Feasibility study of peer-led and school-based social network Intervention (STASH) to promote adolescent sexual health

Abstract

Background Effective sex education is the key to good sexual health. Peer-led approaches can augment teacher-delivered sex education, but many fail to capitalise on mechanisms of social influence. We assessed the feasibility of a novel intervention (STASH) in which students (aged 14–16) nominated as influential by their peers were recruited and trained as Peer Supporters (PS). Over a 5–10-week period, they spread positive sexual health messages to friends in their year group, both in-person and via social media, and were supported to do so via weekly trainer-facilitated meetings. The aims of the study were to assess the feasibility of STASH (acceptability, fidelity and reach), to test and refine the programme theory and to establish whether the study met pre-set progression criteria for continuation to larger-scale evaluation. Methods The overall design was a non-randomised feasibility study of the STASH intervention in 6 schools in Scotland. Baseline (n=680) and follow-up questionnaires (approx. 6 months later; n=603) were administered to the intervention year group. The control group (students in year above) completed the follow-up questionnaire only (n=696), 1 year before the intervention group. The PS (n=88) completed a brief web survey about their experience of the role; researchers interviewed participants in key roles (PS (n=20); PS friends (n=22); teachers (n=8); trainers (n=3)) and observed 20 intervention activities. Activity evaluation forms and project monitoring data also contributed information. We performed descriptive quantitative analysis and thematic qualitative analysis. Results The PS role was acceptable; on average across schools >50% of students nominated as influential by their friends, signed up and were trained (n=104). This equated to 13% of the year group. Trained PS rarely dropped out (97% completion rate) and 85% said they liked the role. Fidelity was good (all bar one trainer-led activity carried out; PS were active). The intervention had good reach; PS were reasonably well connected and perceived as ‘a good mix’ and 58% of students reported exposure to STASH. Hypothesised pre-conditions, contextual influences and mechanisms of change for the intervention were largely confirmed. All bar one of the progression criteria was met. Conclusion The weight of evidence supports continuation to full-scale evaluation. Trial registration Current controlled trials ISRCTN97369178

Perceptions of and Satisfaction with Sexual and Reproductive Health Interventions in Pre-Adolescent and Adolescent Students in UE/EEA Countries: A Systematic Review

“…Main reasons for exclusion after full-text screening were the availability of data inherent only in the prevention of unintended pregnancy, or only in affectivity, or only in information about STIs, in all cases, without covering an assessment of adolescent satisfaction. Among the included studies, study designs were heterogeneous: two papers were quasi-experimental [ 17 , 18 ], another two papers were RCTs [ 19 , 20 ], and one paper had an observational design [ 21 ].…”

“…We assessed the risk of bias of each study using different tools, as explained in the Methods section. Two of the included papers [ 17 , 18 ] had a quasi-experimental design and were assessed by the ROBINS-I scale, finding a moderate risk of bias. The ROB-2 scale was used to assess two RCT studies [ 19 , 20 ].…”

“…Finally, we included only one observational study [ 21 ] analyzed with the STROBE scale. In detail, a study by Benni et al [ 17 ] was found to be of moderate risk, especially for bias in the measurement of outcomes, while the study of Mitchel et al [ 18 ] was found to be generally of a low risk of bias, except for the bias due to missing data during analysis. Del Prete et al was the only RCT study [ 19 ] that obtained a high risk of bias, mainly due to a lack of information in the randomization process.…”

“…The first kind of SRH education program was conducted by health or non-health research groups who administered the lessons and activities offered [ 19 , 20 , 21 ]. The second kind of SRH educational program was structured entirely following the peer-to-peer approach, with prior appropriate training and selection of coaches [ 17 , 18 ].…”

The Need for Earlier Implementation of Comprehensive Sexual Education Within a Formal Classroom Setting and Beyond Based on the Influences of Technology

“…The text was created by a group of university students targeting peers with emphasis placed on contraception methods and feminism [12]. Another ongoing student-peer education intervention implemented in six schools in Scotland targeting adolescents 14 to 16 years old includes the Sexually Transmitted infections And Sexual Health (STASH) program [13,14]. This intervention utilized trained peers to, "spread positive sexual health messages," via in-person conversations with peers as well as on social media websites such as Facebook [13,14].…”