STI prevention and sexual health in secondary schools: an exploratory study of a peer-led intervention (STASH)

Background: Young people report higher levels of unsafe sex and have higher rates of Sexually Transmitted Infections (STI) than any other age group. Schools are well placed to facilitate early intervention but more effective approaches are required. Peer-led approaches can augment school-based education, but often fail to capitalise on mechanisms of social influence. The potential of using social media in sexual health has not been tested in school settings. Objectives: To finalise the design of the STASH intervention; assess recruitment and retention of peer supporters, and acceptability to participants and stakeholders; assess fidelity and reach plus barriers to, and facilitators of, implementation; refine programme theory; understand potential of social media; determine design parameters for a future RCT, including economic evaluation; establish whether progression criteria met. Design: Exploratory study comprising intervention development and refinement of STASH, pilot and non-randomised feasibility trial in six schools. Control data provided by students in the year above the intervention group. Setting: Secondary schools in Scotland. Participants: Students aged 14-16, teachers, and intervention delivery partners. Interventions: STASH was adapted from ASSIST (an effective peer-led smoking intervention), and involves peer nomination to identify the most influential students. We aimed to recruit and train 15% of the year group as peer supporters (PS). The PS deliver sexual health messages to friends in their year group via conversations and using Facebook to share varied content from a curated set of web-based resources. PS are given support themselves via follow-up sessions and via trainer membership of Facebook groups. Main outcome measures: Primary outcome of interest was whether progression criteria were met in relation to intervention acceptability and feasibility; qualitative data on participant experiences of implementing the trial; indicative primary outcomes were piloted. Data sources: Peer supporter questionnaire; observations of activities; interviews with trainers, teachers, PS and students; monitoring log of PS activities (including on Facebook and meeting attendance); questionnaire to control year group; and to intervention year group, prior to the intervention and approximately six months later. Results: Just over half of those nominated were trained as PS; role retention was very high (97%). Intervention acceptability was high among students and stakeholders. Activities were delivered with good fidelity. The PS were active, representative of their year group and well connected within their social network. Carefully managed social media use by PS augmented conversations. A primary outcome of ‘always safer sex’ was identified, measured as no sex or always condom use for vaginal/anal sex in the last 6 months. The intervention cost £42 per student. Six progression criteria were met. A seventh (regarding uptake of role by PS) was not. Limitations: Small exploratory study that cannot comment on effectiveness. Conclusions: STASH is feasible and acceptable within the context of Scottish secondary schools. The results support continuation to a full-scale evaluation. Future work: Small-scale improvements to intervention; refinement to programme theory; funding sought for full-scale evaluation. Study Registration: Current Controlled Trials ISRCTN97369178 Funding details: National Institute for Health Research Public Health Research programme (14/182/14); Scottish Government; Edinburgh and Lothian Health Foundation.