Building multi-sectoral alliances to co-design and pilot a gender-transformative comprehensive sexuality education intervention for adolescents: the case of Si Yo Fuera Juan in Uruguay

Abstract Background Comprehensive sexuality education (CSE) is a fundamental adolescent right and key strategy for sexual and reproductive health and rights (SRHR). However, implementation remains uneven globally, particularly regarding gender-transformative CSE targeting boys. This study adapted, implemented, and evaluated “Si Yo Fuera Juan,” a gender-transformative CSE intervention for adolescents in Uruguay (2020–2023), highlighting two implementation strategies: (1) co-design with adolescents and multi-sectoral stakeholders, and (2) deliberate focus on male engagement. Methods Using a rights-based approach, adolescents, teachers, parents, health professionals, policymakers, and civil society actors collaborated to culturally adapt, co-design and evaluate “Si Yo Fuera Juan.” The pilot intervention was implemented and evaluated in formal and non-formal educational settings across middle and low socioeconomic contexts in Uruguay. Mixed-methods data collection (virtual and in-person due to COVID-19) included focus groups and questionnaires with adolescents, workshops with families, and focus groups with teachers were conducted between 2020 and 2023. Qualitative data underwent deductive-inductive thematic analysis; quantitative data were analyzed descriptively by gender and socioeconomic status. Results The intervention demonstrated high acceptability and feasibility across all stakeholder groups. Key findings included: strong support for the gender-transformative approach; identification of adolescents’, parents’, and teachers’ needs and recognition of gaps in current CSE provision; and the consensus that a cultural adaptation of the original intervention "If I Were Jack" was essential, requiring modifications to reflect Uruguayan social norms and institutional structures. Adolescents found the intervention emotionally engaging and realistic, facilitating critical reflection on gender roles and reproductive decision-making. Teachers valued the interdisciplinary approach and the innovative focus on boys. Implementation challenges included limited institutional time, insufficient teacher training, and infrastructural gaps. Conclusions “Si Yo Fuera Juan” demonstrates successful adaptation of a gender-transformative CSE intervention through participatory co-design with multiple stakeholders. The intervention effectively engages boys in adolescent pregnancy prevention and has been integrated into national CSE policies in Uruguay. Sustained scaling requires institutional commitment, comprehensive teacher training, and strengthened intersectoral linkages between educational institutions and the health system. Plain English Summary Comprehensive sexuality education (CSE) helps young people make informed decisions about their sexual and reproductive health. However, many CSE programs focus mainly on girls, leaving boys out of important conversations about pregnancy prevention and shared responsibility. This study describes how we adapted and tested "Si Yo Fuera Juan" (If I Were Juan), a sexuality education program designed to engage both boys and girls in Uruguay. Between 2020 and 2023, we worked with adolescents, teachers, parents, healthcare professionals, and government officials to create the adapted intervention to fit Uruguay's culture and educational system. The program uses an interactive video drama that shows realistic situations where young people face decisions about sexual and reproductive health and unintended pregnancy. This is combined with classroom activities that encourage discussion and critical thinking about gender roles and corresponsibility. We tested the program in schools and community settings with adolescents from different socioeconomic backgrounds. We collected information through surveys, focus groups, and workshops to understand what participants thought about the program. Results showed that adolescents, teachers, and parents found the program engaging and relevant. Young people appreciated the realistic scenarios and the safe space to discuss difficult topics. Teachers valued the focus on boys as an innovative approach to promote shared responsibility. However, teachers also noted challenges like limited time in school schedules and need for better training. The program has been incorporated into Uruguay's national sexuality education policies. To expand it successfully across the country, schools will need more support, including teacher training programs and better connections between schools and health services.