Research Presentation

Research Presentation Prepared for Teen Pregnancy Team, Wakefield PCT Project C Card Date : 3rd March 2009

Order of Presentation • Introduction • Relationships and Sex • Worries • Contraception • The C-Card Scheme • Conclusions and Recommendations

Background & Objectives C-Card is a scheme designed to offer free condoms to young people aged 13-25 years. The scheme is currently being offered via a number of venues (youth clubs, Connexion vans, Colleges etc.) across Wakefield. Wakefield District PCT would like to widen the service they offer young people and ensure it is relevant, easily accessible and meets their needs as far as possible. • Research is required to find out primarily where young people would prefer to access free condoms, but to also explore the mechanics of how they want to access them and what types of condoms they would like to be made available as well as how awareness of the scheme should be raised. • This document details Platypus Research’s proposed approach for carrying out the research. The details in the proposal are not set in stone and we are more than happy to discuss any element with you in more detail.

Qualitative Approach • All research undertaken with young people aged between 13 to 25 years during January 2009. • All were non-rejectors of free condoms. To have had sex or be thinking of having sex in the near future. • All to live within the Wakefield District area with coverage of the teen pregnancy hotspot wards. C-Card Non Users C-Card Users • 9 x 90 minute triads (depth interviews with 3 young people who know each other) by experienced, trained moderators. • Conducted in a neutral venue (e.g. recruiter’s home) for increased confidentiality and to encourage respondents to respond openly and honestly whilst feeling at ease. • 3 x 13-15 year olds (PRU, YOT) • 3 x 16-18 year olds (random and through Wakefield, Castleford College) • 3 x 20-25 year olds (random and through Wakefield College) • Platform One, Hemsworth - 5 x 15 minute sessions (13 respondents in total) • Pontefract New College – 5 x 15 minute individual interviews (5 respondents in total) • YDSS van, Horbury – 3 x 15 minute sessions (7 respondents in total) • Hemsworth Art and Community College – 4 x 15 minute interviews (4 respondents in total)

Quantitative Research Quantitative : Confirm February 2009 • 81 x Online Surveys with 13 – 25 year olds through online panels and schools. • 58 x Paper based questionnaires through YOTs, PRUs, Open Door Project and in street. • 5 minute questionnaire, designed based on the qualitative findings.

Sample Profile

Relationships and Sex

Sexual Behaviour “I was in a relationship from when I was 13 for 3 and a half years.” Female 17 • Young people are losing their virginity very young. Within some of the hard to reach groups they have a reading age of 6, yet are sexually active. Dealing with serious situations without the ability to understand or deal with the consequences. • Relationships start young and sex progresses quickly in those relationships. • By the time most reach age 20 they have been having sex for around 5 years. Therefore ingrained behaviours/attitudes.

Relationships and Sex “I’ve had loads of one night stands. I’m single so I can do what I want.” Male, 21 One night stand/one-off In a relationship • Many of the young people interviewed had sex in a relationship. • Sex viewed very differently by males when in a relationship • For females, sex is a sign of seriousness of the relationship. • Sex tends to be regular and frequent but not always faithful. • Males and females at both ends of the spectrum. • Males openly admit to this type of sexual relationship • Females more ashamed and sometimes hoping it won’t just be a one off or doing it to get over someone/make someone jealous. • Often alcohol fuelled. • Frequency of sex is sporadic in these cases. “Over the six weeks holidays you tend to go out more and party over the Summer. I got quite a few [one night stands] over Chirstmas and New Year.” Male 23 “Last year I was going with loads of lads, every time I went out it was someone different. But this year I’ve calmed down a bit.” Female, 18

Attitudes to Sex • Positive about sex • Numbers game/bravado • Sometimes apathetic – more important things in life • Boast about starting young Males Females • Having a relationship changes the way they view sex “You kind of care about ‘em and it makes you want to be more careful.” Male 19 • Mixed feelings – some negative/don’t enjoy. • Emotions tied in • Often feeling that they started too young • Having sex changes the way they view a relationship “Once you start having sex that’s it there’s no going back, you can’t just stop doing it.” Female, 17

Sex Talk Leads to Sex is still an embarrassing ‘concept’ for young people fuelled by limited and often one-way communication. Talking about sex is….. Unfamiliar Embarrassing Scared of what people might think A taboo subject Talked about with peers or on visits to clinics but with no one else Girls talk about more extensively – humour, emotion, practical Talk about some STIs (Chlamydia mainly) and experience of visits to clinics Boys talk superficial details Mainly get talked at about sex “We just talk about daft stuff like what happened and things.” Female 16 “It’s a bit of a brag after the weekend innit, filling everyone in on what they’ve been up to.” Male 18 Common mis-conceptions i.e. “Everyone’s doing it at my age” Fear of the unknown Half truths Guesses and assumptions

Worries

Worries and Concerns GETTING PREGNANT • By far the main concern for males and females • The threat of pregnancy was most likely to prompt some form of preventative action (but not always!) • Still a worry but not as big a concern • If satisfied that they are protected against pregnancy there is less chance of action being taken to prevent STIs (i.e. wearing a condom) STIs “CATCHING SOMETHING” “I’m worried I might have HIV because I just found out a lad I went with the other week injects heroin.” Female, 17 “I’ve had chlamydia four times.” Female, 18 “I went out with this lass and she stopped taking the pill without telling me. She got pregnant and we had to get rid of it. I couldn’t trust her after that.” Male, 18 “Two of my mates are pregnant. One of them’s glad because her sister had kids young and I think she wanted one [baby]” Female, 16

STIs – Knowledge “What’s clap? Is that the same as Chlamydia?” Female, 16 “It sounds awful but I don’t really know anything about them. It didn’t even get mentioned at school. I’ve kind of seen those adverts on TV but that just tells you the names. I really should find out” Male, 18 Vague Confused Aware of the names but unaware of symptoms etc. A feeling that they ‘know it all’ Very high awareness of and quite good knowledge of Chlamydia “I went to the clinic to get an HIV pill but she said they didn’t do them” Female, 18 Lots of information on Chlamydia through post or from College/free testing kits. Amount of information received ranges from nothing (Catholic school) to being overloaded. BUT Rarely given at the right time or presented in the right way. Given at school when it may not be relevant (not having sex yet or too immature to listen/care) Information not presented in an interesting way (i.e. long chunks of text) Information too detailed Adverts too vague

STIs – Experience/Attitudes PREVENTION TREATMENT • No young person wants to get an STI but the seriousness of them is very much down played. • STIs are talked about in the same way as having a cold. “You don’t want to catch one but if you do there’s things you can get to treat it.” • Having an STI is not embarrassing to some young people – especially Chlamydia which seems to be viewed as an occupational hazard. • There is a feeling that chlamydia is an acceptable thing to have as it is so common and the symptoms are not necessarily visible. • Worryingly, some were talking of contracting STIs as if it was a badge of honour • Many young people bury their heads in the sand preferring not to think about or accept that they might be at risk of other diseases such as HIV. These are talked about less and are more taboo. Any negative experiences associated with these diseases are kept private although older more experienced are more likely to share details. • These attitudes feed into the lack of preventative action.

Contraception and Condoms

Contraception • CONTRACEPTIVE PILL • Commonly used both when in a relationship or not (‘just in case’) • Negative side effects put young girls off using; • Weight gain • Mood swings • Perceived allergy • Although they may not be on the contraceptive pill they may still use the Morning after pill instead. • Some more careful girls (a minority) would use both the pill and condoms. “I think that’s one of the reasons so many girls are getting pregnant, cos’ they don’t want to take the pill cos it makes you put weight on and everyone wants to be thin these days.” Girl, 17 • MORNING AFTER PILL • Can be viewed as contraception • Taken regularly by some girls. • FEMALE CONDOMS • No one in the sample had used them • Lack of awareness – not knowing what they looked like, how they were used etc. • Fearful of using something different. • More likely to be used if they knew their partner well/in a relationship. “I wouldn’t fancy using them female condoms. It’s bad enough with male ones.” F, 17

Condom Attitudes – Several Aspects 92% of those who had sex had used a condom 67% of those who had sex had not used a condom • Most young people have experience of condoms in one way or another. • However, they have different experiences and attitudes towards accessing, carrying and using condoms. • Different issues/barriers along the way reduce the overall number significantly from those who have accessed condoms to those that actually use a condom.

Condom Attitudes – Accessing Condoms Where currently buy? • Most young people have easy access to condoms. • Younger people (up to 18) mainly have no problems accessing free condoms – get them from Sexual Health Clinics, youth clubs, older siblings or friends. • Very young people (unless aware of the free condom schemes) had difficulty and relied on friends or went without. • Those aged 18+ generally buy their condoms; • Expensive • Very embarrassing • Corner shop (convenient, on way out) • Pub toilets (not embarrassing but expensive and not as trusted) • Petrol station (less embarrassing, on way out) • Supermarkets (older more confident but not generally liked) • Boots/Chemist “I get them from the petrol station cos its usually on my way out and they don’t know me in there.” Male 19 “It’s quite expensive for a pack isn’t it? It’s like £5 for a pack of 3” Male 18

Important Aspects When Accessing Condoms For those accessing free condoms there is a feeling they wouldn’t use them if they had to pay. For those paying, it limits how often they use them due to the cost. Price • Place – convenience is important i.e the local shop, petrol station, trusting the store e.g. Boots and not knowing the people at the venue/store. Place • Brand – A trusted brand is very important. Durex was the main one mentioned and often the only one they knew. They also worried about out of date condoms. Brand • Type – Some liked the pleasure increasing condoms, different sizes and extra sensitive. The flavoured ones had also been tried. Often when buying them they go for the quickest/easiest option. Type • Packaging – this aspect was put down at the bottom of the list but when prompted most wanted a small, paper discreet bag with no branding or writing on it. Something they could put inside their own bag. • Number/amount – one small pack if buying, access in bulk if getting free condoms (so they don’t have to go back a lot). Amount Packaging

Condom Attitudes – Carrying Condoms • Mainly males currently carrying them • Mixed opinions about whose responsibility it is; • Some (both males and females) view females that carry condoms negatively – viewed as ‘easy’ • Most however feel that it is both male and female responsibility to carry them. • Younger age groups (13-15) and females are more likely not to carry them and to keep them hidden away at home “I think girls should start to have them in their bags as they expect us to have them all the time don’t they?” Male 18 “It’s very rare that a girl says to me have you got a condom? And if I say no they are not bothered.” Male 23 “If a lass carries a condom with her at College I’d be thinking what do you think you’re going to be doing? I’d think she were a bit of a slag.” Female, 17 “I usually get them from the clinic for me and my boyfriend. I tend to keep them at home in my drawer” Female, 18 “I think I’ve only ever had one girl that has pulled out a condom and said here put that on. I said yeah, ok!” Male, 23

What Affects Condom Usage? How well they know their partner % Had sex with them before 64 First time I had sex with this person 36 23 77 Knew the person very well 4 78 Didn’t know them at all 4 76 34 66 In a relationship with them Not in a relationship with them 79 25 29 71 Knew didn’t have an STI Don’t know whether had an STI 23 77 Last time used a condom Last time didn’t use a condom

What Affects Condom Usage? Attitudes to contraception % 34 59 I/partner on pill I/partner not on pill 41 49 73% said it was both their idea to use one My idea to (not to) use a condom 11 15 Partner’s idea to (not to) use condoms 75% said it was neither of their ideas/not discussed 13 13 47 44 My condom Partner’s condom 69% of males stated it was their condom vs 24% of females 27 15 18 82 I/partner doesn’t mind wearing condom I/partner doesn’t like wearing condom 37 63 Last time used a condom Last time didn’t use a condom

What Affects Condom Usage? State of mind % Was sober 69 Was drunk 30 34 66 Planned/ thought we might 27 73 Hadn’t planned to have sex 25 76 Last time used a condom Last time didn’t use a condom

What Affects Condom Usage? Those not in a relationship Last time used a condom Last time didn’t use a condom % • Those not in a relationship and not using condoms are more likely not to know their partner, and to have had alcohol – this interferes with likelihood to raise the subject of using a condom.

What Affects Condom Usage? Those not in a relationship Last time used a condom Last time didn’t use a condom % • Lack of discussion around condoms and using the pill prevents condom usage. • Dislike of condoms is also a big barrier to usage

What Affects Condom Usage • LACK OF KNOWLEDGE • Optimistic Bias –’Won’t happen to me’ • Not realising how serious STIs can be • Can judge whether someone has an STI based on their appearance. • IMPAIRED JUDGEMENT • Alcohol • Hormones! “You know what it’s like. You’re usually trolleyed and it’s not until a few days later when you think, shit, we didn’t use anything, I hope its gonna be ok” Male, 18 • SOCIAL BARRIERS • Want to be liked/fear of rejection • Want to please partner (partner doesn’t like wearing condoms) • Don’t want to spoil the moment • Don’t know partner well • Embarrassment “If you’re with a complete binner you’re gonna be more likely to use one ‘cos you don’t know what she’s got.” Male, 17 If they don’t want to wear one I probably would do it without.” Female, 17

C Card Scheme

Free Condom Schemes Generally • Many were already getting free condoms from ‘clinics’, youth clubs, health buses or their mates/siblings. • They either found out from friends, mum took them to clinic or was given free condoms after getting STI. • Inconvenient locations • Inconvenient opening hours • Perception that need to make an appointment • Lack of awareness of where to go • Feeling awkward/embarrassed when go to the clinic • Formal environment/procedure • Being talked down to • Generally ‘ok’ experiences • Can get condoms for free • Can talk to someone if you need to • You are not know (unlike with the doctors etc.) “She just kept saying I’d probably been pregnant and that’s why I’d had some bleeding and the chlamydia was hiding it but I’d have known if I’d have been pregnant. She just kept saying it over and over and it really annoyed me. It put me off going again.” Female, 17

Reactions to the C-Card Scheme • Free Condoms 61% • Access for younger people, 13-15 year olds, IF registered. 57% • Free Advice, IF desired 47% • Shown how to put a condom on correctly 26% • Card is anonymous 20% • Must have card to access free condoms 18% % 99 97 95 Why is it good? • Face to face contact required for registration. (older) • Practical help is perceived to be embarrassing for some. • Access to free condoms should be available without a card. • C –Card badly advertised / low awareness. • Available in limited locations. 20-25 13-15 16-19 • Only 3% rated the scheme as bad, but there were mixed reactions to some elements in the qualitative research when probed. Why is it bad?

Reactions to C-Card Scheme “I think it’s a really good idea but if you didn’t have to register for it ” Male, 19, Non User “It’s a great idea. I wish that van would come back round our area again. Tell them to bring the van back” Male, 15, Non User “It’s good. My brother’s got one, I thought it was just for his age. I wouldn’t know where to go to register or get one from though” Male, 18, Non User “They shouldn’t give them out to people so young. You’re just a kid at that age, you don’t know what you’re doing. Even I feel like I’m too young! They should be telling them not to have sex not encouraging them” Female, 18, Non User “I think it’s a really good idea. It’s got to be better than paying for them. Its good that they check younger people aren’t being abused or anything as well. Female, 15, Non User

C-Card Scheme – Usage & Awareness % 63% of those with a card know where the card is and use it once every few weeks or monthly • Awareness could be higher especially amongst older age groups. • Hard to reach groups more aware and more likely to use it (61% aware, 57% of those aware use it). • Younger less likely to need it, older don’t realise/feel it is for them.

Awareness of the C-Card Scheme Currently find out about the scheme from… Issues with Awareness • Friends/Siblings • Email (New College) • Health Lessons/PHSE (New College/Hemsworth College) • Posters (Youth Club/Van/school) • A ‘talk’ at the start of College • Don’t know how to go about getting a card • Don’t know of any other C-Card venues • Posters are not widely distributed, hidden on notice boards • Not clear from posters what C- Card is • Some signage very small and hard to spot “I know it’s at Connexions but that’s all.” Female 16 “My friend wanted some so I went with her and just thought I’d do it at the same time, I’d been thinking about it anyway.” Female 16 “None of my mates come here [Mix van] and I don’t know where else does it so they can’t get any [free condoms].” Female 15 • Posters/Signage need to be larger, clearer and more visible to young people at key venues i.e. Colleges and Youth Club van. • Word of Mouth is an important way of raising awareness but lack of knowledge of other venues limits its impact.

Finding out about C-Card Scheme Where they’d like to find out about C-Card % • Teenage mags (More, Cosmo) • Gossip mags (OK, Heat, Hello) • Local papers (Wakefield Express)

Finding out about C-Card Scheme Where they’d like to find out about C-Card %

Registration • Those that had registered for the scheme were generally happy with the current registration process. However for non –users, especially the older age group, a face to face meeting was felt to be a hassle. • Fear of getting questions wrong/ felt to be like a test • For younger people misunderstanding as to the purpose of the registration process. • For older people the face to face registration process was a barrier to using the service. • Easier than expected • Learned about condoms and diseases • Generally conducted maturely and comfortably - made it more relaxed than expected • Liked educational matter of fact approach • Prefer to go with friends • Treated like adults • Felt to be a good idea for younger people. “I did feel scared but that was because I thought I’d look stupid getting the questions wrong like he’d think I knew nothing about sex.” Female 13 “She’s really nice, she made you feel really comfortable and it wasn’t half as embarrassing as I thought it would be even when she was showing how to use it.” Female 16

Registration Attitudes to current method Attitudes to future ideas % Good 98 94 94 6 3 6 20-25 13-15 16-19 % Bad

Triggers to Use 18% are using the scheme • Friends talking about it • To save money from buying condoms • Better protection for the girls from getting pregnant • Starting to have sex “It’s cheaper why would you go and buy some when you can get them here for free.” Male 13

Barriers to Use 40% aware of the scheme but aren’t using it • Fear of unknown • Lack of awareness – lack of advertising or posters • Embarrassment • Need to talk about sex lives • Expect older person running the programme/scheme may judge them • Assume it is for older people • Don’t know how to go about getting a card “I think they need to advertise it more cos I only found out about it because my friend used it but its not something you talk about a lot with your friends.” Male 17 “They should tell people how easy it is and it’s not as bad as they think.” Female 16 “I just think people are scared to come and talk about it, you don’t know what they’re going to think of you asking for condoms.” Female 16

Usage • Frequency of usage varied depending upon; • Age Whether in a relationship • Social Grade Maturity • Using scheme mostly rather than purchasing condoms “The boys just mess about with them blowing them up on the way home and wasting them.” Female 16 Stocking up or Wasting Not in a relationship Mature Mixed SEG Younger & Older Boys Not in a relationship Immature Lower SEG Younger Infrequent Frequent Relationship Older Higher SEG More Mature Not in a relationship Older Higher SEG Mature Needs Based

Opening Hours • Service restricted by availability of staff and opening times of venues. • Greater access required out of hours, in particular for youth clubs when it is more discreet and less people there. • Abuse of the service by younger users means in some cases the service is restricted to giving at the end of the session. • After school/College/work and weekend access were desired. “Sometimes she’s not in or with someone so you have to keep coming back…so it’s not always convenient to get them and you might need them for the weekend.” 16 Female “He just gives you them at the end, you go in and get them but then the lads just hassle you for them on the way home, it would be better if you could come down after school and get them..” 16 Female

Venues • The preferred venues are private and out of the way of the main areas. • In some cases currently it was difficult to get any privacy due to the set up of the venue i.e. youth clubs, buses. “The Connexions van comes here, that’s bang on that, he just pulls up at the back. They need to do more stuff like that.” Male, 18 “It’s in a good place cos no one can see you coming down to see her, it’s better here.” Male, 17 % where would prefer to access current C-Card Scheme “If you could nip into your Chemist it would be easier..” Male, 18

Staff • On the whole there were no issues with the C-Card staff. In general they were liked, felt to be approachable and trustworthy. • What could be a very embarrassing process was made comfortable by the staff and their matter of fact approach. • A fine balance needs to be achieved – matter of fact, no silly jokes but not too serious. • Mature, friendly, trustworthy, knowledgeable (especially where trained nurses) • Younger – someone who can relate to them • Female staff member for girls & male for boys • Reassurance; • Can talk to them about or ask them anything • Privacy/confidentiality • Matter of fact • Some try to joke/ break the ice which is not liked • Older staff – fear of being judged especially during registration • Known to staff (i.e. from school etc.) “She’s more our age so you feel like she understands you more. I registered at another and it was an older woman I just felt she was judging me.” Female 16 “He’s great he’s like your mate so I would rather go to him than [name], you feel like he’s been through everything you have.” Male 14

Accessing Condoms “We dare each other to ask for them cos its embarrassing.” Female, 15 • Generally no problems. • The process worked best when; • Private room, ‘Off the beaten track’ • Designated time – you go in that room to ask for condoms therefore not worried about bringing up the subject. • Where no set procedure/time slot- embarrassed to raise the question in the first place as not sure how to broach the subject (e.g. at Youth Clubs). • No privacy - given out in front of others – too exposed, hassle from boys, needs to be more private and discreet. • Option of getting them after school when club not running (Platform 1) “It would be better if you didn’t have to see someone once you’d registered and then you just get them when you wanted.” Female 16 • Ideally they would like to have the chance to pick up condoms without having to ask anyone for them. • There was a concern however that they may get tampered with if this was the case so measures would need to be put in place to prevent this and reassure. • They did feel that the option of being able to speak to someone should still be there.

Advice and Information - Currently • Not currently being used very often for advice either because; • Didn’t feel like needed it • In some venues only a male available – girls reluctant to talk • Some staff members less approachable, immature, joking • Received initial leaflet – throw away, read once if at all. • Males preferred verbal information so they could ask questions • Females preferred information to take home • In some cases there was a feeling that they would feel comfortable getting advice, but others were less comfortable depending on the venue. “I wouldn’t go to [name] if I had a problem I’d rather go to one of the women instead you feel more comfortable.” Female 13 “I would definitely come and talk to her because she’s more like our age and she puts you at ease as soon as you walk in. Plus I’ve already had to talk to her about some other personal issues anyway” Male, 17

Advice and Information – Ideal • Potential to provide information differently for 13-15s vs 16+ years • A website would help to target information • They felt some information should be given out but very basic, bullet points with pictures/diagrams/ step by step instructions. • Straightforward language but not ‘cool’ language and try to avoid silly diagrams e.g. a condom with a name and a smiling face. • Short leaflets and posters were felt to be the best way of communicating. • Face to face information for under 16s is essential – especially for younger, disengaged boys who are unlikely to read a leaflet and need face to face interaction to gain attention. • The Challenge • Wide age range • Some already had lots of information – feel like they know it all. • Or are older and feel like they know it all. • Don’t want to read lots of text. • Some with attention/reading problems. “I hate it when they give condoms a name, like Connie the condom, its so naff. But then again I really like that advert where the condom doesn’t get into the bar. I think with adverts it can be humorous but with information it needs to be serious” Female, 17

The Card • Younger users more likely to hide the card and forget about it when they needed it. • Older users more likely to carry it with them 18% have a card. Where is it now? 13% 50% 17% Lost 21% ? “I keep forgetting it so I end up nicking my brothers’.” Female, 16 “Mine’s under my bed so my mama and dad don’t see it.” Male, 13

Brands • Pasante is not a well known brand. Even C-Card users struggle to recall the brand name of their free condoms. • In an ideal world, Durex was the condom of choice as this is the most well known and trusted and for some the only brand they know. • Most however would accept any brand that was given away by the NHS. % Disagree % Agree I would trust the condoms given out by the NHS even if don’t recognise brand 26 69 Don’t mind what make it is as long as its safe 64 14 I’d only trust Durex 19 52 “They’ve told us to look for the date and look for the sign so it doesn’t matter to me which one it is.” Male User 16

Range Currently There was a perception that the current range and choice was sufficient, but.. “He just gives you a selection, you don’t get to choose but I’d like to.” Male 16 “I always go for a mixed bag its just easier.” Female 17 Most would like to be able to pick and choose their own Needs to be carefully managed in youth club type venues.

Range Ideal • Younger age groups (especially boys) treat them like toys and want to experiment, hence want a • wide range. Older age groups are more experienced, know what they like and are more practical. • The most popular choices were; • Non latex • Sensitive (thin) • Different sizes • Pleasure increasing • Extra strong/ safe • Lubrication – a few use currently. Not everyone understands why they would want to use it but are interested in the prospect. “I usually buy those sensitive ones so I’d want to be able to get them.” Male 17 “I’ve tried those flavoured ones before but they don’t seem very good, not as safe.” Female 17 • Femidom • Dental dams

Research Presentation