Advanced search
1 file | 5.79 MB Add to list

How are gender attitudes interlinked with sexual health and well-being during adolescence? A multiple-methods research within a sex-positive framework among adolescents living in Belgium and Ecuador

Sara De Meyer (UGent)
Author
Promoter
(UGent) and (UGent)
Organization
Project
Abstract
Summary The cohort of adolescents (ten-nineteen years) alive today is the largest in history. Since the international Conference on Population and Development (ICPD) in 1994, where representatives of 179 governments recognized reproductive health and the empowerment of women and gender equality as pillars of sustainable development, adolescent sexuality and adolescent sexual and reproductive health (ASRH) has been increasingly rising on the global agenda. Though today’s adolescents are healthier than before, ASRH is still a major public health concern. Unequal advance in many ASRH outcomes is obvious within and between countries. More than half of all adolescents grow up in multi-burden countries, characterized by high levels of all types of adolescent health problems, including diseases of poverty - such as HIV, poor SRH and violence. In these countries, adolescents continue to have high fecundity and high unmet need for contraception, particularly the unmarried, sexually active adolescents. In addition, efforts to implement adolescent SRHR policies and programmes are hindered by widespread resistance to the delivery of comprehensive SRHR services and information to adolescents because of taboos and social norms around adolescents' sexuality. For a long time, ASRH interventions and programmes have focused on risk reduction and avoiding risky sexual behaviour and negative consequences of adolescent sex. In recent years, the sex positive approach is increasingly gaining ground. This approach argues that the focus of policies, programmes and research on ASRH should not merely be on risk reduction of individual behaviour but also on promoting the positive aspects of sexuality within a broader social and structural structure. Therefore this approach is closely linked to adolescent sexual well-being as aspects of ASRH such as pleasure, feeling emotionally connected and discovering positive feeling about one’s body are frequently considered to be part of adolescent sexual well-being or are seen as influencing factors. In investigation on social structures that might influence ASRH, gender norms have been recognized as scripts that influence behaviour. Gender scripts prescribe a set of actions – including sexual behaviour - which align with ideas of masculinity or femininity and that can be reflected in diverse health outcomes for male and female adolescents. Former research of this kind has indicated how gender inequitable attitudes correlate with a number of poor sexual and reproductive health outcomes and risk behaviours such as violence, unwanted pregnancy and HIV among adolescents and young adults. Less studies used a more positive approach and have illustrated how gender equal attitudes go hand in hand with positive sexual health outcomes such as stronger condom negotiation self-efficacy, sexual pleasure and good communication between sexual partners. The overarching research aim within this PhD dissertation was to contribute to the understanding of the association between gender attitudes and sexual health and well-being in adolescence. To be able to respond to this general objective, three specific objectives were formulated focusing on research implemented among young people in Belgium (Flanders) and Ecuador (Cuenca). Two countries with different ASRH outcomes and challenges and a diverse Gender Inequality Index. To collect data, three different research studies were implemented: Conceptualization of adolescent sexual well-being in Belgium and Ecuador, The Global Early Adolescent Study (GEAS) and Community Embedded Reproductive Health Care For Adolescents in Latin America (CERCA). The first study, funded by the Global Minds Operational Grant, aimed to understand how young people (eighteen-twenty years old) in Belgium (Ghent) and Ecuador (Cuenca) conceptualize sexual well-being and which factors they defined as contributing factors for adolescent sexual well-being. The second project (GEAS) was a multi-country research project - led by Johns Hopkins Bloomberg School of Public Health and the World Health Organization - that sought to understand how gender socialization in early adolescence occurs around the world, and how it shapes health and well-being for individuals and their communities. The third project - funded by the 7th European Framework Programme - was intervention research that aimed to develop and evaluate complex interventions that sought to improve access to, and the use of, sexual and reproductive health services by adolescents. The study was implemented in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador), and Managua (Nicaragua). This PhD study did not have the intention to compare the results from Belgium and Ecuador. Nevertheless, the differences between the countries allowed to investigate the specific objectives and to test their related hypotheses in two different contexts. An exploratory sequential multiple-methods research, combining quantitative and qualitative methods was applied to do so. In our research analysis, we first focused on qualitative research methodologies that allowed us to use an inductive approach and as such focus on open research questions. We applied this strategy to conceptualize adolescent sexual well-being from the perspective of adolescents living in Belgium and Ecuador (specific objective 1) and to identify current gender attitudes among adolescents in Belgium and Ecuador (specific objective 2). Subsequently, quantitative methods were applied to explore the association between gender attitudes of very young and older adolescents with adolescent sexual well-being (specific objective 3). Findings of this doctoral dissertation have been published in three published peer-reviewed articles and one submitted paper to SAGE open. In the discussion section of this dissertation, the results are used to explain why the five hypotheses - that are linked to the specific objectives – can or cannot be confirmed based on the data collected in this research. Comparisons are made with other research results. In short – and based on our data - adolescents in Belgium and Ecuador seem to be able to conceptualize adolescent sexual well-being meaningfully and to describe what contributes to it. However, the respondents in both countries did not necessarily distinguish between what they considered to be sexual well-being and what they recognized as influencing factors. In addition, it shows that adolescent sexual well-being does not occur in a vacuum but is the consequence of various determinants at individual, interpersonal and societal levels that not only influence the individual adolescent but also each other. This result is in line with most former studies who tried to conceptualize adolescent sexual well-being. This research also confirms the second hypothesis which stated that socialization of gender inequitable norms is already present among very young adolescent girls and boys. In accordance with former research, girls expressed more positive attitudes toward gender equality than boys. However, if we consider the third hypothesis of this dissertation (Is socialization of gender inequitable norms consistent among diverse gender attitudes?) this might not be necessarily true for all gender attitudes. Young people seem not to be consistently gender equitable or inequitable, but their viewpoints can vary depending on the specific dimension of gender equality that is being measured. Investigating hypothesis four illustrated that we could not confirm that personal gender attitudes of young people in Belgium and Ecuador are aligned with the Gender Inequality Index of the research settings. Different explanations are discussed. To end, the research in this dissertation allows to state that it is largely true that adolescents in both countries with more positive attitudes towards gender equality also have better sexual health and well-being outcomes compared to adolescents with less gender equal attitudes. The statement is discussed and linked to other relevant research. Finally, limitations of the research are discussed such as for example the fact that our study was based on a limited amount of gender attitudes and adolescent sexual well-being indicators which also differed between the studies. Moreover, our research was conducted among young people of different age groups and in specific groups of adolescents and young people. For example, gender diverse adolescents were not included. This can influence the generalizability of our results. To end, conclusions and recommendations for optimising and advancing programming, policy and research are made. I recommend the use of a positive approach towards adolescent sexual health and well-being, to implement gender transformative ASRH programmes and multi-component (systems) approaches which are designed based on a theory of change and that also target very young adolescents. In research, it is considered important to invest in: a better understanding of adolescent sexual well-being and gender equality from adolescents’ perspectives; longitudinal research on the association between these both concepts; evaluations of gender transformative programmes - and its participants who indicate behaviour change - and ASRH programmes with a positive focus. To conclude, understanding which role gender equal attitudes and gender norms have on adolescent sexual well-being is complicated but with this research I have proven there are positively associated. Additional research is required to investigate if gender equality also directly leads to increased adolescent sexual well-being.
Samenvatting Nooit eerder waren er wereldwijd zoveel jongeren. Sinds de Internationale Conferentie over Bevolking en Ontwikkeling in 1994, waar vertegenwoordigers van 179 regeringen reproductieve gezondheid en de empowerment van vrouwen en gendergelijkheid als pijlers van duurzame ontwikkeling erkenden, is seksualiteit van adolescenten en seksuele en reproductieve gezondheid (SRG) van adolescenten in toenemende mate op de mondiale agenda komen te staan. Hoewel de adolescenten van vandaag gezonder zijn dan voorheen, vraagt de SRG van adolescenten nog steeds een inspanning voor de volksgezondheid. Ongelijke vooruitgang in veel SRG uitkomsten is duidelijk in en tussen landen. Meer dan de helft van alle adolescenten wereldwijd groeit op in landen met complexe problematieken wat zich ook weerspiegelt in uitgebreide gezondheidsproblemen bij adolescenten, waaronder ziekten gerelateerd aan armoede, zoals HIV, slechte SRG en geweld. In deze landen hebben adolescenten nog steeds een hoge vruchtbaarheid en een grote onvervulde behoefte aan anticonceptie, voornamelijk de ongehuwde, seksueel actieve adolescenten. Bovendien worden inspanningen om programma’s en beleid op het vlak van SRG en rechten voor adolescenten te implementeren, gehinderd door wijdverspreide weerstand tegen het verstrekken van SRG-diensten en informatie aan adolescenten omwille van taboes en sociale normen omtrent seksualiteit van adolescenten. SRG interventies en -programma’s voor jongeren zijn lange tijd gericht geweest op het vermijden van risicovol seksueel gedrag en negatieve gevolgen van seks bij adolescenten. De laatste jaren wint een meer positieve benadering ten aanzien van seksualiteit aan terrein. Deze stelt dat de focus van beleid, programma's en onderzoek naar SRG van adolescenten niet alleen zou moeten liggen op risicovermindering van individueel gedrag, maar ook op het bevorderen van de positieve aspecten van seksualiteit binnen een bredere sociale structuur. Daarom is deze benadering nauw verbonden met het seksuele welzijn van adolescenten. Aspecten van SRG zoals plezier, zich emotioneel verbonden voelen en het ervaren van een positief lichaamsbeeld worden vaak beschouwd als onderdeel van het seksuele welzijn van adolescenten of worden gezien als beïnvloedende factoren. Bij onderzoek naar sociale structuren die de SRG van jongeren kunnen beïnvloeden, zijn gendernormen erkend als scripts die gedrag beïnvloeden. Genderscripts schrijven handelingen voor - inclusief seksueel gedrag - die aansluiten bij bepaalde ideeën over mannelijkheid of vrouwelijkheid en die kunnen leiden tot bepaalde gezondheidsresultaten voor jongens en meisjes. Eerder onderzoek dat werd uitgevoerd in deze context heeft aangetoond hoe stereotype attitudes ten aanzien van mannen en vrouwen correleren met een aantal negatieve seksuele en reproductieve gezondheidsuitkomsten en risicogedrag zoals geweld, ongewenste zwangerschap en HIV bij adolescenten en jonge volwassenen. Minder onderzoek gebruikte een positieve benadering en toonde aan hoe gendergelijkheid hand in hand gaat met positieve seksuele gezondheidsuitkomsten, zoals een groter zelfvertrouwen in het onderhandelen van condoomgebruik, seksueel plezier en goede communicatie tussen seksuele partners. De algemene doelstelling van dit proefschrift was om bij te dragen aan het begrip omtrent de associatie tussen genderattitudes en seksuele gezondheid en welzijn in de adolescentie. Om aan deze algemene doelstelling te kunnen beantwoorden, werden drie specifieke doelstellingen geformuleerd die toegespitst zijn op onderzoek uitgevoerd bij jongeren in België (Vlaanderen) en Ecuador (Cuenca). Twee landen met verschillende SRG-uitkomsten en uitdagingen bij adolescenten en een diverse Gender Inequality Index. De data werd verzameld via drie verschillende onderzoeksstudies: Conceptualisering van het seksuele welzijn van adolescenten in België en Ecuador, The Global Early Adolescent Study (GEAS) en Community Embedded Reproductive Health Care For Adolescents in Latin America (CERCA). De eerste studie, gefinancierd door de Global Minds Operational Grant, had tot doel te begrijpen hoe jongeren (achttien tot twintig jaar) in België (Gent) en Ecuador (Cuenca) seksueel welzijn conceptualiseren en welke factoren ze identificeren als beïnvloedende factoren van seksueel welzijn. Het tweede project (GEAS) was een onderzoeksproject in meerdere landen - geleid door de Johns Hopkins Bloomberg School of Public Health en de Wereldgezondheidsorganisatie - dat trachtte te begrijpen hoe gendersocialisatie in de vroege adolescentie overal ter wereld plaatsvindt, en hoe het de gezondheid en welzijn van individuen en hun gemeenschappen beïnvloedt. Het derde project - gefinancierd door het 7e Europese Kaderprogramma -was interventieonderzoek dat tot doel had om complexe interventies - die beoogden de toegang tot en het gebruik van seksuele en reproductieve gezondheidsdiensten door adolescenten te verbeteren - te ontwikkelen en te evalueren. Hetonderzoek werd uitgevoerd in drie Latijns-Amerikaanse steden: Cochabamba (Bolivia), Cuenca (Ecuador) en Managua (Nicaragua). Dit doctoraatsonderzoek had niet de intentie om de resultaten van België en Ecuador met elkaar te vergelijken. Desalniettemin maakte de diversiteit tussen de landen het mogelijk om de specifieke doelstellingen en hun gerelateerde hypothesen in twee verschillende contexten te onderzoeken en testen. Hiervoor is een verkennend sequentieel onderzoek met diverse methoden toegepast, waarbij kwantitatieve en kwalitatieve methoden werden gecombineerd. In de analyse hebben we ons eerst gericht op kwalitatieve onderzoeksmethodologieën waarbij we ons focusten op open onderzoeksvragen om: seksuele welzijn te conceptualiseren vanuit het perspectief van adolescenten die in België en Ecuador wonen (specifieke doelstelling 1) en om de huidige genderattitudes bij adolescenten in België en Ecuador te identificeren (specifieke doelstelling 2). Vervolgens werden kwantitatieve methoden toegepast om de associatie tussen genderattitudes van zeer jonge en oudere adolescenten en seksueel welzijn van adolescenten te onderzoeken (specifieke doelstelling 3). De resultaten die besproken worden in dit proefschrift zijn beschreven in drie gepubliceerde peer-reviewed artikels en één paper die werd ingediend ter publicatie bij SAGE open. In het discussiegedeelte van dit proefschrift wordt aan de hand van de resultaten uitgelegd waarom de vijf hypothesen - die gekoppeld zijn aan de specifieke doelstellingen - wel of niet kunnen worden bevestigd op basis van de gegevens die in dit onderzoek werden verzameld. Daarnaast worden er vergelijkingen gemaakt met andere onderzoeksresultaten. In het kort- en op basis van onze gegevens - lijken adolescenten in België en Ecuador in staat om seksueel welzijn van adolescenten zinvol te conceptualiseren en om beïnvloedende factoren te beschrijven. Daarbij maken de respondenten niet noodzakelijkerwijs onderscheid tussen wat zij als seksueel welzijn definieerden en wat zij als beïnvloedende factoren beschouwden. Bovendien laat het onderzoek ook zien dat het seksuele welzijn van adolescenten niet in een vacuüm plaatsvindt, maar het gevolg is van verschillende determinanten op individueel, interpersoonlijk en maatschappelijk niveau die niet alleen de individuele adolescent maar ook elkaar beïnvloeden. Dit resultaat komt overeen met eerdere onderzoeken die probeerden het seksuele welzijn van adolescenten te conceptualiseren. Dit doctoraatsonderzoek bevestigt ook de tweede hypothese die stelt dat socialisatie van genderongelijke normen al aanwezig is bij zeer jonge adolescenten. In overeenstemming met eerder onderzoek, uitten meisjes een positievere houding ten opzichte van gendergelijkheid dan jongens. Als we echter de derde hypothese van deze dissertatie (Is socialisatie van genderongelijkheidsnormen consistent tussen verschillende genderattitudes?) beschouwen, zou dit echter niet noodzakelijkerwijs waar zijn voor alle genderattitudes. Jongeren lijken niet per definitie gendergelijkwaardige of gender stereotype attitudes te hebben, maar hun standpunten kunnen verschillen afhankelijk van de specifieke dimensie van gendergelijkheid die wordt gemeten. Het onderzoek omtrent onderzoekshypothese vier toonde aan dat de persoonlijke genderattitudes van jongeren in België en Ecuador niet per sé in lijn zijn met de Gender Inequality Index van de onderzoekslocatie. Verschillende verklaringen hiervoor worden besproken. Om te eindigen, laat het onderzoek in dit proefschrift toe om te stellen dat het grotendeels waar is dat adolescenten - in beide landen - met een positieve houding ten opzichte van gendergelijkheid ook betere seksuele gezondheids- en welzijnsresultaten hebben in vergelijking met adolescenten met minder gendergelijke attitudes. De stelling wordt besproken en gekoppeld aan ander relevant onderzoek. Ten slotte worden beperkingen van het onderzoek beschreven, zoals bijvoorbeeld het feit dat ons onderzoek was gebaseerd op een beperkt aantal genderattitudes en indicatoren voor seksueel welzijn van adolescenten die bovendien ook verschillend waren in de diverse onderzoeksstudies. Daarnaast is ons onderzoek uitgevoerd bij specifieke groepen van jongeren van verschillende leeftijden. Zo werden genderdiverse adolescenten niet opgenomen. Dit kan de generaliseerbaarheid van onze resultaten beïnvloeden. Tot slot worden conclusies en aanbevelingen gedaan voor het optimaliseren en bevorderen van programmering, beleid en onderzoek. Ik adviseer het gebruik van een positieve benadering ten aanzien van seksuele en reproductieve gezondheid en welzijn van adolescenten, om gender transformatieve SRG programma’s voor jongeren te implementeren en multi-component (systeem) benaderingen op te stellen. Hierbij is het belangrijk om bij het ontwerp gebruik te maken van een ‘Theory of Change’ en om ook jongen adolescenten te betrekken. Op het vlak van onderzoek stel ik de voor om te focussen op: aanvullend onderzoek omtrent hoe jongeren seksueel welzijn en gendergelijkheid conceptualiseren en definiëren; longitudinaal onderzoek naar de associatie tussen gender attitudes en seksueel welzijn van jongeren; evaluaties van gender transformatieve programma's - en de deelnemers die gedragsverandering aangeven - en SRG-programma’s voor jongeren met een positieve focus. Concluderend, begrijpen welke rol gender gelijkwaardige attitudes en normen hebben op het seksuele welzijn van adolescenten is ingewikkeld maar met dit proefschrift heb ik aangetoond dat er een positieve associatie is. Aanvullend onderzoek zal moeten aantonen of gendergelijkheid ook leidt tot een verbetering in het seksueel welzijn van jongeren.
Keywords
adolescents, gender, gender identity, gender norms, youth, gender socialisation, sex assigned at birth, sexual orientation, srhr, young people, very young adolescents, gender diversity, early adolescents

Downloads

  • (...).pdf
    • full text (Published version)
    • |
    • UGent only
    • |
    • PDF
    • |
    • 5.79 MB

Citation

Please use this url to cite or link to this publication:

MLA
De Meyer, Sara. How Are Gender Attitudes Interlinked with Sexual Health and Well-Being during Adolescence? A Multiple-Methods Research within a Sex-Positive Framework among Adolescents Living in Belgium and Ecuador. Ghent University. Faculty of Medicine and Health Sciences, 2023.
APA
De Meyer, S. (2023). How are gender attitudes interlinked with sexual health and well-being during adolescence? A multiple-methods research within a sex-positive framework among adolescents living in Belgium and Ecuador. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Chicago author-date
De Meyer, Sara. 2023. “How Are Gender Attitudes Interlinked with Sexual Health and Well-Being during Adolescence? A Multiple-Methods Research within a Sex-Positive Framework among Adolescents Living in Belgium and Ecuador.” Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
Chicago author-date (all authors)
De Meyer, Sara. 2023. “How Are Gender Attitudes Interlinked with Sexual Health and Well-Being during Adolescence? A Multiple-Methods Research within a Sex-Positive Framework among Adolescents Living in Belgium and Ecuador.” Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
Vancouver
1.
De Meyer S. How are gender attitudes interlinked with sexual health and well-being during adolescence? A multiple-methods research within a sex-positive framework among adolescents living in Belgium and Ecuador. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2023.
IEEE
[1]
S. De Meyer, “How are gender attitudes interlinked with sexual health and well-being during adolescence? A multiple-methods research within a sex-positive framework among adolescents living in Belgium and Ecuador,” Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium, 2023.
@phdthesis{01GW1XERPE5QGG80SF1XHGQXK5,
  abstract     = {{Summary
The cohort of adolescents (ten-nineteen years) alive today is the largest in history. Since the international Conference on Population and Development (ICPD) in 1994, where representatives of 179 governments recognized reproductive health and the empowerment of women and gender equality as pillars of sustainable development, adolescent sexuality and adolescent sexual and reproductive health (ASRH) has been increasingly rising on the global agenda. Though today’s adolescents are healthier than before, ASRH is still a major public health concern. Unequal advance in many ASRH outcomes
is obvious within and between countries. More than half of all adolescents grow up in multi-burden countries, characterized by high levels of all types of adolescent health problems, including diseases of poverty - such as HIV, poor SRH and violence.
In these countries, adolescents continue to have high fecundity and high unmet need for contraception, particularly the unmarried, sexually active adolescents. In addition, efforts to implement adolescent SRHR policies and programmes are hindered by widespread resistance to the delivery of comprehensive SRHR services and information to adolescents because of taboos and social norms around adolescents' sexuality. For a long time, ASRH interventions and programmes have focused on risk reduction and avoiding risky sexual behaviour and negative consequences of adolescent sex. In recent years, the sex positive approach is increasingly gaining ground.
This approach argues that the focus of policies, programmes and research on ASRH should not merely be on risk reduction of individual behaviour but also on promoting the positive aspects of sexuality within a broader social and structural structure. Therefore this approach is closely linked to adolescent sexual well-being as aspects of ASRH such as pleasure, feeling emotionally connected and discovering positive feeling about one’s body are frequently considered to be part of adolescent sexual well-being or are seen as influencing factors. In investigation on social structures that might influence
ASRH, gender norms have been recognized as scripts that influence behaviour. Gender scripts  prescribe a set of actions – including sexual behaviour - which align with ideas of masculinity or femininity and that can be reflected in diverse health outcomes for male and female adolescents. Former research of this kind has indicated how gender inequitable attitudes correlate with a number of poor sexual and reproductive health outcomes and risk behaviours such as violence, unwanted
pregnancy and HIV among adolescents and young adults. Less studies used a more positive approach and have illustrated how gender equal attitudes go hand in hand with positive sexual health outcomes such as stronger condom negotiation self-efficacy, sexual pleasure and good communication between sexual partners. 
The overarching research aim within this PhD dissertation was to contribute to the understanding of the association between gender attitudes and sexual health and well-being in adolescence. To be able to respond to this general objective, three specific objectives were formulated focusing on research implemented among young people in Belgium (Flanders) and Ecuador (Cuenca). Two countries with different ASRH outcomes and challenges and a diverse Gender Inequality Index.
To collect data, three different research studies were implemented: Conceptualization of adolescent sexual well-being in Belgium and Ecuador, The Global Early Adolescent Study (GEAS) and Community Embedded Reproductive Health Care For Adolescents in Latin America (CERCA). The first study, funded by the Global Minds Operational Grant, aimed to understand how young people (eighteen-twenty years old) in Belgium (Ghent) and Ecuador (Cuenca) conceptualize sexual well-being and which factors they defined as contributing factors for adolescent sexual well-being. The second project (GEAS) was a
multi-country research project - led by Johns Hopkins Bloomberg School of Public Health and the World Health Organization - that sought to understand how gender socialization in early adolescence occurs around the world, and how it shapes health and well-being for individuals and their communities. The third project - funded by the 7th European Framework Programme - was intervention research that aimed to develop and evaluate complex interventions that sought
to improve access to, and the use of, sexual and reproductive health services by adolescents. The study was implemented in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador), and Managua (Nicaragua).
This PhD study did not have the intention to compare the results from Belgium and Ecuador. Nevertheless, the differences between the countries allowed to investigate the specific objectives and to test their related hypotheses in two different contexts. An exploratory sequential multiple-methods research, combining quantitative and qualitative methods was applied to do so. In our research analysis, we first focused on qualitative research methodologies that allowed us to use an inductive approach and as such focus on open research questions. We applied this strategy to conceptualize adolescent sexual well-being from the perspective of adolescents living in Belgium and Ecuador (specific objective 1) and to identify current gender attitudes among adolescents in Belgium and Ecuador (specific objective 2). Subsequently, quantitative methods were applied to explore the association between gender attitudes of very young and older adolescents with adolescent sexual well-being (specific objective 3). Findings of this doctoral dissertation have been published in three published peer-reviewed articles and one submitted paper to SAGE open. In the discussion section of this dissertation, the results are used to explain why the five hypotheses - that are linked to the specific objectives – can or cannot be confirmed based on the data collected in this research. Comparisons are made with other research results. In short – and based on our data - adolescents in Belgium and Ecuador seem to be able to conceptualize adolescent sexual well-being meaningfully and to describe what contributes to it. However, the respondents in both countries did not necessarily distinguish between what they considered to be sexual well-being and what they recognized as influencing factors. In addition, it shows that adolescent sexual well-being does not occur in a vacuum but is the consequence of various determinants at individual, interpersonal and societal levels that not only influence the individual adolescent but also each other. This result is in line with most former studies who tried to conceptualize adolescent sexual well-being. This research also confirms the second hypothesis which stated that socialization of gender inequitable norms is already present among very young adolescent girls and boys. In accordance with former research, girls expressed more positive attitudes toward gender equality than boys. However, if we consider the third hypothesis of this dissertation (Is socialization of gender inequitable norms consistent among diverse gender
attitudes?) this might not be necessarily true for all gender attitudes. Young people seem not to be consistently gender equitable or inequitable, but their viewpoints can vary depending on the specific dimension of gender equality that is being measured. Investigating hypothesis four illustrated that we could not confirm that personal gender attitudes of young people in Belgium and Ecuador are aligned with the Gender Inequality Index of the research settings. Different explanations are discussed. To end, the research in this dissertation allows to state that it is largely true that adolescents in both countries with more positive attitudes towards gender equality also have better sexual health and well-being
outcomes compared to adolescents with less gender equal attitudes. The statement is discussed and linked to other relevant research.
Finally, limitations of the research are discussed such as for example the fact that our study was based on a limited amount of gender attitudes and adolescent sexual well-being indicators which also differed between the studies. Moreover, our research was conducted among young people of different age groups and in specific groups of adolescents and young people. For example, gender diverse adolescents were not included. This can influence the generalizability of our results.
To end, conclusions and recommendations for optimising and advancing programming, policy and research are made. I recommend the use of a positive approach towards adolescent sexual health and well-being, to implement gender transformative ASRH programmes and multi-component (systems) approaches which are designed based on a theory of change and that also target very young adolescents. In research, it is considered important to invest in: a better understanding of adolescent sexual well-being and gender equality from adolescents’ perspectives; longitudinal research on the association between these both concepts; evaluations of gender transformative programmes - and its participants who indicate behaviour change - and ASRH programmes with a positive focus. To conclude, understanding which role gender equal attitudes and gender norms have on adolescent sexual well-being is complicated but with this research I have proven there are positively associated. Additional research is required to investigate if gender equality also directly leads to increased adolescent sexual well-being.}},
  author       = {{De Meyer, Sara}},
  keywords     = {{adolescents,gender,gender identity,gender norms,youth,gender socialisation,sex assigned at birth,sexual orientation,srhr,young people,very young adolescents,gender diversity,early adolescents}},
  language     = {{eng}},
  pages        = {{V, 234}},
  publisher    = {{Ghent University. Faculty of Medicine and Health Sciences}},
  school       = {{Ghent University}},
  title        = {{How are gender attitudes interlinked with sexual health and well-being during adolescence? A multiple-methods research within a sex-positive framework among adolescents living in Belgium and Ecuador}},
  year         = {{2023}},
}