School nurse-involved sexual and reproductive health education for adolescents’ students in high-income countries: a mixed-methods systematic review

This mixed-methods systematic review evaluated the effectiveness of school nurse-involved educational interventions in promoting adolescents' sexual and reproductive health (SRH) in high-income countries. The review adopted the Joanna Briggs Institute (JBI) convergent segregated approach. A multi-database search was conducted between March and May 2024. Two researchers independently selected the relevant studies and assessed the risk of bias using RoB 2.0, RoB 2 for Cluster Randomized Trials (CRT), RoBANS 2, and the JBI Critical Appraisal Checklist for Qualitative Research. Nineteen studies (12 quantitative, 7 qualitative) were included, with 75% of quantitative studies showing a high risk of bias. The intervention group showed significantly improved knowledge [standardized mean difference = 1.36; 95% confidence interval (0.46, 2.26), I2 = 93%], but no significant changes in attitudes or behaviours. Key facilitators included school nurses' expertise, trust, and active learning, while barriers involved limited time, lack of materials, passive parents, and rigid policies. The integrated findings highlighted that effective school nurse-involved SRH education relied on active learning, consistent education, and collaboration across disciplines. School nurse-involved interventions can effectively enhance adolescents' SRH knowledge despite challenges such as high heterogeneity across studies.