Stakeholders’ Experiences and Preferences Regarding Comprehensive Sexuality Education in Zambia: Implications for Determining Programme Priorities and Strategies

Background: Understanding and exploring stakeholders&rsquo: perceptions and preferences regarding comprehensive sexuality education (CSE) is critical in enhancing programme acceptability. We conducted this qualitative study to explore stakeholders&rsquo: experiences and preferences of CSE in Kitwe district, Zambia. Methods: We employed a qualitative descriptive design within the interpretive paradigm at nine purposefully selected secondary schools. Data were collected through classroom observation, in-depth interviews, and focus group discussions. In depth interviews were undertaken among 21 pupils, 17 teachers, 4 policymakers, 4 parents, and 4 religious leaders. Two focus group discussions were conducted among 14 pupils with each group having seven pupils. Data were analysed using inductive thematic analysis. Interviews continued until data saturation. Results: Our analysis yielded themes on stakeholder experiences of CSE which included: a lack of pupil-centred pedagogy: a lack of stakeholder engagement: a lack of CSE competency and skills: holding back culturally sensitive topics: a lack of guidance from the comprehensive sexuality curriculum: and a lack of CSE prioritisation in schools. Themes on preferences included: the formation of community advisory boards: the need to enhance teachers&rsquo: professional competencies, linking CSE with community SRH services, pupils SRH needs assessment. Conclusions: A community participatory approach to the design and implementation of a CSE programme is critical in enhancing programme acceptability in schools. While understanding the experiences and preferences of pupils regarding CSE can help determine programme content and priority, improving teachers&rsquo: competency and skills through appropriate CSE training can help to reconcile teachers&rsquo: personal beliefs and the content of CSE.