InForm

Funded by NHS Kensington & Chelsea’s NHS Innovation Fund, the aim of the InForm Project was to better understand the barriers and challenges that prevent young men from engaging with sexual health and wellbeing services.

The InForm Report

Please click here to download your free copy of the 67 page InForm Report. Alternatively, please see below for the Executive Summary.

The Film

The Context
The UK ranks as one of the worst countries in Western Europe with respect to rates of unwanted pregnancies and sexually transmitted infections (STIs). Addressing the specific needs of young people has been identified as a key priority to improving the overall sexual health of the nation. Young people between the ages of 16 and 24 are disproportionally affected by poor sexual health. They are also the age group least likely to have the information and the skills to practice safer sex behaviours. The Royal Borough of Kensington and Chelsea (RBKC) currently has the highest life expectancy in the UK. This excellence, however, overshadows considerable health inequalities. From 2002 to 2006, there was a 15.3% increase in diagnosed cases of HIV in RBKC, making it the 7th highest prevalence in 15-59 year olds in England. RBKC has committed significant investments to improve the sexual health of their residents. Local residents and service providers in RBKC have called for services that better meet the needs of young people. Improving the uptake of sexual health and wellbeing services and programmes requires addressing the current underrepresentation of young men in the borough.

The InForm Project
Funded by NHS Kensington & Chelsea’s NHS Innovation Fund, InForm is a young men’s sexual health project developed by Living Well. The InForm Project was borne out of the recognition that young men are consistently underrepresented in the services offered by Living Well (and others) and a wish to try and understand how to get more young men to come to programmes, and once there, how to keep them engaged.

The research questions in this study were: “What prevents young men for using sexual health and wellbeing services?” and “What can organisations do to improve engagement of young men in sexual health and wellbeing services?”. This report presents the result of a 3-month study that sought to answer these questions.

Methodology
Our approach to data collection involved talking to young men as well as health professionals to understand perceived barriers to attending sexual health services and workshops. We hypothesised that what is being said by young men as to the challenges they face in accessing health services is different to what professionals say, and that this incongruence may offer valuable insight into young men’s general lack of engagement.

To understand whether this is the case, we triangulated data from qualitative and quantitative sources to capture a comprehensive picture of young men’s beliefs and attitudes around sexual health and wellbeing services. We did this using online questionnaires, focus group and in-depth interviews. Online questionnaires were used to ascertain quantitative information on attitudes and behaviours surrounding sexual health services for young people and to understand current strategies used by professionals in working with young people. Focus Groups and in-depth interviews were used to supply the quantitative data necessary to support and flesh out concepts covered in the questionnaire.

The analysis of qualitative data was carried out using an inductive coding approach. Themes were identified and then the data re-examined for evidence to support each theme. When new themes arose, these were incorporated into subsequent interviews and Focus Groups. Quantitative and qualitative analyses were also based loosely on the Health Belief Model (HBM).

Findings
Young Men
Throughout the study Living Well engaged with 122 young men. Of the 122, 17 took part in in-depth interviews, 13 took part in focus groups, 36 complete an online survey and 56 declined an interview. Of those respondents that completed the online questionnaire, most were in school, working or a combination of both. Survey respondents showed a high level of education, with most completing A-levels or higher. Black African, Black Caribbean, White British and Mixed White-Black Caribbean were the most common ethnic groups represented.
Young men reported accessing youth-focused services to get free condoms, to take part in sport and to access computers. Young men in our study most commonly took part in sexual health services and programming through school-based Sex and Relationship Education (SRE) or to test for a sexually transmitted infection (STI). Some young men did not attend sexual health services for themselves, but did so to support a female friend or partner.

Friends were the most common source for sexual health information, though younger young men (aged 16 to 19) also looked to parents and relatives for advice and support. The young men we sampled had an overall positive opinion regarding the importance of sexual health services before, and after becoming sexually active. Younger young males showed greater comfort than their older peers in going to sexual health clinics and an increased interest in being part of a sexual health youth group.

Professionals
Thirty-eight professionals completed the online questionnaire in its entirety, most of which were female. Professionals came from organisations that delivered a range of services, including sex and relationship advice, life skills training and housing services. Nearly all of the professionals interviewed came from organisations that targeted young people specifically. These programmes involved the provision on sex and relationships, work with young fathers, running gender-specific youth groups, engaging young men at football matches and running drama programmes on health and wellbeing issues. Professionals were also asked to comment on their beliefs about the importance of sex and relationship education, and the extent to which they felt young men were informed and capable of meeting their sexual health wants and needs.

Professionals nearly unanimously agreed that sex and relationship education was important for young people before, and after, they become sexually active. However, they felt that young people lacked the knowledge and the skills to carry out safer sex behaviours.

Barriers to engaging young men
Comparison of the answers young men and professionals provided when asked “What do you think are barriers some young men face in accessing sexual health and wellbeing programmes?” highlights the incongruence that exists between young people and the people who are supposed to work on their behalf. Professionals largely believed that young people did not access services because of a lack of knowledge as to where they were located, what times they were open and fear of the process of attending a sexual health workshop.
Answers provided by young people showed that they are very aware of sexual health services in their community, but do not access them because they are embarrassed, lazy or were unaware of the extent of services provided in health and wellbeing programmes. Many young men also faced difficulty getting to these services, did not see themselves as young people anymore (thus youth-services lacking in relevance) or believed them to be for women only.
Young men were also seen to practice behaviours typical of the socially prescribed definition of a “man”. These include difficulty asking for help in light of sexual ill-health, of being uncomfortable admitting a lack of sexual health knowledge and fears of tarnishing an image of invincibility if accessing sexual health services.

Recommendations
Based on the findings of this project, we put together 10 recommendations for other professionals who wish to develop programmes on behalf of young men.
1. Engage young men on their own terms – This requires engaging young men in the places they wish, the times that they find convenient and with people they trust and respect. Working on behalf of young men requires an understanding of what they want to gain for a session and how to achieve this in a way that is fun and effective.

2. Recognise the diversity of young men – Young men are multi-dimensional and this needs to be reflected in sexual health programming. The needs and wants of young men will also change and services must evolve with them. Young men are keen to be involved in the development of programmes and we should encourage this involvement at every step along the way.

3. Find out what your young men want – We cannot build effective programmes if we don’t listen to the wishes of young men. Programmes need to incorporate needs-based research into their development or risk ending up ineffective and irrelevant to young men. Selecting the right facilitators is a key step in ensuring programmes are fun and engaging the young men you work with.

4. Recognise masculinities in attitudes and behaviour – Young men often ascribe to notions of what is means to be ‘male’, including risk-taking, downplaying of injury and reluctance to ask for help. The way that young men present themselves in their private lives is often different to than in their public lives. Programmes must recognise this incongruence and seek to find ways that appeal to both of these personas.

5. Provide incentives – Incentives provide young men with an excuse to access sexual health services, often doing so under the guise of ‘getting free stuff’. The provision of incentives provides professionals the opportunity to engage young men in discussions around sexual health – opportunities that need to be taken advantage of.

6. Encourage reflection and highlight benefits – Many young men recognise the value of attending sexual health programming; many even want to attend these programmes. Young men can be very engaged, reflected and communicative when in the right environment. Professionals need to strive to create these conditions as this is when they will be most effective at changing attitudes and behaviours.

7. Involve parents – Young people consider their parents an important source of sexual health information, but are often underused. Parents often feel uncomfortable talking about sex with their children. Involving them in programmes may help to bring down some of the communication barriers between parents and young men.

8. Ensure sustainability – Programmes must adapt with the evolving sexual health needs of young men. Piloting and evaluation should be built into programmes from their inception. Involving young men themselves will also help ensure that programme topics are relevant and there is evidence to suggest that young men are interested in taking on this role.

9. Focus on solutions – Far too often we ask young men about their problems, but not how we can help them develop solutions. Programmes must strive to understand the barriers that face young men in leading healthy lives and to equip them with the skills to make the changes necessary in addressing these barriers.

10. Be pro-young men! – A condition that speaks for itself, but often overlooked! Young men have a great deal to contribute and professionals a great deal to learn from them. We will only realise the potential of young men when we start listening to them.

Conclusions
Findings from this study show that young men respond best to interventions that have clear aims and where activities are engaging and active. Young men want to know about sexual health issues relevant to them and where to find services that meet their needs. Those targeting young men must consider the time, location and subject matter that are most relevant to this group and recognise that there is often incongruence in what men say and what they actually want. Organisations must strive to identify the opportunities that exist in engaging young men in their own lives and social structures, and take advantage of young men’s engagement if and when they accompany services with female friends and partners. The window of opportunity to do this is often small, making it even more important to involve young men as stakeholders in their own health.