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ENHANCING SEXUAL WELLBEING IN SCOTLAND- A SEXUAL HEALTH AND RELATIONSHIPS STRATEGY: ANALYSIS OF NON-WRITTEN CONSULTATION EVIDENCE ON THE DRAFT SEXUAL HEALTH AND RELATIONSHIPS STRATEGY
APPENDIX TWO METHODOLOGY
Research for Real
A2.1 Consultation responses were tracked from the outset in order to anticipate and identify key gaps in the responses. It was anticipated that key population groups or their representatives for whom the SHRS is very relevant would not necessarily respond to the consultation exercise. A number of such gaps were identified in discussion with the Scottish Executive Health Department and members of the Reference Group.
A2.2 Research was conducted to gather their views on the SHRS, by engaging directly or indirectly with some of those who are identified as having the greatest barriers to sexual health. These were people of African descent living with HIV, working men who are not otherwise categorised as 'young', men who have sex with men but who don't necessarily identify themselves as gay or bisexual, commercial sex workers or prostitutes and older people. Flyers were also issued to all GUM clinics in Scotland inviting service users to take part in confidential interviews, although no response was received through this approach.
A2.3 Four focus groups were organised through contact with voluntary agencies and other organisations working with the key target group. These were with:
African men living with HIV (African men group).
5 men, aged 20+ including some parents.
African women living with HIV (African women group)
7 women, ages 20-50s, all were parents.
Working men employed in different industries (Working men group)
7 men aged 26-60+, 5 straight, 2 gay including some parents
Outreach staff working on LGBT issues (LGBT outreach group). 7 staff members, 5 men, 2 women.
A2.4 In addition, individual or small group interviews were conducted with nine individuals as follows:
Commercial sex workers/prostitutes (Sex worker interviews) 6 women.
A Consultant Clinical Psychologist working with older people (Consultant clinician interview) One individual.
A national voluntary sector agency working with older people (Older agency interview) Two individuals.
A2.5 Focus group participants and those being interviewed in a non-professional capacity received a 20 voucher for their participant and travel expenses. Each focus group and interviews with those not working in health or social care commenced with a short account of the key features of the strategy. A topic guide was prepared but the discussions were largely unstructured to allow the participants' scope to focus on issues of concern to them. Each focus group or interview lasted around 1.5-2 hours.
A2.6 In addition, the researcher was formally responsible for the moderation of the on-line discussion forum. In practice, this had very few contributions and to preserve anonymity these have been treated as written responses and incorporated into the analysis of all the written responses.
Scottish Civic Forum
A2.7 The Scottish Civic Forum organised eight events, one in each of the 'list' regions of Scotland in February 2004. Over 100 people attended including those with a professional interest in the issues and lay people.
A2.8 Invitations to participate started with the Civic Forum's own membership, and then reached beyond to as many potentially interested parties as could be identified. Every effort was made to spread news of the events and encourage participation, including circulation through all relevant networks. Adverts were placed in local press in the lead-up to each event, in the hope of attracting individuals with a personal interest in the subject. Adverts were also sent to every Genito-Urinary Medicine Clinic in Scotland, in the hope of attracting service users into the process.
A2.9 Civic Forum events are designed to provide opportunities to discuss issues with different people from different backgrounds and points of view. This dynamic not only allows participants to hear new ideas and perspectives they otherwise may not, but it also creates new ideas as a result. The Civic Forum designed these particular events with two key principles in mind; firstly, to provide a "safe space" where people with different views and opinions could come together, and secondly to record views without bias or judgement, giving all views equal weight and value.
A2.10 The events were organised and advertised locally by Civic Forum Co-ordinators; a network of local-based workers who specialise in working with networks of smaller, grassroots-level organisations. The Co-ordinators, like all Civic Forum staff involved in this type of work, have developed expertise in planning and running consultation events based on the two principles mentioned above. The overall process was co-ordinated by staff at Scottish Civic Forum head office.
A2.11 Before this process had started, a Scottish Civic Forum briefing paper on the consultation had been widely circulated throughout civic society. This paper was aimed at providing an introduction to the key themes up for discussion. All those registering in advance for the events in this process were also sent the paper. It was hoped that with the aid of this paper, those at the events would start with a certain degree of familiarity with the proposals.
A2.12 Each event started with a brief introduction to the strategy. Civic Forum staff introduced the topic. Participants were then split into smaller groups for discussion of the proposals. Most events ran from approximately 10.30 until 14.30, which allowed for two group discussion sessions of approximately 1_ hours each. Some of the events also featured a plenary feedback session after each of the group discussions. The role of facilitator was key to this process, as it ensured that discussions would be safe and constructive, and that all participants would be encouraged to join in. It also ensured that discussions stayed relevant to the issues at hand, and people felt able to express their views without fear of redress. Comments made by participants were recorded by facilitators on either flipcharts or in notebooks.
A2.13 There were around 100 proposals in the Reference Group's draft strategy, too many to cover in a day event. A decision was taken to base conversations around 4 general areas, as identified in the summary document. At the events themselves, participants were given copies of the full and the summary strategy. It was found that the summary version in particular was a useful aide to discussions.
The Poverty Alliance
A2.14 The Poverty Alliance (PA) conducted two focus groups in February 2004 with women in Greenock and Maryhill, Glasgow
A2.15 The meeting in Maryhill was attended by seven members of a community group for new mothers. All the participants were women, all were in their early to mid-30s, and all lived in the Woodlands and Maryhill areas of Glasgow. The meeting in Greenock was attended by seven members of a project based in Greenock aimed at providing IT skills to people from the local area. All the participants were women, four in their early 20s, two in their mid thirties, and one in her early 40s. All were parents. All of the participants lived in the local area.
A2.16 The overall aim of each of the focus groups was to promote discussion and reflection regarding sexual health and well-being amongst members/users of community based organisations. It was recognised that not all of the recommendations contained in the draft strategy would be of interest to those who attended focus groups. In order to facilitate discussion those attending the focus group were given a short presentation on the draft Sexual Health and Relationships Strategy, which outlined key elements of the strategy. Following the presentation, four main issues were addressed:
How can a more positive view of sexual health and relationships be promoted in Scotland?
What are the barriers that prevent people from using the sexual health services that exist?
How can parents best be supported to talk to their children about sex and relationships?
What should the role of schools be in providing better education on sex and relationships?
A2.17 These questions were designed to prompt discussion of key issues in the consultation document.
Children in Scotland
A2.18 The main aims of this research were to gather the views of young people aged 14 and over on the draft Sexual Health and Relationships Strategy; to analyse these views; and to identify significant areas of concern regarding the implementation of the draft Sexual Health and Relationships Strategy recommendations. The original research design comprised both qualitative and quantitative components. It was decided to discontinue work on the quantitative component following discussions with the Scottish Executive Health Department. This was due to concerns about the practical and ethical appropriateness of such a research design (which had suggested a web survey) on this topic, with young people. The research project therefore used qualitative methods only.
A2.19 Five focus groups were conducted across Scotland with young people of a range of ages and experiences between January and April 2004. The focus groups consisted of the following young people:
Three young women who are mothers, aged 19-20 (young mothers group)
Seven young men currently accommodated in a Young Offenders' Institute, aged 18-21 (young men group)
Three young gay men (two of whom are care leavers), aged 17-20 (young gay men/care leavers group)
Three young men who are fathers, aged 19-25 (young fathers group)
Three young women who are in third year at secondary school, all aged 14 (young women group)
A2.20 In identifying potential participants, Children in Scotland aimed to ensure representation both of the views of young people from under-represented groups, and of the views of young people for whom the draft Strategy is particularly relevant. Children in Scotland supports the Participation Network, which comprises over two hundred organisations across Scotland and supports organisations in promoting young people's participation in decision-making processes. Four groups were identified and accessed through this network. The fifth group was established via a Local Authority, by making contact with a secondary school.
A2.21 One of the research objectives was to identify and engage with young people in and leaving local authority care. Children in Scotland was not able to consult young people who are currently looked after by the local authority. Although efforts were made to access such young people through a member of Children in Scotland's participation network, it was not possible to arrange a focus group within the required timescale. However, the study did engage successfully with two young care leavers. Similarly, it was intended that young people from minority ethnic and travelling communities would also be represented and efforts were made to engage with these young people via the participation network. However this was not possible due to practical problems in securing the participation of young people from these communities within the time frame.
A2.22 In relation to school-based focus groups, six secondary schools were approached and asked to facilitate access to pupils; however, only one school was able to accommodate a focus group due to the timing. Schools could not be contacted until permission had been obtained from the relevant Directors of Education and this was not granted until 2 weeks after contact was made with them. This meant that schools were not contacted until the end of March, by which time timetables were full prior to the Easter holiday period. Additionally, most pupils aged 14 and over (the age specified for the study) were sitting examinations and could not take part in focus groups due to the demands of study, whether before or after the Easter holiday period.
A2.23 Given the sensitive nature of the issues addressed by the research, informed consent was particularly important. All potential participants were advised both in writing and verbally of the project and its aims prior to agreeing to take part. They were assured confidentiality and anonymity; however the limits of confidentiality were explained where relevant in respect of child protection guidelines. It was made clear to the young people that participation in the study was voluntary and that they could choose to withdraw from it at any time. Consent forms were signed by all participants and where appropriate local authority and parental consent was also sought.
A2.24 The topic schedule comprised 10 questions, focusing on the key elements in the draft Sexual Health and Relationships Strategy: sex and relationships education and health services for young people. The same topic schedule was used for both the male and female groups with a few key differences; where relevant gender differences were present, different questions were used. Children in Scotland developed a Young People's Policy Briefing on the draft Sexual Health Strategy, as well as a flyer designed to explain the purpose of the focus group, which was distributed to participants prior to the focus group sessions in order to inform the discussions. These materials were developed in consultation with the Scottish Executive and informed by Children in Scotland's previous work with young people on sexual health issues.
A2.25 The focus groups were semi-structured. Although they followed the topic schedule, it was done in a way that avoided restricting areas of discussion that the young people themselves considered relevant. Flip charts were used to present a range of sources of help/information on sexual health and relationships for discussion.
A2.26 Four of the five focus groups lasted for approximately two hours. In the case of young women group, which took place in a school, the young people were only able to participate for a limited time during the school day, the length of the discussion was limited to one and a half hours.
A2.27 In the case of three groups, each discussion was facilitated by the group's youth workers - who had already established a good working relationship with the participants - due to the sensitivity of the issues being discussed. In each case, a member of Children in Scotland's research and policy staff acted as assistant facilitator and recorded the discussion by taking notes. Perhaps unsurprisingly in view of the study's findings that trust and creating a safe environment are essential to enabling open discussions of sexual health and relationships, the use of youth workers who were already known to the young people was found to be very helpful in facilitating these discussions.
A2.28 In the case of the young gay men/care leavers group, the discussion was facilitated by experienced members of Children in Scotland's research and policy staff, but the youth worker was present at the start of the first one-hour session, which helped the young people feel at ease. Additionally, the group consisted of older young people, one of whom was experienced in being asked his views. The group's discussions were therefore frank and open and did not appear to be inhibited by the fact that they did not know the facilitator or assistant facilitator well.
A2.29 One group took place in a school and was facilitated by 2 experienced members of Children in Scotland staff. For this particular group, there was no teacher or 'youth worker' present. It was felt that this allowed for the young people to speak freely, particularly when being asked questions regarding schools being involved in SRE.
A2.30 All Focus Groups were held within the project or setting through which contact had been made with the participants and with which they were familiar. Priority was given to creating as safe and comfortable an environment as possible in view of the sensitive issues being discussed.
A2.31 The data is based on the notes taken by the assistant facilitator. Notes produced for each focus group provided a detailed description and preliminary analysis of the main issues discussed and the underlying themes raised. Analysis was then based on a standard theme-based approach which involved the coding of material and the identification of linkages and relationships.
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