Introduction
Why Men?
Why This Intervention?
Method
Trial Design
Participants and Recruitment
Randomisation and Blinding
Intervention | |
Name and brief description: If I Were Jack is an evidenced-based educational resource designed to prevent unintended pregnancy by increasing teenagers’ intentions to avoid unprotected sexual intercourse. It is especially designed to provoke thought on the role of teenage men in preventing unintended teenage pregnacy, but is designed to engage both males and females in mixed-sex settings. In development since 2013, it has involved sustained communication with target groups, including pupils, teachers and parents, along with a wide range of stakeholders. A detailed description of the design process, including logic model, is available (Aventin et al. 2015). | |
Why, rationale of essential elements: If I Were Jack is built on an innovative set of concepts which previous research has identified as contributors to effective RSE education. These include: • Activities targeting theoretically informed behavioural and psycho-social correlates of risk behaviour including knowledge, attitudes, perceptions of risk, peer and gender norms, self-efficacy in communication and intention to avoid sexual risk-taking behaviour (Swann et al. 2003; Gavin et al. 2010) • Engagement of teenagers by addressing the operation of gender and social class norms, age-appropriateness, cultural relevance and integration of interactive media (Bailey et al. 2010; Gavin et al. 2010) | |
What, a description of the materials:
(i) The If I Were Jack opening interactive video drama (IVD) is a culturally sensitive (locally filmed in NI) film intended to immerse teenagers in a story of a week in the life of Jack, a teenager who has just been told his girlfriend is pregnant. By asking males and females to imagine they were Jack and how they would think and feel if they were in his situation, it is designed to expose and challenge the gender assumptions around roles and responsibilities for teenage pregnancy by opening them up for reflection and negotiation. (ii) Classroom materials for teachers with four detailed lesson plans with specific classroom-based and homework activities which provide pupils with sexual health information and opportunities for discussion, skills practice, reflection and anticipatory thinking. (iii) Sixty-minute face-to-face training session for teachers provided by the researcher. (iv) Sixty-minute information/discussion session for parents/guardians led by RSE teachers. (v) Information brochures and factsheets about the intervention and unintended teenage pregnancy for schools, teachers, teacher trainers, young people and parents. | |
Who delivers? Trained RSE teachers to pupils, incorporating significant peer discussion. | |
How, modes of delivery: To be delivered during four consecutive RSE lessons in classroom settings. The IVD is to be delivered on individual computers/tablets with headphones. | |
Where, locations where intervention has occurred: In NI and Ireland, using a further locally produced IVD for Ireland. A version of the IVD has been delivered in South Australia. |
Outcome Measures
Demand
Acceptability
Implementation/Practicality, Integration and Economic Cost
Preliminary Study of Effects
Procedure
Questionnaire Data Collection
Statistical Methods
Qualitative Data Collection and Analysis
Qualitative Transferability Study
School ID | Country | Location | School management type |
---|---|---|---|
1 | England | London (urban) | Academy Converter Mainstream |
2 | London (urban) | Academy Sponsor Led (Church of England) | |
3 | London (urban) | Academy Converter Mainstream | |
4 | Scotland | East Central (urban) | State |
5 | East Central (semi-urban) | State | |
6 | West Central (urban) | State | |
7 | West Central (urban) | State | |
8 | Wales | South Wales (urban) | Roman Catholic |
9 | West Wales (rural) | State | |
10 | North Wales (rural) | State |
Results
Demand
School ID | Location | School management type | All pupils eligible free school meals | % Religion per school | Trial allocation |
---|---|---|---|---|---|
1 | Urban | Integrated secondary in deprived area | 57.4% | 50.4 P 31.3 C 18.3 0 | Intervention |
2 | Semi-urban | Roman Catholic secondary | 45.5% | Pa Ca 0.0 O | Intervention |
3 | Urban | State grammar | 4% | 62.7 P 12.4 C 25.0 O | Intervention |
4 | Urban | State secondary | 35.1% | Pa Ca 16.5 O | Intervention |
5 | Rural | Roman Catholic secondary in deprived area | 48% | 0.0 P Ca Oa | Control |
6 | Semi-urban | Roman Catholic grammar | 8.5% | 0.0 P 99.5 C Oa | Control |
7 | Urban | State grammar | 15% | 62.7 P 6.5 C 30.5 O | Control |
8 | Semi-Urban | Integrated secondary | 32.4% | 74.4 P 5.9 C 19.8 O | Control |
Acceptability
Pupils were largely very favourable towards the intervention, signalling that it was relatable:I thought it was really thought-provoking and, you know, it was realistic. I think that’s the key to something like this. It has to be on their level. I think it’s actually a very good resource... my class would be a class that sometimes would be ‘urgh’…and all that, but they did, they were interested in it and they did have some discussions on it, and to have a discussion with my class is an achievement in itself so (Female teacher, S5).
They remarked that it was thought provoking in relation to gender norms and got them talking:You sometimes get stuff, like resources, and they’re really, like, they’re set by people who don’t relate it very well to people our age and it’s hard to kind of understand. This one was a lot better because it was set with someone our age, like at the present time, doing the same stuff as we’d do. (Male pupil, S7, FG1)You immediately sort of put yourself in their shoes. (Male pupil, S3, FG1)
Young people thought that it was useful in helping them to plan not to have a teenage pregnancy:Yeah, it was good to see … because, usually, you focus on the girl, like how it would affect the girl, but there, you see…it isn’t affecting the guy physically at all. But it’s…like the moral implications of it, so how he’d think, what would be right, and usually you don’t think of that. Usually, guys are portrayed as just leaving. (Male pupil, S7, FG1)It’s kind of hard to get a serious conversation between your friends because, a lot of the time, especially … with guys, you know. I think everyone thinks about it but nobody really … Like nobody thinks it’s a suitable topic to discuss within a group of friends. (Male pupil, S7, FG1).
Nonetheless, there were also some criticisms of the intervention which will inform suggested changes. The IVD, it was thought, would date quickly, if it had not already done so: ‘Look at that phone!’ (Male principal, S7). The most common complaint about the IVD, however, was that there were too many interactive questions and too many demands on the viewer to answer questions when they wanted to let the film flow. Occasionally also, there was concern expressed that there was a disproportionate emphasis on boys’ perspectives in the IVD:P1: It helped us learn a bit more about protection and stuff like that there.P2: Yeah, it was beneficial. Like it reminded me of the dangers of having sex unprotected anyway. (Male pupils, S5, FG2)… what it’s trying to show you is, like, this can happen to anybody, and like, it makes you think about it more before you, like, maybe do something you’d regret. (Female pupil, S3, FG2).
It would be better if you could, like, go from, like, each side, each perspective, if they took, like, the girl and the boy. It would be better because you’d get a rounded perspective of what it would be like. (Male pupil, S7, FG1).
Implementation/Practicality and Integration
However, implementation logs and follow-up interviews with teachers demonstrated that not every teacher followed ‘the wee book’. While all four intervention schools attempted to watch the online version of the film on individual computers with at least one class group, technical difficulties relating to the school network meant that all but one school showed the film on an overhead projector with pupils provided with a paper copy of the questions. Teachers saw the advantages of using individual computers, but most agreed that showing the film on an overhead projector was easier to organise and had benefits for pupils with reading difficulties. Pupils had mixed views and seemed to tolerate both approaches.T8: I think we appreciated it from the point of view that we had lessons to follow, timings were there, suggested activities, but also the worksheets. It was great that we were able to get them run-off [photocopied].… So the off-the-shelf materials are great to have. (Female teacher, S4).
Overall, interviews with teachers and pupils and observations made by the researchers suggested that teachers wanted to ‘tweak’ the intervention to help it fit with lesson timings and to respond to what engaged the pupils most or caused least disruption. Somewhat ironically, there was a perception by some teachers and female pupils that boys in the classroom were sometimes the hardest to engage and that this disrupted implementation.P1: Yeah, I liked it on the overhead better…Miss explained it more, on the questions. (Female pupil, S5, FG1)
Turning to future integration into the RSE school curriculum, in general, teachers and pupils appeared very positive about the potential for this. There was very little variation across the intervention schools in this regard, regardless of management type, faith-based or not.P1: No, the boys like… They were so immature about it.P2: Because the boys were being quite immature so we didn’t get to do it as much. And then the teacher kept stopping to shut them up… (Female pupils, S3, FG2)
R: Would you use the resource again?T2: Yeah, definitely, and it’s a topic that, as I say, the majority of the class were all very interested in. And I said to them, you know ‘If we were to do more things like this, you know, would you be interested?’ and they all put their hand up and said yes, you know, because it’s a topic that’s so current. (Female teachers, S5)
Results from the Transferability Study
However, two stand-out additional lessons were learned which would serve to enhance acceptability in the other nations. The first related to the value of generating a culturally sensitive IVD for England and Wales, where the NI accent of the characters in the original IVD impeded easy understanding, although the accent translated well among Scottish pupils. The second lesson related to the need for greater ethnic diversity among the characters in the IVD which were ‘too white’. This was especially relevant in the London area schools.it shows they [boys] go through the same things we go through. (Wales, S1, f)
Cost Analysis
Item | Cost (£) |
---|---|
Stage 1 planning and preparation for delivery | |
Materials | 244.15 |
Training | 565.19 |
Stage 1:totala | 809.34 |
Stage 2: delivery totalb | 4292.34 |
Overall totalc | 5101.68 |
Mean cost per teacher (SE)d | 364.41 (75.24) |
Mean cost per school (SE)d | 1275.42 (341.32) |
Mean cost per pupil (SE)d | 13.66 (4.51) |
Preliminary Effectiveness
Outcome measure | Intervention baseline n = 411 | Intervention 9 months n = 370 | Control baseline n = 392 | Control 9 months n = 375 | Between-group difference (control/intervention) | ||||
---|---|---|---|---|---|---|---|---|---|
Unprotected sex | 3.6% (1.8–5.5%) | 5.4% (3.1–7.7%) | 2.5% (1.0–4.1%) | 5.6% (3.3–7.9%) | |||||
Change from baseline | + 1.8% | + 3.1% | 1.3% | ||||||
Unprotected sex (stratified by sex) | Male (n = 225) 5.3% (2.4–8.3%) | Female (n = 186) 1.6% (0.0–3.4%) | Male (n = 188) 4.8% (1.7–7.8%) | Female (n = 182) 6.0% (2.6–9.5%) | Male (n = 191) 4.2% (1.3–7.0%) | Female (n = 201) 1.0% (0.0–2.4%) | Male (n = 185) 5.4% (2.1–8.7%) | Female (n = 190) 5.8% (2.5–9.1%) | |
Change from Baseline | − 0.5% | + 4.4% | + 1.2% | + 4.8% |