Evaluation of a Disability-Focused Sexual and Reproductive Health Curriculum for Health Students in Tanzania

Sexual and reproductive health and disability knowledge will be assessed using 36 survey items from the Tanzabilities Survey Instrument, which incorporates investigator-developed items, adapted items from the National Inclusive Curriculum for Health Education-Medical (NICHE-MED) scale, and adapted items from the Sexual Health Education for Professionals Scale (SHEPS). Twenty-two items are multiple choice, 8 items are true/false, and 6 items are Likert-scale knowledge self-assessment questions. The outcome will be calculated as a composite score of responses to knowledge-related survey questions. Scores range from 6 to 52, with higher scores indicating greater knowledge. Primary between-group comparisons will assess change from baseline to 3-month follow-up. Within the intervention group, change will also be assessed from baseline to immediate post-intervention.

Attitudes toward the provision of sexual and reproductive health services for persons with disabilities will be assessed using 40 Likert-scale survey items from the Tanzabilities Survey Instrument, which incorporates investigator-developed items, adapted items from the National Inclusive Curriculum for Health Education-Medical (NICHE-MED) scale, and adapted items from the Sexual Health Education for Professionals Scale (SHEPS). The outcome will be calculated as a composite score of responses to attitude-related survey questions. Scores range from 40 to 200, with higher scores indicating more positive attitudes. Primary between-group comparisons will assess change from baseline to 3-month follow-up. Within the intervention group, change will also be assessed from baseline to immediate post-intervention.

Skills related to providing sexual and reproductive health care to persons with disabilities will be assessed using 60 Likert-scale survey items from the Tanzabilities Survey Instrument, which incorporates investigator-developed items, adapted items from the National Inclusive Curriculum for Health Education-Medical (NICHE-MED) scale, and adapted items from the Sexual Health Education for Professionals Scale (SHEPS). The outcome will be calculated as a composite score of responses to skills-related survey questions. Scores range from 60 to 300, with higher scores indicating greater skills. Primary between-group comparisons will assess change from baseline to 3-month follow-up. Within the intervention group, change will also be assessed from baseline to immediate post-intervention.

Differences in composite knowledge scores between medical, nursing, and midwifery students will be assessed by calculating and comparing group composite knowledge scores for each discipline (medical, nursing, and midwifery) within the intervention group. The composite knowledge score (range 6 to 52, as defined in Primary Outcome Measure 1 and drawn from the Tanzabilities Survey Instrument will be analyzed across health disciplines to evaluate baseline differences and changes across all three timepoints (baseline, immediate post-intervention, and 3-month follow-up).Composite scores will be compared across medical, nursing, and midwifery students within the intervention group across baseline, immediate post-intervention, and 3-month follow-up.

Differences in composite attitudes scores between medical, nursing, and midwifery students will be assessed by calculating and comparing group composite attitudes scores for each discipline (medical, nursing, and midwifery) within the intervention group. The composite attitudes score (range 40 to 200, as defined in Primary Outcome Measure 2 and drawn from thTanzabilities Survey Instrument will be analyzed across health disciplines to evaluate baseline differences and changes across all three timepoints (baseline, immediate post-intervention, and 3-month follow-up).Composite scores will be compared across medical, nursing, and midwifery students within the intervention group across baseline, immediate post-intervention, and 3-month follow-up.

Differences in composite skills scores between medical, nursing, and midwifery students will be assessed by calculating and comparing group composite skills scores for each discipline (medical, nursing, and

midwifery) within the intervention group. The composite skills score (range 60 to 300, as defined in Primary Outcome Measure 3 and drawn from the Tanzabilities Survey Instrument will be analyzed across health disciplines to evaluate baseline differences and changes across all three timepoints (baseline, immediate post-intervention, and 3-month follow-up). Composite scores will be compared across medical, nursing, and midwifery students within the intervention group across baseline, immediate post-intervention, and 3-month follow-up.

Advocacy tendencies related to sexual and reproductive health and disability will be assessed using 11 Likert-scale survey items from the Tanzabilities Survey Instrument, which incorporates investigator-developed items, adapted items from the National Inclusive Curriculum for Health Education-Medical (NICHE-MED) scale, and adapted items from the Sexual Health Education for Professionals Scale (SHEPS). The outcome will be calculated as a composite score of responses to advocacy-related survey questions. Scores range from 11 to 55, with higher scores indicating greater advocacy tendencies. Composite scores will be compared across medical, nursing, and midwifery students within the intervention group across baseline, immediate post-intervention, and 3-month follow-up.