1. A systematic review of school-based skills building behavioural interventions for preventing sexually transmitted infections in young people Jonathan Shepherd 1, Josephine Kavanagh 2, Jo Picot 1, Angela Harden 2, Elaine Barnett-Page 2, Andrew Clegg 1, Geoff Frampton 1, Debbie Hartwell 1, Alison Price 3 1 Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, UK 2 Evidence for Policy and Practice Information and Co-ordinating -Centre (EPPI-Centre), Institute of Education, University of London, UK 3 NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton, UK Objectives To conduct a systematic review and economic evaluation to assess the effectiveness of behavioural interventions for the prevention of STIs in young people aged 13-19 years. A separate poster at this conference presents the results of our economic evaluation of behavioural interventions.† Background Rates of sexually transmitted infections (STIs) continue to increase, particularly amongst young people. Interventions to encourage young people to adopt and maintain safer sexual behaviour are one approach to preventing STIs and promoting sexual health. Methods A two-stage process was followed: (i) development of a descriptive map of the key characteristics of studies evaluating behavioural interventions, followed by (ii) detailed systematic review of a policy relevant sub-set of interventions. A comprehensive literature search was conducted for the period for 1985 to March 2008. Eligibility criteria for inclusion in the descriptive map were: controlled trials (random or non-random), evaluating a behavioural intervention (defined as any activity to encourage young people to adopt sexual behaviours that will protect them from acquiring STIs), in young people aged 13 to 19 years, which reported a sexual behavioural outcome. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number 06/72/02) and be published in full in Health Technology Assessment. See www.hta.ac.uk for further project information. Contact: Dr Jonathan Shepherd, SHTAC, University of Southampton. SO16 7NS Tel: +44 (0)23 80 597055 Email: jps@soton.ac.uk. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health. † K Cooper, J Jones, J Shepherd. An economic evaluation of school-based skills building behavioural interventions for preventing sexually transmitted infections in young people. (poster number P4.154) Conclusions School-based behavioural interventions which provide information and teach young people sexual health negotiation skills can bring about improvements in knowledge, and increased self-efficacy. However, in this systematic review there were few significant differences between the skills based behavioural interventions and standard sexual health education, in terms of changes in behavioural outcomes such as condom use. Results A total of 8037 references were identified through literature searching. A total of 136 studies met the inclusion criteria for the descriptive map. The results illustrated the predominance of North American trials of educational interventions conducted in schools with young people targeted primarily because of their age. Discussion with the project’s advisory group enabled the prioritisation of a policy-relevant sub-set of studies for systematic review. To be included studies had to: Be a randomised controlled trial (RCT) Evaluate a behavioural intervention including factual information on STIs, in addition to an element of skills development for negotiation of safer sex Be delivered in a school Report a sexual behavioural outcome (in addition to other outcomes). Results (continued) A total of 15 RCTs met the inclusion criteria for the systematic review. The majority were conducted in the United States, with only two in the UK. Of the 15 RCTs, 12 were judged to be methodologically sound and were included in the analysis of effectiveness. A variety of behavioural outcomes were reported, in addition to knowledge, attitudes, and self- efficacy, but none of the studies reported changes in infection rates. Meta-analysis for condom use generated a fixed-effect pooled odds ratio of 1.07 (95% confidence interval 0.88, 1.30) with no statistically significant difference between intervention and comparator (see figure below). No statistically significant heterogeneity was detected (p = 0.333, I 2 = 12.9%). Nine of the 12 methodologically sound RCTs conducted a process evaluation. Synthesis of the process findings to explore reasons for the limited impact of the interventions revealed two sets of factors (i) interventions were not always implemented as intended, (ii) not all young people found the interventions engaging or acceptable.