SHARE Trial

Twenty five schools in the east of Scotland were recruited to the trial. They were allocated either to deliver the SHARE programme or to continue with their existing sex education, according to a balanced randomisation that took into account the main characteristics of each school and its catchment (Raab and Butcher, 2001).

Outcome evaluation
Two successive cohorts of third year secondary pupils (N = 7,616), aged 13/14, were recruited into the trial in 1996 and 1997. Self-complete questionnaires were administered at the start of third year and the initial follow-up was at the start of fifth year (age 15/16), approximately six months post-programme (N = 5,854). The self-complete questionnaires were administered by trained researchers in exam conditions in classroom settings. Young people who had left school at follow-up and non-attenders were contacted at home by post. The cohorts have subsequently been followed-up with postal self-complete questionnaires at the ages of 17/18 and 19/20.

The interim findings from the SHARE trial showed that, in comparison with conventional sex education, SHARE was evaluated more highly by both pupils and teachers, it increased practical sexual health knowledge, and it slightly improved the quality of sexual relationships, primarily by reducing regret. However, the programme had only an extremely small (positive) effect on four of the many cognitions targeted, and by the mean age of 16 years, 1 month, there was no impact on the age of first intercourse, levels of sexual activity, or condom or contraceptive use.

The main outcome measure, however, was the termination rate for women by the age of 20 in each arm of the trial, 4.5 years after the intervention, an outcome not subject to sample attrition or reporting bias.  Anonymized NHS records of pregnancies and terminations for those women who had attended the 25 trial secondary schools were provided in aggregate form (N=4196, 99.5% of those eligible).  In an “intention to treat” analysis there were no significant differences between the groups in registered conceptions per 1000 pupils (300 SHARE v 274 control; difference 26, 95% confidence interval − 33 to 86) and terminations per 1000 pupils (127 v 112; difference 15, − 13 to 42) between ages 16 and 20.  This specially designed sex education programme did not reduce conceptions or terminations by age 20 compared with conventional provision, confirming the lack of behavioural effect in the interim outcomes. The lack of effect was not due to quality of delivery. Enhancing teacher led school sex education beyond conventional provision in eastern Scotland is unlikely to reduce terminations in teenagers.

Process evaluation
A process evaluation has investigated:

a) the extent and quality of delivery of SHARE and the sex education programmes in control schools;

b) which kind of pupils are reached by these programmes;

c) the mechanisms by which they work (if at all), and

d) enabling and confounding influences on either the delivery of SHARE or its impact on pupils.

Methods used have included teacher questionnaires and interviews, pupil interviews and group discussions, classroom observation and ethnographic observation.