In the following sections we report the findings from consultations with school staff, students and other youth and policy stakeholders and describe how these informed the design of both interventions. These are also summarised in Table 2.
Consultation with schools
Eight staff and nine students (five girls, four boys) from year 8 (age 12-13) participated in the Positive Choices consultations. Fourteen staff and 66 students (34 girls, 32 boys) from years 9-10 (age 13-15) participated in the Project Respect consultations (Table 1).
For both Positive Choices and Project Respect, staff and students generally confirmed the acceptability of intervention aims, approaches and components. DRV, sexual harassment and unintended teenage pregnancy were recognised as salient issues for schools to address.
With Positive Choices, the prospect of tailoring of the intervention to specific student was particularly welcomed. Several school staff, nevertheless, raised concerns about student responses being used to inform curriculum content because they felt students might be unable to foresee what they needed to learn about relationships and sex for themselves.
Staff and students were also positive about Project Respect components. Parent engagement, a classroom curriculum, hotspot-mapping and the Circle of Six app were perceived as appropriate and achievable. Teachers supported the ‘train-the trainer’ approach as a means of capacity development and limiting need for training cover. However, they also highlighted that it could be difficult for schools to release even these key staff for training and that this needed to be well planned out with each participating school. The scheduling of hour-long curriculum lessons was also highlighted as a potential issue and staff suggested that there was a need for curriculum lessons to be adaptable for split delivery over shorter (usually around thirty minute) tutor-time slots or longer ‘off-timetable’ days.
With regard to intervention materials, staff in both Positive Choices and Project Respect consultations reported that, because there was so little time for planning interventions and relationships and sex education (RSE), manuals needed to be comprehensive, but concise, ‘sticking to the essentials’ necessary for delivery. Similarly, teaching staff in Project Respect reported a preference for ‘plug-and-play’ curriculum materials that provided detailed lesson plans, scripts to help guide classroom discussion and PowerPoint slides, so staff with limited confidence, experience or time to prepare could deliver an effective lesson.
In contrast some staff also requested some flexibility in the curriculum design to allow those with more experience to adapt activities including where topics had already been covered in earlier RSE provision. Staff also reported they favoured materials provided electronically, and interactive PDF documents where they could easily locate relevant resources via live links.
Students laid out that intervention should reflect the reality of their experiences and recognise their emerging sexuality and involvement in intimate partner relationships – something they felt much of the RSE they had previously received did not do. In terms of curriculum format for Project Respect, they supported proposed pedagogical approaches including the use of role-play and small-group activities particularly for discussing sensitive topics and recreating real life scenarios. Students also indicated that it would be important to cover subtler or less obvious forms of abuse, such as controlling and coercive behaviours, and emotional abuse. They highlighted the need for training on how to respond if friends disclose DRV as well as the importance of ensuring that lessons covered the role of social media in DRV and sexual harassment. Staff and students also offered a range of terms to describe DRV and relationships, and suggested that terminology should be introduced and defined early in lessons. For both Project Respect and Positive Choices students suggested that the curriculum elements should be introduced before year 9, in year 7 or 8 when students are 11-13.
In consultations students had mixed views about the acceptability of teacher-delivered RSE proposed in both interventions. Some saw benefits to delivery by staff with whom they already had trusting relationships, suggesting this could promote reporting of safeguarding issues. However, they also associated teacher-led delivery with risk of breaching student confidentiality. Lessons led by teachers with whom students had more negative relationships were perceived to potentially to compromise learning. Some suggested that an external provider might allow more honest conversations and increase confidentiality. Most important though, was that whoever taught the lessons should be non-judgmental, able to respect confidentiality and connect with the ‘reality of young peoples’ lives’. Staff explained, however, that in practice the selection would largely depend on timetabling and availability.
Across both interventions, teachers proposed that involving outside specialists could usefully cover topics they felt ill-equipped to teach, such as sexual violence and female genital cutting/mutilation. Some students and staff also commented that lessons discussing sensitive issues should be taught in single-sex groups. One teacher’s preference for single-sex teaching was rooted in an explicitly feminist conviction to provide female students with a safe and supportive environment for active participation, where they would feel less marginalised by boys. A suggestion from staff and students was to teach some of the content in single-sex classes, but bring groups together at the end of a lesson to share learning.
Consultation with students and staff on the most appropriate models of engaging with parents revealed that schools already had a variety of approaches including: sending letters home with students; communicating via email, text or social media; posts on school websites; and parent events.
Consultation with the ALPHA group
A total of 12 males and 10 females participated across three ALPHA consultations (Table 3).
For Positive Choices ALPHA members were generally supportive of the student-led social-marketing element of the intervention as complementary to more formal teacher-led lessons on the grounds that student-led campaigns could ensure sexual health messaging was relevant to young people. Participants raised the importance, however, of ensuring campaigns were both genuinely student-led and that messages were consistent with the programme aims.
Participants broadly supported the parent component of Positive Choices, recognising the value of informing parents about the RSE being taught in school and involving them in supporting their children’s learning at home. Some participants, however, were more sceptical about resources (like homework assignments or newsletters) aiming to prompt conversations at home and felt that many students would avoid carrying out homework activities due to the risk of embarrassment or breaching existing child/parent boundaries.
For Project Respect, ALPHA consultations generally supported the use of small group and scenario-based learning activities that enabled students to reflect on ‘real-life’ scenarios. ALPHA also raised some concerns about the sensitivity of some of the Project Respect lesson plans and ensuring appropriate support for students who have experienced or witnessed DRV or other abuse. They suggested that, across lessons, attention to the use of online and social media in the conduct of young people’s relationships was important.
Consultation with practitioners and policy-makers
Twenty-three practitioner and policy-maker stakeholders from governmental and non-governmental organisations in the field of education and health attended the event.
Stakeholders were generally positive about both interventions, their theoretical basis and the whole school approach, although some were concerned about curriculum only covered year-9 and/10 rather than including a spiral curriculum spanning all years and how the intervention might affect existing provision in schools, especially where this was already good. Participants anticipated that one of the major challenges to implementation would be ensuring schools prioritised the interventions, given other pressures, and made suggestions to address this. These included: increased engagement with head teachers and/or senior leadership teams; dissemination of programme information to all school staff; seeking ‘buy-in’ from school governors and parents; involving local partners with long-standing relationships with schools, such as those in public-health departments or school networks; and maintaining regular contact with a named strategic lead with enough seniority to drive implementation.
Participants recommended that to ensure school commitment, the researchers should highlight what schools stood to gain from the interventions beyond the improved sexual health of their students. This included: free staff training to support continued professional development; specialist-designed curriculum materials; improved safeguarding procedures; meeting statutory obligations to support students’ social and emotional wellbeing; contributing to meeting national school-inspectorate criteria; and potential for improved pupil attendance and attainment. Stakeholders also suggested implementing service-level agreements with schools, highlighting expectations for intervention providers, schools and researchers.
Incorporation of feedback into intervention design
Table 2 summarises how student, staff, ALPHA and policy and practitioner feedback was incorporated into Positive Choices and Project Respect designs. Due to the timeline for the two projects, many of the findings from the Project Respect consultations could successfully inform Positive Choices. However, resource constraints leading to the joint stakeholder meeting falling later that initially anticipated, meant it was not possible for findings from this meeting to be fully incorporated into Project Respect prior to the start of piloting.
Feedback from all stakeholders in general confirmed the acceptability of interventions aims and components in both interventions, so these were not modified. Staff concern around student preference shaping curriculum content in Positive Choices also supported our planned approach to include a recommended set of ‘essential’ RSE lessons to be covered in all schools and a set of ‘add on’ lessons, the selection of which would be informed by student data.
Based on findings from teachers, an element of flexibility was built into both Positive Choices and Project Respect, to enable the delivery of lessons in shorter periods. However, SEF (the Positive Choices intervention development partner) advised against delivery through single ‘off timetable’ (or ‘drop-down’) days if possible, as this approach does not allow for sufficient reflection between lessons and for students to build knowledge, skills, competence and over time.
Manual materials were developed with teacher preferences in mind, but recommendations for curriculum materials to be very prescriptive was contentions for SEF as they were concerned that this did not fit with best practice for delivery of quality RSE in schools in which highly trained, competent and confident professionals curate and tailor available resources to their context and students. After some discussion, however, researchers and SEF agreed that it was a priority that materials enabled the research to team to effectively measure fidelity and that the materials fitted with what was likely to be the current reality of teaching RSE in many English secondary schools, where the subject is afforded little priority, time for preparation is limited and less experienced teachers may be required to deliver. Ultimately both interventions were designed with detailed and prescriptive lesson plans, slides and guidance notes. Based on teacher feedback some flexibility was, however, also built into lesson plans through the incorporation of additional optional material that teachers could draw on to extend learning beyond essential items. Decisions to omit any part of the curriculum due to prior teaching and whether intervention or existing materials were similar provision already existed were to be managed by the schools and the specialist provider on a case by case basis.
Based on student feedback we opted to continue with teacher delivered curriculum in both interventions, but with clear instruction on the selection criteria for teachers to deliver the curriculum elements. Suggestions to cover subtler, less obvious forms of violence and include training on how to help someone experiencing DRV confirmed planned approaches in Project Respect, while the inclusion of accurate signposting information and increased acknowledgement of the relevance of online and social media in young people’s relationships was included in both interventions. Identifying the range of terminology used by young people for DRV also led to key terminology to be used in Project Respect lessons being clearly defined early in curriculum materials. Student feedback that that curriculum materials should ‘reflect the reality of their lives’ also underscored the value of the needs assessment in Positive Choices.
Although some students had suggested that curriculum elements should be introduced earlier, this was not something that was possible to incorporate into either intervention as this contradicted earlier consultation with teachers in the initial proposal development phase and had already become established in our agreed study protocols. Including a curriculum for all school years, as suggested by professional and policy stakeholders, was also not feasible due to the constraints of the study design. Similarly, we were unable to offer an option for external educators to compliment the curriculum elements due to budget constraints. Despite both staff and student feedback, single-sex teaching in co-educational settings was also generally not recommended as some important learning in both interventions was reliant upon discussion between students of different genders. Preferences to deliver in single-sex classes because of cultural or religious sensitivities were, however, to be discussed with individual schools on a case-by-case basis.
Based on student and ALPHA feedback flexibility was built in to how the parent materials could be disseminated by schools. Homework activities in Positive Choices were also chosen to reflect ALPHA concerns that these could be embarrassing for parents and children. Activities aimed to ease into discussions at home, focussing initially on the universal, relatively less sensitive topic of ‘rites of passage’ progressing to focus on ‘abusive and healthy relationships’ in a later assignment.
ALPHA feedback regarding genuine student participation and a need for accountability of student led marketing campaigns led to plans for the joint staff-student School Health Promotion Councils (SHPCs) to oversee student led social marketing activity.
Strategies for increasing school engagement suggested by the professional and policy stakeholders were incorporated in to the Positive Choices manual and school communication materials, and additional school meetings and service level agreements were planned for pilot schools.