A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT
Background: The UK still has the highest rate of teenage births in western Europe. Teenagers are also the age group most likely to experience unplanned pregnancy, with around half of conceptions in those aged < 18 years ending in abortion. After controlling for prior disadvantage, teenage parenth...
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Format: | Article |
Language: | English |
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NIHR Journals Library
2021-01-01
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Series: | Public Health Research |
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Online Access: | https://doi.org/10.3310/phr09010 |
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doaj-fa532476484846a097da9759ea3b7eef |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ruth Ponsford Sara Bragg Elizabeth Allen Nerissa Tilouche Rebecca Meiksin Lucy Emmerson Laura Van Dyck Charles Opondo Steve Morris Joanna Sturgess Elizabeth Brocklehurst Alison Hadley GJ Melendez-Torres Diana Elbourne Honor Young Maria Lohan Catherine Mercer Rona Campbell Chris Bonell |
spellingShingle |
Ruth Ponsford Sara Bragg Elizabeth Allen Nerissa Tilouche Rebecca Meiksin Lucy Emmerson Laura Van Dyck Charles Opondo Steve Morris Joanna Sturgess Elizabeth Brocklehurst Alison Hadley GJ Melendez-Torres Diana Elbourne Honor Young Maria Lohan Catherine Mercer Rona Campbell Chris Bonell A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT Public Health Research teenage pregnancy sexual health relationships and sex education adolescents prevention schools |
author_facet |
Ruth Ponsford Sara Bragg Elizabeth Allen Nerissa Tilouche Rebecca Meiksin Lucy Emmerson Laura Van Dyck Charles Opondo Steve Morris Joanna Sturgess Elizabeth Brocklehurst Alison Hadley GJ Melendez-Torres Diana Elbourne Honor Young Maria Lohan Catherine Mercer Rona Campbell Chris Bonell |
author_sort |
Ruth Ponsford |
title |
A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT |
title_short |
A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT |
title_full |
A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT |
title_fullStr |
A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT |
title_full_unstemmed |
A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT |
title_sort |
school-based social-marketing intervention to promote sexual health in english secondary schools: the positive choices pilot cluster rct |
publisher |
NIHR Journals Library |
series |
Public Health Research |
issn |
2050-4381 2050-439X |
publishDate |
2021-01-01 |
description |
Background: The UK still has the highest rate of teenage births in western Europe. Teenagers are also the age group most likely to experience unplanned pregnancy, with around half of conceptions in those aged < 18 years ending in abortion. After controlling for prior disadvantage, teenage parenthood is associated with adverse medical and social outcomes for mothers and children, and increases health inequalities. This study evaluates Positive Choices (a new intervention for secondary schools in England) and study methods to assess the value of a Phase III trial. Objectives: To optimise and feasibility-test Positive Choices and then conduct a pilot trial in the south of England assessing whether or not progression to Phase III would be justified in terms of prespecified criteria. Design: Intervention optimisation and feasibility testing; pilot randomised controlled trial. Setting: The south of England: optimisation and feasibility-testing in one secondary school; pilot cluster trial in six other secondary schools (four intervention, two control) varying by local deprivation and educational attainment. Participants: School students in year 8 at baseline, and school staff. Interventions: Schools were randomised (1 : 2) to control or intervention. The intervention comprised staff training, needs survey, school health promotion council, year 9 curriculum, student-led social marketing, parent information and review of school/local sexual health services. Main outcome measures: The prespecified criteria for progression to Phase III concerned intervention fidelity of delivery and acceptability; successful randomisation and school retention; survey response rates; and feasible linkage to routine administrative data on pregnancies. The primary health outcome of births was assessed using routine data on births and abortions, and various self-reported secondary sexual health outcomes. Data sources: The data sources were routine data on births and abortions, baseline and follow-up student surveys, interviews, audio-recordings, observations and logbooks. Results: The intervention was optimised and feasible in the first secondary school, meeting the fidelity targets other than those for curriculum delivery and criteria for progress to the pilot trial. In the pilot trial, randomisation and school retention were successful. Student response rates in the intervention group and control group were 868 (89.4%) and 298 (84.2%), respectively, at baseline, and 863 (89.0%) and 296 (82.0%), respectively, at follow-up. The target of achieving ≥ 70% fidelity of implementation of essential elements in three schools was achieved. Coverage of relationships and sex education topics was much higher in intervention schools than in control schools. The intervention was acceptable to 80% of students. Interviews with staff indicated strong acceptability. Data linkage was feasible, but there were no exact matches for births or abortions in our cohort. Measures performed well. Poor test–retest reliability on some sexual behaviour measures reflected that this was a cohort of developing adolescents. Qualitative research confirmed the appropriateness of the intervention and theory of change, but suggested some refinements. Limitations: The optimisation school underwent repeated changes in leadership, which undermined its participation. Moderator analyses were not conducted as these would be very underpowered. Conclusion: Our findings suggest that this intervention has met prespecified criteria for progression to a Phase III trial. Future work: Declining prevalence of teenage pregnancy suggests that the primary outcome in a full trial could be replaced by a more comprehensive measure of sexual health. Any future Phase III trial should have a longer lead-in from randomisation to intervention commencement. Trial registration: Current Controlled Trials ISRCTN12524938. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 1. See the NIHR Journals Library website for further project information. |
topic |
teenage pregnancy sexual health relationships and sex education adolescents prevention schools |
url |
https://doi.org/10.3310/phr09010 |
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doaj-fa532476484846a097da9759ea3b7eef2021-01-20T15:42:03ZengNIHR Journals LibraryPublic Health Research2050-43812050-439X2021-01-019110.3310/phr0901014/184/02A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCTRuth Ponsford0Sara Bragg1Elizabeth Allen2Nerissa Tilouche3Rebecca Meiksin4Lucy Emmerson5Laura Van Dyck6Charles Opondo7Steve Morris8Joanna Sturgess9Elizabeth Brocklehurst10Alison Hadley11GJ Melendez-Torres12Diana Elbourne13Honor Young14Maria Lohan15Catherine Mercer16Rona Campbell17Chris Bonell18London School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKNational Children’s Bureau Sex Education Forum (NCB SEF), London, UKLondon School of Hygiene & Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKUniversity of Cambridge, Cambridge, UKLondon School of Hygiene & Tropical Medicine, London, UKDepartment of Health and Social Care, London, UKUniversity of Bedfordshire, Luton, UKUniversity of Exeter, Exeter, UKLondon School of Hygiene & Tropical Medicine, London, UKCardiff University, Cardiff, UKQueen’s University Belfast, Belfast, UKUniversity College London, London, UKUniversity of Bristol, Bristol, UKLondon School of Hygiene & Tropical Medicine, London, UKBackground: The UK still has the highest rate of teenage births in western Europe. Teenagers are also the age group most likely to experience unplanned pregnancy, with around half of conceptions in those aged < 18 years ending in abortion. After controlling for prior disadvantage, teenage parenthood is associated with adverse medical and social outcomes for mothers and children, and increases health inequalities. This study evaluates Positive Choices (a new intervention for secondary schools in England) and study methods to assess the value of a Phase III trial. Objectives: To optimise and feasibility-test Positive Choices and then conduct a pilot trial in the south of England assessing whether or not progression to Phase III would be justified in terms of prespecified criteria. Design: Intervention optimisation and feasibility testing; pilot randomised controlled trial. Setting: The south of England: optimisation and feasibility-testing in one secondary school; pilot cluster trial in six other secondary schools (four intervention, two control) varying by local deprivation and educational attainment. Participants: School students in year 8 at baseline, and school staff. Interventions: Schools were randomised (1 : 2) to control or intervention. The intervention comprised staff training, needs survey, school health promotion council, year 9 curriculum, student-led social marketing, parent information and review of school/local sexual health services. Main outcome measures: The prespecified criteria for progression to Phase III concerned intervention fidelity of delivery and acceptability; successful randomisation and school retention; survey response rates; and feasible linkage to routine administrative data on pregnancies. The primary health outcome of births was assessed using routine data on births and abortions, and various self-reported secondary sexual health outcomes. Data sources: The data sources were routine data on births and abortions, baseline and follow-up student surveys, interviews, audio-recordings, observations and logbooks. Results: The intervention was optimised and feasible in the first secondary school, meeting the fidelity targets other than those for curriculum delivery and criteria for progress to the pilot trial. In the pilot trial, randomisation and school retention were successful. Student response rates in the intervention group and control group were 868 (89.4%) and 298 (84.2%), respectively, at baseline, and 863 (89.0%) and 296 (82.0%), respectively, at follow-up. The target of achieving ≥ 70% fidelity of implementation of essential elements in three schools was achieved. Coverage of relationships and sex education topics was much higher in intervention schools than in control schools. The intervention was acceptable to 80% of students. Interviews with staff indicated strong acceptability. Data linkage was feasible, but there were no exact matches for births or abortions in our cohort. Measures performed well. Poor test–retest reliability on some sexual behaviour measures reflected that this was a cohort of developing adolescents. Qualitative research confirmed the appropriateness of the intervention and theory of change, but suggested some refinements. Limitations: The optimisation school underwent repeated changes in leadership, which undermined its participation. Moderator analyses were not conducted as these would be very underpowered. Conclusion: Our findings suggest that this intervention has met prespecified criteria for progression to a Phase III trial. Future work: Declining prevalence of teenage pregnancy suggests that the primary outcome in a full trial could be replaced by a more comprehensive measure of sexual health. Any future Phase III trial should have a longer lead-in from randomisation to intervention commencement. Trial registration: Current Controlled Trials ISRCTN12524938. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 1. See the NIHR Journals Library website for further project information.https://doi.org/10.3310/phr09010teenage pregnancysexual healthrelationships and sex educationadolescentspreventionschools |