STASH study intervention feasibility and acceptability

This chapter assesses the acceptability of the STASH study to students, teachers and parents, including whether or not the relevant trial progression criteria were met. We defined acceptability as the degree to which the participants deemed the STASH study intervention ‘appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention’.119 We also measured uptake and completion of the PS role as a more objective measure of acceptability.119

We draw on data from structured observations, semistructured interviews with students and staff, PS training evaluations, the PS online questionnaire, activity observations, the project monitoring log and the follow-up questionnaire (see Chapter 3 and Report Supplementary Material 4). Differences by school or by gender are highlighted when relevant.

Significantly, in terms of feasibility and acceptability, no harms (as defined in Chapter 3) were reported in the course of the study.

Acceptability of the STASH study to peer supporters

Recruitment and retention of peer supporters

Students receiving the most nominations from their peers (roughly the top 25% of year group, stratified by gender) were invited to the STASH study recruitment meeting (see Chapter 2). Across schools, an average of 87% of those nominated attended the meeting and 52% of those nominated (63% of those attending the meeting) were trained. Of those trained, 97% fulfilled the requirements of the role, defined as posting three or more STASH study messages on Facebook or having two or more face-to-face conversations about the STASH study, and attending two or more follow-up sessions (Table 8). In relation to progression criterion 1, > 50% of nominees were trained in only three of the six schools, so the green and amber targets were not reached. However, 97% of trained PSs fulfilled the role – 100% of those trained in four of six schools – meaning that the green target for progression criterion 2(a) was far surpassed.

As progression criterion 1 was not met, we did a sensitivity check to see if students accepting the role differed from those who did not, in terms of the number of nominations they received. We found that students accepting and completing the role received 15.6 nominations from their peers, whereas those who did not take up the role received an average of 13.5 nominations. This suggests that students receiving more nominations were slightly more likely to take up the role and means that had we invited the top 21% (as opposed to the top 25%), we may have performed better on this progression criterion.

Role uptake and completion was slightly higher among young women. There were slightly more young men at the recruitment meeting (52.4%), but slightly more young women trained (54.8% young women, 104 students) and completing the role (56.6% young women, 99 students). In terms of acceptability across schools, observational and project monitoring data suggested that variation primarily reflected differences in levels of school support and buy-in to the intervention (e.g. HT presence at recruitment meeting, provision to students of clear information about where and when recruitment meetings would take place). There were small differences in engagement by gender, with slightly more young women than young men reporting all the key PS activities.

Motivation to participate

The most commonly cited reasons for attending training (student evaluation form, n = 104) were curiosity (27%), benefit to CV (21%) and fun (19%). The main reasons for remaining engaged throughout the intervention (PS questionnaire, n = 88) were learning useful information (44%) and viewing the project as fun (34%). These motivations were echoed in interviews, for example ‘I thought it’d be good to learn about it as well, but it’d also be quite fun’ (school 4, PS boy). In one group interview, PSs suggested that some students ‘went for the free food but . . . then everybody, I think, enjoyed it, like, so it was an experience’ (school 5, PS girl, mixed group).

When asked why they thought that some friends had decided not to take up the role, PSs cited ‘feeling uncomfortable’ and simple disorganisation and forgetting to ‘hand their letter in fast enough’ (school 4, PS boys). In terms of the latter, schools played a vital role in helping ensure that student disorganisation (e.g. in not returning parental consent forms) did not preclude participation. Particular schools were observed putting in extra effort, such as phoning parents and carers and obtaining verbal consent if a PS had forgotten their form.

Reasons for reducing involvement or withdrawal from the STASH study

Twelve PSs said that their level of involvement tailed off towards the end (PS questionnaire, 15%). The most common reasons were not wanting to miss classes (five students) and frustration with technical problems (three students). These students had nevertheless fulfilled the role’s minimum requirements. Although we were unable to obtain PS questionnaires from the five students who did not complete the role, informal conversations with PSs, trainers and teachers suggested that one felt uncomfortable with other PSs and the remainder were discouraged by timetable conflicts.

Factors associated with peer supporter engagement in the STASH study

Recruitment

Recruitment meetings consisted of one or two of the trainers hosting an information session during class time, usually in a classroom or assembly hall. Speaking with a PowerPoint^® presentation (Microsoft Corporation, Redmond, WA, USA), trainers provided an overview of why students had been invited and what the project would involve. The trainers emphasised that students had been invited because they had been nominated as influential by their peers. We observed four recruitment meetings to capture student engagement. In each, there was initial curiosity, as students did not know why they were there. Engagement appeared greater in schools in which senior staff were present and encouraging attention, trainers were more confident and enthusiastic, and the group was not too large or dominated by one strong character. For example, a large and rowdy group of potential recruits in school 3 – in combination with a trainer who seemed relatively less confident in delivery of the session – created a challenging situation, which saw a relatively low training uptake (45% of attendees). In contrast, a much smaller group in a smaller school (school 4) were familiar with each other and with the trainer (the school having previously participated in ASSIST). The trainer emphasised the fun aspect of the project, students appeared to engage more readily and uptake was higher (56%). The highest uptake occurred in school 5 (77%), in which the HT attended the session and the trainer gave a highly persuasive presentation (this session was not formally observed, but was witnessed by a member of the research team).

The majority of students remained fairly impassive during the meetings, although there were murmurs of excitement when they were told that they were there because they had received the most nominations from their peers. The news that they would be trained to talk to their peers about sexual health appeared to elicit more reaction, with responses ranging from grimaces to giggles. Various questions were raised by PSs, including why nomination as ‘influential’ meant that they needed to learn about sexual health and whether or not they were perceived as sexually active. Trainers reassured them that this was not the case.

Peer nomination appeared to contribute to students’ willingness to participate, supporting a key assumption of our initial programme theory. Some were ‘surprised’ to have been nominated as they ‘just didn’t think many people would put [their] name down’, but were flattered ‘that [ . . . ] other people had thought of me’ (school 4, PS girl). Others were humorous in claiming that the nomination confirmed what they already suspected: ‘I wasn’t surprised . . . I’m an influential guy, you know?’ (school 6, PS boys).

Peer supporter training

The 2-day training took place at a local hotel. Each session was facilitated by at least two trainers, using a mix of plenary sessions, small group work and activities. All students who began training completed it, bar one withdrawal due to illness. Group size seemed to influence engagement, with the largest group of trainees (n = 27) proving most challenging to keep on task. Owing to the impracticalities of switching between the central horseshoe and ‘café-style’ tables, most sessions for this school had to be completed in small groups, which had an impact on focus in less interactive sessions. In interviews, the trainers suggested that a maximum of 20 students would be preferable.

An appropriate training space was also crucial. Owing to a booking problem in one venue, two smaller rooms were provided, one of which had (poor) Wi-Fi. This necessitated repeated moving between rooms which, according to observations and trainer reports, disrupted the training flow, made it challenging to maintain focus and limited website access (necessitating PSs viewing this at home).

Students reported that they enjoyed the training, citing the ‘nice environment’ the trainers created, the fact that ‘everyone was, like, getting on [and] there wasn’t any awkwardness’, balance between learning and fun and avoidance of ‘information overload’ (school 3, mixed group).

Trainer–trainee rapport was also a significant facilitator of engagement, with students valuing the trainers being ‘good at having a laugh with us’ (school 4, PS girls). School staff also noted a positive impact of this relationship and the trainers being ‘approachable’:

I thought they had a really good rapport with the kids, and they talked to them in a way they needed to talk to them to get them on board, to get them discussing.

Although school staff initially had concerns about some students disrupting the project, observations suggested that the trainers were largely able to manage any challenging personalities in a way that fostered engagement. Indeed, the trainers noted that vocal students could sometimes stimulate group interaction, suggesting that a lively character ‘here and there does help move things along’ (trainer 1).

Trainers noted a need to ‘warm up’ the group first thing each day and that, although it was initially ‘like trying to get blood out a stone’ for some groups, taking time to warm up meant ‘they became a lot better and were really quite vocal’ (trainer 1). Observational data suggested that the small group work, alongside other trainer strategies (e.g. mixing friendship groups, dynamic games, humour) maintained student engagement once established and promoted interaction across the group.

Follow-up meetings and peer supporter activities

The six in-school follow-ups took place in class time and typically comprised trainers checking in on weekly or fortnightly activity and troubleshooting, plus an interactive activity on a STASH study topic (see Chapter 2). Attendance averaged 80%, varying slightly by week and school (Figure 7). The school with highest overall attendance had the smallest group of PSs (school 6 with 10 PSs) and the lowest overall attendance came from one of the two largest groups (school 1 with 26 PSs), suggesting that smaller groups may be simply easier to manage. School support (e.g. in reminding PSs about the meetings) appeared another potential explanation for the variation across schools.

FIGURE 7 Peer supporter attendance at follow-up sessions. FU, follow-up. (Figure not reproduced here; see the original article.)

Most PSs found follow-ups ‘quite good’, worth missing classes for, useful as a reminder of their role and a top-up for key information:

It was a good refresh, ‘cause if we hadn’t had the follow ups then we [. . .] would’ve forgotten quite a lot and not know as much.

However, some felt that they were less interesting than the training, possibly affecting attendance:

I think everybody would be more involved if there was more activities at the follow-ups. [. . .] I think that’s maybe why people haven’t turned up so much ‘cause it’s . . . not as interactive.

In designing the feasibility study, we deliberately set follow-ups either weekly or fortnightly to explore any difference this might make. This was originally for three schools apiece, but changed to four schools weekly and two fortnightly when some sessions were rearranged at one school’s request. Qualitative and monitoring data suggested that students were satisfied with either follow-up, that regular spacing and reminders were important and that sufficient time between follow-ups also facilitated engagement, giving PSs time to share messages:

It was all so much more information and [. . .] it was always spread out so we had enough time to post things.

A practical consideration related to the use of Facebook by trainers to communicate reminders to PSs. A lack of scheduling clarity – particularly for Facebook non-users and when schools had requested timetable amendments – had an impact on attendance. Some students did not know when follow-up sessions were or only found out at the last minute, particularly in school 3, which had the lowest proportion of Facebook users (and relatively low follow-up attendance).

Observational data also highlighted a range in trainers’ ability to maintain engagement and rapport, including using students’ names and apparent familiarity with session materials, which led to some variation in what was delivered and how (see Chapter 6).

In schools 5 and 6, PSs suggested that conflict with popular examination subjects may also have contributed to attendance drop-off, particularly when follow-up sessions were scheduled repeatedly against the same academic subjects. Although timetable conflicts made it challenging to participate in follow-ups, this did not always equate to lower overall engagement. For example, a school 4 PS who reported a timetable conflict was nevertheless one of the highest engagers on Facebook and contributed significantly to the follow-up sessions that he did attend.

Extent to which peer supporters liked the role

The intervention was highly acceptable to PSs, with 85% of PSs reporting in the PS questionnaire that they liked the role [94% girls, 71% boys; range across schools 75% (school 1) to 100% (schools 3 and 4)]. Progression criterion 2b was therefore met with ease.

Overall, the PSs interviewed were positive about the STASH study, with common comments including ‘it was quite a good experience’ and ‘I think we’ve been well informed’. There was a sense in interviews that the role became more comfortable as they gained skills and experience. Although they had initially expected to feel ‘awkward speaking to other people about it’, they eventually felt that ‘it wasn’t as if it was something totally new that we were talking about, so, it wasn’t really a big jump . . .’ (school 4, PS girls). Engagement was also facilitated by group cohesion, which emerged in all schools to some degree. This was typically about familiarity and a sense of a shared experience, rather than friendships with other PSs. Boys from school 6, for example, felt that if the training had been ‘with 12 total strangers it wouldn’t have been that good a laugh’ and that being ‘with . . . I wouldn’t say pals, but folk that you kinda get along with, then . . . you’re a wee bit more laid-back in what you say and you know that it’s not gonna offend anybody’ (school 6, PS boy).

Peer supporters described the broader benefits of their involvement in the project as including an increase in their comfort levels in discussing sex and relationship issues, the additional learning around these topics, and the information and skills – ‘mental preparation’ (school 4, PS girl) – that this provided them with for the future. PS questionnaire data supported these findings, with 86% of PSs saying that the role would benefit their CV and 94% saying learning from the STASH study would help them protect themselves in the future. Some also noted that participation in the intervention had made them ‘more sociable’ and that being a PS was a ‘good life skill’ (school 3, PS mixed group), whereas others highlighted a broad benefit of showing what information and resources are ‘out there’ (school 6, male friend), highlighting a potential contribution to young people’s online sexual health literacy.

Acceptability of time commitment

Around half of the PSs (52%) reported spending < 30 minutes per week on STASH study activities (posting Facebook messages or talking about the STASH study, excluding follow-up meetings); 29% spent 30–60 minutes and the rest spent > 1 hour (with two PSs spending > 3 hours). The majority (84%) found the amount of weekly time they spent on the STASH study to be acceptable, with 7% saying that it was too much and 9% saying that it was too little. Most (61%) reported the number of weeks they spent as a PS to be ‘just right’. There was no clear pattern in views on intervention length according to whether the PS had weekly or fortnightly follow-ups.

Acceptability of online and social media components to peer supporters

For the most part, PSs reported accessing the STASH study website at home alone (51%) or in school with others (44%). Most (84%) PSs liked how the website looked and found it easy to navigate (64%). The majority (70%) found it easy to post messages from the website to Facebook and 87% found it easy to direct friends to the website. Eight per cent (n = 7) reported that their friends had disliked the STASH study messages or website.

The use of social media use in the STASH study was broadly acceptable to PSs, once they knew that posts would be made in a closed group. This was indicated by general comments like ‘it was actually alright’ (school 6, PS girl). There were mixed views on the relative merits of social media compared with face-to-face communication. Some felt that it was ‘a good way to get across to other people in our year’ (school 4, PS girl) and that there was enough flexibility to allow them to feel comfortable about who was in their Facebook group. Others felt that the use of Facebook, specifically, had constrained the project by limiting its perceived kudos (see Chapter 6 for associated limitations to intervention reach). A benefit of using social media was that it generated interest in sex and relationships information on the internet and social media, potentially enhancing digital literacy and use of the internet as a source of advice:

In general, interviewees seemed to take the view that although online communication bypassed awkwardness or embarrassment, face-to-face conversations (when engaged in) allowed them to expand on or explain in more detail about the posts they had shared.

Acceptability compared with usual sex and relationships education

Peer supporters found the STASH study more relevant (71%), helpful (76%) and interesting (75%) than their usual classroom SRE. Relative advantages included depth of information, with PSs saying that ‘it was good for us to have that knowledge, ‘cause it’s not really something that’s massively spoken about in school’, beyond the basics of ‘use protection and be safe’ (school 4, PS girl). PSs also felt that it bypassed the awkwardness of classroom SRE:

Acceptability of the STASH study to the wider year group

Students were defined as ‘exposed’ to the STASH study if they were a PS or reported one or more of the following in the follow-up questionnaire:

• shown the STASH study website by a PS or accessed it themselves
• joined a Facebook group, viewed posts or followed links
• talked to friends about the STASH study Facebook posts or talked to/asked a PS about a STASH study topic.

In this section, we focus on the 268 students (43.9% of all S4 students) who were not a PS but reported one or more of the above exposures in the follow-up questionnaire (see also Chapter 6).

Across all schools, the majority of exposed students reported that the way the STASH study was run was acceptable (74.5%) and that the information provided was acceptable (78.2%). Acceptability was higher among young women than young men (76.7% vs. 70.1% for delivery and 81.5% vs. 73.2% for information, respectively). All six schools surpassed the green target of 60% for acceptability, meaning that progression criterion 3a was easily met.

Peer supporters perceived that their friends viewed the STASH study positively (87% said their friends did not get fed up with them talking about it). In interviews, friends themselves reported the delivery of the STASH study as broadly acceptable. Some friends said they grew ‘more confident talking to [the PS]’. This was partly because they observed the PS themselves growing in confidence, and partly a recognition of the training that the PS had received:

. . . it’d be weird if they just came up and started talking about that [. . .] But, now that they’ve been taught about it, it’s OK, you can listen to them a bit more, ‘cause you know that they know what they’re talking about.

In the follow-up questionnaire, among students who had seen the website, 89% agreed that they liked the way it looked and 79% said that they found the information useful. Of students who were members of the Facebook group, 60.2% agreed that they were happy to be. In interviews, non-PS reactions to receiving STASH study posts via Facebook ranged from openness and interest to indifference. A few non-PSs recalled initial surprise at seeing the early posts, but quickly remembered having been told about the STASH study and viewed the messages in that light. One student described how the posts stood out as different:

It made you read it, ‘cause you don’t really see that.

Conversely, students in one mixed-gender interview group did not find the content ‘weird’ or ‘unusual’, indicating instead that ‘[t]hey just put it in the chat an’ we talk about it’ (female non-PS, mixed-gender interview group). Other students said that the content was not of immediate interest to them because they felt that they already had sufficient knowledge, whereas others suggested that sexual health content had limited appeal compared with other content on social media. A few students who were members of multiple groups expressed frustration with the volume of post notifications.

There were mixed views from friends whether online or face-to-face interaction was preferable. Some saw the opportunity to engage online as less awkward, whereas others preferred face-to-face conversation. The majority appeared to favour a combination, given that ‘social media’s a thing that a lot of people use’ and that if ‘you all see the same post, you might end up, like, having a conversation about it’ (school 6, male friend). To the extent that non-PSs registered and responded positively to messages, it appeared important that messages were sent by someone they knew and were seen by others in the group, such that there were opportunities for discussion.

For those who viewed Facebook posts, there was an appreciation of the integration of humour with serious information, which ‘made it funny but like . . . you got the information across. So it’s like a bit of both’ (school 4, female friends).

There was a sense among some friends that Facebook was an acceptable platform for the project, but students in all groups suggested that use of additional or alternative platforms, particularly Instagram, might enhance acceptability. For some, the use of Facebook had limited their engagement, as this was not typically a platform they used.

Perhaps unsurprisingly, exposed students in the wider year group viewed the intervention less favourably than PSs, as they did not participate in key elements, such as the training. Compared with usual SRE, about half said that the STASH study was just as relevant (51.5%, with 20.8% finding it more relevant), helpful (50.2%, with 17.5% finding it more helpful) and interesting (51.6% ,with 12.4% finding it more interesting). These findings were supported in interviews with PSs’ friends. Some felt that the STASH study was ‘a bit more in-depth [. . .] than it is in school ‘cause they just cover it briefly and move onto the next thing’ (school 4, female friends), whereas others felt that the STASH study covered similar ground to school lessons, namely regarding ‘all the infections’ (school 6, male friends).

Acceptability of the trainer role

Trainers maintained a visible presence in PS Facebook groups, to offer support, monitor activity and pick up on any misinformation or inappropriate behaviour. This was explained at training and PSs were asked to add the trainer immediately on creating their groups.

Of 71 PSs who completed the PS questionnaire and said that they used Facebook for the STASH study, 59% were glad to have the trainer in their group, with girls notably more accepting of this than boys (73% vs. 36%, respectively). Forty per cent indicated that they had asked the trainer a question via Facebook and 8% said they had contacted them about something private. In interviews, PSs said that they were conscious of the trainers’ monitoring role. Although this too was viewed as acceptable, there was a sense from some that their presence may have inhibited other students from engaging, with friends who did not know the trainers, potentially ‘scared to say some things’ and choosing not to ask questions because ‘this stranger’s in the group that I don’t know’ (school 5, PS girl).

The trainer–student relationship was expected to make a key contribution as per our programme theory, and observational data suggested a broadly high level of rapport throughout. This was borne out in the interviews, in which (particularly female) PSs were very positive about the trainers and their approach:

They were really nice and like worked well with us. Like, [. . .] they were patient and . . . just . . . good.

The trainers themselves found their role acceptable and were enthusiastic about the project. The trainers were strongly invested in the STASH study, having co-designed intervention content with the research team (see Chapter 2). They valued their ongoing role in refining and optimising, including ‘the fact that we sat down together and tweaked [the content] before we went [to the training] and after’ (trainer 1) to review the sessions. Beyond this, they were satisfied with the overall running, communication and expectations of them.

The trainers felt that their continuing presence at each school facilitated greater rapport with students and this meant that PSs felt more comfortable approaching them with queries or concerns. One trainer commented that being seen as ‘a constant’ also facilitated engagement online:

I think they just feel a sense of a connection more. [. . .] I don’t think they feel as valued if somebody’s jumped in and out [. . .] [They think] ‘So you’ve something better to do today? Well, why should I be here?’

The STASH study required some degree of social media literacy of the trainers. Only one of the three trainers was fully comfortable with Facebook, and thus took on most of the online monitoring and communication. Although the trainers highlighted that monitoring high volumes of PS posts from the STASH study trainer account had been complicated, the work had played an important part in keeping PSs engaged and making them feel valued:

I think it’s about keeping on top of it, and making sure that the PS know that you’re there for them.

Acceptability of the STASH study among stakeholders

No major acceptability issues were identified via the process evaluation or in general project communication with schools.

Data on acceptability to parents and carers were collected indirectly via PSs and teachers. One student reported in the PS questionnaire that their parents or carers were unhappy about them being a PS and, therefore, easily meeting the target of < 15%. This meant that both criteria 3b and 3c were met. In interviews, four students described any direct comment from parents or carers, including queries as to why S4 students were targeted:

Another PS described how his mum encouraged him to participate:

My mum’s pretty much the one that told me to do it. [. . .] So then, obviously, she was asking lots about it. She thought [the website] was good, [that] it was good for like people that are younger to be able to see all this.

Although teachers were initially concerned about how parents might react, particularly to the intervention’s social media component, none reported any actual complaints.

Peer supporters reported that their teachers were largely positive or neutral towards the STASH study. Most felt supported by the STASH study contact teacher (71%) and 46% agreed, or neither agreed nor disagreed (43%), that their teachers were happy they were a PS. There was some variation by school (Figure 8), with no students in school 6 agreeing that their teachers were happy that they were a PS (78% neither agreed nor disagreed) and a relatively high proportion in school 5 agreeing that they were. Again, this may reflect relative levels of ‘buy-in’ from schools, which (as noted earlier) was higher in school 5 and lower in school 6.

FIGURE 8 Peer supporter views on contact teacher support and extent to which teachers were happy with them undertaking the role. (Figure not reproduced here; see the original article.)

Most school staff interviewed found the intervention acceptable, particularly when they saw it as offering ‘leadership opportunities’ and when they supported the ‘ethos that [sex is] something that we’re not embarrassed to talk about’ (school 3, DHT). Common to other schools, the same DHT was positive about the trainers having ‘a really good handle on the kids’, who she believed ‘would have felt that they were respected and listened to’.

Staff, likewise, noted the significance of trainers maintaining rapport and being ‘inclusive of the group’:

. . . they definitely had the right idea. If you go too heavy with these things [. . .] then sometimes you then just create the stigma or the barrier that you’re trying to get rid of in the first place. I thought the staff dealt with that really well.

Another noted that the ‘excellent’ quality of delivery and appropriate tone of the intervention had enabled trainers to ‘get a lot of information into a short space of time’ (school 5, CT). These comments echo the evaluations of the training days, in which the various components of the training were consistently described by school staff as ‘good’ or excellent’.

Of eight staff members interviewed, only one raised any notable concerns, and these related primarily to the capacity of that school to participate in such an intervention. This school was the smallest of the six, and we included it as a ‘case study’ to capture potential issues associated with small size. The original contact teacher went on sick leave, and the senior staff member who took over had not been involved in the original decision to participate. Although perceiving the project to be well organised and flexible, this teacher had reservations about taking part in STASH, partly because the school was undergoing a significant transition. In interview, the teacher talked about a late timetable change by the school, which meant follow-up sessions clashed with an examination class and ‘created a bit of a monster’ with regard to satisfying staff and students that they would not miss important class time. He valued the fact that ‘as far as delivery [was concerned], there was no expectation on us’. However, he remained somewhat sceptical of the intervention, maintaining that participation created ‘pressures across the school because of something that, in theory, directly only impacts nine kids’ (school 4, DHT).

There was a fairly consistent view across school staff interviews that, whatever attempts might be made, S4 is a very challenging year for any additional activities to fit into and that the ‘big commitment’ required took ‘a big chunk out of their [examination subject] lessons that they then have to catch up on’ (school 6, CT 2).

Teachers who were in a position to compare the STASH study with SRE in their school (about half the sample) saw the STASH study as offering an update to materials that students had suggested were out of date. The relatively relaxed STASH study environment was also highlighted as facilitating students asking ‘sensible questions [. . .] about risk-taking behaviour’:

I wondered if they found that easier to ask those questions because it was people that they were meeting in that context, not teachers that they would . . . they certainly wouldn’t ask me those questions.

In one school, it was suggested that the STASH study content was ‘very similar’ to what the school currently delivered, which was taken as validation that they were doing something right:

There was quite a bit of crossover, which was quite nice, actually, for me to think what we’re teaching is actually still relevant to the youth of today.

The school’s higher level of buy-in to the STASH study may be because the school was already invested in effective SRE.

In terms of broader impact, teachers noted the combined growth in ‘young people’s awareness about sex education’, along with the fact that the STASH study had ‘developed confidence [and] given them an opportunity to develop leadership skills’ (school 5, DHT). The benefit of improved confidence was particularly highlighted in school 5, with a contact teacher also noting ‘how articulate, vocal’ one male PS had become, as well as improvements among the girls:

Some of those skills were already there. But again, them delivering a presentation to their peers? If you’d asked them that at the start, I reckon you’d have got one, maybe two. [. . .] 10? 10! [Laughs] So yeah, clearly an important skill set that they’ve gained.

Acceptability of continued participation

Despite the practical challenges noted earlier, all bar one school was keen to continue involvement in the STASH study in future years. A few (male) PS interviewees expressly said that they were unlikely to extend their involvement in the STASH study, whereas most expressed interest in continuing to share messages and, potentially, in collaborating with PSs from other schools:

Post intervention, the Edinburgh & Lothians Health Foundation (which funded the intervention costs) allowed the team to use a small underspend to continue to support the PS activities. The PSs in three schools were supported by Fast Forward to set up a lesbian, gay, bisexual, transgender club, run STASH drop-in sessions, support an ongoing Healthy Respect drop in and establish links with community groups. This work continued for about 1 year after the end of the STASH intervention.