Abstract
Background:
Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools.
Methods:
A cluster-randomised trial of ‘Positive Choices’ compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners’ equal willingness or contraception).
Results:
Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved ‘good’ fidelity; two achieved ‘adequate’ fidelity across components. 11 achieved ‘adequate fidelity on selected components’ (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI −0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student).
Conclusion:
Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools.
Trial registration number: ISRCTN16723909.
Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools.
Methods:
A cluster-randomised trial of ‘Positive Choices’ compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners’ equal willingness or contraception).
Results:
Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved ‘good’ fidelity; two achieved ‘adequate’ fidelity across components. 11 achieved ‘adequate fidelity on selected components’ (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI −0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student).
Conclusion:
Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools.
Trial registration number: ISRCTN16723909.
| Original language | English |
|---|---|
| Article number | 225004 |
| Number of pages | 10 |
| Journal | Journal of Epidemiology and Community Health |
| Early online date | 7 Nov 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 7 Nov 2025 |
Bibliographical note
Publisher Copyright:© Author(s) (or their employer(s)) 2025.
Keywords
- SEXUAL HEALTH
- RANDOMIZED CONTROLLED TRIAL
- ADOLESCENT
- SEX EDUCATION