SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand

Background: Unintended adolescent pregnancy and sexually transmitted infections (STIs) remain pressing public health concerns in Northeastern Thailand. Although school-based sexuality education is widespread, risk behaviors persist, underscoring the need for innovative approaches. This study evaluated the SESS (System-Empowerment-Support-Social Network) model, a multi-component framework designed to strengthen adolescent sexual health. Methods: A quasi-experimental, two-school study was conducted among 240 students aged 15-19 years in Nakhon Ratchasima Province. One school (n = 120) implemented a 16-week SESS program, while a comparison school (n = 120) continued with the standard curriculum. The SESS model combined system coordination, empowerment workshops, peer and institutional support, and digital platforms (Facebook, LINE). Data were collected with validated questionnaires and analyzed using ANCOVA, adjusting for baseline values. Exploratory analyses reported mean differences with 95% confidence intervals (CIs). Results: Groups were comparable at baseline. Post-intervention, the intervention school showed higher perception scores (mean difference = +13.0; 95% CI: 10.5-17.0) and preventive practice scores (mean difference = +14.0; 95% CI: 10.1-17.9). Attitudes showed minimal change. No pregnancies or self-reported STI cases were documented among intervention participants during the follow-up period. Conclusions: In this two-school quasi-experimental evaluation, the SESS model was associated with improvements in perceptions and practices, though attitudinal changes were limited. Findings suggest the feasibility of integrating empowerment, social support, and digital engagement into school-based programs while highlighting the need for multi-school trials to establish effectiveness.