Volitional Intervention Development (VoID)

Completed Projects:

Project lead: Dr Katherine Brown

Stage 1: Evidence shows that young people may often hold strong intentions to use a chosen contraceptive method, but fail to consistently translate that intention into action, and thus fail to engage the volitional process of behavioural change. With funding from the British Academy, we developed a prototype interactive intervention designed to help young people who want to use contraception, plan effectively to do so, every time they have sex. Young people and sexual health professionals were consulted on the intervention.

Stage 2: Further funding from Coventry and Warwickshire PCT has allowed us to beta-test the intervention in sexual healthcare settings. This intervention can currently be viewed by clicking here.

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Development of a smart phone app to increase access to and uptake of sexual health services across Coventry and Warwickshire

Project lead: Katie Newby.

The Health Innovation and Education Cluster awarded SASH funding in conjunction with Warwickshire County Council, NHS Warwickshire, Coventry city council, and NHS Coventry to develop a smart phone app to increase uptake of sexual health services amongst young people in the region. The development included a needs assessment, concept development, product development, social marketing and is currently undergoing evaluation. The app concept was showcased on the Department of Health ‘Maps and Apps’ website. The app was launched in November 2012 and is hosted on the Respect Yourself Warwickshire website.

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PR:EPARe: A ‘Serious Game’ for Relationships and Sex Education (RSE) in Schools

Project lead: Dr Katherine Brown

The Health Innovation and Education Cluster funded an 18 month project to develop a serious game for use in RSE in schools. The project has involved input from young people and a range of stakeholder groups in the concept development. The game called PR:EPARe (Positive Relationships: Eliminating Coercion and Pressure in Adolescent Relationships) makes use of the theory and evidence base around young people, sex education and enhancing safer sex behaviour. The game is currently at completion stages and will be evaluated in early 2013.

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Evaluation of an educational resource on Chlamydia for secondary school pupils

Project lead: Katie Newby.

Stage 1: In partnership with the Health Protection Agency (HPA), this project developed an educational resource for secondary school pupils on Chlamydia. The resource is now available to download from for free from the HPA’s e-Bug website. The website is available across 10 EU countries and hosts teaching resources for secondary school pupils on microbes, including the spread of STIs. The resource itself is theory and evidence based, and consists of a lesson plan and set of associated exercises. The exercises have clear and specific learning objectives and incorporate recognised behaviour change techniques which aim to motivate positive sexual behaviour through modifying chlamydia risk perceptions and condom use self-efficacy. A key focus of the resource is to challenge secondary school pupils’ beliefs about the seriousness of chlamydia and their susceptibility to it. Click here to view the most recent conference poster.

Stage 2: We are currently conducting a randomised control trial (RCT) of the resource with young people from secondary schools across the West Midlands.

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Parents’ sex and relationships communication serious game

Project lead: Julie Bayley

Following development of the What Should We Tell the Children group programme, SASH sought to offer the training through alternative methods to maximise parental engagement. Whilst the group programme benefits greatly from the social and facilitator elements, practical difficulties and social anxieties may inhibit some parents from attending. SASH, in partnership with the Serious Games Institute and Playgen have therefore developed a free online game version for parents/guardians of primary and secondary school children. The ultimate aim of the game is to help parents build confidence and skills in talking with their child by practicing communication in a safe, virtual environment.

This serious game gives parents the opportunity to practice talking to their children about sex and relationships in a safe virtual environment, and makes them aware of how they react to questions and how their child feels. Users play through five realistic situations and a quiz, and can choose between two versions – one for parents of younger children (aged 5-9) and one for older children (aged 10-14). Players also get ‘top tips’ to print off and tailored feedback on how they can improve their communication in future.

The game is currently being evaluated and all players are asked to complete three very short surveys (before, immediately after and 3 months after). During this trial period the game is available only for parents in Coventry and Warwickshire, although an alternative text based version can be played by anyone. Once we have sufficient data the game will be fully released. We would greatly welcome your participation in either form. The game/text version can be accessed here and a demo is available here. For a flyer to pass to colleagues and other parents please click here: Parents game information

This game has been developed in with, and endorsed by NHS Coventry, Coventry County Council, NHS Warwickshire and Warwickshire County Council. The game has been funded by NHS Warwickshire and the evaluation stage by West Midlands (South) Health Innovation and Education Cluster

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Researching FGM Intervention Programmes Linked to African Communities in the EU (REPLACE)
Project lead: Dr Katherine Brown

European Commission funding was awarded to Dr Katherine Brown and Prof Hazel Barrett (Faculty of Business, Environment and Society, Coventry University) in 2010. The funding is for a project that looks at ways in which psychological behavioural change approaches can be applied to education programmes designed to reduce the incidence of Female Genital Mutilation (FGM; sometimes referred to as Female Circumcision). This cultural practice affects many women and children amongst migrant communities in the UK and wider EU. For more information about FGM, visit our partner organisation’s website forwarduk.org.uk. The project, began in April 2010, and will be complete in May 2011. For more information about the work of the REPLACE project, please visit the project website at www.replacefgm.eu.

NB Other partners in this work include the Federation of Somali Associates in the Netherlands (FSAN; fsan.nl) and the West Midlands European Service WMES website.

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Early interventions for substance misuse, teenage pregnancy and sexual coercion: a scoping study

Project lead: Julie Bayley

SASH were commissioned by Coventry Respect Yourself Campaign and NHS Coventry to undertake a scoping study on early interventions. As part of a local drive to revise the model of prevention and risk reduction strategies for young adolescents, the commissioners required information and conclusions on the evidence base relating to the most effective techniques for intervening with high risk young teens to prevent these behaviours. SASH have undertaken a desktop review of established and promising strategies for early interventions in these areas, exploring systematic reviews, RCTs and existing UK programmes and generating recommendations for programme content and delivery. The results of the study have been provided to the commissioners and will support planning and policy setting for the upcoming prevention strategy. SASH will aim to disseminate the findings publicly once the project is completed.

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Completed Projects:

Warwickshire review of Relationships and Sex Education (RSE) in secondary schools

Project lead: Katie Newby.

Warwickshire County Council’s Respect Yourself Campaign commissioned a review of Relationship and Sex Education (RSE) in 8 secondary schools in Warwickshire between December 2010 and March 2011, with a view to improving future quality of RSE in secondary schools. The review was undertaken by Anna Sewell Implementation Ltd, in conjunction with SASH and LJ Consultancy. Outcomes of this work are: a final report, an example of good practice report, a strategic plan to address the RSE needs of young people in Warwickshire, and finally individualised reports to all participating schools (outlining current position and making recommendations to improve delivery).

The final report has been made publicly available by the Respect Yourself Campaign and can be accessed here: Final Report.

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Health Protection Agency (HPA) Chlamydia Screening Study

Project lead: Katie Newby.

A randomised controlled trial (RCT) was conducted to determine the effectiveness of a structured complex intervention to increase opportunistic chlamydia screening in people aged 15-24 in general practice. The trial was led by collaborators at the Health Protection Agency. The SASH team supported this work by investigating the psychological predictors of screening offers made by practice staff, using the findings to inform intervention content, and examining the effectiveness of the intervention in changing behaviour. A final report is currently being written.

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Application of the Theory of Planned Behaviour to condom, oral and emergency contraceptive use in under 16s

Project lead: Julie Bayley

SASH have been working with one of the world’s largest pharmaceutical companies on a project which investigates the predictors of effective use of condoms, oral contraception and emergency contraception in young teenagers. The main aim of this research was to better understand the relationship between use of these three methods by young teenagers over time as well as understanding the relevant psychological predictors of each method.

The project consisted of three stages a) development of a TPB survey in consultation with under 16s, b) cross-sectional administration of the survey and c) a longitudinal administration to predict behaviour over time. A paper is in currently being prepared for this study and will be submitted early 2013.

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What Shall We Tell the Children … About Relationships and Sex?

Project lead: Julie Bayley

Originally commissioned by Coventry Primary Care Trust, this project used an Intervention Mapping approach to develop a group-based intervention designed to improve parents’ communication with their children about sex and relationships. Evaluative work has been conducted and the intervention is currently being used with parents in Coventry and Warwickshire. SASH has recently been funded to develop this face-to-face group intervention into an on-line ‘serious game’ intervention in order to broaden its accessibility to parents. To view the on-line game and related materials please see besavvy.org.uk. A paper was published in 2011 about the development of the intervention which can be accessed here.

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Regional Project to Investigate Under-16 Conceptions in the West Midlands

Project lead: Katie Newby.

Against a backdrop of declining under-18s conceptions rates in the West Midlands, local data released for 2008 indicated that some areas were experiencing an increase in their under-16 rates which had previously remained static. In order to act on this emerging trend, Government Office for the West Midlands (GOWM) commissioned SASH to investigate young people’s circumstances leading up to conceptions, and decision making about the outcome of pregnancy, amongst under 16s. The report released in February 2010 includes a number of important recommendations which have been developed for practice and policy to improve health education and services. Click on the links below to access the report and its appendices in pdf format.

Access the Report.

Access the report’s Appendix a (interview and focus group schedules)

Access the report’s Appendix b (logic diagram)

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Perceptions of the Risk of Chlamydia Infection among Young People Attending a Genito-Urinary Medicine Clinic

Project lead: Katie Newby.

This research explored the structure, content and accuracy of Chlamydia risk perceptions held by young genitor-urinary medicine (GUM) clinic attendees. Chlamydia risk perceptions amongst this group were found to be low and based on errors in reasoning. Errors included believing that Chlamydia was not serious because it was easily treatable and often asymptomatic but at the same time relying on symptoms to prompt treatment seeking, and believing that they reduced their susceptibility to infection through using indirect approaches, such as assessing reputation and personal appearance, to gauge the sexual health risk posed by potential sexual partners. For more information on this study click here. This research was published in the British Journal of Health Psychology in 2012. The article can be accessed here..

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Young People’s Aspirations Research Project

Project lead: Katie Newby.

SASH, in partnership with the Applied Research Centre in Sustainable Regeneration (SURGE) and Anna Sewell Implementation Ltd., were awarded a tender by NHS Coventry in Sept 2010 to explore young people’s aspirations for education, career and future in order to make recommendations to reduce teenage pregnancy. Participants were young people who all met an at-risk profile for teenage pregnancy. The sample included young people who were either teenage parents, or had a history of positive engagement in education, employment, training, or another similar activity.

The rational for this approach was that through comparing these two groups of young people, it may be possible to improve understanding of the value of aspirations for education/career in providing an alternative pathway/trajectory to teenage conception amongst those at greatest risk. The project commenced in September 2010 and was completed in June 2011. The Full report and summary report are now available. The participant feedback sheet is also available here.

The team received a letter of commendation from the commissioner on close of this project. To read this letter click here.

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Teenagers and emergency contraception in the UK: A focus group study of salient beliefs using concepts from the Theory of Planned Behaviour

Project lead: Julie Bayley

Emergency contraception (EC) has received comparatively little academic attention in relation to condom and contraceptive pill research. SASH undertook an exploratory study of EC beliefs within a Theory of Planned Behaviour (TPB) framework. Six single sex focus groups comprising a total of 25 female and 23 male pupils aged 13–16 years were conducted in schools in Central England. Results showed that overall, attitudes to emergency contraception (EC) were positive in relation to the rewards of avoiding teenage pregnancy. Participants had positive beliefs about the effectiveness of EC, although knowledge of crucial time limits varied. EC use was more socially acceptable than teenage pregnancy, yet both outcomes were perceived negatively. Motivation to comply with social pressure was influenced by the appraisal of individuals’ intentions. Participants reported high self-efficacy in accessing EC, but had concerns over confidentiality and access. The authors concluded that the desire to avoid pregnancy was high in this group, but practical factors and attitudes may be more important for those ambivalent about pregnancy. Adolescents perceive accessing EC as difficult, are concerned about confidentiality, and anticipate negative reactions from staff. Data support the TPB as a suitable framework for understanding attitudes to EC use. This study was published in 2009 and can be accessed here.

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Fathers and parenting programmes: barriers and best practice

Project lead: Julie Bayley

Fathers are particularly difficult to recruit to voluntary parenting programmes, despite the advantages of such programmes for confidence and skills in parenting and associated improvements in child behaviour. This review gathered information on barriers to fathers’ engagement with parenting support services and identifies best practice for recruitment. It drew on published academic literature, government and community organisation reports and empirical data collection through interviews with parenting experts (n=9) and focus groups and questionnaires with fathers (n=29). The barriers identified were lack of awareness, work commitments, female-orientated services, lack of organisational support and concerns over programme content. Aspects of best practice included actively promoting services to fathers rather than parents, offering alternative forms of provision, prioritising fathers within organisations and taking different cultural and ethnic perspectives into account. Achieving greater engagement of fathers in parenting support programmes requires a greater understanding of the perspectives of fathers. This study was published in 2009 and can be accessed here.

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Accessing, carrying, negotiating use, using and disposing: An exploratory elicitation study of five condom behaviours

This project is part of Jude’s PhD in exploring safer sex behaviours. Research into safer sex behaviours has traditionally focussed on condom use but this is actually one of the latter stages of performing safer sex. This exploratory work is based on the Theory of Planned Behaviour and aims to investigate the beliefs people hold about the range of condom behaviours.

This study looked at beliefs in a range of populations from under-18s to over-65 year olds. Findings from this project have been presented as a poster at the 2010 UKSBM conference. If you would like to know more about the project please email Jude.

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A cross-sectional investigation of condom beliefs using the ACNUD scale

This is the second project of Jude’s PhD research. Results from the qualitative exploration study have been used to develop the ACNUD scale (Accessing, Carrying, Negotiating, Using and Disposing). This study was undertaken in two phases.

Phase one – Developing the ACNUD scale
A convenience sample completed the pilot version of the scale. All beliefs generated in the qualitative study were included in the scale. The scale is an augmented TPB questionnaire separating behavioural beliefs into affective and cognitive questions and including subjective, descriptive and moral norms. Data collected was subjected to validation analysis. Only scale items with high internal consistency and significantly contributing to the variance in TPB constructs were retained for the cross-sectional study. Analysis demonstrated that belief-based measures significantly contributed to the variance in TPB construct more so than multiplicative composites. Therefore only belief-based measures were retained in the final scale.

For a copy of the results please see the ACNUD development poster or brief results.

Phase two – Cross-sectional study
An opportunistic sample of the general population completed the ACNUD scale. Data was subjected to various statistical analyses in order to determine condom behaviours and psychological variables to target in an online safer sex intervention. Carrying, negotiating and using behaviours were identified as target behaviours for the intervention. Variables to target which were most predictive of intention to perform these behaviours were moral norm and affective attitudes. These data suggest that an augmented Theory of Reasoned Action rather than an augmented Theory of Planned Behaviour would be a better model for the online intervention.

For a copy of the ACNUD scale please click here or here view the DHP 2011 abstract or summary findings.

If you have further questions about the project please email Jude.

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Delivery and evaluation of an online safer sex intervention

This was the final project in Jude’s PhD. This randomised control trial used an opportunistic sample. Participants completed an online safer sex intervention. A broad range of individuals’ completed the intervention; both genders, individuals’ with different sexual orientation, and sexually experienced and inexperienced individuals’ participated. Data collected was subjected to a series of analyses. Part of the analyses explored whether positively- or negatively-framed intervention messages work better than a control message at changing various condom behaviour intentions and actual condom behaviours. Intervention screen shots may be viewed. A summary of the intervention finding are available, please click here. The ENRGHI abstract is also available.

For more information email Jude.

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