the jack trial
The 'If I were Jack' team have developed an evidence-informed educational resource about young men and unintended pregnancy, which is suitable for use within the Relationship and Sexuality Education (RSE) curricula of post-primary schools across the United Kingdom.
The World Health Organisation and the authors of a number of systematic reviews recognise that teenage boys have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. The If I Were Jack intervention aims to increase the intention of both teenage boys and girls to avoid teenage pregnancy by reducing the prevalence of unprotected sex. The intervention addresses gender inequalities in RSE provision by explicitly focusing on young men and teenage pregnancy. The proposed effectiveness trial will be a continuation of a programme of work. It builds upon the team’s successful feasibility trial, and their earlier Knowledge Translation Award from the ESRC (through which the intervention was initially developed), as well as a ‘translation study’ offering insights into generating an intervention that is culturally generalisable across the United Kingdom (UK).
Developing and Testing
Stage One involves development and testing of intervention refinements deemed necessary as an outcome of (1) Feasibility trial in Northern Ireland (NI) and (2) Transferability study of intervention acceptability outside of NI in the three other countries of the UK. These refinements will be assessed against progression (‘stop/go’) criteria before progressing to Stage two.
Stage Two involves an NIHR-funded cluster randomised controlled trial (cRCT) in post-primary schools across the UK with embedded process and health economic evaluations. Sixty-six post-primary schools will participate, with schools as the unit of randomisation. Each participating pupil will be in the study for approximately 19 months and will be asked to complete a questionnaire two times – at baseline and 18 months later (12-14 months post intervention). The process evaluation will assess fidelity to implementation protocol and contextual factors associated with participation and effectiveness via semi-structured interviews with teachers, focus group discussions with pupils, a survey of parents (with potential follow-up focus group discussions), and observations of a sample of lessons. The economic evaluation will involve two components: (a) a cost-consequences analysis of trial data, and (b) a behaviour change-based decision model to evaluate the long term cost-effectiveness of the intervention.
PURPOSE OF THE STUDY
Teenage Pregnancy, Relationship and Sexuality Education, and Young Men
Reduction of unintended teenage pregnancy rates remains on the international policy agenda. While not all adolescent pregnancies are unplanned or inevitably lead to negative life course outcomes, many teenage pregnancies are unintended and can result in adverse health problems for teenagers and their infants, as well as generating emotional, educational and economic costs for adolescents, families and society.
Achieving reductions in unintended teenage pregnancies is a complex process which is unlikely to be achieved through educational interventions alone. However, research also suggests that high quality Relationship and Sexuality Education (RSE) is an essential part of the process which can also contribute to positive sexual and emotional health for young people.
In developing educational interventions which aim to reduce rates of unintended adolescent pregnancy, it is increasingly recognised that targeting teenage men is an important yet often neglected focus. While it is teenage men who are currently most in need of effective and stimulating RSE they are the least well provided for, and are more likely to rely on peers and pornography for an understanding of sexual relationships. The If I were Jack project aims to address this gap by focusing on the consequences of an unintended pregnancy in the lives of teenage men.
Download an article from the Every Child Journal which highlights the importance of including young men in relationship and sexuality education. [Every Child Article]
DEVELOPMENT OF THE STUDY
Jack's History: From Research to Intervention
The If I Were Jack project builds on previous research studies relating to young men's attitudes to unintended pregnancy and parent's approaches to communicating with their teenagers about relationships and sexuality (Lohan et al., 2010; Lohan et al., 2011; Lohan et al., 2012; Hyde et al., 2010).
The primary aim of one of these studies (Lohan et al., 2011) was to increase understanding of the psychosocial determinants of adolescent men’s attitudes and decision-making in relation to a hypothetical unintended pregnancy. The study adopted an innovative methodological approach. Drawing on earlier research conducted in Australia (Condon et al, 2006; Condon et al., 2001), the research team developed a computer based interactive video drama (IVD) for the purposes of the research. Through a short interactive film entitled ‘If I were Jack’, the researchers attempted to ‘bring to life’ the story of a week in the life of a young man whose girlfriend has just told him she is unexpectedly pregnant.
The study took place in Ireland using an Irish version of the IVD but the team also produced a Northern Ireland version, using Northern Irish actors and settings. The rationale for developing two versions of the IVD was to enable the greatest opportunity for adolescents to identify with the lead character and the situation.
As part of this study the research team assessed the educational impact of the resource with end users and received overwhelmingly positive responses from teachers, pupils, and health and education sector professionals. This study was based on a representative sample of male pupils in Ireland (N=360) and a smaller sample of teachers (N=5) and RSE policy experts (N=4).
|The adolescent men’s response was almost universally positive and also showed the potential impact in their lives.||
79% agreed with the statement 'If I were Jack made me think about issues I hadn’t thought about before’;
85% agreed with the statement 'If I were Jack helped me understand the effect an unplanned pregnancy would have on a guy like me’;
84% agreed with the statement 'If I were Jack made me aware that I could talk to a counselling service if I were in Jack’s situation.’
|Teachers also endorsed the educational benefits of using the IVD in the classroom:|| I think it is addressing a gap, a very definite gap there between the knowing how a girl gets pregnant and the actual consequences of somebody saying it to you, “I’m pregnant” and all the feelings that would go through them. [Teacher 1]
I think it would be a very good module, not just alone from the point of view of adolescent pregnancy, but just from the point of view of the whole thought process of a decision that has to be made and how to think it through and how to work out the positives and negatives. [Teacher 4]
RSE educational specialists commended its authenticity and its interactive features:
It’s so different from the mainstream stuff, just the tone of it is completely different, the setting is completely different, the language is completely different. [The mainstream stuff] is almost sterile in its content in comparison. [Specialist 1]
I strongly recommend that you take it forward as an educational tool. I’d love to be able to give that to teachers. It is so different; it is so different, the perspective, the interactiveness, the boy’s perspective and the quality of the filming and everything is very good. [Specialist 4]
THE STUDY IN SCHOOLS
Jack as an Educational Resource
We worked in partnership with end-users and professionals to develop the Irish and Northern Irish versions of the If I were Jack IVD as educational resources suitable for use within the RSE curricula of post-primary schools in Northern Ireland and Ireland and we are currently producing versions suitable for use in Scotland, England and Wales.
The IVDs are coupled with a training package for teacher trainers, educational material to assist teachers in using the IVD in the classroom and web-based educational material for parents, including two animated films which help parents have conversations with their children about sex and pregnancy.
The feasibility trial findings indicated that the content, components and implementation process for the intervention are acceptable and feasible. The Public Health Agency NI Research and Development Office has also provided funding for the development of parents' anmations.
We are currently examining the effectiveness of the resource in reducing unprotected sex amongst teenagers as part of our UK-wide trial.