Periodic Reporting for period 1 - PE4PPI (Peer ethnography for the promotion of patient and public involvement: young people and sexual health service development.)
Reporting period: 2015-09-08 to 2017-09-07
The project “Peer ethnography for the promotion of patient and public involvement: young people and sexual health service development” (PE4PPI) was devised in response to the need to deliver improvements in the sexual health of young people (YP) in England. YP aged 16-24 have the highest rates of sexually transmitted infections (STIs) in England, and the majority of under-18 conceptions continue to be unplanned; further research into YPs’ use of services and their sexual health information needs have been recommended. Numerous complex factors are known to influence YP’s sexual initiation and behaviour, including social expectations related to gender. The use of technology and associated access to pornography and social media are also considered to be transforming attitudes, communication and behaviour, but in ways not clearly understood, while sex and relationship education in the UK is known to offer only limited guidance to YP navigating early experiences of intimacy.
Barriers to service access by marginalized groups, such as YP, are often misconceived by outsiders, hence strategic research can provide new insight into (potential) users’ perspectives. The project’s strategy was to train YP themselves as researchers of young people’s “life worlds”, to enhance adult understanding and inform appropriate service provision. The project, carried out by the Beneficiary, based in the “patient and public involvement” team of the University of West of England (UWE), was explicitly associated with public involvement, an approach founded on the principle that those most affected by health and service provision research should have some say in how it is undertaken. The project aimed to pilot the research method of “peer ethnography”, to elicit knowledge unobtainable through other means. A group of “peer researchers” would conduct ethnography exploring YPs’ knowledge, expectations and behaviour surrounding intimate and sexual relationships, their perceptions of sexual health services, and priorities for support. The peer researchers would be instrumental in communicating findings with stakeholders working in service provision for YP and the wider public. Several lasting impacts of the peer-led study were envisaged:
- new insight into peer ethnography as a methodology for use within public involvement;
- data and knowledge for evidence-based policy-making and service provision for YP in the field of sexual health and other areas; and
- a group of YP equipped with research, communication and advocacy skills.
A wider aim was to broaden the Beneficiary’s skills and experience in applied health research and service development, and enhance her employability within the UK academic environment.
Five YP (four female and one male) were provided with systematic training in qualitative research methods, research ethics and safeguarding. A total of 15 interviews were subsequently conducted, as well as peer group observation and several focus group discussions. The peer ethnography method was found to be innovative, and potentially worth replicating in other public involvement work. However, the extensive time required to ensure the study was ethically rigorous, YP-led and fitted within the peer researchers’ availability (all were in full-time education) posed particular challenges to the two-year project time frame. Significant new data and knowledge were elicited relevant to policy-making and service provision for YP. Details emerged concerning gender determination, gender role conditioning, gender relations, and social expectations, which informed much of YPs’ lived reality of early intimate and sexual relationships. Interviews highlighted poor knowledge of STIs and the sexual health services available. Knowledge of where to obtain condoms was also generally poor, and there was an expressed fear of and resistance to purchasing condoms or using doctors’ surgeries or specialist clinics, as opposed to dedicated YP services. These findings have particular ramifications for service delivery in England, including the recent shift to “Under Twenties” provision (previously services targeted Under-25s).
The poor, patchy nature of sex and relationships education in schools was highlighted, which under-serves YP at critical stages in their personal, emotional and sexual development. The gay and transgender YP interviewed felt particularly marginalised by the “hetero-normative” messages communicated; such findings flag the increasingly recognised links between sexuality, well-being and mental health. Study data provided nuanced detail on internet use by YP, including their variegated exposure to and interest in online pornography at different ages. Findings both confirmed and challenged current concerns regarding pornography in YP’s lives, suggesting the need for greater YP involvement in planned new educational activities in this area. New information was also elicited about vulnerability, risk-taking and transactional sex for drugs amongst YP. Overall study findings underscore the importance of a broad conceptualisation of “sexual health”, and associated educational, awareness-raising and empowerment initiatives for young women and men, which are unlikely to be met through conventional educational and sexual health services alone.
All five peer researchers reported that their research and communication skills had been enhanced by the project. Selected study findings were presented at a British Council seminar “Is porn the new sex education?” leading to a new UWE collaboration with the Sex Education Forum, a campaigning and educational body which disseminates teaching materials throughout the UK. Study findings were presented by the peer researcher team to the Lead Officer responsible for sex and relationships education at Bristol City Council. The team provided detailed input into the online service interface for YP in Bristol, North Somerset and South Gloucestershire developed for the newly commissioned “Unity” sexual health services, which provides advice and service information (www.unitysexualhealth.co.uk/for-the-under-20s/).
Unforeseen, unavoidable delays resulted in a post-project phase, with the team of peer researchers committed to producing several short films based on elements of the YPs’ narratives collected, for example on harassment and coercion related to male use of pornography. These have significant potential for raising awareness and stimulating debate, particularly through online dissemination via YP and Sex Education Forum networks and will be finalised by mid-2018.
The team was invited to join the “Unity” public involvement sub-group, and will therefore advise on sexual health service development for YP beyond the project lifetime. Unanticipated impacts include new academic partnerships with the University of Bath, UK and the University of Calgary, Canada, in the development of methodological tools for the co-production of narrative interviews with YP, and a new research proposal on sexuality through the life course in partnership with the Sex Education Forum.
The project had significant impact on the Beneficiary’s employability, enlarging her research and management skills and academic experience, all of which was instrumental to her establishment at UWE, where she continues to be employed as a Senior Research Fellow.