JACK trial protocol: a phase III multicentre cluster randomised controlled trial of a school-based relationship and sexuality education intervention focusing on young male perspectives

Abstract

IntroductionTeenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-aware interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by WHO and identified in systematic reviews of (relationship and sexuality education (RSE)). This study aims to test the effectiveness of an interactive film-based RSE intervention, which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years.Methods and analysisA phase III cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations and will be delivered to replace some of the usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socioeconomic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales), including approximately 7900 pupils. A questionnaire will be administered at baseline and at 12–14 months postintervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use and diagnosis of sexually transmitted infections.Ethics and disseminationEthical approval was obtained from Queen’s University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research.Trial registration numberISRCTN99459996

How men and women learn about sex: multi-generational perspectives on insufficient preparedness and prevailing gender norms in Scotland

“…In addition, there are strong socio-cultural barriers that influence learning about sexual health and relationships, especially in relation to gender and cultural norms, as highlighted by similarities in experiences across diverse age groups regarding accounts of experiences in school. While the effectiveness of population-level school-based sex education has been called into question (Elliott et al 2013 ), new approaches rightly continue to be tested (Forsyth et al 2018 ; Lohan et al 2018 ). A lack of evidence of the effectiveness of school-based interventions may be due to ingrained cultural norms and the inherently slow-changing nature of these institutions, and of broader society (Couch et al 2006 ).…”

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

“…These limitations impose barriers to understanding the real-world effectiveness and reach of existing programmes and also point to a gap in knowledge relating to our understanding of the acceptability and feasibility of digital programmes for engaging parents. This study addressed this gap by working with UK parents, teachers and RSE policy experts to co-produce digital parental components for an RSE programme and implementing them during a UK-wide school-based cluster randomised trial [79]. The aim was to assess implementation fidelity of parental digital components; determine their acceptability and feasibility; and explore barriers and facilitators of using digital programmes as a means of engaging parents in school-based SRH promotion.…”

“…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.…”

The Design, Content and Delivery of Relationship and Sexuality Education Programmes for People with Intellectual Disabilities: A Systematic Review of the International Evidence

“…To this end, RSE programmes enable people to make informed decisions about their future relationships, develop resilience and know where to access help and support when necessary [ 17 ]. To achieve this objective, many countries have established structured RSE programmes that are embedded within the school curriculum that is intended to be inclusive of all young people [ 18 , 19 , 20 ].…”