Can Teenage Men Be Targeted to Prevent Teenage Pregnancy? A Feasibility Cluster Randomised Controlled Intervention Trial in Schools

Abstract

The World Health Organisation advocates a direct focus on adolescent men in reducing adolescent pregnancy; however, no trials have been conducted. This trial (ISRCTN11632300; NCT02092480) determines whether a novel Relationship and Sexuality Educational intervention, If I Were Jack, is acceptable and feasible to implement in mixed sex UK classrooms. The intervention is a teacher-delivered intervention that emphasises male alongside female responsibility in preventing unintended pregnancies and is designed to prevent unprotected sex. The trial was a parallel-group cluster randomised controlled feasibility trial with embedded process and cost evaluation in eight secondary schools (unit of randomisation) among 831 pupils (mean age 14) in Northern Ireland, alongside a qualitative evaluation of transferability in ten schools in Scotland, Wales and England. The sampling strategy was a maximum variation quota sample designed to capture a range of school management types. Four schools were randomised to each arm and the control arm continued with usual practice. Study duration was 12 months (from November 2014), with follow-up 9 months post-baseline. Results demonstrated that the intervention was acceptable to schools, pupils and teachers, and could be feasibly implemented, cost-effectively, with minor enhancements. The between-group difference in incidence of unprotected sex (primary outcome at pupil level) of 1.3% (95% CI 0.5–2.2) by 9 months demonstrated a potential effect size consistent with those reported to have had meaningful impact on teenage pregnancy. The study responds to global health policy for a paradigm shift towards inclusion of men in the achievement of sexual and reproductive health goals in a practical way by demonstrating that a gender-sensitive as well as a gender transformative intervention targeting males to prevent teenage pregnancy is acceptable to adolescent men and women and implementable in formal education structures. If I Were Jack now merits further effectiveness testing.Electronic supplementary materialThe online version of this article (10.1007/s11121-018-0928-z) contains supplementary material, which is available to authorized users.

Interventions addressing men, masculinities and gender equality in sexual and reproductive health and rights: an evidence and gap map and systematic review of reviews

“…There is increasing recognition that men and boys can play a role as either supporting and championing or damaging and denying the health and rights of women and girls. Hence, focusing on boys/men through a gender-transformative approach goes beyond a men’s health focus or the inclusion of men as partners of women with respect to SRH decision making 23–31. Despite more than a decade of gender-transformative programming on engaging men/boys in several areas of health including SRHR, there is a paucity of evidence on the effectiveness of interventions to improve SRHR outcomes; how best to engage men/boys from a gender-transformative perspective; and what works and for which SRHR health outcomes.…”

Engaging parents in digital sexual and reproductive health education: evidence from the JACK trial

“…Further, unlike the current study, all offered monetary incentives for implementation fidelity, thereby making it difficult to disentangle the efficacy of the programme (versus the incentive) for parent fidelity. When compared with non-OMT studies that did not offer incentives, which report fidelity rates of between 7 and 10% [52,72], the current results are favourable. Considering this, and given the implications that using digital media for engaging parents might have for reach and reduction in resources required to deliver RSE, it could be argued that even moderate increases in fidelity rates, as demonstrated in the current study, suggest that digital methods are a promising means of increasing parental engagement with RSE.…”

“…The neglect to involve parents in RSE may be, in part, explained by reported difficulties engaging them [3,68] and the expense of facilitated face-to-face workshops, which most programmes with parents to date have utilised [29]. The JACK feasibility trial engaged only 7% of eligible parents in its school-delivered face-to-face workshops [3,52] and other research reports similar difficulties engaging parents [69][70][71][72]. Barriers to engagement and implementation fidelity (although underreported in the literature) are likely to include parents' inability to attend workshops due to other commitments, lack of time or motivation, perceived embarrassment or underestimations of the value of RSE in general [3].…”

“…If I Were Jack [52,79,80] is an evidence-informed, theory-based, gender-transformative (challenges gender inequalities relating to SRH) RSE programme designed to reduce unintended teenage pregnancy and promote positive sexual health. It aims to increase intentions to avoid teenage pregnancy by encouraging delayed initiation of sexual intercourse and/or consistent use of contraception and is designed to be delivered in educational settings.…”

“…Programme components include: an interactive film which tells the story of 16-year-old Jack, who has just found out that his girlfriend Emma is unexpectedly pregnant; classroom materials for teachers containing detailed lesson plans with specific classroom-based and homework activities; a 90-min training session delivered by RSE specialists to teachers implementing the programme and parent components as described below. The JACK programme and Trial methods are described in full elsewhere [52,79] and more information about the project can found at https://www.ifiwerejack.com.…”