Acceptability of an interactive film-based intervention targeting adolescent boys to prevent sexual risk-taking: findings from the JACK cluster randomised controlled trial process evaluation

Background Global health policy recognises the need for evidence-based interventions to promote positive sexual health among teenage boys. Creative solutions involving digital technologies have potential for engaging boys, but there remains insufficient evidence regarding the acceptability and effectiveness of these methods. We aimed to address this gap by examining the acceptability and feasibility of a coproduced, teacher-delivered intervention that uses interactive film to encourage adolescents to engage in episodic future thinking to help prepare for relationships and sexual health decision making.
Methods Acceptability and feasibility of the intervention was determined with a systematic iterative process of intervention development involving a parallel-group feasibility cluster randomised controlled trial with embedded process and cost evaluation, which piloted trial processes and methods in Northern Ireland and a qualitative evaluation of acceptability in England, Scotland, and Wales. The sampling strategy was a maximum variation quota sample and the control group continued with normal practice. Process evaluation data were also collected. Triangulated data were analysed with thematic analysis.
Findings Between November 2014 and December 2017 eight post-primary schools (831 adolescents, mean age 14·4 years [SE=0·019]) were enrolled into the pilot trial and 13 schools were involved in the qualitative evaluation of acceptability. Process evaluation data were collected from 17 focus groups with adolescents, 30 small focus groups and individual semi-structured interviews with school management staff and teachers, four classroom observations, and a satisfaction survey with 159 pupils. Results showed that the intervention was acceptable to schools, engaging to adolescents and teachers, and could be feasibly and cost-effectively implemented with minor amendments including development of an English version of the film for use in England and Wales, amendment of materials for faith-based schools, and refinement of parental components to include online materials. The satisfaction survey revealed that 100% (n=6) of teachers and 91% (n=145) of adolescents were satisfied with the intervention materials. Recruitment and retention targets were achieved. Of 21 schools approached 38% (n=8) agreed to take part with no withdrawal. Of 1027 eligible students, 81% (n=831) were recruited with 93% (n= 774) retention.
Interpretation Co-produced interactive film that encourages episodic future thinking is an acceptable method of engaging teenage boys in sexual health behaviour change programmes. Further applications of this technique in adolescent public health are possible and, thus far, have included smoking cessation, marijuana use, and future fatherhood in male prisoners.