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Sex education takes to the road

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VOL: 98, ISSUE: 05, PAGE NO: 36

Sally Reeve, RGN, RSCN, is a community school nurse at Tilehurst Clinic, Reading

There has been growing concern in recent years over the high rate of unwanted teenage pregnancies in the UK. In 1999 the government responded by setting up the Teenage Pregnancy Unit, which aims to halve the rate of conceptions among under-18s by 2010 (Social Exclusion Unit, 1999). The following year, The NHS Plan (Department of Health, 2000) set an interim target of achieving a 15% reduction in unwanted teenage pregnancies by 2004.

There has been growing concern in recent years over the high rate of unwanted teenage pregnancies in the UK. In 1999 the government responded by setting up the Teenage Pregnancy Unit, which aims to halve the rate of conceptions among under-18s by 2010 (Social Exclusion Unit, 1999). The following year, The NHS Plan (Department of Health, 2000) set an interim target of achieving a 15% reduction in unwanted teenage pregnancies by 2004.

If these targets are to be met, health professionals will have to take an innovative approach to sex education. A team of community school nurses (CSNs) in Reading came up with the idea of running a series of sexual health roadshows. They visited six local secondary schools, reaching a total of about 1,000 pupils aged between 13 and 14. This article describes how the nurses developed the roadshow and how it affected the views of the teenagers who took part.

Setting up the roadshow
Six local secondary schools agreed to participate in the programme. Four were mixed comprehensives and the rest were single-sex schools (one for boys and one for girls). The roadshow involved a team of up to 20 CSNs spending a morning in each of the schools, delivering three consecutive sessions to groups of pupils. The nurses worked in pairs to lead the sessions for groups of 15 to 33 pupils, depending on the school.

Developing the content of the roadshow
In planning the content of the roadshow, the nurses followed the government's Sex and Relationship Education Guidance (Department for Education and Employment, 2000). They split the delivery of information into three sessions, based on the main elements of the personal, social and health education framework.

The first session addressed attitudes and values, and concentrated on relationship issues. The second looked at knowledge and understanding: pupils were given practical information on contraception and sexually transmitted infections, and were told where to get further help and information. The final session was on personal and social skills, and examined how these skills could influence decision-making.

A variety of informal teaching methods, including brainstorming, group activities and scenario games, helped to keep the teenagers interested. The aim was to make the sessions interactive and encourage participation. At the end of the morning each pupil was given a pack containing some sexual health leaflets and an information sheet with a list of useful telephone numbers, websites and addresses.

Aims and objectives
The overall aim was to raise pupils' awareness and encourage them to make informed choices on sexual health and relationship issues. They were encouraged to:

- Identify sources of help and information;

- Recognise the importance of making informed choices in relationships;

- Demonstrate their knowledge of safe sex, including the use of condoms;

- Recognise their own values and opinions, and possible external influences on them.

Evaluation of effectiveness
All the pupils were given a questionnaire to fill in several weeks before the roadshow arrived at their school. A second questionnaire was distributed immediately after they had completed all three sessions. This enabled the team to evaluate how effective the roadshow had been in meeting its stated objectives.

About 900 questionnaires were sent out both before and after the roadshows. Of these, 632 (70%) were returned before the roadshows and 750 (83%) were returned after them. The following evaluation is based on these questionnaires.

Identifying sources of help and information
The questionnaires completed before the roadshows suggested that pupils were most likely to seek information or advice on sexual health and relationships from their parents or other family members (80%). Friends were cited as a source in 30% of these responses.

The questionnaires completed after the roadshows implied that family and friends were still popular sources of advice, but the percentages were lower in both cases (56% and 19% respectively).

GPs were the second most commonly cited source in the questionnaires completed before the roadshows (68%) but the main source in those completed after the roadshows (80%).

The number of pupils who cited the family planning clinic as a source of help and advice rose from 14% before the roadshows to 69% after them.

The number of pupils who saw the school nurse as a source remained fairly constant at about 17-19% of responses.

Awareness of the role of genitourinary medicine clinics increased after the roadshows. Only one pupil identified these as a source before the roadshows, compared with 53 (8%) of those who completed the second questionnaire.

The school or teachers were cited in 11-15% of responses in both questionnaires.

Helplines of various types were commonly cited before the roadshows (16%), but this dropped to 4% after them.

Generally, the questionnaires completed after the roadshows suggest that the respondents had greater awareness of where they could obtain advice on sexual health than they did before the roadshows (Fig 1). Families and friends continued to play an important role.

Pupils also identified a number of other sources, such as books, magazines and pharmacies, but none of these were mentioned by a significant number of participants.

The evaluation suggests that the roadshows raised pupils' awareness of appropriate sources of help and information on sexual health matters.

Recognising the importance of making informed choices in relationships
The reasons pupils gave for saying 'no' to sex illustrate some awareness of choice. They included:

- In both sets of questionnaires, the most common reasons for refusing sex related to rape, fear of violence or being bullied (21% before the roadshows and 25% after them);

- Peer pressure was identified in 24% of responses after the roadshows compared with 12% of those completed before them;

- Alcohol and drugs were given as reasons in 10% of responses before and 16% of those after the roadshows;

- Both before and after the roadshows, about 10% of pupils were concerned about losing a relationship, or being laughed at or teased.

These responses are concerned mainly with other people and how they might react or dominate a situation.

The pupils gave a range of other reasons for saying 'no', including many that suggested an understanding of the importance of individual choice. These included avoiding pregnancy and sexually transmitted infections, not feeling 'ready' and an awareness of the effect that having sex might have on their feelings about themselves or their relationships with their parents or friends.

Awareness of the legal age of consent for sex rose from 55% before the roadshows to 96% afterwards.

Awareness of the different types of sexually transmitted infections increased noticeably in the questionnaires completed after the roadshows. Before the roadshows, HIV and AIDS were the most commonly mentioned sexually transmitted infections (61%). After the roadshows they were again cited most often (34%), but the number of responses that mentioned other infections rose significantly, particularly chlamydia, which rose from 4% to 12%.

This does not prove that the roadshows made the pupils recognise the importance of informed choices in relationships. However, it does suggest greater awareness of the different influences on the choices they make and increased knowledge of the potential risk factors.

Demonstrating a knowledge of safe sex, including the use of condoms
Before the roadshows, 49% of the pupils expressed some idea of the significance of a kite mark on a condom packet, that is that the condom has been approved and is safe to use. After the roadshows, 95-97% of the respondents cited the kite mark and expiry date as being important to look for on condom packets. After the roadshows, 54% also said that undamaged packaging was important.

Before the roadshows, 9% of the respondents recognised that safer sex was concerned with preventing pregnancy and sexually transmitted infections, but after the roadshow this rose to 20%.

In the questionnaires completed before the roadshows, 44% of the respondents recognised that emergency contraception was known as 'the morning after Pill', but only 4% were aware that it should be used within 72 hours. After the roadshows, 41% of the respondents understood the correct way to use emergency contraception.

The pupils increased knowledge of the correct use of condoms, sexually transmitted infections, and sources of help and information suggest that there is greater potential for the pupils to practise safer sex a result of the roadshows.

Recognising own values and opinions and possible external influences
This is a difficult area to evaluate, but the information provided in the 'reasons for saying no' section, together with an apparent increase in the pupils' awareness and knowledge of sexual health issues in general, suggest that they have become aware of a broad spectrum of values, opinions and potential influences.

The other objectives of the project appear to have been met, at least in part, and this in turn should enable the pupils to recognise their own values and opinions, empowering them to make informed choices on their sexual health and well-being.

Conclusion
The roadshows raised awareness and encouraged pupils to make informed choices on sexual health and relationship issues. The fact that 60% of the participants felt they had learnt 'a little' and 32% 'a lot' from the roadshows implies that the content of the sessions was relevant and met a need.

Some of the pupils' suggestions on topics for future sessions cannot realistically be met because they are inappropriate. However, they are definitely interested in more information on the effects and options surrounding pregnancy, as well as greater detail on contraception and sexually transmitted infections. These issues could be addressed in future programmes.

Further evaluation by the nurses who took part in the roadshows was generally positive, although a number of areas for improvement have been identified.

Overall, the project was a success and information from all evaluations will be used to modify and improve the service while responding appropriately to young people's needs.

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