Thesis

Constructing models of alcohol and sexual health literacy in adolescence.

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Abstract

In the UK, research has highlighted the need for improved education in alcohol and sexual health in the adolescent population. Consequently, Relationships and Sex Education and Health Education were made compulsory in 2019. However, preceding research highlighted that school-based alcohol and sexual health education was ill-suited to building associated health skills and competencies. Health literacy as a concept aims to address these issues by providing a framework within which health related competencies and outcomes can be developed. Consequently, the aim of this research was to develop models of alcohol and sexual health literacy in adolescents and further interrogate the use of such models in education, exploring the barriers to developing alcohol and sexual health literacy in adolescents though formal education. A pragmatic, mixed methods approach was utilised to explore the research questions. The study contributed to the field of research by creating robust, theory-based models of alcohol and sexual health literacy and discovering the following: • Current measures of adolescent health literacy are poorly designed, often only accounting for functional health literacy. • There are many barriers that need to be overcome to effectively deliver alcohol and sexual health education in schools, specifically, that competencies in alcohol and sexual health are perceived as challenging to teach and measure within a school setting. • Internationally, curriculum guidelines tend to focus on the risks associated with alcohol and sexual health and fall short in building competencies over knowledge and in aiding educators with instruction. • Introduction of compulsory Relationships and Sexual Health Education and Health Education in the UK will have little significant impact if it is not supported with more training and support for educators. These findings and the models produced have significant connotations for the design and delivery of alcohol and sexual health education in schools.

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Aim The aim of this study was to explore the role and activities of the school nursing service in sexual health within a large inner London borough. Background School nurses (SNs) are specialist community public health nurses working with the school age population to promote their health and well-being and therefore are arguably in a prime position to promote the sexual health of children and young people. This is particularly pertinent in inner city boroughs where the rates of sexually transmitted infections and under-18 conceptions are a significant problem. Methods Following a review of the literature, a mixed methods study was undertaken which included an audit of documentary data to identify the referrals received in relation to sexual health and also included questionnaire surveys of school staff and SNs on their views of the role of the SN in sexual health. Findings SNs and school staff identified that SNs have a role in sexual health, which was reflected in the referrals received during the audit of documentary data. There appeared to be inconsistencies across the service and evidence suggested that the school nursing service may be underutilised in comparison to the number of students who require sexual health support. The current service appears to be predominantly reactive, particularly for males and those less than 12 years old. However, both SNs and school staff would like to see a more preventative approach; including greater sexual health promotion, condom distribution and school health clinics.
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This chapter introduces Abductive Thematic Network Analysis (ATNA) as a methodological approach for qualitative data analysis. It starts by providing a brief description on abductive theory of method and thematic analysis method. Then, it highlights how the two methods are combined to create ATNA. Using a qualitative data set, this chapter demonstrates the steps in undertaking ATNA with a computer-aided qualitative data analysis software—ATLAS-ti v.7.5. The chapter concludes that ATNA provides to researchers a much-needed pragmatic and logical way of reasoning, organising, and presenting qualitative data analysis.
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Objective: Per-capita alcohol consumption in Australia increased between 2001 and 2007 and has subsequently declined, particularly for young people over this period. We examine trends in general attitudes to alcohol and to perceptions of risk from alcohol consumption to assess whether consumption trends have been mirrored by changing ideas about alcohol. We also examine whether trends in attitudes vary across sociodemographic subgroups. Method: Data are from the National Drug Strategy Household Survey (n = 127,916), 2001-2013. To examine trends in attitudes to alcohol and perceptions of risk related to alcohol, logistic regression was used to assess changes over time, with interaction analyses used to explore whether changing attitudes have been consistent across sociodemographic subgroups. Results: There were statistically significant increases in the percentage of the population naming excessive alcohol consumption as the most serious drug problem in Australia (22.6% in 2001 to 43.6% in 2013, p < .001), naming alcohol as the drug that causes the most deaths (22.7% in 2001 to 34.2% in 2013, p < .001), and suggesting thresholds for low-risk drinking below two drinks per day for men (22.4% in 2001 to 33.0% in 2013, p < .001) and women (54.4% in 2001 to 64.8% in 2013, p < .001). These trends were consistent across all sociodemographic subgroups. Conclusions: Australian attitudes to alcohol became more conservative between 2001 and 2013. These trends may partly explain the decline in youth drinking observed over the same period, with young people's consumption potentially more likely to be affected by growing social concern about alcohol, although shifts in attitudes occurred even while consumption was increasing.
Article
Prospero registration number: Although we attempted to register our protocol with PROSPERO, we did not meet eligibility criteria because we were past the data collection phase. The full PROSPERO-aligned protocol is available from the authors.
Article
Governments around the world have adopted national policies and programs to improve health literacy. This paper examines progress in the development of evidence to support these policies from interventions to improve health literacy among community populations. Our review found only a limited number of studies (n=7) that met the criteria for inclusion, with many more influenced by the concept of health literacy but not using it in the design and evaluation. Those included were diverse in setting, population and intended outcomes. All included educational strategies to develop functional health literacy, and a majority designed to improve interactive or critical health literacy skills. Several papers were excluded because they described a protocol for an intervention, but not results, indicating that our review may be early in a cycle of activity in community intervention research. The review methodology may not have captured all relevant studies, but it provides a clear message that the academic interest and attractive rhetoric surrounding health literacy needs to be tested more systematically through intervention experimentation in a wide range of populations using valid and reliable measurement tools. The distinctive influence of the concept of health literacy on the purpose and methodologies of health education and communication is not reflected in many reported interventions at present. Evidence to support the implementation of national policies and programs, and the intervention tools required by community practitioners are not emerging as quickly as needed. This should be addressed as a matter of priority by research funding agencies.
Article
Cuts to sexual health services in parts of England are placing the care of patients at risk, a new report has warned. The research by the healthcare think tank the King’s Fund concluded that budget cuts of more than 20% to genitourinary medicine (GUM) services in some parts of the country had led to service closures and staffing cuts that have harmed patient care.1 Experts said that the findings were particularly worrying given that numbers of diagnoses of sexually transmitted infections such as syphilis and gonorrhoea were rising. Current pressures on services were also having a negative effect on staff morale and leading some staff to consider alternative careers, the report warned. The researchers analysed data and interviewed frontline staff to examine the effect of funding pressure on patient care across four service areas: GUM, district nursing, elective hip replacements, and neonatal care (box). Their findings indicated that sexual health and district nursing had been hardest hit, which the researchers said undermined the vision set out in NHS England’s Five Year Forward View to strengthen prevention and community based services. The authors said that sexual health services such as GUM had become more prone to budgetary cuts since moving from the NHS to local government, because of local authorities’ legal obligation to balance their books. Authorities’ overall spending on GUM across England fell by 3.5% between 2014-15 and 2015-16. But within this there was substantial variation: around a quarter (36) of the local authorities cut spending on GUM by more than 20% between 2013-14 …
Article
Background Health risk behaviours are prominent in late adolescence and young adulthood, yet UK population-level research examining the relationship between drug or alcohol use and sexual health and behaviour among young people is scarce, despite public health calls for an integrated approach to health improvement. Our objective was to further our understanding of the scale of and nature of any such relationship, using contemporary data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Methods Analyses of data from Natsal-3, a stratified probability survey of 15 162 men and women (3869 aged 16–24 years), undertaken in 2010–2012, using computer-assisted personal interviewing, were carried out. Logistic regression was used to explore associations between reporting (1) frequent binge drinking (≥weekly), (2) recent drug use (within past 4 weeks) or (3) multiple (both types of) substance use, and key sexual risk behaviours and adverse sexual health outcomes. We then examined the sociodemographic profile, health behaviours and attitudes reported by ‘risky’ young people, defined as those reporting ≥1 type of substance use plus non-condom use at first sex with ≥1 new partner(s), last year. Results Men and women reporting frequent binge drinking or recent drug use were more likely to report: unprotected first sex with ≥1 new partner(s), last year; first sex with their last partner after only recently meeting; emergency contraception use (last year) and sexually transmitted infection diagnosis/es (past 5 years). Associations with sexual risk were frequently stronger for those reporting multiple substance use, particularly among men. The profile of ‘risky’ young people differed from that of other 16–24 years old. Conclusions In this nationally representative study, substance use was strongly associated with sexual risk and adverse sexual health outcomes among young people. Qualitative or event-level research is needed to examine the context and motivations behind these associations to inform joined-up interventions to address these inter-related behaviours.
Article
Despite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participants’ knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness. Methods Thirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence. Results Thirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies. Conclusions There is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the serious consequences of high-risk sexual behaviors, there is an urgent need for well-designed UK based trials, as well as training and support for staff implementing sexual health risk reduction interventions.
Article
The Every Teacher Project involved large-scale survey research conducted to identify the beliefs, perspectives, and practices of Kindergarten to Grade 12 educators in Canadian public schools regarding lesbian, gay, bisexual, transgender, and queer (LGBTQ)–inclusive education. Comparisons are made between LGBTQ and cisgender heterosexual participants, between participants teaching at different grade levels, and between participants in school districts with and without antihomophobia and antitransphobia harassment policies. The authors present an analysis of the findings framed in terms of problematic gaps between educators' beliefs, perceptions, and practices. These gaps are considered in light of emerging best practices in LGBTQ-inclusive education that have been developed to improve school climates for all students, and especially for sexual and gender minority students, students with sexual and gender minority parents and other loved ones, and indeed any students who are negatively affected by homophobic, transphobic, and heteronormative school climates.
Article
School nurse contacts provide an opportunity for interventions with children, yet evidence suggests that there is limited evaluation of the outcomes of these interventions. This review of the literature explored the impact of school nurse interventions relating to mental health and behaviour change. A total of 29 papers were included in the review. Analysis revealed positive outcomes for young people including increased access and engagement with services, improved levels of stress and anxiety and behaviour change relating to lifestyle issues. School nurses were viewed as unique professionals with effective communication and interpersonal skills supported by training and service delivery methods. There were also benefits for schools in developing supportive environments and improved pupil attendance. A number of gaps and barriers relating to intervention delivery and evaluation were also revealed; there was a need for improved education and training for school nurses and challenges to service delivery were described pertaining to working with other services and professionals. A variety of evaluation methods were used to identify outcomes, including qualitative and quantitative methods and standardised tools. However, the majority of papers described outcomes without reference to a systematic approach to evaluation. Evaluation and measurement of school nurse practice is a valuable activity and school nurse teams need to ensure robust methods for evaluation are established to demonstrate outcomes and develop practice.
Article
Overwhelmingly, school-based sexuality education programmes focus on the prevention of infection, pregnancy and abuse, with little if any attention given to positive views of sexuality and rarely the inclusion of sex positive issues such as pleasure, intimacy and desire. This paper explores the experience of teaching about pleasure to pre-service health and physical education teachers as part of compulsory studies in a unit on sexuality education designed to prepare them to teach sexuality education in secondary schools. Drawing on the aims, theoretical framework, content and pedagogical structure of the unit, and data collected from 42, third-year pre-service teachers (PST) in Australia via surveys and student assessment, the paper provides some practical examples of what teaching about pleasure might look like in practice. It argues that with adequate preparation, a framework to celebrate sex and sexuality, a gender lens to examine normative discourses, and the opportunity for reflection, PST can develop the confidence, skill and willingness to include pedagogies of pleasure in their school-based work.
Article
The average one-year health expenditure per capita in the European member states has doubled in the last 15 years. Prevention is less expensive than treatment, and changes in diet and lifestyle remain the most effective way to reduce the financial health care costs. However, European health systems are primarily treatment systems, not preventive systems. Improper diet and lack of physical activity are the most critical factors contributing to the overweight and obesity pandemic. Along with heavy alcohol consumption and smoking, these four factors contribute the most to the development of chronic non-communicable diseases. These diseases kill more than 36 million people worldwide annually, with more than 9,000,000 deaths occurring before the sixtieth year of life. In 2008, The Czech Republic government responded to the deteriorating financial health care situation by installing fees for medical services. In 2004, the Czech Republic Government utilized preventive services by introducing the new educational field of Health Education to the public school curriculum for pre-school, primary, and secondary education. The fundamental role of the Health Education Curriculum is performed through primary education (the only required stage of education for all Czech students). Nutrition Education is a necessary tool in shaping lifelong positive behaviors of students, leading to actively promoting and maintaining health. Nutrition Education is delivered through the Expected Outcomes and Prescribed Curriculum, which are mandatory for the implementation in Czech schools. Czech educators gained the freedom as well as responsibility to determine how to meet the prescribed curriculum.