The Positive Choices trial: study protocol for a Phase-III RCT trial of a whole-school social marketing intervention to promote sexual health and reduce health inequalities

Ruth Ponsford, Rebecca Meiksin, Elizabeth Allen, G. J. Melendez-Torres, Steve Morris, Catherine Mercer, Rona Campbell, Honor Young, Maria Lohan, Karin Coyle, Chris Bonell

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Abstract

Background: Positive Choices is a whole-school social marketing intervention to promote sexual health amongsecondary school students. Intervention comprises school health promotion council involving staff and studentscoordinating delivery; student survey to inform local tailoring; teacher-delivered classroom curriculum; student-runcampaigns; parent information; and review of sexual/reproductive health services to inform improvements. This trialbuilds on an optimisation/pilot RCT study which met progression criteria, plus findings from another pilot RCT ofthe Project Respect school-based intervention to prevent dating and relationship violence which concluded suchwork should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexualhealth; most do not report competence at first sex. Relationships and sex education in schools can contribute topromoting sexual health but effects are small, inconsistent and not sustained. Such work needs to besupplemented by ‘whole-school’ (e.g. student campaigns, sexual health services) and ‘social marketing’ (harnessingcommercial marketing to social ends) approaches for which there is good review-level evidence but not from theUK.Methods: We will conduct a cluster RCT across 50 schools (minimum 6440, maximum 8500 students) allocated 1:1to intervention/control assessing outcomes at 33 months. Our primary outcome is non-competent first sex.Secondary outcomes are non-competent last sex, age at sexual debut, non-use of contraception at first and last sexamong those reporting heterosexual intercourse, number of sexual partners, dating and relationship violence,sexually transmitted infections, and pregnancy and unintended pregnancy for girls and initiation of pregnancy forboys. We will recruit 50 school and undertake baseline surveys by March 2022; implement the intervention over the2022–2024 school years and conduct the economic and process evaluations by July 2024; undertake follow-upsurveys by December 2024; complete analyses, all patient and policy involvement and draft the study report byMarch 2025; and engage in knowledge exchange from December 2024.
Original languageEnglish
Article number818
Number of pages19
JournalTrials
Volume22
Issue number1
DOIs
Publication statusPublished - 01 Dec 2021

Keywords

  • Adolescents
  • Cluster trials
  • Pregnancy
  • Public health
  • Schools
  • Sexual competence
  • Sexual health
  • Sexually transmitted infections
  • Whole-school

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