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Sexual health
Research
What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views
  1. Pandora Pound1,
  2. Sarah Denford2,
  3. Janet Shucksmith3,
  4. Clare Tanton4,
  5. Anne M Johnson5,
  6. Jenny Owen6,
  7. Rebecca Hutten7,
  8. Leanne Mohan3,
  9. Chris Bonell8,
  10. Charles Abraham9,
  11. Rona Campbell1
  1. 1School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2Children’s Health and Exercise Research Centre, University of Exeter St Luke's Campus, Exeter, UK
  3. 3School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
  4. 4Research Department of Infection and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
  5. 5Institute of Epidemiology and Health Care, University College London, Institute of Epidemiology and Health Care, London, UK
  6. 6Public Health Section, School of Health and Related Research (SHARR), University of Sheffield, Sheffield, UK
  7. 7School of Health and Related Research (SHARR), University of Sheffield, Sheffield, UK
  8. 8Department Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  9. 9Psychology Applied to Health, University of Exeter, Exeter, UK
  1. Correspondence to Dr Pandora Pound; pandora.pound{at}bristol.ac.uk

Abstract

Objectives Sex and relationship education (SRE) is regarded as vital to improving young people’s sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation.

Design This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations.

Settings Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide.

Results Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a ‘life skills’ approach and not focus on abstinence. Young people advocated a ‘sex-positive’ approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence.

Conclusions We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE.

  • Sex and relationship education
  • young people
  • best practice
  • stakeholders
  • evidence

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-014791

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    Footnotes

    • Contributors PP conducted the searches, quality appraisal, data extraction and qualitative synthesis for Work Package 2. She conducted stakeholder consultations with young people and experts and practitioners, synthesised the evidence from the five work packages and from stakeholders, and drafted this paper.

      RC conceived the idea and design for the overall project, as well as the qualitative synthesis (Work Package 2). She conducted the stakeholder consultation with experts and practitioners, contributed to the interpretation of the qualitative synthesis, the design and reporting of Work Package 5, and assisted in drafting and critically revising this paper before approving the final version.

      SD conducted the searches, quality appraisal, data extraction and narrative synthesis for Work Package 5, contributed to the stakeholder consultation with experts and practitioners, and assisted in critically revising this paper before approving the final version.

      JS contributed to the design for the overall project and designed and managed Work Package 3. She contributed to the stakeholder consultation with experts and practitioners, the synthesis of the data, and assisted in critically revising this paper before approving the final version.

      LM collected and analysed data for Work Package 3.

      JO and RH planned and carried out the interviews for Work Package 1. They both conducted preliminary analyses of the data, and JO compiled a report that informed this paper. JO contributed to the stakeholder consultation with experts and practitioners.

      AMJ contributed to the analysis of Natsal-3 (Work Package 4), critically revised this paper and approved the final version. She contributed to the stakeholder consultation with experts and practitioners.

      CT led one of the analyses of the Natsal-3 data for Work Package 4 and contributed to the other analysis in Work Package 4. She critically revised this paper and approved the final version.

      CB contributed to the interpretation of study findings, the stakeholder consultation with experts and practitioners, and the drafting of the paper.

      CA worked on the design, execution and reporting of Work Package 5, and commented on the draft paper. He contributed to the stakeholder consultation with experts and practitioners.

    • Funding This paper presents independent research funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in the study design, nor in data collection, analysis or interpretation, nor in the writing of the report or the decision to submit the article for publication. The SPHR is funded by the NIHR. NIHR SPHR is a partnership between the universities of Sheffield, Bristol, Cambridge, Exeter and UCL; the London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the universities of Liverpool and Lancaster and Fuse; and the Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside universities. Natsal-3 was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health. CA is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC). However, the views expressed in this report are those of the authors and not necessarily those of NIHR, PenCLAHRC or the Department of Health.

    • Competing interests AMJ has been a Governor of the Wellcome Trust since 2011. All other authors have no competing interest to decline.

    • Ethics approval Work Package 1: ScHARR Research Ethics Committee granted ethical approval for this study (17.2.14). Work Package 2: Not applicable. Work Package 3: The School of Health and Social Care Research Governance and Ethics Committee at Teesside University granted ethical approval for this study (Ref: 061/14). Work Package 4: Natsal-3 was granted ethical approval by the Oxfordshire Research Ethics Committee A (Ref: 09/H0604/27). Work Package 5: Not applicable. Stakeholder consultations were with established Young Peoples Advisory Group members and professionals who had given their consent to participate.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The Natsal-3 data set (Work Package 4) is available in the UK Data Service repository, unique persistent identifier: 10.5255/UKDA-SN-7799-1;).