City Research Online

Abstract

Background:
Sexual health and wellbeing is a central focus of public health policy and service development in England (Department of Health (DH) 2013a, 2013b, Public Health England (PHE) 2015). Historically, services in the UK have been delivered through Family Planning clinics for contraceptive services or Genito-Urinary (GUM) clinics for sexual health issues. Current NHS Service Specifications for sexual health services emphasise an integrated service, delivered by a single health professional (DH 2013b), which has significant implications for the sexual health workforce. Within the South West, there was a disparity of sexual health education provision with little emphasis on the practical competence element. In order to equip sexual health nurses with the appropriate knowledge and skills to deliver an integrated sexual health service, the University of the West of England (UWE) entered a formal agreement with a partner university who had developed an educational package. UWE commenced delivery of two new sexual health modules in September 2013, incorporating both a newly developed classroom delivered Foundations of Sexual Health module and an established Integrated Sexual Health Education module which incorporated a practice placement, mentor support and blended learning approaches to deliver the theory element. This package had previously been successfully delivered in the North of England (McNall and Kain 2010). Aims This research, conducted between 2013 and 2015, explored the transferability of the model to the South West region and the degree to which the educational delivery met service demands in relation to integrated sexual health provision.

Research Methodology:
Data were collected using quantitative and qualitative methods, specifically longitudinal baseline and follow-up survey data from students (n=49) using two validated self-efficacy scales, focus groups with students (n=22) and semi-structured interviews with students (n=7) and strategic managers (n=6). Quantitative analysis of questionnaire data was conducted on baseline and follow-up data using SPSS version 2.2. The data exploring self-efficacy were analysed using Wilcoxon tests and Friedman’s tests. Descriptive statistics and frequencies were used to examine the characteristics of the study population. Qualitative analysis was conducted through thematic analysis and constant comparative methods (Braun and Clarke 2006).

Key Findings:
The results indicated that students who undertook the modules demonstrated significant increases in self-efficacy when using the evidence base in sexual health practice and when communicating in difficult situations. The highest percentage point increase in self-efficacy occurred when the students completed both modules rather than one in isolation. Service manager and student expectation regarding the instructional immediacy and technological specification of the e-learning package were not always met but the electronic mode of delivery was praised for its flexibility, especially important given the large geographical spread of students. Service managers and students were aware of the move to integrated service delivery but were often frustrated by structural restraints that impeded innovation and practice development, such as fragmented commissioning arrangements or lack of collocated services. Although these restraints limited the impact that new learning could have on the service that was offered to patients, there was some evidence that the students were using their professional autonomy to manipulate the system, in line with Lipsky’s (1980) concept of street level bureaucracy.

Recommendations:
Consideration should be given to the balance of e-learning and face-to-face contact within modules, to enhance instructional immediacy and increase student satisfaction. E-learning packages should be reviewed to meet student expectation by incorporating interactive technology and opportunities for collaborative learning. In addition, where service delivery is in a state of flux, modules should incorporate elements of leadership development to enable practitioners to initiate and manage change in practice.

Publication Type:	Report
Publisher Keywords:	sexual health; education; integration
Subjects:	L Education R Medicine > RA Public aspects of medicine
Departments:	School of Health & Psychological Sciences

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