Healthy Respect 2 National Demonstration Project
In collaboration with Lawrie Elliott and Gillian Raab (Napier University, Edinburgh) and Claudia Martin (Scottish Centre for Social Research), we have evaluated the second phase of the national sexual health demonstration project, Healthy Respect. This was designed by Lothian Health Board and aims to improve the sexual health and well being of young people in Lothian in the long-term, with a particular focus on Midlothian and North West Edinburgh. A multi-faceted approach links education, information and services for young people aged 10 - 18.
The evaluation had four components:
- how the intervention was delivered and sustained
- how it was experienced by those who used it
- its effects on young people
- its long term outcomes.
The Unit's primary role was the evaluation within school settings, at both secondary and primary levels.
Healthy Respect has introduced the Zero Tolerance Respect package to Midlothian primary schools. It aims to promote good citizenship, respect for differences and avoidance of gender stereotyping in order to facilitate more respectful relationships in the short and long-term. In a balanced cluster-randomised trial, the Midlothian primary schools were randomised either to deliver Respect immediately or after one year. Following a feasibility study to develop measures, baseline and 6 month (average) follow-up data were collected. This work was funded by the Scottish Executive.
The Evaluation's Interim Report showed that Healthy Respect reached many young people. The Zero Tolerance Respect package to develop respectful relationships was delivered to 50% of primary school children in Midlothian. The SHARE sex education programme was delivered to 22% of secondary schools across Lothian. The drop-in clinics received 7,025 visits between 2005 and 2007. The Healthy Respect website was visited on average 1,225 times a month. It was estimated that the media campaigns reached 13,000 young people. The tracking surveys indicated that between 40% and 66% of young people were aware of Healthy Respect, although the secondary school survey places this at the lower end of the range, with 21% recalling information about Healthy Respect and 38% recognising the logo. Perhaps the strongest evidence of engagement was from the secondary schools survey. In the intervention area (Midlothian and North West Edinburgh), 47% of young people reported using sexual health services compared with 22% in the comparison area (North Ayrshire and East Dunbartonshire). This difference was particularly noted among boys. However, it is likely that this difference in service use also reflects the intervention area’s greater investment in sexual health service provision over a decade or more, and is not solely attributable to the more recent Healthy Respect interventions.
We have evaluated the Zero Tolerance Respect (ZTR) package for primary school children (aged 10 to 12) by carrying out a cluster randomised trial in 30 primary schools that were randomised to be either intervention or control schools. The ZTR package was identified as a resource that would improve pupils’ respect for others and so might have beneficial effects in future sexual relationships. ZTR was augmented by activities for parents and pupils to carry out together. We obtained data before and after ZTR from 847 pupils in 30 schools and compared a series of outcome measures between intervention and control pupils.
There was no evidence that ZTR changed attitudes for girls, but boys’ attitudes to respect were significantly better in the intervention schools, especially for those with disrespectful attitudes at baseline. Outcome measures to evaluate gender stereotyping did not differ between intervention and control groups and this topic did not seem to have much salience for the pupils. Unlike similar research carried out 13 years ago, we found very little evidence of any racist attitudes in either intervention or control schools. ZTR was evaluated very highly by both pupils and teachers. The uptake of the homework activities by schools was patchy, but where they were used and followed up teachers felt they had been very effective.
Elliott L, Henderson M, Nixon C, Wight D. Has untargeted sexual health promotion for young people reached its limit? A quasi-experimental study. Journal of Epidemiology & Community Health 2013;67:398-404pubmed open access
Phase Two Programme Evaluation Team , External Evaluation Team (Including Henderson M & Wight D & Nixon C) . The final report of Healthy Respect phase 2. Edinburgh, 2010open access
Phase Two Programme Evaluation Team, External Evaluation Team, (Including , Henderson M, Wight D, Nixon C, ). Evaluation of Healthy Respect phase 2: Interim Report - Executive Summary. Edinburgh, 2008open access
Phase Two Programme Evaluation Team, External Evaluation Team, (Including , Henderson M, Wight D, Nixon C, ). Evaluation of Healthy Respect phase 2: Interim Report. Edinburgh, 2008open access
Raab G, Burston A, Henderson M, Storkey H, Elliot LS, Davies J. Final Report on the randomised control trial of Zero Tolerance Respect (pre-sex education/citizenship education) in Midlothian Primary Schools. Report to CSO (CZG/2/313). Edinburgh, 2008
Raab G M, Storkey H, Henderson M, Davis J, Elliot L. Development of instruments and procedures for a randomized controlled trial to evaluate the Zero Tolerance Respect package in Midlothian Primary Schools. Edinburgh, 2007open access