Engagement with and Acceptability of a School-based Relationships and Sexual Health Intervention: Student Perspectives from Trial-nested Qualitative Research in English Secondary Schools

Evidence suggests that school-based relationships and sex education plus school-level actions may be effective in promoting sexual health. We conducted a trial of a relationships and sexual-health intervention in English secondary schools. We draw on nested qualitative research to explore student engagement and acceptability. Twenty-four intervention schools participating in a randomised trial delivered a two-year programme aiming to comprise classroom lessons for year 9 and 10 students (aged 13–15 years), alongside school-level actions (e.g. student-led campaigns and reviews of sexual health services), although implementation fidelity of the latter was poor. We conducted 40 student focus groups across 19 intervention schools and analysed these thematically. Lesson acceptability was high but undermined when teachers appeared uncomfortable, uncommitted or insufficiently knowledgeable. Students valued that class discussions allowed them to express themselves and learn from others, particularly across genders. This was compromised where teachers curtailed dialogue. Boys could feel targeted where they were positioned as responsible for problem behaviours. Awareness of school-level elements was low, but students involved valued these when well-implemented. Although relationships and sex education is now mandatory in schools in England, gaps in provision remain with regard to schools’ capacity to implement good-quality relationships and sex education. Ensuring that statutory relationships and sex education is delivered by staff who are well trained, committed and prepared to foster open, inclusive and critically reflexive conversations is necessary to meet the demands of increasingly complex curricular requirements. ISRCTN registry 16723909.