Integrating Process with Outcome Data in a Randomized Controlled Trial of Sex Education

Integration of process with outcome evaluations has been recommended as a way of addressing some of the criticisms of Randomized Controlled Trials (RCTs) for evaluating social interventions. This is the second of two articles (the first was published in issue 10(4) of this journal) discussing the design, implementation and analysis of a process evaluation as an integral part of the RIPPLE (Randomized Intervention of Pupil Peer-Led sex Education) Study. The methods for integrating process and outcome data are outlined and findings are presented to illustrate how integration of process and outcome data enabled exploration of: 1) variation between schools in the extent and quality of the intervention implemented, and any impact of this on outcomes; 2) the processes by which the intervention might affect outcomes; and 3) the extent to which different subgroups of students or schools may have responded differently to the intervention. The article concludes with a discussion of the methodological issues arising from this attempt at integrating process and outcome evaluations within the design of an RCT

Using research questionnaires with young people in schools: the influence of the social context

Whilst there is an extensive literature on the use of self-completion questionnaires as a research tool, very little attention has been paid to the influence of the social context in determining the ways in which questionnaires are used in practice. This paper describes our experiences of working with 27 English, mixed sex, state schools to carry out a questionnaire survey with 4754 students aged 13-14 years. The survey was part of a randomized controlled trial of peer led sex education. Using data from the questionnaires and from researcher fieldnotes, we highlight ways in which aspects of the social context affected the administration of the questionnaire, students' participation in the survey and the quality of the data collected. [ABSTRACT FROM AUTHOR

What young people want from sex education? The results of a needs assessment from a peer-led sex education programme

This paper presents data on the need for sexual health information and advice of 4353 students aged 13/14 years in 13 English secondary schools. Data were collected by peer educators as part of a sex education programme, and through a questionnaire survey administered by researchers. Data illustrate young people's need for concrete information and advice on issues related to physical development and puberty; transmission of sexually transmitted diseases; accessing and using condoms and other contraception; using sexual health services; managing relationships and dealing with jealousy, love and sexual attraction; how people have sex; sexual pleasure; masturbation; and homosexuality. Differences between the concerns and interests raised by young people and current UK guidance on sex and relationships education are examined, and the implications of these findings for designing future policy and effective school based sex education programmes are discussed. The paper highlights some of the wider social norms around sex and sexuality that influence young people's understanding and sexual behaviour, and the importance of addressing these within sex education is noted. Factors influencing the processes of expressing and assessing needs are explored

Mixed-sex or single-sex sex education : how would young people like their sex education and why?

This article examines young people's views about sex education and focuses specifically on their views about interaction in single- and mixed-sex groups. Analysis of data from a survey of 3355 young people (aged 15/16 years), carried out in 13 co-educational English secondary schools (as part of the RIPPLE study), showed that the majority of girls, and about one-third of boys, would like some or all of their sex education to be delivered in single-sex groups. Data from 15 focus groups were analysed to examine the reasons for these preferences. The way in which sex education lessons are 'gendered' was explored by examining young people's views about the ways in which particular aspects of sex education classes (including the characteristics of teachers, the content, teaching methods and age of students) influenced their responses and interaction in lessons. Interaction in single- and mixed-sex focus group discussions was also analysed to provide insight into how interaction about sexual health issues may differ in single- and mixed-sex groups. It is concluded that the views of these young people support the call for more sex education with girls to be delivered in single-sex groups

Sex and relationship education for 13–16 year olds: evidence from England

This article examines the quantity and content of sex and relationship education (SRE) delivered to students in Years 9-11 (aged 13-16 years) in 12 coeducational state secondary schools in England during 1997-2000. Teachers reported the delivery of an average of seven (range 0-12) sessions of SRE across the three years, with no SRE delivered in up to five schools in each year. Most teachers reported having covered contraception, sexually transmitted diseases and relationships at least once. Topics such as homosexuality and the negotiation of relationships and sexual encounters were rarely covered. Data collected from students provided a slightly different picture. At least one-half of students in all schools reported having received some SRE during Year 9 and at least 85% reported receiving some SRE during Years 10 and/or 11. Teachers identified various factors that limited the quality of the SRE delivered. The article discusses some of the challenges that arose when attempting to reconcile data gathered from students and teachers

Evaluating Processes : A case study of a randomized controlled trial of sex education

This article explores the rationales offered in the evaluation literature for studying the processes involved in programme implementation, and their relationship with current arguments about the use of experimental designs to evaluate social interventions. It describes, as a case study, a process evaluation carried out as an integral part of a randomized controlled trial of peer-led sex education. The process evaluation was designed to answer important questions about the implementation of the intervention, the social context of the trial, and the experiences of trial participants. The article describes the methods used to collect process data, and some of the challenges involved. It concludes by arguing that process evaluation is necessarily complex, but essential to the task of understanding why and how interventions and outcomes may be related

Pupil-led sex education in England (RIPPLE study) : cluster-randomised intervention trial

Background Improvement of sex education in schools is a key part of the UK government's strategy to reduce teenage pregnancy in England. We examined the effectiveness of one form of peer-led sex education in a school-based randomised trial of over 8000 pupils. Methods 29 schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). In intervention schools, peer educators aged 16–17 years delivered three sessions of sex education to 13–14 year-old pupils from the same schools. Primary outcome was unprotected (without condom) first heterosexual intercourse by age 16 years. Analysis was by intention to treat. Findings By age 16 years, significantly fewer girls reported intercourse in the peer-led arm than in the control arm, but proportions were similar for boys. The proportions of pupils reporting unprotected first sex did not differ for girls (8·4% intervention vs 8·3% control) or for boys (6·2% vs 4·7%). Stratified estimates of the difference between arms were –0·4% (95% CI –3·7% to 2·8%, P=0·79) for girls and –1·4% (–4·4% to 1·6%, P=0·36) for boys. At follow-up (mean age 16·0 years [SD 0·32]), girls in the intervention arm reported fewer unintended pregnancies, although the difference was borderline (2·3% vs 3·3%, P=0·07). Girls and boys were more satisfied with peer-led than teacher-led sex education, but 57% of girls and 32% of boys wanted sex education in single-sex groups. Interpretation Peer-led sex education was effective in some ways, but broader strategies are needed to improve young people's sexual health. The role of single-sex sessions should be investigated further

Sex and relationship education for 13–16 year olds : evidence from England.

This article examines the quantity and content of sex and relationship education (SRE) delivered to students in Years 9-11 (aged 13-16 years) in 12 coeducational state secondary schools in England during 1997-2000. Teachers reported the delivery of an average of seven (range 0-12) sessions of SRE across the three years, with no SRE delivered in up to five schools in each year. Most teachers reported having covered contraception, sexually transmitted diseases and relationships at least once. Topics such as homosexuality and the negotiation of relationships and sexual encounters were rarely covered. Data collected from students provided a slightly different picture. At least one-half of students in all schools reported having received some SRE during Year 9 and at least 85% reported receiving some SRE during Years 10 and/or 11. Teachers identified various factors that limited the quality of the SRE delivered. The article discusses some of the challenges that arose when attempting to reconcile data gathered from students and teachers