Addressing sexual and reproductive health and rights with men in prisons: co-production and feasibility testing of a relationship, sexuality and future fatherhood education programme.

PURPOSE: Young incarcerated male offenders are at risk of poorer sexual health, adolescent parenthood and lack opportunities for formative relationship and sexuality education (RSE) as well as positive male role models. The purpose of this paper is to report the process of co-production and feasibility testing of a novel, gender-transformative RSE programme with young male offenders to encourage positive healthy relationships, gender equality, and future positive fatherhood. DESIGN/METHODOLOGY/APPROACH: Using a rights-based participatory approach, the authors co-produced an RSE programme with young offenders and service providers at two UK prison sites using a sequential research design of: needs analysis, co-production and a feasibility pilot. Core components of the programme are grounded in evidence-based RSE, gender-transformative and behaviour change theory. FINDINGS: A needs analysis highlighted the men's interest in RSE along with the appeal of film drama and peer-group-based activities. In the co-production stage, scripts were developed with the young men to generate tailored film dramas and associated activities. This co-production led to "If I Were a Dad", an eight-week programme comprising short films and activities addressing masculinities, relationships, sexual health and future fatherhood. A feasibility pilot of the programme demonstrated acceptability and feasibility of delivery in two prison sites. The programme warrants further implementation and evaluation studies. ORIGINALITY/VALUE: The contribution of this paper is the generation of an evidence-based, user-informed, gender-transformative programme designed to promote SRHR of young male offenders to foster positive sexual and reproductive health and well-being in their own lives and that of their partners and (future) children.

Improving sexual healthcare delivery for men in prison: A nurse-led initiative.

AIMS AND OBJECTIVES: The study aim was to develop and evaluate a nurse-led sexual health service and health promotion intervention for men in prison. BACKGROUND: Men in prison are particularly marginalised members of our society, negatively impacting on their ability to making healthy choices. In relation to sexual health, prison provides an opportunity for curative and preventive care, for an otherwise often hard-to-reach, priority population. DESIGN: Practice development, audit and evaluation. METHODS: Employing a practice development and participatory methodology, we empowered prison nursing staff to provide robust asymptomatic testing for sexually transmitted infections, including the management of chlamydia, with appropriate treatment and partner notification. Collaboratively with young men and nursing staff, a short animation video to promote the service was developed. A case note audit of 172 patients seen in the service during the 6-month period 1 July 2018-31 December 2018 was undertaken. The Standards for Quality Improvement Reporting Excellence (SQUIRE, see Supplementary Material) checklist was followed. RESULTS: National outcome measures were exceeded for some clinical outcomes. During the 6-month period, there were 12 chlamydia-positive (7% positivity rate) and 3 gonorrhoea-positive results. In addition, two new cases of syphilis were detected and a further two cases of known HIV were highlighted. There were seven cases of hepatitis C (3 previously diagnosed) and three cases of hepatitis B. A short animation Dick Loves Doot was developed. CONCLUSION: Successful partnerships between sexual health and prison healthcare services, in partnership with service users, can achieve well-coordinated services and health promotion interventions. RELEVANCE TO CLINICAL PRACTICE: This nurse-led model of care increased detection and early treatment of asymptomatic STIs among men in prison, impacting positively the men, their partner (s) and the public health of the society to which they return.

Young people's sexual readiness: insights gained from comparing a researchers' and youth advisory group's interpretation.

This study explored young people's understandings of sexual readiness and what influenced their decision to initiate first sex. Interviews conducted with 20 heterosexual young people aged 16-18 years, attending sexual health clinics in Northern Ireland, were analysed using a combined approach. This included comparing a researchers and youth advisory group's interpretations of the same data. Thematic analysis enabled comparison to draw out insights across both interpretations. Three themes emerged from each analysis that aligned closely with one another: Mental/Intimate Contact; People/Peer Influences; Self/Socio-Cultural Influences. One additional theme, Adult Control, emerged from the researchers' understanding alone. Results suggest that young people actively deliberate about sex as inevitable and find it difficult to resist the peer and social influences that regulate their lives, with many initiating sex 'to-get-it-over-with'. Gender ideologies and relationship status influenced expectations, motivations and the context surrounding first sex. Sexual readiness was informed by whether first sex was 'good', 'not so good' or 'bad', highlighting the gaps in young people's understanding. Health, law, and education sectors should co-produce interventions with young people to provide relevant and realistic information that explores the effects of gender equality in everyday life on related concepts such as respect, rights, responsibility and resilience.

Developing a Sexual Health Promotion Intervention With Young Men in Prisons: A Rights-Based Participatory Approach.

BACKGROUND: The sexual health of young men in prisons is often among the poorest in any given country. They may have developed sexual behaviors that, from a public health perspective, are considered problematic and burdensome. These include poorer use of condoms and engaging in more frequent casual sex, resulting in higher rates of sexually transmitted infections, including HIV and viral hepatitis. Thus, young incarcerated men are a highly marginalized and socially excluded high-risk group, in greater need of sexual health education and services. OBJECTIVE: The aim of this study was to create an innovative sexual health promotion intervention, made for and with young men in prisons, to encourage them to avail of regular sexual health checkups. This included developing a Web-based animated-style sexual health promotion intervention (1.42 min) coupled with upskilling the prison nurses to offer a partnership approach to prison health care. This paper focuses on the development of the intervention and the importance of the underpinning rights-based (RB) participatory intervention design. METHODS: We employed an RB participatory approach and recruited 14 participants who attended 3 coproduction workshops held within a prison site in Northern Ireland, United Kingdom. A bespoke 3-day training for nurses beforehand, ensured they gained a deeper understanding of the determinants of poor sexual health. The coproduction team comprised young men, prison nurses, nurse sexual health consultant, media company representatives, and facilitator. Workshops focused on content, design, tone and medium of communication for a Web-based intervention that would be appealing and engaging for young incarcerated men. RESULTS: A 1.42-min animation Dick loves Doot was created to promote a positive attitude toward sexual health checkups. The RB approach enabled the young men to participate, have their voices heard and see their stories reflected through the animation. The nurses' capacities to protect, fulfill, and respect the young men's rights to appropriate sexual health services and education was also enhanced. Evaluations confirmed that we successfully provided accurate sexual health information in a way that was engaging and accessible and that encouraged the young men to avail of the new prison sexual health services that were set up in the prison and now provided by nurses. CONCLUSIONS: The RB participatory approach to health advanced in this study provided a means to (1) gain invaluable insider knowledge to understand the impact of structural determinants on health and health inequalities and strategies by which to target young incarcerated men (2) create inclusive opportunities for developing bespoke targeted interventions, and (3) galvanize collaborative partnerships to disrupt the structures and processes that lead to and encourage health inequities. To reduce future risk, effective treatment, coupled with coproduced interventions that transmit relevant health messages in a relevant and meaningful way, is key to success.

Challenges of Conducting Research With Young Offenders With Traumatic Brain Injury.

The purpose of this commentary is to highlight the challenges encountered when conducting research with young offenders. This is drawn from the first-hand experience of 3 researchers working on separate projects within this environment. Young offenders present as a complex clinical population with high levels of illiteracy, substance abuse, and mental health issues. Significant planning is therefore required before working with this group. Consideration must be given to the heterogeneity of prison populations alongside the potential limitations of datacollection methods, in particular, reliance on self-report. The capacity of young offenders to comprehend and effectively engage with research is also of concern, posing issues of both a practical and ethical nature. The absence of a consistent "research culture" within prison environments poses further practical challenges, potentially also placing significant burden on both researchers and prison resources. The challenges discussed in this article may help inform future studies in the area and emphasize the need for greater critical reflection among researchers conducting work of this type.

A systematic review and qualitative synthesis of adolescents' views of sexual readiness.

AIM: The aim of this study was to synthesize the qualitative evidence investigating adolescents' views on heterosexual readiness. BACKGROUND: Adolescents' understandings of sexual readiness are often missing in research and debates on sexual health and related concepts like sexual consent. Research to date has predominantly focussed on age and socio-cultural predictors of sexual debut, thus failing to explain how adolescents themselves conceptualize their readiness for heterosexual relations. DESIGN: A systematic review and thematic synthesis of qualitative evidence. DATA SOURCES: CINAHL, Psychinfo, PubMed, Web of science were searched, 1985-Feb 2016. REVIEW METHODS: Critical Appraisal Skills Programme checklist was used to assess methodological quality. A thematic synthesis focused on commonalities and variations in the data from included studies on adolescents' perspectives of their readiness for sex. RESULTS: Sixteen studies were included. Themes identified were: social learning, relationships and implications for sexual health promotion and practice. CONCLUSIONS: Adolescents may not view initiating sex as problematic, focusing instead on the rewards sex brings and less on health concerns. Adolescents tend to reproduce dominant gender norms of masculinity and femininity in communication about sexual decision-making, which are sometimes influenced by social scripts of career aspirations and ethnic identity. Age was also significant in adolescents' accounts. Early adolescence is a critical period when understandings of gender equality become embedded, thus an opportunity to engage adolescents in critiquing ideas about gender equality and sexual rights. Further research exploring adolescents' understandings of sexual readiness is required. We recommend a participatory approach to support the inclusion of adolescent voices to inform contextually relevant sexual health promotion strategies.

Ethical considerations of doll therapy for people with dementia.

The use of doll therapy for people with dementia has been emerging in recent years. Providing a doll to someone with dementia has been associated with a number of benefits which include a reduction in episodes of distress, an increase in general well-being, improved dietary intake and higher levels of engagement with others. It could be argued that doll therapy fulfils the concepts of beneficence (facilitates the promotion of well-being) and respect for autonomy (the person with dementia can exercise their right to engage with dolls if they wish). However, some may believe that doll therapy is inappropriate when applied to the concepts of dignity (people with dementia are encouraged to interact with dolls) and non-maleficence (potential distress this therapy could cause for family members). The absence of rigorous empirical evidence and legislative guidelines render this a therapy that must be approached cautiously owing to the varied subjective interpretations of Kitwood's 'malignant social psychology' and bioethics. This article suggests that by applying a 'rights-based approach', healthcare professionals might be better empowered to resolve any ethical tensions they may have when using doll therapy for people with dementia. In this perspective, the internationally agreed upon principles of the United Nations Convention on the Rights of Persons with Disabilities provide a legal framework that considers the person with dementia as a 'rights holder' and places them at the centre of any ethical dilemma. In addition, those with responsibility towards caring for people with dementia have their capacity built to respect, protect and fulfil dementia patient's rights and needs.