COI for LB of Wandsworth Social Marketing: Formative Research towards

1. COI for LB of Wandsworth Social Marketing: Formative Research towards Interventions in Teen Pregnancy Full Deck: July 2009 Define Research & Insight Ltd, Colton House, Princes Avenue, London N3 2DB T: 020 8346 7171, Fax: 020 8883 4111, www.defineinsight.co.uk VAT No 713 9062 46, Registered in England No. 331602

2. Structure of this Document • Introduction • Background • Project Context • Formative Research Objectives • Formative Research Considerations • Formative Method Overview • Formative Method in Detail • Formative Sample • Findings • Fit with National Segmentation • Wandsworth girls • Key Influencing Points to consider • Intervention Themes in Overview • Intervention Ideas in Detail • Conclusions • Summary • Recommendations London Aerial Photograph: Astronaut Photography: NASA Wandsworth Borough Map: Ward Boundaries – Wandsworth Council

3. ‘It is hard to say no when a boy tells you that you are beautiful and you feel like you are in love and they want to have sex. Alexandra, 16-17, Wandsworth 2009

4. 1. Introduction

5. 1i. Background • An unexpected rise in teen pregnancy (latest data 2006) has caused concern and raised queries. • Wandsworth PCT has identified the reduction of teenage pregnancy as a priority area where a Social Marketing approach could improve effectiveness of PCT communication/intervention programmes • A project was set up to enable a thorough foundation to a Social Marketing approach to be created: research, audience insight and stakeholder input would be combined and a route forwards for activity would be delivered • A key focus for the project was the transfer of Social Marketing insights to the programme team for future use Overall, Wandsworth PCT seeks to get a better understanding of the at-risk groups and the communication/intervention approaches that offer the best chance of reducing incidence of teenage pregnancies in the borough

6. 1ii. Project Context • Extensive work by Wandsworth Borough and COI was undertaken to provide a firm platform for insights. Two initial phases of research (conducted by COI) lead to a third, commissioned phase from Define Research and Insight. • 1) An initial scoping exercise using desk research • Review of international and national research/interventions • Analysing existing Wandsworth data, (statistics and demographic information) to build a picture of teen pregnancy in the borough of Wandsworth • Exploration the DCSF national segmentation of Children for Wandworth-relevant information • 2) A programme of Stakeholder (service provider) interviews • To understand from the stakeholder perspective what might – or might not – be appropriate intervention in this Social Marketing arena 3) The final phase in the project was a formative research piece with target audience, commissioned to develop ideas and to deliver insight which might be built upon to address the project objectives

7. 1iii. Formative Research Objectives • The third phase of the project will need to inform future PCT commissioning of teenage pregnancy services and interventions. In addition, PCT confidence in the national segmentation work (DCSF) will need to be founded in the data. • To that end, the qualitative research methodology will need to work through a number of particular and challenging goals: • explore and validate key segmentation behaviours and attitudes with the target audience, and understand any differences • place interventions in front of target audience and allow them to own and develop those interventions • invite the target audience to identify key media routes (for themselves and others) and pinpoint where and how interventions will have greatest effectiveness in turning the tide against teen pregnancy Overall Objectives: To deliver clarity on the types of local interventions that have the ability to lead key target groups (girls aged 14-18) toward behaviour change Establish how one might engage with key target groups to signpost the appropriate interventions; through what channels?

8. 1iv. Formative Research Considerations • Researching the subject of sexual activity, sexual health, contraception and pregnancy with young teens is a challenge • There are a number of research effects in formative work with this target audience which need to be understood and mitigated against • Embarrassment (subject matter) in front of adult researchers • Willingness to please and to provide the ‘right answers’ • Interest in making the research process as short as possible in order to escape difficult questions • Fear of shocking the adult researcher (through using wrong vocabulary) • Hot-housed and facilitated respondents delivering data which is not applicable to the general population • Failing to account for and access the ‘social support effect’ of the young person’s network The methodology to address the issues and to access the appropriate level of rigorous, valid and reliable data is a challenge. Define proposes a multi-layered methodology which uses time away from the respondents to maximise the time spent with respondents (and the data emerging from both)

9. 1iv. Formative Research Considerations (cont’d) • From the DCSF national segmentation work, two segments were identified as being of particularly high risk for teen pregnancy across the UK • These two segments have been named (Jasmine and Alexandra) for ease of reference – they are not intended to refer to any real individual • Older Teen • Vulnerable • Sexually active • Not engaged • with school • Rebellious and social Alexandras • Younger Teen • Vulnerable • Not (regularly) • sexually active • (Currently) engaged • with school Jasmines High levels of conflicted relationships Social class DE Low family cohesion Including dual heritage* Low confidence, low self-esteem Low self-concept as confident (sexual) being Recruitment needed to take account of these two segments and to find a way to include individuals from two areas of high deprivation within the borough boundaries (Latchmere and Roehampton) where risk was felt to be highest * Thanks are due to Shirley Wiggins of Wandsworth for help and advice around the issue of mono- and dual-heritage cultural experiences amongst Wandsworth’s UK/Caribbean young people

10. 1iv. Formative Research Considerations (cont’d) • To ensure comfort and confidence amongst respondents • Jasmines and Alexandras were researched separately • Respondents were recruited in friendship pairs • Research was conducted outside of the individual’s immediate environs (in a central Wandsworth location) • Ages were split (Jasmines 14-15 and Alexandras 16-17) • To ensure good spread of ethnic background • Key respondents were recruited by ethnic background (white British, Black Caribbean/Black British-Caribbean, dual heritage of above) • Friends were not recruited by ethnic background • To fit with budgetary constraints • Pairs from the two locations across Wandsworth were mixed within a research group • Ultimately, this proved to be an inappropriate step to take since it affected dynamics and respondent confidence • Define had to continue the research in smaller location-specific units with the younger respondents

11. 1v. Formative Method Overview • The methodology was layered with 3 targets in groups of 6 respondents • (Target 1: Jasmines, Target 2: Alexandras, Target 3: Year 11 girls) • Target 1 and 2 Facebook: • respondents familiarise themselves (at a distance from adult researcher) with the subject before face-to-face research groups • Target 1 and 2 Creative Workshop: • a creative workshop on developing and shaping ideas for sexual health and contraception interventions with the adult researcher present • Target 1,2,3: Peer Questionnaire: • main interventions explored by Workshop 1 respondents with peers away from adult researcher. Feedback captured in simple tickbox questions • Target 3: • Year 11 Panel to give feedback on emerging ideas and to check that interventions aimed at at-risk individuals could also mainstream • Target 1 and 2 Communications Workshop: • designed to look at communications’ routes for information • with adult researcher present

12. 1v. Formative Method Overview (cont’d) Jasmines Alexandras Creative Workhops: Jasmines/Alexandras Immediate Network: questionnaire Year 11 Panel Communications Workshops: Jasmines/Alexandras

13. 1vi. Formative Method in Detail (Facebook) • Two groups were set up – one for each of the target audiences • The Facebook was set up by one of the research moderators as a “secret group.” The group did not appear in search results or in the profiles of its members. Membership was invitation only, and only members would be able to see the group information and content. • A series of discussion topics, questions and stimulus was posted on the group page, allowing comments and responses to run over the course of the project • Content on the group included: • Discussion about condom use • Discussion about pregnancy statistics for the borough • Links to BBC article on teen pregnancy • Links to the ‘Want Respect’ campaign and adverts • Copies of the questionnaires • Reminders about the face-to-face groups • Resources links • The group allowed respondents to get familiar with the subject matter before coming to the group and giving them the opportunity to feel more in control of the situation and prepared for the discussion.

14. 1vi. Facebook Stage (cont’d) Learnings: Online methodology works as part of slow burn methodology • Useful in introducing the subject to the girls and allowing them to get to grips with the topic before having to talk about it. • Some girls prefer to watch rather than actively participate which enables them to stay within their comfort zone and observe activity. • For the girls who do have internet access, this is not a big part of their lives so getting online regularly is not a priority. The older girls are more open to internet use. • Some fears about internet history and sporadic access to internet and other issues around poor retention of information and inability to put information into practice • Need to be shown and told how to do things multiple times before they are able to do it by themselves, which meant use of the group increased after the first face-to-face meeting

15. 1vi. Formative Method in Detail (Creative Workshops) • Respondents were invited to work through ‘clocks’ of each of the proposed intervention areas, to answer questions and to find ways of improving their current experience in these areas • Where they had no experience, for example not all the girls had visited sexual health clinics before, they were invited to develop best idea from their imagination or from other areas that they were familiar with Example of clock stimulus

16. 1vi. Creative Workshop Stage (cont’d i) Learnings from workshop methodology: • Useful in engaging young girls with subject matter • Important to allow girls to own interventions by “creating them from scratch” • Giving some structure and a way of ensuring that client questions were included without making the discussion guide too dense for the respondents • Allowed maximum flexibility for girls to merge ideas across the interventions

17. 1vi. Creative Workshop Stage (cont’d ii) • Some of the younger respondents struggled to think beyond their own experience • Noticeably, the girls struggled to hold information, and to think strategically • Some of the younger girls were very uncreative and significantly lacked confidence to invent even to the extent of struggling to think of improvements to known everyday services, let alone sexual health services they had not accessed. • Being able to represent the fledgling ideas back to the girls in the questionnaire, and Workshop 2 helped them to build • Between stages, the research team were able to analyse data and to build ideas with the mainstream Panel and the older Alexandras • Being able to represent ideas with this level of input helped the ideas to develop fully.

18. 1vii. Formative Sample • 4 x Jasmine friendship pairs (14-15) – including white, Caribbean and dual heritage girls), drawn from Latchmere and Roehampton urban centres • 3 x Alexandra friendship pairs (16-17) – including white, Caribbean and dual heritage girls), drawn from Latchmere and Roehampton urban centres • 6 x Year 11 Panel females including spread of backgrounds, drawn from Central Wandsworth urban centre • Plus, approximately 20 additional responses from peers interviewed through questionnaires Formative work took place June 2009

19. 2. Findings

20. 2i. Fit with National Segmentation • National segments seems to hold in Wandsworth • Jasmines and Alexandras found with little initial difficulty • Through youth workers, Connexions, in-street recruitment and peer-to-peer recruitment • Part of their characteristics made researching them a specific challenge: they find it difficult to organise themselves in the world and were late to research groups in several instances • Jasmine and Alexandra groups have distinct identities • But tend to merge into each other to a large extent (i.e. Jasmines become Alexandras as they gain in confidence and as they come to rely more on their peers than their parents) • Jasmines (younger but up to 16) – passive and are still very concerned about impression they are making on adults still – especially teachers • Jasmines not sexually active (as far as could be established) • Alexandras (older but can be as young as 14) much less connected to adult approval of them • Parents finding control over ‘teen sexual activity’ difficult: cause of some disagreement and friction (increasing disconnection of parent-child bond leads Alexandra to connect and be influenced more by peers) • Alexandras reporting that they are/have been/would be likely to be sexually active in the near future and some have visited clinics “Adult impression management” strongly influences interventions

21. 2ii. Wandsworth Girls • A number of key characteristics about the way that the Wandsworth girls live and operate in their lives merit attention • In evaluating the interventions (see section on Interventions later in this document), it is important to retain data from the following themes. Not all respondents report all of these experiences, but where they do, light may be shed on the target audience’s attitudes and behaviour related to teen pregnancy: Home and family life Other adult influences Male-female relationships Money and work Self-protection

22. 2ii. Wandsworth Girls: Home and Family Life • HOMES - Safety and greatest comfort is behind closed front door • Several living in high-rise urban blocks: concrete stairwells, lifts (which don’t always work), urine in staircases, windows smashed • Several of respondents’ homes (those seen by accident by research team) in disarray, dirty, lacking plaster, graffiti on walls = deprivation at an extreme level, but living-room as a “nest” with plasma screen, big leather sofas, family photos • FAMILY -Mothering fitting in around everything else • Eldest siblings having children concurrently as matriarch continues family – often wide spread of ages across children, 26yrs – 6 months) • Responsibility for parenting can devolve (to grandparents, adult siblings, oldest children, friends). Some mums not awake in daytime; mothering a flexible experience. • FATHERS-Male as sexual partner separate from male as parent • Biological fathers – several absent or present but not parenting • Other males temporarily in homes as mother’s partner (but not assuming parenting responsibilities) • Some non-partner males in “sporadic” parenting roles • Teen girls not thinking in terms of waiting to find life-partner: sex is natural next step in every relationship (however short-term) Home and family life

23. 2ii. Wandsworth Girls: From this Theme • Safety and greatest comfort behind a closed front door - living room as ‘nest’ for family against the world • Mothering fitting in round everything else – a flexible experience • Males who are sexual partners are not necessarily fathers • Teen girls are not waiting to find a potential ‘father’ for their children; they are seeing sex as a natural step in every relationship, no matter how short-term • Identity still forming, but a clear pathway to a childfree young adulthood not easily seen (not mapped out or modelled). Pregnancy and ‘nesting’ = familiar. • Sexual activity is seen as natural part of relationship, and an expected next step, without formality of engagement, marriage or even long-term courtship. • Males chosen for their sexual attractiveness/seduction ability, rather than their partnership qualities (which means that ‘players*’ are more successful with the girls). Shorter-term relationships based on flirting and physicality offer little space to ‘talk seriously’ about contraception and sex. • Girls persuaded into unprotected sex in attempt to keep ‘player’ interested *player: term to encapsulate usu. Male who is very flirtatious, sexually promiscuous, often with several current partnerships or ‘a love them and leave them’ approach to females. Often self-identity built on being a “charmer” within own family

24. 2ii. Wandsworth Girls: Other Adult Influences • NEIGHBOURS- Little experience of ‘bridging divide with stranger’ • No public conversation with strangers: some of those in immediate proximity may pose threat (substance abuse visible). Multi-ethnic environment (segregation by dress and language) so little social interaction opportunity = ‘stick with those you know’ • SCHOOL and TEACHERS -School self and Real self operating by different rules • School and home environment are separate islands (physically, visually, in ethos), offering different expectations of girls (ordered, on-time, focused, open to experience). Messages about sex not followed by girls’ parents, let alone girls themselves. • Several focusing on reproductive biology instruction rather than contraception and sex/relationship education • PROFESSIONALS WORKING WITH YOUNG PEOPLE - Perceived to be possible route to sexual health help • School nurse seen to socialise with teachers, so a risk to confide • Jasmines, in particular, at pains to manage adult perceptions; anxious to please and aware of how things might appear – may not to reveal to those she wants to stay close to • BUT some strong connections and freebies given by Youth programmes are retained Other adult influences

25. 2ii. Wandsworth Girls: From this Theme • Little experience of bridging divide with stranger: no public conversations • Stick with those you know – don’t step outside of group • School self and Real self operating by different rules • Professionals perceived to be route to sexual health help • Jasmines may prefer not to self-reveal to those they want to remain close to • Girls find it hard to self-express, not used to opining and to sharing basic information about themselves and how they operate • Not easily able to ‘small-talk’ so powers of recovery (from an unexpected comment, question, joke or observation) not strong • Comfort zone very narrow and challenge to organise self as individual • Divide between school self and home self = very good at impression management; in conversation, scanning for clues that they’ve been “caught”, so not relaxed or confident of their legitimate place in the world • Professionals known to have information and resources they need

26. 2ii. Wandsworth Girls: Male-Female Relationships • ADULT ROLE MODELS - Seeing temporary nature of relationships, and multiple adult relationships without formalities • Not mentioning marriage and life-partnership as a goal • Very aware of television and media representations of romance, sexual attraction and sexual attractiveness – default setting if uncertain what to say to boy • Limited awareness or experience of conversation and partnership working in maintaining relationships. Where relationships are longer-term (in their experience) tending towards very gendered and traditional (separated lives and roles within same household) • BOYS-Males aggressive, useful, ever-present, sexually virile • Gang culture important feature of the girls’ lives • Network of males (brothers, cousins, boyfriends) to whom they are ‘attached’ and therefore protected by • Even where not overtly gang-connected, sense of being in a wider protection network (people who know people) • Boyfriend as way of gaining status: proof of attractiveness (amongst girl friends) and higher social status (in mixed group) • Often having sex with male in order to retain status – if refuse, will be dropped in favour of someone who will have sex • Multiple fatherings is sign of virility – “babymommas” a cause of pride and status for males (and females, within the peer context) Male-female relationships

27. 2ii. Wandsworth Girls: From this Theme • Seeing temporary nature of relationships, and multiple adult relationships without formalities • Very aware of television and media representations of romance, sexual attraction and sexual attractiveness – default setting • Males aggressive, useful, ever-present, sexually virile • Often having sex with male in order to retain status – if refuse, will be dropped in favour of someone who will have sex • Multiple fatherings is sign of virility – “babymommas” a cause of pride and status for males (and females, within the peer context) • Lacking ways of interacting with boyfriends without flirting/sexual content • Girls abused from early age through graphic language and denigratory imagery from sexually active male peers (videophones of sex acts passed round). • Exposure to very explicit information about other teens’ activity lowers normative benchmark • Some males very skilled at seduction moves, and girls wanting to believe: worst case scenario is not “getting pregnant”, it’s “not being wanted” or being too ugly to be found desirable, so sex is attempt to validate self-worth

28. 2ii. Wandsworth Girls: Work and Money Relationships • LACK OF MONEY - Resources very low • Limited money coming from adults around them and several mentioning that they themselves can’t find work (depressing) • General perception that there is nothing to do inside the borough; lack of money for transport if need to go outside (depressing) • Some girls connected via youth workers to very interesting things – prompted envy and aggression from girls who were not accessing this level of adult attention and energy (entrenched their resentment and negativity) • ASPIRATIONS-Fantasy and escapist aspirations; disconnected from need to strategise and take things step-by-step • Several talking about extreme lifestyle (rich and famous) but with limited connection to any work, effort, planning or thinking • Very high levels of confidence that these lifestyles were achievable, so low cognisance of need to be highly careful and cautiousto avoid getting pregnant (which they acknowledge could ruin their dreams) • Several of their mothers aggressively promoting abstinence and schoolwork (they were abandoned penniless as teen mums) - this closes the conversation about contraception altogether Money and work

29. 2ii. Wandsworth Girls: From this Theme • Resources very low, limited money • Depressing lack of work opportunities • Entrenched resentment and negativity • Fantasy and escapist aspirations; disconnected from need to strategise and take things step-by-step • Low cognisance of need to be highly careful and cautious abot pregnancy avoidance • Maternal attitude closes the conversation about contraception altogether • Girls spending lots of unstructured and unfocused time hanging around • Peer rules and mores are setting the norms for behaviour – adults are hardly present. • Boyfriends and sexual relationships a ‘free activity’ – can’t afford condoms • Main source of information is mother – from whom they are actively hiding sexual activity • No connection between goals and how to achieve them

30. 2ii. Wandsworth Girls: Self-Protection • AROUND OTHER GIRLS - envy, isolation and physical attack from allies a possibility • Female network an essential connection; somewhere to go, someone to talk to, a person to share experience with • Necessary for safety: moving outside of front room through the estate and to school. Gangs and connections very important to be aware of – accusation of ‘dissing’ (disrespecting) a real danger • Securing position important; at a lower level, through not ’breaking rank’, at a higher level, through retaining control of other girls via threats for those who don’t follow • Moralising about girls’ sexual activity is a simple way of maintaining superiority (“dirties” are those who go to sexual health clinics – they have something to be ashamed of) • AROUND ADULTS - Caution required • Awareness that they are not necessarily living mainstream lifestyle – some need to protect their family from ‘outsider’ view (be that criticism of the adults’ behaviour or of their own)>Better not to talk about anything ‘difficult’ • Also aware that – in case of sexual activity – their mothers will strongly disapprove. Needing to manage ‘secret’ activity and to hide (leading to a need to “self-deceive” in order to keep the story straight) Self-protection

31. 2ii. Wandsworth Girls: From this Theme • Envy, isolation and physical attack from allies a possibility • Securing position important; at a lower level, through not ’breaking rank’, at a higher level, through retaining control of other girls via threats for those who don’t follow • Moralising about girls’ sexual activity is a simple way of maintaining superiority (“dirties” are those who go to sexual health clinics – they have something to be ashamed of) • Caution required to protect family from ‘outsider’ view (be that criticism of the adults’ behaviour or of their own). Better not to talk about anything ‘difficult’ • Needing to manage ‘secret’ activity and to hide (leading to a need to “self-deceive” in order to keep the story straight) • .Time away from girl peers is difficult, and decisions to protect self have to be taken in a wider context (self-boundaries difficult to determine without female gang) • Adults seen as potentially liable to judge their family so a challenge to ;let them in’ • Pretence of not having sex means that the challenge of accessing sexual health information and kit needs to be approached very privately

32. 2iii. Key Influencing Points to Consider Closed front door mentality: valuing home information over ‘official’ information and adult role models at odds with SRE Official information not focused on ‘sperm avoidance’ – especially in church schools, more about ‘baby annoyance’ which girls cannot work backwards from Boys an important currency and boyfriends a free activity Approaching people about the subject of pregnancy is a challenge Sexual activity Without caution Boys aggressively pushing for and asking for sex and seeking self-validation through conquest: widespread impression that many girls having sex Contraception– totally private access impossible and EHC myths abounding over ID needed, payment, parental permission and informing Very low capacity to organise self and to deal with complexities of new activities (getting to and from clinics, making appointments very difficult) Girls (especially dual heritage and white girls) having very few self-valuing markers that they can hold onto; wanting to believe romantic sales pitch

33. 2iii. Key Influencing Points: Following Rules ‘Alcohol is often used as an excuse to justify sex’. Alexandra, 16-17 • Strong gendered rules about girls and sex • Partly religious-based • Partly based in reputation management from families who are trying to prevent history repeating itself in some way • Over and above gendered rules, there are also substance “rules” • Using alcohol as excuse to have sex or to act in a way that might be ‘out of character’ • Acting drunk means you cannot then ask for condoms • No routes through which to safely gain access to the definitive answer on any given question • Peer-led enquiry often results in wrong answers • Most dramatic answers are best ‘value’ for conversation – but not necessarily accurate We have never had any lessons about sex. We talked about periods and stuff. They say you can only have sex in a loving committed relationship. Jasmine 14-15

34. 2iii: Key Influencing Points to consider: Contraception • Girls not using contraception • Moralising (dirties and undercovers = girls who have sex and go to clinics!) • Many talk of condoms splitting (not aware of ‘female readiness’ necessary for sexual activity) – combined with difficulties in accessing, seen as very unreliable • Pill preferred (symbolises greater trust in boyfriend – but harder to use regularly than condoms because needs to be hidden, so forgotten) • No access to morning after pill (perceived) ‘There are undercovers, they are girls who do nasty things but they never say anything about it to anyone so they appear to be all sweet and innocent Jasmine 14-15 ‘Girls can feel disgraced to go to the clinic and they ask so many questions when you go there, which are too personal’. Jasmine, aged 14-15

35. 2iv: Intervention Themes in Overview • Girls invited to consider interventions across eight themes • Drawn out form desk research and stakeholder interviews as being important areas to probe for detail • Exact questions included in Appendix How best to talk about sex & relationships Talking about S&R in schools SRE in the community Sexual health/family planning clinics and services School Nurses Peer Education Sexual Health Clinics Text messaging service

36. 2iv: Intervention Themes in Overview • Girls building and developing integrated ideas that offer the same simple information in a variety of ways: very consistent repsonses Text Messaging service School Nurses Information points in the Community Sex and Relationship Day Improved sexual health clinic services Free condom vending machines

37. 2v. Intervention Ideas in Detail: Text Messaging Service Text Messaging service • Overview: • A free text message service which teenagers can text their questions about sex and relationships. Messages would be sent direct to their mobile phones. • The service would be available all day everyday so teenagers can access information and advice wherever they are. • In addition to answering questions it can be used to provide picture or video messages e.g. with diagrams of how to use condoms • It can give you information about local sexual health services such as clinics, drop in centres or talks to help teenagers access other services.

38. Continued (1) Promoted on leaflets and on posters – GP surgery, school, youth service Text Messaging service Who • Seen as good for all ages – male and female • Particularly good for the younger age group to asking detailed or embarrassing questions avoiding face-to-face contact How would it work? • Text the free (easy to remember) number with questions to get an instant answer • Diagram MMS to show some information in a more accessible way • Can text key words to get responses to FAQs e.g. text EMERGENCY to number to get local morning after pill locations • Text message number given out with other services (school day, condom vending machines) • Could sign up to ongoing texts in SRE classes as a first step • Users might text and retext the same questions over and over again

39. Intervention 1: Text Messaging Service Suitable for all aged 13+ Text Messaging service • Positives • A form of communication they are used to • Anytime/Anywhere information • Discrete - answers to questions that you’d be too embarrassed to ask • Can refer back to information e.g. diagrams • Can give information about services and locations which can be difficult for them to obtain currently • Updates can provide regular reminders about sex and relationships related information and service to keep it front of mind • Negatives/Barriers • Needs to be free to be universally appealing (financial resources low) • Signing up for updates not popular for all so needs to be easy opt-in/opt-out • Fear of people seeing unplanned text messages

40. Audience Response “Posters would tell you the numbers to call” Jasmine, 14-15 Text Messaging service “You can delete the message when you have read it so no one can see” Alexandra, 16-17 We have been brought up to not talk about sex. We were told that we were made by the stork. We need to talk about it honestly” Alexandra, 16-17 “I think if I was younger and I had a boyfriend that wanted to have sex, I might text and say how do I know if I’m ready?” Alexandra, 16-17 “That’s pretty good that’s exactly what we need and I don’t know why it took so long to get it out” [Panel] “That’ll really help when girls have unprotected sex and want the morning after pill” [Panel]

41. 2v. Intervention Ideas in Detail: Free Condom Vending Machines Suitable for all girls Free condom vending machines • Overview: • Condoms would also be available from special vending machines in school toilets and locations around the community (youth club, shopping centre and fast food restaurant toilets) • Young people can swipe a special card and receive free condoms from the machines along with instruction cards about how to use them properly and other information and details of sexual health services. • Combining the card with a student discount card would help the teenagers keep hold of the card and may reduce embarrassment about carrying it.

42. Intervention 2: Free Condom Vending Machines Free condom vending machines • Who • Year 9 plus – given cards to all pupils at the school sexual health day or start of term • How would it work? • Medivend-style vending machine • Swipe card in machine to get free condoms • Condoms would come with a little information card/booklet with information on how to out on condom and information about other services • Could include the “Are you Ready?” information • Could possibly include lubricant • Could include EHC voucher • And other re-readable information about clinic location and services

43. Intervention 2: Free Condom Vending Machines Delivering leaflets for other interventions Free condom vending machines • Positives • Increases 24-7 access to free condoms • In less public locations so less issues around embarrassment • Can be combined with student discount card to ensure card is retained. • Card can also carry other key information about clinics and advice numbers • Negatives/barriers • Need to be in locations where young people go anyway and not limited to youth groups and sexual health clinics • In schools people may take the condoms to play tricks on friends or wind up teachers • Needs to be very discretely located in places with long opening hours

44. Audience Response “The morning after pill should be available in the vending machines” Jasmine, 14-15 Free condom vending machines “It’s saying if they’re going to have sex then be safe about it” Alexandra, 16-17 “It should work with a plastic card, like a credit card” Jasmine, 14-15

45. 2v. Intervention Ideas in Detail: School Sexual Health Day Capturing Jasmines from start; Alexandras may not be targeted via school Sex and Relationship Day • Overview: • A full day workshop held at least once a year in school. Each class is split into small single sex groups and rotated around a number of speakers, practical demonstrations and interactive sessions. • The sessions will cover a variety of year group relevant practical information • During the session everyone will have a chance to put anonymous questions into a box and these will be answered in a final session at the end. • Everyone who takes part will be given a goodie bag with freebies and take home information.

46. 2v. Intervention Ideas in Detail: School Sexual Health Day Including males and females separately Sex and Relationship Day • Who • Start from year 7 but shift focus from relationships and answering questions to practical information and advice on sex and relationships by year 9 – 11. • Boys as well as girls involved in gender-separated workshops • How would it work? • Split class into small groups, each visiting a different ‘station’ with a peer speaker, condom practical demo or clinic worker. Rotate around stations. • Emphasis not only on contraception but on relationships, sexual confidence, readiness, how to talk to boys about contraception etc. • Speakers chosen for positive presence, good attitude and approachability

47. Intervention 3: School Sexual Health Day Sex and Relationship Day • Positives • Very popular particularly with younger girls • Move away from just getting teenage mums in – need a whole range of speakers who work for both boys and girls and focus on all aspects of sexual health • Young dads coming in indicated to the girls that there was shared responsibility for pregnancy and STI prevention not solely the responsibility of girls • Interactivity and a variety of activities will get info fixed in their minds • Small groups can help embarrassment and mixed groups help boys and girls learn how to talk to each other about s&r • Goodie bags are very popular and a good way of giving them take home information • Practical advice will help to them to use contraception correctly and ensure every participant knows how to do it properly

48. Continued (1) Sex and Relationship Day Negatives/Barriers • Some schools may not allow it (Catholic schools) • Issues around disruptive kids but this is not seen as huge barrier • Want the day to be more than once per year • Girls warn that if they are told it will be happening on a specific day, they will feel obliged not to attend

49. Continued (2) Girls want to see materials that reflect their background and ethnicity Sex and Relationship Day Who would run sessions • a young mum who got pregnant when she was a teenager, • a young dad (to give a male perspective and reinforce the collective responsibility for pregnancy) • someone who has HIV/AIDS • someone who has had an STI who will talk about their experiences • Someone from the local sexual health clinic will also lead a sessions about who what to expect when you visit the clinic • Interactive, practical sessions on how to put on a condom (everyone to do it) • Role play sessions on how to talk about contraception and allow them to practice the phrases they need • Interactive elements to all sessions – games, quizzes, presentations, group work Materials • Need to ensure all material represent the range of girls that they can relate to in terms of ethnicity, SEG, locations.

50. Continued (3) Sex and Relationship Day Extra: • Goodie bags are hugely popular. • Doesn’t have to be expensive or particularly complex • Girls will retain things from these bags for long periods of time (many had sexual health freebies with them from promotions – school and youth groups – from several years ago) • Oyster card holders with info inside or printed on the outside, USB sticks pre-loaded with information • Condom keyrings were very popular • Pocket sized information is more likely to be retained and carried • Small incentives such as Jelly Beans can be used as justification for talking the goodie bags • Contents can also be used to encourage sexually healthy behaviours • Condom key-rings can be an embarrassment-free way of carrying a condom at all times • Wallet-sized condom instructions • Rape alarms (can be combined with talking about consent and the right to say no when it comes to their own bodies)