Effects of a whole-school relationships and sexual health intervention on non-competent sexual debut: cluster-randomised trial

Ponsford, Ruth, Meiksin, Rebecca, Sturgess, Joanna, Muraleetharan, Veena, Tilouche, Nerissa, Opondo, Charles, Morris, Steve, Melendez-Torres, G J, McAllister, Josephine, Sundaram, Neisha, Hadley, Alison, Lohan, Maria, Mercer, Catherine Heather, Young, Honor ORCID: https://orcid.org/0000-0003-0664-4002, Campbell, Rona, Coyle, Karin, Allen, Elizabeth and Bonell, Chris 2025. Effects of a whole-school relationships and sexual health intervention on non-competent sexual debut: cluster-randomised trial. Journal of Epidemiology and Community Health 10.1136/jech-2025-225004

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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.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) Schools > Social Sciences (Includes Criminology and Education)
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by-nc/4.0/, Start Date: 2025-11-07, Type: open-access
Publisher:	BMJ Publishing Group
ISSN:	0143-005X
Date of First Compliant Deposit:	11 November 2025
Date of Acceptance:	19 October 2025
Last Modified:	11 Nov 2025 15:20
URI:	https://orca.cardiff.ac.uk/id/eprint/182338

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