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Positive Choices

Our trial evaluates Positive Choices, a whole-school social-marketing intervention to promote sexual health, across 50 secondary schools in England.  

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Positive Choices

The Positive Choices trial is a randomised controlled trial (RCT) involving 50 schools in England. The study investigates whether incorporating the Positive Choices intervention into school provision is more effective in preventing non-competent first sex compared to treatment as usual. 

Background

Most young people in England do not report competence at first sex. Lack of competence at first sex is strongly associated with increased risk across adolescence and adulthood of unplanned pregnancy, sexually transmitted infection (STI) diagnoses among young women, experiencing non-volitional sex and sexual function problems.

About
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The Positive Choices trial is a randomised controlled trial (RCT) involving 50 schools in England, UK. It investigates whether incorporating the Positive Choices intervention into secondary school provision is more effective in preventing non-competent first sex compared to treatment as usual. Non-competence is defined as a lack of: contraception use; autonomy of decision; partners’ equal willingness; and individual judging it to have been the ‘right time. 

Study background

Most young people in England do not report competence at first sex and lack of competence at first sex is strongly associated with several increased risks across adolescence and adulthood. These include unplanned pregnancy, sexually transmitted infection (STI) diagnoses among young women, experiencing non-volitional sex (sex against will) and sexual function problems.

In England and Wales, young people carry a disproportionate burden of adverse sexual health. Young people are having sex earlier and sexually transmitted infections (STIs) are increasing across the English population, with the highest burden in young people aged 15-24 years. Dating and relationship violence (DRV) is also a significant issue, with youth in the UK experiencing higher rates compared to young people in other countries.

There is good evidence from existing reviews that whole-school interventions are effective in delaying sexual debut, increasing contraception use and preventing STIs and teenage pregnancy. Informed by this evidence, the Positive Choices intervention comprises the following: a school health promotion council involving staff and students coordinating delivery of lessons and student-led social marketing campaigns; a student survey to inform local tailoring; teacher-delivered classroom curriculum; student-led social marketing campaigns; parent information; and a review of sexual/reproductive health services to inform improvements.

Who we are
Team Block
Core team

Chris
Bonell

Professor

Chris Bonell directs the study. His research interests include adolescent health, sexual health and evaluation methods. He is experienced in qualitative and quantitative research, systematic reviews and incorporating realist evaluation methods in randomised trials. He is co-author of the forthcoming book Understanding Impact (Cambridge University Press). He previously provided advice to government during the COVID-19 pandemic and worked in the Social Exclusion Unit.

Ruth Ponsford

Assistant Professor and Trial Manager

Ruth Ponsford is Assistant Professor in School Health Intervention Research and is the Positive Choices Trial Manager. Ruth has long-standing interests in the health and wellbeing of young people and the role of schools in promoting health. She has previously worked on a systematic review of whole-school interventions to prevent substance use and violence; the pilot of the Positive Choices study; and a qualitative study of the experiences of young motherhood in England. Ruth has also conducted research on community empowerment for health, worked on a number of small-scale evaluations of sexual health interventions for young people in England and was previously co-ordinator for the National Chlamydia Screening Programme (NCSP) in health services in south-west London.

Rebecca
Meiksin

Research Fellow

Rebecca Meiksin is a Research Fellow in Social Science at LSHTM. Her background is in reproductive health, gender-based violence, and research and evaluation with a focus on qualitative methods. Rebecca’s PhD research focuses on the role and measurement of social and gender norms for the prevention of violence in young people's dating and relationships.

Josie
McAllister

Professional Services
Research Assistant

Josie McAllister is a Research Assistant and Communications Officer at LSHTM. Her primary research interest is sexual and reproductive health, with previous research focusing on menstrual health and hygiene in low-income settings.

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Collaborators

  • Elizabeth Allen (Lead Statistician), London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. elizabeth.allen@lshtm.ac.uk
  • Steve Morris (Lead Economist), Cambridge University Department of Public Health & Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK. sm2428@medschl.cam.ac.uk
  • GJ Melendez-Torres, University of Exeter College of Medicine and Health, South Cloisters, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU, UK, g.g.melendez-torres@exeter.ac.uk
  • Catherine Mercer, UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, off Capper Street, london WC1E 6JB, UK. c.mercer@ucl.ac.uk
  • Rona Campbell, University of Bristol, 1-5 Whiteladies Road, Clifton, Bristol, BS8 1NU, UK. rona.campbell@bristol.ac.uk
  • Maria Lohan, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. m.lohan@qub.ac.uk  
  • Honor Young, DECIPHer, Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK. youngh6@cardiff.ac.uk
  • Alison Hadley, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire, University Square, Luton, LU1 3JU, UK.

Partners

The Sex Education Forum is the voice of Relationships and Sex Education (RSE) in England. They promote and protect the physical and mental health of children and young people by improving their access to RSE.

Research
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The Positive Choices trial aims to examine the implementation, effectiveness, cost-effectiveness and mechanisms of the Positive Choices intervention and answer the following research questions:

  1. What is the effect of the Positive Choices intervention on student-reported measures of non-competent first sex (primary outcome), and various pre-hypothesised secondary outcomes and intermediate outcomes?
  2. Does this differ by student gender, sexual orientation, ethnicity or socioeconomic status (SES), or by school-level GCSE attainment or local deprivation?
  3. Are associations greater in on-treatment analyses accounting for intervention fidelity?
  4. What does the intervention cost and is it cost-effective?
  5. Is the intervention delivered with good fidelity, reach and acceptability and how does this vary between schools and students?
  6. What is usual treatment in control schools?
  7. What do qualitative data suggest about implementation processes/intervention mechanisms and how these might vary between schools or students?
  8. What do the trial findings overall suggest about the intervention theory of change and the potential for the intervention to be delivered and be effective elsewhere?

What is a process evaluation?

Process evaluation aims to understand processes of intervention planning, delivery and receipt as well as how the mechanisms interventions trigger interact with context to generate outcomes. Process evaluation uses a mixture of qualitative and quantitative methods to explore questions of feasibility, fidelity, reach, acceptability and appropriateness.

Publications
Publications
Enacting whole-school relationships and sexuality education in England: Context matters.
Bragg, S., Ponsford, R., Meiksin, R., Lohan, M., Melendez-Torres, G. J., Hadley, A., Young, H., Anne Barter, C., Taylor, B., & Bonell, C.
2022
British Educational Research Journal, 48, 665– 683
Dilemmas of school-based relationships and sexuality education for and about consent
Sara Bragg, Ruth Ponsford, Rebecca Meiksin, Lucy Emmerson & Chris Bonell
2021
Sex Education, 21:3, 269-283