New approaches to developing & evaluating sexual health promotion for young people

The sexual health of young people in Australia is of considerable concern due to the high prevalence of sexually transmitted infections (STIs), together with common behavioural risk factors such as multiple sexual partners and inconsistent condom use. Traditionally sexual health promotion for young people has been delivered through institutional-based sex education programs, peer education and mass media campaigns. These approaches are generally resource-intensive, and evidence of effectiveness is mixed. Communication technologies including mobile phone text messages (SMS) and online social networking sites offer a novel means of reaching large numbers of young people, who are the greatest and most frequent users of these technologies. However little is known about how best to utilise these technologies for sexual health promotion to young people, and how to appropriately evaluate such interventions. This thesis presents three different approaches to delivering sexual health promotion for young people in Australia – mass media, text messages and social networking sites. Throughout the thesis, novel evaluation designs and tools are employed to evaluate the interventions developed. The limited observed impact of the ‘You never know who you’ll meet’ campaign highlights the limitation of using mass media for sexual health promotion. This is in contrast to the two sexual health SMS interventions developed which had demonstrated positive outcomes. The evaluation of the first intervention (SMS 2008) found that SMS were a feasible, popular and effective method of sexual health promotion for young people, with a significant increase in sexual health knowledge (p<0.01) and STI testing (p<0.05) observed over time. Qualitative evaluation of this intervention identified the key elements of message style, content and language that contributed to the acceptability and utility of the messages. The second SMS intervention (S5) was the first trial of mobile advertising (advertising on mobile phones) to deliver health related SMS to a large number of young people. Despite difficulties experienced during implementation, the intervention again showed positive impacts on sexual health related outcomes among those targeted. Online social networking sites offer another potential means of delivering sexual health promotion messages to young people, particularly due to their interactive functions and rapidly growing popularity. A critical examination of the use of social networking sites for sexual health promotion to date revealed the extent to which these sites are currently being used, finding a focus on organisational promotion in high income countries, with great diversity in site popularity and activity. This is followed by a discussion of the implementation of “The FaceSpace Project”, one of the first sexual health interventions delivered via social networking sites. Recommendations from this project regard the design and implementation of interventions using social networking sites should directly inform future development of interventions in this setting. In summary, text messages and social networking sites are promising methods of delivering sexual health promotion for young people, although they are not without their challenges. Appropriate evaluation strategies should be considered for all interventions developed, in order to usefully assess intervention effectiveness, and factors impacting upon effectiveness.