Increasing boys’ and girls’ intentions to avoid teenage pregnancy: a cluster randomised controlled feasibility trial of an interactive video drama-based intervention in post-primary schools in Northern Ireland

Abstract

BackgroundAdolescent men have a vital yet neglected role in reducing unintended teenage pregnancy (UTP). There is a need for gender-sensitive educational interventions.ObjectivesTo determine the value and feasibility of conducting an effectiveness trial of theIf I Were JackRelationship and Sexuality Education (RSE) intervention in a convenience quota sample of post-primary schools in Northern Ireland. Secondary objectives were to assess acceptability to schools, pupils (male/female, aged 14–15 years) and parents/guardians; to identify optimal delivery structures and systems; to establish participation rates and reach, including equality of engagement of different socioeconomic and religious types; to assess trial recruitment and retention rates; to assess variation in normal RSE practice; to refine survey instruments; to assess differences in outcomes for male and female pupils; to identify potential effect sizes that might be detected in an effectiveness trial and estimate appropriate sample size for that trial; and to identify costs of delivery and pilot methods for assessing cost-effectiveness.DesignCluster randomised Phase II feasibility trial with an embedded process and economic evaluation.InterventionA teacher-delivered classroom-based RSE resource – an interactive video drama (IVD) with classroom materials, teacher training and an information session for parents – to immerse young people in a hypothetical scenario of Jack, a teenager whose girlfriend is unintentionally pregnant. It addresses gender inequalities in RSE by focusing on young men and is designed to increase intentions to avoid UTP by encouraging young people to delay sexual intercourse and to use contraception consistently in sexual relationships.Main outcome measuresAbstinence from sexual intercourse (delaying initiation of sex or returning to abstinence) or avoidance of unprotected sexual intercourse (consistent correct use of contraception). Secondary outcomes included Knowledge, Attitudes, Skills and Intentions.ResultsThe intervention proved acceptable to schools, pupils and parents, as evidenced through positive process evaluation. One minor refinement to the parental component was required, namely the replacement of the teacher-led face-to-face information session for parents by online videos designed to deliver the intervention to parents/guardians into their home. School recruitment was successful (target 25%, achieved 38%). No school dropped out. Pupil retention was successful (target 85%, achieved 93%). The between-group difference in incidence of unprotected sex of 1.3% (95% confidence interval 0.55% to 2.2%) by 9 months demonstrated an effect size consistent with those reported to have had meaningful impact on UTP rates (resulting in an achievable sample size of 66 schools at Phase III). Survey instruments showed high acceptability and reliability of measures (Cronbach’s alpha: 0.5–0.7). Economic evaluation at Phase III is feasible because it was possible to (1) identify costs of deliveringIf I Were Jack(mean cost per pupil, including training of teachers, was calculated as £13.66); and (2) develop a framework for assessing cost-effectiveness.ConclusionTrial methods were appropriate, and recruitment and retention of schools and pupils was satisfactory, successfully demonstrating all criteria for progression to a main trial. The perceived value of culture- and gender-sensitive public health interventions has been highlighted.Future workProgression to a Phase III effectiveness trial.Trial registrationCurrent Controlled Trials ISRCTN99459996.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 1. See the NIHR Journals Library website for further project information.

JACK trial protocol: a phase III multicentre cluster randomised controlled trial of a school-based relationship and sexuality education intervention focusing on young male perspectives

“…Such a difference of 1.4% in unprotected sex has been shown to have a meaningful impact on pregnancy rates. 14 50–52 The between-group difference in the incidence of unprotected sex of 1.3% (95% CI 0.5% to 2.2%) by 9 months in our feasibility trial 43 demonstrates that such an effect size is plausible and is consistent with effect sizes seen in the literature. 50 The study will take account of clustering.…”

“…In the earlier feasibility trial, we had consulted extensively with pupils about the questionnaire. 43 The intervention and trial design has also been informed by a Trial Stakeholders Group. This group is composed of relationship and sexuality education experts and teachers and senior representatives from key statutory organisations and government departments from all four nations of the UK.…”

“…Schools with <30 pupils in the target year group (year 11 in NI, S3 in Scotland and year 10 in England and Wales) will be excluded. Schools that have already participated in the feasibility (n=8 in NI), 43 transferability (England n=3, Scotland n=3 and Wales n=3) and pilot studies (England n=1, Scotland n=1 and Wales n=1) involving the If I Were Jack intervention in preparation of this for phase III study will also be excluded.…”

“…First, proximal risk factors of teenage pregnancy begin manifesting in this age group, 14 44 making it an appropriate time for preventative sex education that is considered acceptable in society and education. 14 27 45 Second, there is an identified deficit in resources for this age group in relation to teenage pregnancy, 46 47 and third, findings from the JACK feasibility study 43 indicated that there is a greater opportunity for implementation of the intervention during a year where there are no statutory examinations. Finally, this population has been chosen to facilitate a 12–14 months follow-up of pupils (postintervention) before some pupils exit formal education following their first major statutory exams or reaching the age of 16 years.…”

Peer-led walking programme to increase physical activity in inactive 60- to 70-year-olds: Walk with Me pilot RCT

“…Resources were categorised according to the stage in the process at which they were incurred [planning and preparation for delivery (stage 1) or intervention delivery (stage 2)], in keeping with other trials of public health intervention. [79][80][81][82] Resources associated with the development of the intervention (stage 0) were not included in the overall costs, as they would not be incurred should the intervention be adopted into practice in the future. Details about the steps involved in developing the intervention are presented in Chapter 1 of this report.…”