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A Needs Assessment in South Wales Schools for a Novel Medical Student-Led Sex Education Programme

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Title: A Needs Assessment in South Wales Schools for a Novel Medical Student-Led Sex Education Programme
Language: English
Authors: Twine, C., Robbe, I. J., Forrest, S., Davies, S.
Source: Sex Education: Sexuality, Society and Learning. May 2005 5(2):137-152.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 16
Publication Date: 2005
Document Type: Journal Articles
Reports - Evaluative
Education Level: High Schools
Secondary Education
Descriptors: Medical Students, Health Education, Sex Education, Needs Assessment, Negative Attitudes, Confidentiality, Foreign Countries, Early Adolescents, Intervention, Student Surveys, Sexuality, Information Sources, Contraception, Pregnancy, Health Services, Adolescent Attitudes, Questionnaires, Statistical Analysis
Geographic Terms: United Kingdom (Wales)
DOI: 10.1080/14681810500038822
ISSN: 1468-1811
Abstract: The rationale behind using medical students as sexual health educators in light of current UK governmental policy agenda and research on effective interventions is described in this paper, which also examines the results of a cross-sectional survey of the sexual health knowledge and attitude of 14-15 year-olds in some South Wales schools. Major current sources of sexual health information include school, magazines and other young people. Young people are generally well informed about contraception but ill informed of contraceptive services while tending to have a negative attitude towards their utilisation. Reasons for this include insufficient information and education on services, inaccurate perceptions of the levels of confidentiality of services and embarrassment towards general practitioners. The implications of these results are discussed in the context of the development of an effective sexual health education programme using medical students as educators in South Wales secondary schools. (Contains 3 tables.)
Abstractor: As Provided
Number of References: 42
Entry Date: 2009
Accession Number: EJ834464
Database: ERIC
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  Value: <anid>AN0017108295;bf401may.05;2019Feb15.14:57;v2.2.500</anid> <title id="AN0017108295-1">A needs assessment in South Wales schools for a novel medical student‐led sex education programme. </title> <sbt id="AN0017108295-2">Introduction</sbt> <p>The rationale behind using medical students as sexual health educators in light of current UK governmental policy agenda and research on effective interventions is described in this paper, which also examines the results of a cross‐sectional survey of the sexual health knowledge and attitude of 14–15 year‐olds in some South Wales schools. Major current sources of sexual health information include school, magazines and other young people. Young people are generally well informed about contraception but ill informed of contraceptive services while tending to have a negative attitude towards their utilisation. Reasons for this include insufficient information and education on services, inaccurate perceptions of the levels of confidentiality of services and embarrassment towards general practitioners. The implications of these results are discussed in the context of the development of an effective sexual health education programme using medical students as educators in South Wales secondary schools.</p> <p></p> <hd id="AN0017108295-3">The sexual health and behaviour of teenagers in the UK</hd> <p>Despite a decrease in the number of teenage pregnancies in the United Kingdom (UK) in recent years, the rate is still the highest in Western Europe. Wales has the highest teenage pregnancy rate of the four countries in the UK at 47.3 per 1000 under 18 year‐olds ([<reflink idref="bib29" id="ref1">29</reflink>]). Although age at first sexual intercourse now appears to have stabilised, it is still reported as being younger than before the 1990s ([<reflink idref="bib42" id="ref2">42</reflink>]). Up to 75% of teenage pregnancies are unplanned ([<reflink idref="bib1" id="ref3">1</reflink>]) and 44% currently end in abortion ([<reflink idref="bib29" id="ref4">29</reflink>]). Teenage pregnancy is associated with an increased risk of poor economic, social and health outcomes for the mother and child ([<reflink idref="bib13" id="ref5">13</reflink>]). The rate of diagnosis of new sexually transmitted infections (STIs) in the teenage group continues to rise annually ([<reflink idref="bib42" id="ref6">42</reflink>]).</p> <hd id="AN0017108295-4">The policy agenda and research on effective interventions</hd> <p>In 1999 the Social Exclusion Unit (SEU) reported on the reasons for high rates of UK teenage pregnancy ([<reflink idref="bib6" id="ref7">6</reflink>]). This report provided a governmental action plan whose main goal is to halve the rate of conceptions in the under‐18 age group by 2010. The National Assembly for Wales recognises the specific need to reduce the teenage pregnancy and STI rates in Wales, and has launched a framework for tackling them ([<reflink idref="bib39" id="ref8">39</reflink>]). A major focus of the work of these bodies is the collating of data and concepts resulting in effective sexual health interventions, and the production of review documents as an 'evidence base' in order to support the implementation of prevention programmes.</p> <p>The single most effective form of sexual health intervention is still unclear. The variation between programmes in terms of duration, components, approach and age and setting of the target population, coupled with variability in terms of the standard of evaluation and research, currently makes it impossible to identify a 'gold standard' ([<reflink idref="bib5" id="ref9">5</reflink>]). Recent meta‐analyses and reviews of the academic literature have produced conflicting results ([<reflink idref="bib18" id="ref10">18</reflink>]; [<reflink idref="bib7" id="ref11">7</reflink>]). However, evidence is emerging identifying multi‐faceted strategies to be effective ([<reflink idref="bib21" id="ref12">21</reflink>]). This is apparent in other European countries (especially The Netherlands) where agencies acting in unison appear to be affecting behavioural change and consequently reducing teenage conception rates ([<reflink idref="bib20" id="ref13">20</reflink>]). In the light of this evidence, a major proposal of UK working groups is effective sex and relationships education (SRE) starting in school while forming consistent links with family planning, GUM (genito‐urinary medicine) and other components of a multi‐faceted approach ([<reflink idref="bib27" id="ref14">27</reflink>]). The most effective mode of delivery of revamped sexual health education is also unclear, although it has recently been suggested that the effective limit of teacher‐based SRE may already have been reached ([<reflink idref="bib44" id="ref15">44</reflink>]).</p> <p>Sex and relationship education forms a compulsory, though minor, part of the National Curriculum in England and Wales, covering only basic facts and theories. Weaknesses in teacher training and support in this traditionally sensitive subject mean that provision is patchy and inconsistent ([<reflink idref="bib43" id="ref16">43</reflink>]). This is acknowledged in the recent report by OfSTED (Office for Standards in Education) on school‐based SRE which highlighted the benefits which accrue from supporting specialist teams of teachers, and noted the need to shift from a biological focus on providing information to programmes which emphasise the development of relevant inter‐personal skills:</p> <p>Schools should broaden their coverage and their definition of achievement to include the development of pupils' values and attitudes and personal skills, as well as the acquisition of practical knowledge. (Office for Standards in Education, [<reflink idref="bib31" id="ref17">31</reflink>]b, pp. 33–34)</p> <hd id="AN0017108295-5">Peer‐led approaches to sex and relationships education</hd> <p>Peer‐led education is defined as education by those considered as contemporaries, or those of similar status, age or social norms to the intervention group ([<reflink idref="bib35" id="ref18">35</reflink>]). Peers are claimed to have an advantage over teachers by being regarded as more credible sources of information, while a number of psychosocial theories have been applied to peer‐methods to support their use ([<reflink idref="bib40" id="ref19">40</reflink>]). The process of peer education has, conversely, been criticised for undue praise due to a lack of unequivocal evidence ([<reflink idref="bib12" id="ref20">12</reflink>]), from work with an inadequately specified theoretical base ([<reflink idref="bib28" id="ref21">28</reflink>]). Recent considered process evaluations are beginning to explore the theory and application of peer education with positive outcomes ([<reflink idref="bib2" id="ref22">2</reflink>]; [<reflink idref="bib11" id="ref23">11</reflink>]).</p> <p>The benefits of peer education for the peer educators include positive changes in subject knowledge, confidence, group interaction and a shift towards more liberal attitudes ([<reflink idref="bib2" id="ref24">2</reflink>]; [<reflink idref="bib37" id="ref25">37</reflink>]). The process evaluation of Forrest <emph>et al</emph>. ([<reflink idref="bib11" id="ref26">11</reflink>]) also suggests that peer‐led SRE is preferred by students to that delivered by teachers because they perceive less embarrassment and ascribe less moralistic attitudes towards sex to peer educators and young people in general. Recent comparison with adult‐led SRE has found peer education to be more effective in establishing conservative norms and attitudes relating to sexual behaviour ([<reflink idref="bib26" id="ref27">26</reflink>]).</p> <hd id="AN0017108295-6">Medical students as peer educators</hd> <p>Previous studies have shown doctors (GPs) as sex educators in schools to be effective in changing attitudes towards service utilisation ([<reflink idref="bib25" id="ref28">25</reflink>]). This is in accordance with results showing that school‐based SRE led by medical staff can be effective when linked to access to contraceptive services ([<reflink idref="bib18" id="ref29">18</reflink>]). While medical staff are difficult to use in programmes due to time and cost constraints, medical students are relatively more available, will work for free and may even have teaching time allocated to SRE programmes due to the observed benefits for the educators ([<reflink idref="bib37" id="ref30">37</reflink>]). They are unlikely to be known by the intervention group, which has previously been shown to be important to young people ([<reflink idref="bib37" id="ref31">37</reflink>]).</p> <p>The medical students taking part in such a programme will have expert knowledge of sexual health due to in‐course and intervention‐related education led by a support network of enthusiastic academic and non‐academic sexual health experts. Training during the programme will also address other issues cited previously as problems pertaining to SRE by teachers and doctors. Medical students also stand to benefit in terms of professional and personal development ([<reflink idref="bib37" id="ref32">37</reflink>]). Indeed, while all doctors are expected to teach one another and medical students, specific educational methods are currently absent in the undergraduate curriculum.</p> <p>The feasibility of medical students as peer educators was examined by Jobanputra <emph>et al</emph>. ([<reflink idref="bib19" id="ref33">19</reflink>]). Ninety‐three per cent of young people interviewed felt that medical student involvement in SRE was a good idea, and 70% said that they would talk more openly with medical students. Teachers also welcomed medical student involvement in SRE. Studies examining peer acceptance have shown that young people's acceptance of popular peers may be determined to a degree by academic ability, level of interpersonal skills and ability to obtain goals ([<reflink idref="bib23" id="ref34">23</reflink>]): traits encompassed by many medical students. Other studies have shown demographic similarity to be less important than the personal qualities of peer educators ([<reflink idref="bib9" id="ref35">9</reflink>]), although some literature emphasises the importance of similarity between educators and the target group ([<reflink idref="bib34" id="ref36">34</reflink>]). Medical student‐led education is in truth 'quasi‐peer' education. However, their use as peer educators may impart the knowledge and positive attitude change observed in peer education, while bridging the gap between young people and services observed following SRE involving doctors. The approach is therefore in line with recent working group and OfSTED recommendations concerning the integration of multi‐faceted programmes ([<reflink idref="bib6" id="ref37">6</reflink>]; [<reflink idref="bib39" id="ref38">39</reflink>]; [<reflink idref="bib27" id="ref39">27</reflink>]), while potentially being more effective than an analogous teacher‐led programme.</p> <p>Following examples of medical student‐led SRE in Australia ([<reflink idref="bib14" id="ref40">14</reflink>]) and other countries, medical students in Edinburgh investigated the feasibility of using UK medical students as peer educators. This paper is the first of a series building on the work of Jobanputra <emph>et al</emph>. ([<reflink idref="bib19" id="ref41">19</reflink>]), documenting the planning, design, implementation and evaluation of a medical student‐led sexual health education scheme called 'Sexpression' in South Wales, based at the University of Wales College of Medicine (UWCM). 'Sexpression' programmes are currently running in several other medical schools around the country; however the design and planning of each is currently different. This intervention is aimed at secondary schools, and is looking to build expertise within a self‐sustaining programme in special study modules of the undergraduate curriculum.</p> <p>Our aims at this stage in the development of the programme were to:</p> <p></p> <ulist> <item> 1. Investigate the needs of our target group by evaluating their knowledge of sexual health and contraception.</item> <p></p> <item> 2. Appraise the attitudes of our target group towards contraceptive use and contraceptive services.</item> <p></p> <item> 3. Combine the information gleaned with practical evidence of peer‐led education and recent working group recommendations to design the UWCM 'Sexpression' training programme involving medical students, teachers and young people.</item> </ulist> <hd id="AN0017108295-7">Methods</hd> <p></p> <hd id="AN0017108295-8">Participants</hd> <p>We identified teenagers in Year 10 on 1st July 2002 in the Cardiff area as our population sample. Year 10 was chosen as it is the last year in which SRE is taught in Cardiff schools. All 13 LEA (Local Education Authority) maintained secondary schools in the Cardiff area were contacted by letter from one of the authors (CT) and the head of Obstetrics and Gynaecology at the University Hospital, Cardiff (Professor A. Fiander). A copy of the questionnaire was included with the letter. Two schools agreed to allow access to their Year 10 students. The other 11 schools chose not to participate in the study citing timetabling constraints, examinations and school policy as reasons for refusal.</p> <p>The pupils attending in the two schools studied are predominantly from working class backgrounds (social classes III–IV) and are of various races ([<reflink idref="bib38" id="ref42">38</reflink>]). Both schools were LEA‐maintained, non‐religious schools, with an average class size of 22.9 pupils and a pupil–teacher ratio of 16.8. There is an average GCSE/GNVQ point score per pupil of 32, with 42% gaining at least five GCSE grades A*–C ([<reflink idref="bib38" id="ref43">38</reflink>]).</p> <hd id="AN0017108295-9">Study design and distribution</hd> <p>The study is a questionnaire‐based cross‐sectional survey of sexual health knowledge and attitude designed with Year 10 (14–15 year‐old) pupils in mind. The questionnaire contained three broad sections—a section on current knowledge of sexual health and contraception, a section on attitude towards contraceptive use, and a section on attitude towards primary healthcare contraceptive services. The sections each contained true/false, multiple choice and Likert‐type scales, as well as a box for independent comment. The question on sources of sexual health information was modified from the study by Jobanputra <emph>et al</emph>. ([<reflink idref="bib19" id="ref44">19</reflink>]), and questions from the section on attitudes towards contraceptive use and services were modified from the 1995 Welsh Youth survey ([<reflink idref="bib16" id="ref45">16</reflink>]). The rest were devised independently with the needs of a peer‐led SRE programme in mind. Examples of question design include tick box questions with the choices Agree, Disagree, Don't know, phrased:</p> <p>'I would be too embarrassed to go to my GP for help with contraception.'</p> <p>Multiple choice tick box questions were typically phrased:</p> <p>'If a condom splits during sex when no other protection is being used what is best done to reduce the risk of pregnancy?'</p> <p>Choices: Nothing, Take a bath, Seek emergency contraception, Don't know. Only 'seek emergency contraception' was viewed here as correct. The questionnaire was piloted among 25 Year 10 (15 year‐old) teenagers who were attending neither of the schools in the study. Changes were made as a consequence of the pilot to make some questions less ambiguous. Validity and reliability of the questionnaire is discussed later.</p> <p>Optional participation, anonymity and confidentiality of the individual responses to the questionnaires was expressed orally to the students prior to participation and on the first page of the questionnaire. It was emphasised to pupils that they should not write their names on the questionnaires. These issues were reiterated in writing on the questionnaire in specific sub‐sections including questions pertaining to personal sexual activity. Any identifiable or purposeful disclosure of abuse orally or via the questionnaire would have been dealt with in accordance with the individual school's policy. The questionnaires were distributed under examination conditions by third year medical students with teachers present. Pupils placed the completed questionnaires into unmarked, sealable envelopes before putting them a collection box, again to ensure confidentiality and anonymity. Questionnaires were read and analysed by two of the authors, and the completed papers kept in a locked filing cabinet at the University Hospital of Wales, Cardiff. The questionnaires were linked by neither name nor number so there are no connections between data and individuals.</p> <p>The data were analysed anonymously using the Statistical Package for the Social Sciences (SPSS) software ([<reflink idref="bib36" id="ref46">36</reflink>]). Independent <emph>t</emph>‐tests were used to test for significant differences between groups when differences were found or when the difference may be of theoretical interest. Gender differences are explored as these are commonly highlighted in comparable literature. Graphs were created using Microsoft Excel. Comments supplied by the respondents were categorised by one of the authors (CT).</p> <hd id="AN0017108295-10">Results</hd> <p>There were 524 pupils on the schools' registers for Year 10. On the study days 98 (18%) were absent; therefore 426 questionnaires were distributed. While participation was optional, no pupils chose to leave the questionnaire blank. There were three spoiled questionnaires; thus 423 usable responses were collected consisting of 200 boys and 223 girls. Non‐respondents and absentees were not followed up due to time constraints. 91% of boys and 85% of girls were 15 years old; the remainder were almost all 14 (one girl was 13). There were no significant differences in the age distribution of the male and female respondents.</p> <hd id="AN0017108295-11">Current sources of sexual health information</hd> <p>Table 1 summarises the results on the respondents' sources of sexual health information. School lessons (75%) and friends (66%) were the major sources cited, with a similar proportion of answers from both sexes. Significantly more (i.e. a greater proportion of) girls than boys reported parents and magazines as sources of sexual health information. The most common 'Other' sources of information cited were television and the Internet.</p> <p>Table 1. Sexual health information sources of those in this study (figures are numbers [percentage] of teenagers giving a positive response)</p> <p> <ephtml> <table><thead valign="bottom"><tr><td valign="top">Information source</td><td valign="top">Total (% of total teenagers)</td><td valign="top">Boys (% of total boys)</td><td valign="top">Girls (% of total girls)</td></tr></thead><tbody><tr><td valign="top">School lessons</td><td valign="top" char="(">317 (75%)</td><td valign="top" char="(">151 (76%)</td><td valign="top" char="(">166 (74%)</td></tr><tr><td valign="top">Friends</td><td valign="top" char="(">279 (66%)</td><td valign="top" char="(">131 (66%)</td><td valign="top" char="(">148 (66%)</td></tr><tr><td valign="top">Parents</td><td valign="top" char="(">163 (39%)</td><td valign="top" char="(">63 (32%)</td><td valign="top" char="(">100 (45%)*</td></tr><tr><td valign="top">Magazines</td><td valign="top" char="(">175 (42%)</td><td valign="top" char="(">67 (34%)</td><td valign="top" char="(">108 (48%)*</td></tr><tr><td valign="top">Haven't learnt</td><td valign="top" char="(">3 (0.7%)</td><td valign="top" char="(">2 (1%)</td><td valign="top" char="(">1 (0.4%)</td></tr><tr><td valign="top">Other</td><td valign="top" char="(">19 (5%)</td><td valign="top" char="(">13 (7%)</td><td valign="top" char="(">6 (3%)</td></tr></tbody></table> </ephtml> </p> <p>1 * Indicates <emph>P</emph><0.05 for the difference between boys and girls.</p> <hd id="AN0017108295-12">Sexual health education at school</hd> <p>Students were asked to assess the quality of SRE on a three point Likert‐type scale. Data show that 60% (<emph>n</emph> = 240) of students did not believe that they received enough SRE at school; a slightly higher proportion were girls (31% of the total compared to 29% boys, <emph>P</emph>>0.05). 54% of the pupils wanted more sexual health education, 41% thought that they received enough and 5% thought they received too much. When asked who taught them SRE at school 88% cited a teacher, 7% a school nurse, 3% a teacher and nurse and 2% other.</p> <hd id="AN0017108295-13">Contraceptive knowledge</hd> <p>Table 2 reports results pertaining to contraceptive knowledge. The majority knew when to put on a condom to reduce the risk of pregnancy and knew to seek emergency contraception if their condom split. However, only 77% knew that using spermicide offered extra protection over using two condoms (data not shown). Results were less favorable for "What do condoms protect against?" with only 63% knowing that condoms protect against pregnancy and STIs (as opposed to answers citing only one of these alternatives). A similar 59% knew that the oral contraceptive pill protects against pregnancy (as opposed to answers citing STIs or pregnancy and STIs). Girls account for a significantly higher proportion of correct responses for both the pill (df = 417, <emph>P</emph> = 0.013) and condom (df = 416, <emph>P</emph> = 0.038) questions.</p> <p>Table 2. Knowledge of contraception</p> <p> <ephtml> <table><thead valign="bottom"><tr><td valign="top" /><td valign="top">Response</td></tr><tr><td valign="top">Correct</td><td valign="top">Incorrect</td><td valign="top">Unsure</td><td valign="top">Total for Question</td></tr><tr><td valign="top">%</td><td valign="top"><italic>n</italic></td><td valign="top">%</td><td valign="top"><italic>n</italic></td><td valign="top">%</td><td valign="top"><italic>n</italic></td><td valign="top">%</td><td valign="top"><italic>n</italic></td></tr></thead><tbody><tr><td valign="top"><bold>Condom</bold></td><td valign="top" /></tr><tr><td valign="top"> What do condoms protect against?</td><td valign="top" char=".">63%</td><td valign="top" char=".">266</td><td valign="top" char=".">35%</td><td valign="top" char=".">148</td><td valign="top" char=".">2%</td><td valign="top" char=".">8</td><td valign="top" char=".">100%</td><td valign="top" char=".">422</td></tr><tr><td valign="top"> When do you put a condom on to reduce the risk of pregnancy?</td><td valign="top" char=".">82%</td><td valign="top" char=".">259</td><td valign="top" char=".">8%</td><td valign="top" char=".">22</td><td valign="top" char=".">10%</td><td valign="top" char=".">31</td><td valign="top" char=".">100%</td><td valign="top" char=".">312</td></tr><tr><td valign="top"> If a condom splits during sex when no other form of contraceptive is used what is best done to reduce the risk of pregnancy?</td><td valign="top" char=".">91%</td><td valign="top" char=".">380</td><td valign="top" char=".">3%</td><td valign="top" char=".">14</td><td valign="top" char=".">6%</td><td valign="top" char=".">23</td><td valign="top" char=".">100%</td><td valign="top" char=".">417</td></tr><tr><td valign="top"><bold>Emergency contraception</bold></td><td valign="top" /></tr><tr><td valign="top"> When is the latest that emergency contraception can be effective after unprotected sex?</td><td valign="top" char=".">32%*</td><td valign="top" char=".">132</td><td valign="top" char=".">58%</td><td valign="top" char=".">247</td><td valign="top" char=".">10%</td><td valign="top" char=".">40</td><td valign="top" char=".">100%</td><td valign="top" char=".">419</td></tr><tr><td valign="top"><bold>Contraceptive myths</bold></td><td valign="top" /></tr><tr><td valign="top"> A girl can get pregnant after:</td><td valign="top" /><td valign="top" /><td valign="top" /><td valign="top" /><td valign="top" /><td valign="top" /><td valign="top" /><td valign="top" /></tr><tr><td valign="top">  Sex for the first time, not using contraception.</td><td valign="top" char=".">84%</td><td valign="top" char=".">341</td><td valign="top" char=".">8%</td><td valign="top" char=".">34</td><td valign="top" char=".">8%</td><td valign="top" char=".">31</td><td valign="top" char=".">100%</td><td valign="top" char=".">406</td></tr><tr><td valign="top">  Sex standing up, not using contraception.</td><td valign="top" char=".">74%</td><td valign="top" char=".">294</td><td valign="top" char=".">15%</td><td valign="top" char=".">60</td><td valign="top" char=".">11%</td><td valign="top" char=".">44</td><td valign="top" char=".">100%</td><td valign="top" char=".">398</td></tr><tr><td valign="top">  Sex during a period, not using contraception.</td><td valign="top" char=".">52%</td><td valign="top" char=".">207</td><td valign="top" char=".">18%</td><td valign="top" char=".">72</td><td valign="top" char=".">30%</td><td valign="top" char=".">117</td><td valign="top" char=".">100%</td><td valign="top" char=".">396</td></tr><tr><td valign="top"><bold>Contraceptive provision by services</bold></td><td valign="top" /></tr><tr><td valign="top"> Do you know where your nearest Family Planning clinic is?</td><td valign="top" char=".">44%</td><td valign="top" char=".">186</td><td valign="top" char=".">56%</td><td valign="top" char=".">237</td><td valign="top" char=".">–</td><td valign="top" char="." /><td valign="top" char=".">100%</td><td valign="top" char=".">423</td></tr><tr><td valign="top"> Do contraceptives from the Family Planning clinic need to be paid for?</td><td valign="top" char=".">2%</td><td valign="top" char=".">9</td><td valign="top" char=".">67%</td><td valign="top" char=".">282</td><td valign="top" char=".">31%</td><td valign="top" char=".">131</td><td valign="top" char=".">100%</td><td valign="top" char=".">422</td></tr><tr><td valign="top"> Do contraceptives from a GP have to be paid for?</td><td valign="top" char=".">7%</td><td valign="top" char=".">28</td><td valign="top" char=".">63%</td><td valign="top" char=".">265</td><td valign="top" char=".">30%</td><td valign="top" char=".">128</td><td valign="top" char=".">100%</td><td valign="top" char=".">421</td></tr><tr><td valign="top"> Can contraceptives be prescribed to under 16s without parental consent?</td><td valign="top" char=".">57%</td><td valign="top" char=".">242</td><td valign="top" char=".">16%</td><td valign="top" char=".">66</td><td valign="top" char=".">27%</td><td valign="top" char=".">115</td><td valign="top" char=".">100%</td><td valign="top" char=".">423</td></tr></tbody></table> </ephtml> </p> <p>2 * Correct response taken as 72 hours.</p> <p>The teenagers were then questioned about emergency contraception. While 90% were aware of its existence, 58% were incorrect about the precise timing of its use, shown in Table 2. Sexual myths were not overtly held in our population sample, although only 52% knew that it was possible to become pregnant following sex during a period if not using contraception.</p> <hd id="AN0017108295-14">Knowledge of contraceptive provision by services</hd> <p>Table 2 also summarises knowledge of services. There was no statistically significant difference between boys' and girls' answers. 56% teenagers (<emph>n</emph> = 237) did not know where their nearest family planning clinic was, and of those 11% (<emph>n</emph> = 26) had never heard of them. High numbers were unsure or incorrect about the cost of contraceptive provision by family planning clinics and GPs (67% and 63% respectively). These questions provoked the highest response to the 'don't know' category in the whole questionnaire, along with one of the questions on contraceptive myths.</p> <hd id="AN0017108295-15">Attitude towards various aspects of sexual health</hd> <p>When questioned on their views towards condom use most respondents said they would not be too embarrassed to buy condoms, would always use a condom while having sex, could easily obtain a condom and would suggest using one to a partner (Table 3). More girls responded that they would always use a condom (df = 393, <emph>P</emph> = 0.041); however girls also responded significantly more frequently that they would be too embarrassed to buy and too embarrassed to suggest using condoms, and would also be frightened that their GP would tell their parents if they went for contraceptive advice. The overall perception of contraceptive provision and advice by GPs was poor with only 48% saying they would access their GP for advice, and only 50% thinking that the GP would not tell their parents.</p> <p>Table 3. Teenagers' attitudes towards common sexual issues</p> <p> <ephtml> <table><thead valign="bottom"><tr><td valign="top" /><td valign="top">Yes</td><td valign="top">No</td><td valign="top">Don't Know</td><td valign="top">Total</td></tr></thead><tbody><tr><td valign="top"><bold>Issues surrounding condoms</bold></td></tr><tr><td valign="top">Would always use</td><td valign="top" char="(">301 (76%)*</td><td valign="top" char="(">41 (10%)</td><td valign="top" char="(">53 (14%)</td><td valign="top" char="(">398 (100%)</td></tr><tr><td valign="top">Easily obtainable</td><td valign="top" char="(">293 (74%)</td><td valign="top" char="(">41 (10%)</td><td valign="top" char="(">61 (16%)</td><td valign="top" char="(">395 (100%)</td></tr><tr><td valign="top">Would be too embarrassed to buy</td><td valign="top" char="(">71 (18%)*</td><td valign="top" char="(">271 (68%)</td><td valign="top" char="(">56 (14%)</td><td valign="top" char="(">398 (100%)</td></tr><tr><td valign="top">Would be too embarrassed to suggest using</td><td valign="top" char="(">33 (8%)*</td><td valign="top" char="(">311 (79%)</td><td valign="top" char="(">49 (12%)</td><td valign="top" char="(">393 (100%)</td></tr><tr><td valign="top">Wouldn't stop if I wanted to have sex, but didn't have contraception</td><td valign="top" char="(">78 (20%)</td><td valign="top" char="(">242 (61%)</td><td valign="top" char="(">74 (19%)</td><td valign="top" char="(">394 (100%)</td></tr><tr><td valign="top" char="("><bold>Issues surrounding GP provision of contraceptive advice</bold></td></tr><tr><td valign="top">Too embarrassed to attend for advice</td><td valign="top" char="(">132 (34%)</td><td valign="top" char="(">189 (48%)</td><td valign="top" char="(">73 (18%)</td><td valign="top" char="(">394 (100%)</td></tr><tr><td valign="top">Frightened GP would tell parents</td><td valign="top" char="(">145 (38%)*</td><td valign="top" char="(">195 (50%)</td><td valign="top" char="(">46 (12%)</td><td valign="top" char="(">386 (100%)</td></tr></tbody></table> </ephtml> </p> <p>3 * Indicates that girls answered significantly more frequently than boys.</p> <hd id="AN0017108295-16">Sexual activity and contraceptive use</hd> <p>The questionnaire asked: "Have you ever had sexual intercourse?" 22% (<emph>n</emph> = 91) (11% (<emph>n</emph> = 50) girls and 10% (<emph>n</emph> = 41) boys) reported that they had, 65% (<emph>n</emph> = 275) reported that they hadn't and 14% (<emph>n</emph> = 59) preferred not to answer. The median age of first sexual intercourse was 14 for girls and 15 for boys; the range was 9–15 years. The respondents who acknowledged having sexual intercourse were asked what form of contraceptive they used their first time. Condoms were the most utilized form (57%) with the combination of the condom and pill next (18%), then nothing (9%), withdrawal (8%) and the pill alone (8%).</p> <hd id="AN0017108295-17">Data from 'additional comments' box</hd> <p>The questionnaire had a box at the end with the text 'If there is anything you feel should be taught in school as regards to methods of contraception, using them or getting hold of them, or if you have any comments regarding this questionnaire then please write them in the box below'. There were 48 (11% of students) comments written in these boxes. The highest number of comments pertained to primary healthcare services. Location of family planning clinics was brought up 13 times, with comments ranging from:</p> <p>Graph</p> <p>to:</p> <p>Graph</p> <p>Seven teenagers thought that SRE should be taught at a younger age:</p> <p>Graph</p> <p>Another comment in the same vein was:</p> <p>Graph</p> <p>Oral sex was a topic brought up by six teenagers. 'More taught about oral sex' was written three times. Teenagers' comments on pregnancy (seven comments) were varied, but mainly pertained to:</p> <p>Graph</p> <p>Homosexual issues were mentioned once in the additional comments box with the comment:</p> <p>Graph</p> <hd id="AN0017108295-18">Discussion</hd> <p></p> <hd id="AN0017108295-19">Contraceptive knowledge and attitude</hd> <p>Results show that with regard to contraceptive knowledge (Table 2), young people completing this survey have comparable levels of knowledge to those demonstrated by other research ([<reflink idref="bib16" id="ref47">16</reflink>]; [<reflink idref="bib15" id="ref48">15</reflink>]). Our young people are generally positively inclined towards using condoms, again echoing national data ([<reflink idref="bib42" id="ref49">42</reflink>]). Although generally high, practical and theoretical contraceptive knowledge will nevertheless be addressed within the programme as condoms were the most utilised form of contraception at first intercourse. Indirect interaction with educators, for example in games, may encourage teenagers to divulge erroneously held information of which they are unsure. Visual demonstrations will be utilised in an attempt to facilitate a shift towards reducing embarrassment and enhancing positive attitude change.</p> <p>Sexual health and contraceptive information is mainly derived from school lessons and friends, with this being equally true for males and for females. It is encouraging that school lessons were cited as the major source of sexual health information, as our sessions should therefore provide teenagers with an informed primary source. Fifty‐four per cent of young people felt that they did not receive enough SRE, further indicating our likely acceptance at schools. With friends cited as major contributors to sexual health information it is not surprising that relatively large numbers had various erroneous beliefs about common sexual myths, confirming the comments of Perlaman <emph>et al</emph>. ([<reflink idref="bib32" id="ref50">32</reflink>]) and possibly demonstrating the effects of spread of peer norms. Our data are slightly different to those released by Health Promotion Wales ([<reflink idref="bib16" id="ref51">16</reflink>]) from the Welsh Youth Survey. That study found fewer boys citing friends (58% compared to 66%) and fewer teenagers citing school lessons (41% and 21% compared to our 76% and 74% of boys and girls respectively) as sources of sexual health information. This may be due to increased provision of sexual health information by teachers since 1995, or it may reflect less adequate sexual health education in other areas of Wales.</p> <p>There is a general trend throughout the questionnaire for girls to be more informed about sexual issues. The reasons for this difference may include the current higher academic achievement of girls than boys (Office for Standards in Education, [<reflink idref="bib30" id="ref52">30</reflink>]a), may reflect the social norm of women considering sexual health as a legitimate responsibility or may represent increased provision of information to girls from parents or magazines (Table 1). We may therefore name the more informative girls' magazines during sessions. Girls were not significantly more knowledgeable about contraceptive services or emergency contraception, indicating that these issues may be absent from current information providers. This will therefore be considered in detail, and this is something shown previously to be imparted effectively by doctors ([<reflink idref="bib25" id="ref53">25</reflink>]). Girls often describe difficulty in SRE due to boys not taking the sessions seriously ([<reflink idref="bib33" id="ref54">33</reflink>]), and due to the differences found between girls and boys we will aim to address gender issues and inequalities within the programme. Classes will not, however, be separated by gender due to practical difficulties including accommodation and staff, and because mixed gender SRE has been argued to be more effective than single ([<reflink idref="bib33" id="ref55">33</reflink>]).</p> <hd id="AN0017108295-20">Contraceptive service knowledge and attitude</hd> <p>Results pertaining to knowledge of contraceptive provision by primary services were poor (Tables 2 and 3). They are comparable with previous results regarding a lack of knowledge pertaining to service location ([<reflink idref="bib22" id="ref56">22</reflink>]), provision ([<reflink idref="bib17" id="ref57">17</reflink>]) and confidentiality ([<reflink idref="bib4" id="ref58">4</reflink>]). These issues are not currently included in the government's minimum statutory requirements for SRE ([<reflink idref="bib3" id="ref59">3</reflink>]). Confidentiality concerns pertaining to teenage sexual health have previously been noted: Burack ([<reflink idref="bib4" id="ref60">4</reflink>]) found slightly greater confidentiality concerns in an area of England, which may reflect regional variation. As adolescents are more willing to seek health care when confidentiality is ensured ([<reflink idref="bib10" id="ref61">10</reflink>]), the concept of confidentiality will be actively reinforced at the beginning of each session with ground rules, which will also facilitate non‐personal discussion and define the level of confidentiality within the classroom. Confidentiality of services will be discussed in this setting, using a visual analogue scale to facilitate the direct comparison of levels of confidentiality.</p> <p>The young people had an uncomfortable or anxious attitude towards the use of GPs for contraceptive services. Embarrassment towards GP utilisation has also been noted previously ([<reflink idref="bib8" id="ref62">8</reflink>]). Open, non‐judgemental discussion with medical students may assist in attitude change regarding perceived embarrassment, as General Practitioners and other members of medical staff have previously been shown to be effective in this context ([<reflink idref="bib25" id="ref63">25</reflink>]; [<reflink idref="bib18" id="ref64">18</reflink>]). The young people will be encouraged to utilise services since inviting teenagers to use GPs has previously been shown positively to affect smoking, diet, exercise and alcohol consumption ([<reflink idref="bib41" id="ref65">41</reflink>]).</p> <hd id="AN0017108295-21">Sexual activity</hd> <p>Results pertaining to sexual activity are slightly lower than those released previously from Wales; Health Promotion Wales ([<reflink idref="bib16" id="ref66">16</reflink>]) found higher rates of sexual intercourse, reported condom use and reported contraceptive pill use. Results reported for contraceptive use are still encouraging when compared to others ([<reflink idref="bib24" id="ref67">24</reflink>]; [<reflink idref="bib16" id="ref68">16</reflink>]) as we find a greater incidence of contraceptive use at first intercourse and of that, greater condom use. The 'double Dutch' method of contraception (condom and pill) is cited as one of the major contributors for the low teenage pregnancy rate in the Netherlands but is of low frequency of use in our study and others from the UK ([<reflink idref="bib24" id="ref69">24</reflink>]; [<reflink idref="bib16" id="ref70">16</reflink>]). Thus the use of condoms and the pill used together will be emphasised.</p> <hd id="AN0017108295-22">School participation and demographics</hd> <p>The social demographics of both of these schools centre on children of various races from social class III–IV. Demographics will vary markedly for a minority of schools in certain areas of Cardiff and South Wales, including schools with large numbers of pupils from backgrounds other than white South Welsh and private schools. Each target school would ideally have been studied to tailor the programme as required; however school refusal made this impossible. Schools in the Cardiff area are regularly asked to participate in questionnaires due the presence of two large Universities and teacher training colleges. As a result, some schools have a policy to refuse all questionnaires. To overcome this we may formulate a first session general to all schools where we are accepted with time for a similar (shorter) questionnaire to assess knowledge and attitude. This would help both to tailor further sessions and as part of the assessment of programme impact in terms of knowledge and attitude change. In the light of some schools' frustration at academic studies, it may be possible that the schools taking part felt that they currently have good SRE, resulting in pupils being more informed. The low rate of participation also gave us a relatively small sample size; however the aim was to ascertain the structure and content of 'Sexpression' in our target schools, which for the majority it provides.</p> <p>Results were not analysed by social class, as this information would have no bearing on the school sessions and is often not explored in comparative literature. However it is possible that social class or other factors within the social demographic of the sample are associated with differences in results. While exam conditions were used to encourage anonymity and discourage plagiarism, it is possible that these conditions may have encouraged pupils to respond in a manner which they perceived to be 'correct' rather than valid. Conversely, some responses may be intentionally incorrect. The 18% absenteeism may bias results as these pupils were absent for their mock GCSE exams which are normally recognised as important by students and parents. However, time and resources did not allow for follow up, which is something that may be considered in the future.</p> <p>The validity and reliability of this questionnaire would need further work to prove conclusively. However, the results are consistent with other studies suggesting moderate reliability, and the issues examined are similar to those in other studies suggesting moderate content and construct reliability ([<reflink idref="bib8" id="ref71">8</reflink>]; [<reflink idref="bib22" id="ref72">22</reflink>]; [<reflink idref="bib17" id="ref73">17</reflink>]; [<reflink idref="bib32" id="ref74">32</reflink>]; [<reflink idref="bib42" id="ref75">42</reflink>]).</p> <hd id="AN0017108295-23">Future work</hd> <p>Exploring reasons for the negative attitude found towards services would benefit the programme. For example, if the attitude/knowledge of information sources such as parents and popular magazines are strongly associated with teenagers' attitudes we may have different audiences to consider for prevention. Indeed, these 'other' providers' influence on attitude and behaviour should be more thoroughly investigated to further understanding of the establishment of sexual values. Teacher and parent questionnaire on similar subjects may provide insight. While homosexual issues will be discussed if raised, they may need to be explored in the future for more thorough inclusion into the programme. SRE at a younger age was not only mentioned in the additional comments box, but has been considered recently in the literature. There is a potential minefield of criticism especially from parents, but this needs to be considered in the future if the age of sexual intercourse decreases. Years 9 and 10 will be targeted as their immediate needs with regard to sexual risk taking, knowledge and attitude are known. Building up credibility with schools will be necessary to access younger age groups. Pregnancy and child benefits were mentioned in the additional comments box. As the programme is focused on prevention, we were not aiming to include any aspects of teenage pregnancy. Abortion is another sensitive topic to broach and is difficult to put across in a neutral manner; therefore educators will only be taught the basic information pathways in the event the topic is raised.</p> <p>The intervention and medical student training programme were designed for implementation in the Cardiff area in summer 2003. The programme will be developed by continuing re‐evaluation and literature reviews by medical students undertaking the 'Sexpression' special study module of the third year curriculum. Evaluation will be monitored by questionnaires and by interviews with young people and teachers as the programme progresses. The differences between the results reported here and those of the 1995 Welsh Youth Survey suggest that the Cardiff area is better informed than Wales as a whole. Mid‐ and North‐Wales school access by Cardiff medical students is difficult due to distance, although this may be feasible in the future with trained students travelling to these areas for clinical placements.</p> <hd id="AN0017108295-24">Conclusion</hd> <p>Sex and relationships education is undergoing continued exploration and refinement in order to establish effectiveness. This especially pertains to programmes using a multifaceted approach linking young people with primary healthcare services. The intervention planned in this paper aims to achieve this by using medical students as 'quasi‐peer' educators, within a target population whose needs are known, along current governmental working party and best practice guidelines.</p> <p>This study has reinforced the need for more effective sexual health education in the South Wales area, and has served its purpose as a needs assessment by highlighting key issues which should be addressed with the aim of improving the sexual health of teenagers. These needs include the purpose, confidentiality and location of primary sexual healthcare providers, combined with a greater reinforcement of basic sexual health information. The results reported here will be combined with practical evidence of peer‐led education to design the Cardiff 'Sexpression' training programme.</p> <hd id="AN0017108295-25">Acknowledgements</hd> <p>We would like to thank Professor Alison Fiander for her essential input to the project, the schools involved and the other medical students undertaking the first 'Sexpression' special study module.</p> <ref id="AN0017108295-26"> <title> References </title> <blist> <bibl id="bib1" idref="ref3" type="bt">1</bibl> <bibtext> AllenIBourkeD1998Teenage mothers: decisions and outcomesLondonPolicy Studies Institute</bibtext> </blist> <blist> <bibl id="bib2" idref="ref22" type="bt">2</bibl> <bibtext> Backett‐Milburn, K and Wilson, S. 2000. Understanding peer education: insights from a process evaluation. 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Davies</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib29" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib42" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib39" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib18" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib21" firstref="ref12"></nolink> <nolink nlid="nl7" bibid="bib20" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib27" firstref="ref14"></nolink> <nolink nlid="nl9" bibid="bib44" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib43" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib31" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib35" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib40" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib12" firstref="ref20"></nolink> <nolink nlid="nl15" bibid="bib28" firstref="ref21"></nolink> <nolink nlid="nl16" bibid="bib11" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib37" firstref="ref25"></nolink> <nolink nlid="nl18" bibid="bib26" firstref="ref27"></nolink> <nolink nlid="nl19" bibid="bib25" firstref="ref28"></nolink> <nolink nlid="nl20" bibid="bib19" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib23" firstref="ref34"></nolink> <nolink nlid="nl22" bibid="bib34" firstref="ref36"></nolink> <nolink nlid="nl23" bibid="bib14" firstref="ref40"></nolink> <nolink nlid="nl24" bibid="bib38" firstref="ref42"></nolink> <nolink nlid="nl25" bibid="bib16" firstref="ref45"></nolink> <nolink nlid="nl26" bibid="bib36" firstref="ref46"></nolink> <nolink nlid="nl27" bibid="bib15" firstref="ref48"></nolink> <nolink nlid="nl28" bibid="bib32" firstref="ref50"></nolink> <nolink nlid="nl29" bibid="bib30" firstref="ref52"></nolink> <nolink nlid="nl30" bibid="bib33" firstref="ref54"></nolink> <nolink nlid="nl31" bibid="bib22" firstref="ref56"></nolink> <nolink nlid="nl32" bibid="bib17" firstref="ref57"></nolink> <nolink nlid="nl33" bibid="bib10" firstref="ref61"></nolink> <nolink nlid="nl34" bibid="bib41" firstref="ref65"></nolink> <nolink nlid="nl35" bibid="bib24" firstref="ref67"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: A Needs Assessment in South Wales Schools for a Novel Medical Student-Led Sex Education Programme
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Twine%2C+C%2E%22">Twine, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Robbe%2C+I%2E+J%2E%22">Robbe, I. J.</searchLink><br /><searchLink fieldCode="AR" term="%22Forrest%2C+S%2E%22">Forrest, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Davies%2C+S%2E%22">Davies, S.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Sex+Education%3A+Sexuality%2C+Society+and+Learning%22"><i>Sex Education: Sexuality, Society and Learning</i></searchLink>. May 2005 5(2):137-152.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 16
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2005
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Evaluative
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22High+Schools%22">High Schools</searchLink><br /><searchLink fieldCode="EL" term="%22Secondary+Education%22">Secondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Medical+Students%22">Medical Students</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Education%22">Health Education</searchLink><br /><searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Needs+Assessment%22">Needs Assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Attitudes%22">Negative Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Confidentiality%22">Confidentiality</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Adolescents%22">Early Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Surveys%22">Student Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Sexuality%22">Sexuality</searchLink><br /><searchLink fieldCode="DE" term="%22Information+Sources%22">Information Sources</searchLink><br /><searchLink fieldCode="DE" term="%22Contraception%22">Contraception</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescent+Attitudes%22">Adolescent Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+Analysis%22">Statistical Analysis</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+Kingdom+%28Wales%29%22">United Kingdom (Wales)</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/14681810500038822
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1468-1811
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The rationale behind using medical students as sexual health educators in light of current UK governmental policy agenda and research on effective interventions is described in this paper, which also examines the results of a cross-sectional survey of the sexual health knowledge and attitude of 14-15 year-olds in some South Wales schools. Major current sources of sexual health information include school, magazines and other young people. Young people are generally well informed about contraception but ill informed of contraceptive services while tending to have a negative attitude towards their utilisation. Reasons for this include insufficient information and education on services, inaccurate perceptions of the levels of confidentiality of services and embarrassment towards general practitioners. The implications of these results are discussed in the context of the development of an effective sexual health education programme using medical students as educators in South Wales secondary schools. (Contains 3 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 42
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2009
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ834464
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ834464
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/14681810500038822
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 137
    Subjects:
      – SubjectFull: Medical Students
        Type: general
      – SubjectFull: Health Education
        Type: general
      – SubjectFull: Sex Education
        Type: general
      – SubjectFull: Needs Assessment
        Type: general
      – SubjectFull: Negative Attitudes
        Type: general
      – SubjectFull: Confidentiality
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Early Adolescents
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Student Surveys
        Type: general
      – SubjectFull: Sexuality
        Type: general
      – SubjectFull: Information Sources
        Type: general
      – SubjectFull: Contraception
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Health Services
        Type: general
      – SubjectFull: Adolescent Attitudes
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Statistical Analysis
        Type: general
      – SubjectFull: United Kingdom (Wales)
        Type: general
    Titles:
      – TitleFull: A Needs Assessment in South Wales Schools for a Novel Medical Student-Led Sex Education Programme
        Type: main
  BibRelationships:
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      – PersonEntity:
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            NameFull: Twine, C.
      – PersonEntity:
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            NameFull: Robbe, I. J.
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            NameFull: Forrest, S.
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            NameFull: Davies, S.
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          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2005
          Identifiers:
            – Type: issn-print
              Value: 1468-1811
          Numbering:
            – Type: volume
              Value: 5
            – Type: issue
              Value: 2
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            – TitleFull: Sex Education: Sexuality, Society and Learning
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