Background School-based sexual and reproductive health education (SRHE) programs play an important role in reducing adolescents’ sexual risk behaviour and promoting health and well-being. Comprehensive adolescent SRHE programs have proven to have positive effects on adolescent sexual behaviours. In countries where such programs have been adopted into the education curriculum, there has been a significant association with delayed first intercourse, consistent contraceptive use, and safe sexual practices. Moreover, SRHE is associated with the prevention of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV), reduction in sexual abuse and unintended pregnancies. School-based SRHE programs have also been proven effective in improving parents’ competence, knowledge, and skills related to parent-adolescent sexual and reproductive health communication. There is limited evidence regarding the attitudes and beliefs of parents, school teachers, and school nurses toward the implementation of schoolbased SRHE programs in Islamic cultural settings, including Oman. Research Aim The aim of this study—underpinned by Social Cognitive Theory (SCT)—was to examine the attitudes and beliefs of parents, school teachers and school nurses regarding school-based SRHE programs in Oman. Methods A mixed-method, two-phase sequential explorative descriptive study comprising both quantitative and qualitative research methods design was undertaken. In Phase one, three key stakeholder groups: female school nurses, school teachers (male and female teachers who teach students grades 7-9) and parents (mothers and fathers of children studying in grades 7-9) were invited to participate in seven homogenous single-sex focus group discussions (FGDs). There were between 5-9 persons in each group drawn from two public secondary schools—located in the Saham district—from grades 5-10 (one boys’ school and one girls’ school) using a convenience sampling approach. Each FGD was guided by a pre-piloted set of semi-structured interview questions. Following on from the FGDs, six face-to-face in-depth individual interviews (IDIs) were conducted three months later with two parents, three school teachers and one senior female school nurse—who were participants in the FGDs—to confirm some of the key focus group interview findings. In Phase one, the data was analysed using a thematic analysis approach. In Phase two, a convenience sample of 250 parents comprising an equal number of mothers and fathers of children aged 12 to 14 (grades 7 to 9) was drawn from the same two public secondary schools that were used in Phase one. Participants were invited through the school administration to complete a self-administered questionnaire in Arabic, which is the national language of Oman. The response rate for the questionnaires was 95.6% (n = 125 mothers; n = 114 fathers). The analysis of quantitative data was performed using the Statistical Package for Social Sciences (SPSS) version 24.0. Results Phase one (qualitative results): Four major themes emerged from the thematic analysis of parents’, school teachers’ and school nurses’ responses. Most parents, school teachers and school nurses interviewed in the FGDs and IDIs supported a comprehensive age-appropriate SRHE curriculum that addresses various SRHE topics including controversial issues such as child sexual abuse, contraception, premarital sex, teenage pregnancy, and homosexuality. They believed that the provision of school-based SRHE programs can help to improve adolescent sexual health knowledge and promote adolescent sexual and reproductive health and well-being. In addition, they recommended that SRHE programs should be aligned with Islamic beliefs and delivered by qualified educators. Many parents, school teachers and school nurses stated that Islam is not a barrier to providing SRHE programs. However, they stated that sexual discussion with adolescents outside such programs is taboo in Omani culture and therefore, communication regarding sexual topics is avoided. Finally, they reported that there is a current lack of scientific knowledge to conduct SRHE programs in Omani schools and therefore, there is a need for SRHE training. Phase two (quantitative results): The findings revealed that the majority of parents (72.8%) supported school-based SRHE programs providing they incorporated Islamic scriptural rules and regulations about premarital sexual abstinence. Almost all parents supported comprehensive age-appropriate SRHE programs being taught to students aged 10 to 15 including topics perceived as controversial in Omani culture. However, only 61% of parents endorsed including the topics of birth control and safer sex. Most parents considered themselves, school teachers and school nurses as important sources of SRHE. However, more than 90% of parents indicated that their adolescents had not received good SRHE at school. In addition, most parents reported that they do not discuss SRHE with their adolescents and lacked the knowledge to do so. Finally, 85% of parents wished to attend SRHE training. Implications for School-Based SRHE Programs The findings of this study provide implications for future efforts to change policy and foster implementing school-based SRHE programs for adolescents. The strong parental support for the introduction of school-based SRHE programs can assist school curriculum decision-makers, classroom teachers, school administrators, school healthcare-providers and researchers in Oman and other Muslim countries. Furthermore, the results of this study can help to support implementing SRHE programs globally within Muslim immigrant populations. Use of these data could also help to improve adolescent academic achievements in Oman and other Middle East countries. Sexual and reproductive health education needs to be introduced in the schools to coincide with critical periods of adolescent development. The long-term social and behavioural outcome is through adolescents having sexual and reproductive health knowledge delivered in a credible and supportive environment that will contribute to the reduction of risky sexual behaviours among adolescents and therefore reductions in the prevalence of STIs and adolescent pregnancy. Making school curriculum decision-makers aware about parental support for school-based SRHE programs coupled with evidence-based information about contents and cultural structures of these programs is an important strategy in successfully adopting and designing these programs to support adolescent well-being. In addition, this study suggests that schools and the media can work to develop more positive public views towards school-based education on safe sex and birth control. Lastly, this study also strongly recommends that school curriculum policy-makers should take into account the need to provide parents, school teachers and school nurses with SRHE training sessions in order to conduct successful SRHE programs for adolescents.

Background School-based sexual and reproductive health education (SRHE) programs play an important role in reducing adolescents’ sexual risk behaviour and promoting health and well-being. Comprehensive adolescent SRHE programs have proven to have positive effects on adolescent sexual behaviours. I...