sex partners and didn't realize the importance of condoms to prevent
STI's.”
“Having useful info/ facts to share w/ others & youth.”
There were 48 participants who provided a response regarding recommended changes for
the presentation. The participants who responded said they would change the presentation method
(16%), the age of the audience (10%), and that they would like the presenters to give out condoms
(8%). One participant wrote, “More teenagers could benefit” which aligns with survey responses
asking at what age people should receive this information.
DISCUSSION
The purpose of this study was to determine the effectiveness of thebodyshop Toolkit in its
ability to influence self-efficacy and intentions to use and discuss reproductive life planning,
condoms to prevent STIs, and condoms and various contraception methods to prevent pregnancy,
and to determine the levels of satisfaction and relevance of various elements of the program for
study participants. We presented thebodyshop Toolkit to members in the Cincinnati community of all
races, age groups and genders at six locations city-wide. Cincinnati has one of the highest rates in
Ohio for STI’s and teen pregnancy, and there is a great need for sexual and reproductive health
education programming in our city. Results of our study demonstrate the Toolkit to have a positive
impact in improving self-efficacy and intention to use birth control, and intention to use
reproductive life planning, to use condoms to protect against STIs, and to communicate about sex.
There were no significant differences in results based on race, age, income level, or religious
affiliation in our sample, thus supporting the effectiveness of the Toolkit within a diverse community.
These results present strong evidence of the benefits of comprehensive sexual and reproductive
health education in this community, even with a minimal amount of exposure.
Cincinnati is a city with a long history of religion and religious communities, which can
oftentimes be a significant barrier in delivering sexual and reproductive education. One 2014 poll
showed that nearly 53% of Cincinnati residents polled reported being religious (compared to the
national average of 48%), and 26% of those polled identified specifically as Catholic, one of several
religions that are outspoken against the use of birth control (Religion, 2014). As such, sexual and
reproductive health education programs in the local Cincinnati area are limited and many programs,
particularly those designed for high school students, rely solely on abstinence-only messaging with
little or no discussion of birth control methods. While it is true that abstinence is the only 100%
effective way to prevent pregnancies (Planned Parenthood, 2014), previous research supports a
more comprehensive approach to sexual and reproductive health education to minimize a teen’s risk
for unplanned pregnancies and STIs (Wilson, Wiley, Houseman, McNeil & Rosen, 2015). Therefore it

Page 17
seems the best approach is one that doesn’t choose between abstinence or comprehensive sexual
education, but rather one that utilizes a both/and approach.
When asked about the appropriate age to deliver this program, the majority of our
participants answered between the ages of 10 and 18. Young adults (ages 15-24) make up 25% of
the sexually active population in America and this age group accounts for half of all new cases of
sexually transmitted infections (CDC, 2015b) each year and is facing high pregnancy rates. Data from
the Center for Disease Control and Prevention’s (CDC) 2013 National Youth Risk Behavioral Survey
(YRBS) show that 47% of US high schoolers have engaged in sexual intercourse (Kann et al., 2014),
and teens and young adults tend to take part in high-risk sexual activity, seemingly unaware of the
consequences of their actions. Our community members seemed to be well aware of this fact, as
their recommendation for the right age group for delivery of the Toolkit aligned with the time period
when most young adults begin to be sexually active. As a research team, we believe this suggests a
need for programs like thebodyshop Toolkit to be implemented in middle- and high-school health
education programs. Educating community members when they are just beginning to be sexually
active may help in preventing complications and long-term health consequences resulting from lack
of information.
In line with this argument and previous research, our results show that participants who had
some previous sexual health education before the Toolkit presentation were more impacted by the
Toolkit than those with no prior sexual health education. As such, we conclude that to be most
effective in delivering effective sexual health education, programs should be delivered on an
ongoing basis, and not simply a onetime occurrence.
Strengths
Before beginning this research project, there were some misconceptions about the
willingness of the faith community to receive reproductive health information. There was some
apprehension about utilizing the faith community as a means to disseminate reproductive health
information and we thought the faith community would not be receptive to having us come present
the Toolkit. Another concern of ours was the validity of the data that we would receive at the church.
But on the contrary, we were welcomed and embraced by the churches that we reached out to for
collaboration. One congregation was so happy to have us there they were interested in continuing
to develop our partnership. Through this we’ve learned that even though some people can be
religious or spiritual, they are still humans dealing with struggles similar to those of every other
human. We conclude that while some faith communities are more amenable to discussions about
sex and birth control than others, there is potential for developing a real partnership with the faith
community because of the connection between reproductive health, life opportunity and overall
health. Some churches may never come around to the idea of educating on the topic, but some
churches may begin to see reproductive health and wellness programs as a viable asset to their
congregation and community health.

Page 18
Many sexual and reproductive health education programs seem to focus mostly on women
and women’s health issues. However, about half of our participants were men. We were pleased to
find that the information shared with men was both meaningful and impactful, and there were no
significant differences in the impact on self-efficacy and intention between men and women. As
such, we believe there is a space to share important sexual and reproductive health information with
the male population. We feel the Toolkit could be incorporated into the Men’s Health Initiative, with
perhaps a few modifications to include information regarding male reproductive health.
Prior to this project, the Toolkit was administered in a one-one-one setting exclusively. We
found, however, that the Toolkit can be similarly effective in producing change in an individual’s self-
efficacy and intention to use and discuss important sexual and reproductive health methods when
disseminated in a group setting. Previous thought was that an individual would not feel comfortable
discussing sensitive information in a group of their peers, but this did not seem to be the case in our
facilitation of this program. The ability to provide this information and use the Toolkit in group
settings supports the efficiency and effectiveness of this tool in distributing low-cost and meaningful
sexual and reproductive health education, and could be a key component in plans for wide-spread
distribution of this important information in the community.
There is an obvious need for quality sexual and reproductive health education in the
Cincinnati area and thebodyshop Toolkit has been shown to be effective for a variety of people across
demographics. This program was effective in producing the desired changes, and was even
welcomed by communities of faith. This program is a legitimate tool for combating the sexual health
problems our community is facing, and it has been demonstrated through this research project that
the Toolkit does not require much in terms of delivery. While some of the facilitators involved with
the research had prior experience with facilitation and reproductive health education, most of them
did not. Relatively untrained presenters were able to produce statistically significant improvements
in participant’s intentions and orientations towards condom and birth control use. This suggests that
dissemination of this Toolkit to people who live in the community could have a meaningful effect on
the sexual and reproductive health in Cincinnati. This would enable more people to hear
reproductive health from a facilitator they already know and trust. Placing the Toolkit into the hands
of more community members has the potential to disseminate the information deeper within the
community.
Limitations
There were a few limitations to be found within this study and the Toolkit. First, it is possible
that our use of incentives influenced the participants we recruited and their level of attention during
the presentation of the Toolkit. Our facilitation and recruitment team worked hard to recruit
candidates that were of reproductive age from a variety of locations. Our average age for our
participants was higher than we were aiming for, but overall the information gathered from our
sample was meaningful and helped us to gain a better understanding of the effectiveness of the
Toolkit.

Page 19
Another limitation within our study sample was the high percentage of participants who
reported not being in a sexual relationship. We believe this to be the reason for low mean scores on
questions asking about the applicability of this program. As with age, we focused on learning what
we could from these participants, regardless of their current sexual behavior. We feel these
participants still contributed meaningful data and will be helpful in informing future iterations of this
study.
Some participants made us aware of our mistake in not bringing condoms to distribute.
Future versions of this project will be sure to include condom distribution as part of the program.
The final limitation of this study was with the Toolkit itself. In developing this study, it
become more obvious that this program was developed primarily for people in heterosexual
relationships. As such, we limited our questions on sexuality in the demographics portion of the
post-test. Because of this, we are not necessarily able to know if participants who indicated that the
program was not applicable to them (without answering the open-ended questions about
applicability) felt the program was not appropriate for them because of their sexuality, or if it was
because of another reason or reasons. Future versions of the Toolkit would benefit from
incorporating information and wording that would be more inclusive and relevant for people in all
types of sexual relationships.
Further Research
Further research is recommended to explore what a more community-derived reproductive
health education program could look like. As it was presented in this project, thebodyshop Toolkit
was found to be effective in many ways across a diverse sample in Cincinnati. Further research is
required to determine the effectiveness of this Toolkit with a younger sample. Additionally, it may be
beneficial to measure the effectiveness of this Toolkit delivered over time. A longitudinal look at the
effectiveness of a comprehensive sexual and reproductive health education program over time may
provide valuable insight in to the most effective way(s) to deliver this information and enact
significant change in the health of the community.

Page 20
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