JMIR Publications

ABSTRACT

Background:

Background:

Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become one of public health concerns. In Malaysia, 73% of young adults have engaged in sexting, a rather high rate compared to other western nations. Given that sexting was associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior must be intervened to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults.

Objective:

This study aimed to develop and implement a Sexting Intervention Module (SIM) guided by the Prototype Willingness Model, delivered using online animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext while the secondary outcomes were knowledge, attitude, perceived norm, and prototype perception of sexting.

Methods:

This two-armed, parallel, and single-blinded cluster randomized controlled trial (RCT) was conducted in a public higher educational institution in the state of Melaka. Diploma students from twelve programs were randomly allocated into intervention and control groups. Both groups answered a self-administered online questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the Prototype Willingness Model in the form of five animated videos posted on a private YouTube platform while the control group was put on the waitlist. All participants were observed immediately and three months post-intervention. Data analysis was performed with IBM SPSS (version 26). A generalized linear mixed model was performed to determine the effectiveness of the intervention. P value < 0.05 was considered statistically significant.

Results:

There was a total of 300 participants with an attrition rate of 8.3%. After adjusting for age, sex, relationship status, and the amount of time spent online, there were significant differences in the intention to sext (β=-.12; P=.002; Cohen d =0.26), willingness to sext (β=-.16; P=<.001, Cohen d=0.40), knowledge (β=.12; P=<.001, Cohen d =0.39), attitude (β=-.11; P=.001; Cohen d =0.31), perceived norm (β=-.07; P=.04; Cohen d =0.22), and prototype perception (β=-.11; P =<.001; Cohen d =0.35) between the intervention and control groups over three months.

Conclusions:

In this study, the SIM using the Prototype Willingness Model that was delivered via online animated videos was effective in reducing intention and willingness to sext, as well as improving knowledge of sexting, attitude, perceived norm, and prototype perception. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. Clinical Trial: Thai Clinical Trials Registry on 1 October 2020 (TCTR20201002001).