Julie Bayley

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

Objectives To explore teenagers’ beliefs about emergency contraception (EC) within a Theory of Planned Behaviour (TPB) framework. Methods Six single sex focus groups comprising a total of 25 female and 23 male pupils aged 13–16 years conducted in schools in Central England. Results Attitudes to emergency contraception (EC) were mainly positive about 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. Conclusions 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. Further research should apply quantitative TPB measures to EC use in a wider teenage sample in order to identify potential psychological factors to target in an intervention.

Survey evaluation of the National Patient Safety Agency’s Root Cause Analysis training programme in England and Wales: knowledge, beliefs and reported practices

Background: Root Cause Analysis (RCA) is a systematic approach to investigations, and is applied in many healthcare settings within comprehensive patient safety systems. The National Patient Safety Agency (NPSA) in England and Wales commissioned a survey evaluation of its national training programme which consisted of 3-day workshops and internet support materials. Methods: Anonymous survey of 374 health professionals immediately after they attended the programme (T1), and a further 350 participants 6 months after the programme (T 2), who had attended courses in England and Wales in 2005. Results: T1 knowledge tests showed a greater understanding of the frameworks and techniques of RCA but with less accuracy in application to scenarios. Personal beliefs about conducting RCAs were consistently positive at both times, but many participants experienced personal barriers to conducting RCA in their current role and trust context, and some felt low confidence in undertaking cascade training of other staff in their trust. There was also low confidence in implementing RCA as standard practice at both times. At T2, 76.7% were confident the outcomes from their RCA had been implemented, but only 12.1% were aware if improvements had been shared outside the local organisation. Barriers to RCA at both times most often concerned time and resources to apply RCA. At T1, there was particular concern for personal development, at T2 greater concern for organisational impediments. Conclusions: The RCA programme enhanced knowledge of RCA, and participants valued the programme, but further personal development and organisational support are required to achieve continued improvement in practice and sustained organisational learning.

Exploring attitudes and practices of General Practice staff towards offers of opportunistic screening for chlamydia: a UK survey

AIM This study applied a theory-based questionnaire to examine the behaviours and beliefs of all practice staff who may be involved in offering chlamydia screens to young people aged 15-25 years old. We aimed to identify potential influencing factors and examine the organisational constraints, which may be amenable to change. BACKGROUND The National Chlamydia Screening Programme offers opportunistic screening to men and women between 15 and 25 years old who have ever had sexual intercourse and primary care is the second largest source of screens. In England 15.9% of the target group were screened against a target of 17% in 2008. Interventions to improve the frequency of offers have shown effects with volunteer practices. METHODS A survey of 85 General Practices was completed by 55 doctors, nurses and receptionists. Interviews were conducted with 12 staff from three practices. FINDINGS Respondents were unable to identify the national screening target. Only half record if a patient is sexually active. Half the sample had some recollection of the frequency of offers they made, with a mean of 4 per month. These were predominantly in consultations concerning sexual health. Perceived social norms are favourable to screening and respondents have strong perceived control over offering screens, including to those under 16 who are sexually active. Attitudes towards screening were positive but disadvantages and barriers related to increased pressure on practice resources for longer consultations and contact tracing. There were no differences in beliefs and practice behaviours between medical and nursing staff. CONCLUSIONS Future interventions should be targeted at increasing the range of consultations in which offers are made, demonstrating how to make offers without increasing consultation time, providing more complete records of sexual activity, screens and results, and encouraging audit and review within the practice to promote practice wide approaches to increasing opportunistic screening.

“What Should We Tell the Children About Relationships and Sex?”©: Development of a Program for Parents Using Intervention Mapping

This article describes the development of an intervention that aims to increase the quantity and quality of parent—child communication about sex and relationships. The intervention has been designed as part of a local strategic approach to teenage pregnancy and sexual health. The process and findings of Intervention Mapping (IM), a tool for the development of theory-and evidence-based interventions, are presented. The process involves a detailed assessment of the difficulties parents experience in communicating with their children about sex and relationships. The findings are translated into program and change objectives that specify what parents need to do to improve their communication. Theory-based practical strategies most likely to bring about the desired behavioral change are then identified and pretested. The intervention developed consists of a six-session facilitator-led program that targets parents’ attitudes, knowledge, communication skills, and self-efficacy. Following on from Bartholomew’s seminal work on IM, this article develops and extends the application of this process by presenting explicit detail on the behavioral change techniques used and their theoretical underpinnings. The strengths and weaknesses of IM as a process for the development of health behavior interventions are discussed.

Young women's experience of termination and miscarriage: A qualitative study

In Britain, teenage pregnancy is seen as both a cause and a consequence of social exclusion. The emphasis on ‘prevention’ of teenage pregnancy and a limited conception of ‘support’ within the Teenage Pregnancy Strategy (Social Exclusion Unit, ) positions parenthood for young people as a negative choice; this dominant discourse is likely to influence young peoples reproductive decisions and experiences. With this in mind, this article focuses on a key finding from a multidisciplinary empirical research study, conducted in a city in the West Midlands of England, which considered and explored young peoples experience of support before and following termination and miscarriage. Data were collected via in-depth interviews with professionals and practitioners (n = 15), young mothers (n = 4) and one young father. Although termination and miscarriage are generally perceived as distinct and different issues, the data suggest that the issues become more blurred where younger women are concerned. The experiences of young, ‘inappropriately pregnant teenagers’ often remain unacknowledged and devalued. This analysis highlights the social and political context in which young women experience termination and miscarriage, and suggests that termination and miscarriage should be acknowledged as significant medical, social and emotional events in the lives of young people.

Development of an intervention to increase sexual health service uptake by young people

This study aimed to develop and implement an intervention, delivered via a website and Web app, to increase the uptake of sexual health services by young people. The intervention was co-designed with a group of 10 young people. Intervention mapping was used to guide development. To identify barriers and facilitators of access to sexual health services, three focus groups with 24 young people aged 13 to 19 years, and interviews with 12 professionals recruited from across a range of health and social services, were conducted. Data were analyzed using content analysis. Evidence was supplemented through a literature review. Barriers and facilitators were categorized as theoretical determinants and then suitable behavior change techniques (BCTs) for targeting them were selected. Targeted determinants were attitude, subjective norm, perceived behavioral control, and knowledge. Selected BCTs included “information about others’ approval,” “framing/reframing,” and “credible source.” The website/app enable users to search for services, access key information about them, watch videos about what to expect, and have key concerns removed/addressed. This is the first known digital evidence-based intervention to target this behavior described in the literature. A clear and full description of intervention development and content, including of theorized causal pathways, is provided to aid interpretation of future outcome evaluations.

Developing the evidence- base for gender- and age-relevant school sex education: Questionnaire findings from an adolescent sample using an augmented theory of planned behaviour

BACKGROUND Positive adolescent sexual health is supported by effective school-based sex education. Methods to promote positive sexual health need to reflect determinants of contraception intention, which must include understanding gender and age (year group) differences. To date, there has been limited theory-based exploration of these determinants in school age participants, placing limitations on sexual health educators to tailor learning most effectively. METHODS Cross-sectional survey data were collected from UK school pupils (n=1378) aged 12-16 years. Measures included theory of planned behaviour, prototype willingness, anticipated regret and knowledge items. Linear regression determined significant predictors of intention to use condoms, the oral contraceptive pill and emergency contraception (EC). The significance of differences by gender and school year was evaluated using t-tests and analysis of variance (ANOVA). RESULTS Three distinct predictive models emerged for condom, pill and EC use, predicting 36%, 18% and 23% of variance respectively. Attitude, gender and anticipated regret for unprotected sex significantly predicted intention for all types of contraception (P<0.001). The effects of other explanatory variables differed by contraceptive. Girls scored higher on all variables except condom intention, and intention scores peaked in Year 10. CONCLUSION Intention to use condoms, the pill and EC have different predictive profiles, with girls more strongly motivated and Year 10 a crucial stage for intention. Social comparisons and control beliefs exert different effects across contraceptive types, whereas attitudes and anticipated regret are consistently strong influences. The findings suggest clear scope for supporting sexual health and well being through modified school sex education.

Strategies for the management and adoption of impact capture processes within research information management systems

Following the 2014 UK Research Excellence Framework (REF), attention across the Higher Education sector is turning to embedding impact measurement within the organisation. Impact is defined as the social, financial and environmental effects of research. Planning and capturing impact however is a difficult and resource-intensive activity, demanding both strategic commitment and infrastructure support. A means to systematically capture and monitor impact across the organisation is crucial to continued research success. In addition, with impact data capture as an emerging practice, there is the opportunity and necessity for a degree of standardisation in the approach to measuring impact across HEIs. Vertigo Ventures, an impact measurement consultancy, has been using and expanding its tool- VV-Impact Metrics with UK universities to support assessments by identifying impact pathways, impact indicators, evidence collection and analysis to improve the quality of the evidence and narrative. Vertigo Ventures has been working with Coventry University to use its VV-Impact Metrics tool in their self-service module (ERIC) to create a systematised data capture platform that can be readily used by the academic community to input data. This paper discusses the experience and learning from the process of embedding a solution institutionally.

Building the Concept of Research Impact Literacy

Impact is an increasingly significant part of academia internationally, both in centralised assessment processes (for example, UK) and funder drives towards knowledge mobilisation (for example, Canada). However, narrowly focused measurement-centric approaches can encourage short-termism, and assessment paradigms can overlook the scale of effort needed to convert research into effect. With no ‘one size fits all’ template possible for impact, it is essential that the ability to comprehend and critically assess impact is strengthened within the research sector. In this paper we reflect on these challenges and offer the concept of impact literacy as a means to support impact at both individual and institutional levels. Opportunities to improve impact literacy are also discussed.

Development of a framework for knowledge mobilisation and impact competencies

For research to translate into impact, knowledge must be effectively mobilised beyond the academic domain. However, there is little consensus on the competencies (skills) required. This paper describes the development of a competency framework. Four existing knowledge broker frameworks were synthesised through a process of (1) extraction, (2) categorisation, (3) cleaning and (4) re-categorisation. A final set of 80 distinct, actively-phrased competencies in 11 categories was produced. This paper provides the first comprehensive framework for professional competences for impact beyond commercialisation. The potential applications, implications for competencies and associated competence alongside further research are discussed