Research Presentation Prepared for Teen Pregnancy Team Wakefield

Research Presentation Prepared for Teen Pregnancy Team, Wakefield PCT Project C Card Date : 3 rd 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. l 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 l. All research undertaken with young people aged between 13 to 25 years during January 2009. l All were non-rejectors of free condoms. To have had sex or be thinking of having sex in the near future. l. All to live within the Wakefield District area with coverage of the teen pregnancy hotspot wards. C-Card Non Users l 9 x 90 minute triads (depth interviews with 3 young people who know each other) by experienced, trained moderators. l. 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. l 3 x 13 -15 year olds (PRU, YOT) l 3 x 16 -18 year olds (random and through Wakefield, Castleford College) l 3 x 20 -25 year olds (random and through Wakefield College) C-Card Users l. Platform One, Hemsworth - 5 x 15 minute sessions (13 respondents in total) l. Pontefract New College – 5 x 15 minute individual interviews (5 respondents in total) l. YDSS van, Horbury – 3 x 15 minute sessions (7 respondents in total) l. 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 Total (139) General Sample (81) Hard to Reach (58) Male Female 36 64 64 36 13 -15 16 -19 20 -25 25 27 48 34 66 0 48 14 9 7 6 4 4 4 1 1 1 33 0 12 7 10 7 9 3 9 Region; Centre Ossett Normanton Horbury Pontefract Hemsworth South Kirby Castleford Lupset Knottingley Featherstone

Relationships and Sex

Sexual Behaviour “I was in a relationship from when I was 13 for 3 and a half years. ” Female 17 l 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. l Relationships start young and sex progresses quickly in those relationships. l By the time most reach age 20 they have been having sex for around 5 years. Therefore ingrained behaviours/attitudes.

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

Attitudes to Sex Having a relationship changes the way they view sex Relationship M a l e. F se • Positive about sex • Numbers game/bravado • Sometimes apathetic – more important things in life • Boast about starting young M “You kind of care about ‘em Sex m a l e Having sex changes the way s and it makes you want to be more careful. ” Male 19 Fe ma les • Mixed feelings – some negative/don’t enjoy. • Emotions tied in • Often feeling that they started too young 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 s e l a

Sex Talk Sex is still an embarrassing ‘concept’ for young people fuelled by limited and often oneway communication. Talked about with peers or on visits to clinics but with no one else Unfamiliar Embarrassing Scared of what people might think A taboo subject “We just talk about daft stuff like what happened and things. ” Female 16 Leads to Talk about some STIs (Chlamydia mainly) and experience of visits to clinics Talking about sex is…. . Girls talk about more extensively – humour, emotion, practical Boys talk superficial details Mainly get talked at about sex “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 STIs “CATCHING SOMETHING” • 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) “I’m worried I might have HIV because I just found out a lad I went with the other week injects heroin. ” Female, 17 “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 “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

STIs – Knowledge “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 “What’s clap? Is that the same as Chlamydia? ” Female, 16 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 Given at school when nothing (Catholic school) to being overloaded. Information not it may not be presented in an relevant (not BUT interesting way having sex yet or Rarely given at the right time or presented in (i. e. long chunks too immature to the right way. of text) listen/care) Information too detailed Adverts too vague

STIs – Experience/Attitudes PREVENTION TREATMENT l No young person wants to get an STI but the seriousness of them is very much down played. l 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. ” l Having an STI is not embarrassing to some young people – especially Chlamydia which seems to be viewed as an occupational hazard. l There is a feeling that chlamydia is an acceptable thing to have as it is so common and the symptoms are not necessarily visible. l Worryingly, some were talking of contracting STIs as if it was a badge of honour l 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. l These attitudes feed into the lack of preventative action.

Contraception and Condoms

Contraception “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 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. 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. l 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 Using Condoms 92% of those who had sex had used a condom 67% of those who had sex had not used a condom Carrying Condoms Accessing Condoms • 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. • Corner shop (convenient, on way out) • Pub toilets (not embarrassing but expensive and not as trusted) • Very young people (unless aware of the free condom schemes) had difficulty and relied on friends or went without. Petrol station (less embarrassing, on way out) • Supermarkets (older more confident but not generally liked) Those aged 18+ generally buy their condoms; • Boots/Chemist Younger people (up to 18) mainly have no problems accessing free condoms – get them from Sexual Health Clinics, youth clubs, older siblings or friends. • Expensive • Very embarrassing “It’s quite expensive for a pack isn’t it? It’s like £ 5 for a pack of 3” Male 18 “I get them from the petrol station cos its usually on my way out and they don’t know me in there. ” Male 19

Important Aspects When Accessing Condoms For those accessing free condoms there is a feeling they Price wouldn’t use them if they had to pay. For those paying, it limits how often they use them due to the cost. 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. Brand – A trusted brand is very important. Durex was the main one mentioned and often the only one they knew. They also worried about of date condoms. Type Amount Packaging 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. Number/amount – one small pack if buying, access in bulk if getting free condoms (so they don’t have to go back a lot). 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.

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 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 “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

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

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

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

What Affects Condom Usage? Those not in a relationship % Last time used a condom Last time didn’t use a condom Knew them well Knew them quite well Didn’t know them at all 42 45 12 29 53 18 Knew didn’t have STI Didn’t know whether had STI 41 59 29 71 Drunk Had few drinks Sober 30 21 48 53 24 24 Planned/Might Not planned 63 38 47 53 l 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 Partner on pill Not on pill Don’t know 25 50 30 20 My idea to use/not use Partner’s idea to use/not use Both our decision 20 15 65 10 50 40 My condom Partner’s condom Someone else’s Don’t know if they had one or not Neither of us had one 30 45 25 10 20 40 30 I/Partner doesn’t mind condoms I/Partner doesn’t like condoms 75 25 60 40 l Lack of discussion around condoms and using the pill prevents condom usage. l 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. “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 “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 IMPAIRED JUDGEMENT • Alcohol • Hormones! 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

C Card Scheme

Free Condom Schemes Generally l Many were already getting free condoms from ‘clinics’, youth clubs, health buses or their mates/siblings. l They either found out from friends, mum took them to clinic or was given free condoms after getting STI. l Generally ‘ok’ experiences l Inconvenient locations l Can get condoms for free l Inconvenient opening hours l Can talk to someone if you need to l Perception that appointment need to make an l You are not know (unlike with the doctors l Lack of awareness of where to go 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 it really annoyed me. It put me off going again. ” Female, 17 l Feeling awkward/embarrassed when go to the clinic l Formal environment/procedure l Being talked down to

Reactions to the C-Card Scheme % 95 97 16 -19 Free Condoms ü Access for younger people, 13 -15 year olds, IF registered. 57% ü Free Advice, IF desired ü Shown how to put a condom on correctly 26% ü Card is anonymous ü Must have card to access free condoms 18% × 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. 99 Why is it good? 13 -15 ü 20 -25 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? 61% 47% 20%

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 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 “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 “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 “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

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 l Awareness could be higher especially amongst older age groups. l Hard to reach groups more aware and more likely to use it (61% aware, 57% of those aware use it). l 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 l Friends/Siblings l Don’t know how to go about getting a card l Email (New College) l Don’t know of any other C-Card venues l Health Lessons/PHSE (New College/Hemsworth College) l Posters are not widely distributed, hidden on notice boards l Posters (Youth Club/Van/school) l Not clear from posters what C- Card is l A ‘talk’ at the start of College l 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 l Posters/Signage need to be larger, clearer and more visible to young people at key venues i. e. Colleges and Youth Club van. l Word of Mouth is an important way of raising awareness but lack of knowledge of other venues limits impact.

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

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

Registration l 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. l Fear of getting questions wrong/ felt to be like a test l Easier than expected l Learned about condoms and diseases l Generally conducted maturely and comfortably made it more relaxed than expected l Liked educational matter of fact approach l Prefer to go with friends l Treated like adults really made you feelpeople. really l“She’s Felt to be anice, goodshe idea for younger 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 l For younger people misunderstanding as to the purpose of the registration process. l For older people the face to face registration process was a barrier to using the service. “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

Registration Attitudes to current method Attitudes to future ideas % Good (very) % Bad (very) % Preferred method Fill in form on website get card by post 87 (53) 12 (4) 58 Speak to someone at C Card venue 93 (39) 7(1) 20 Fill in paper application, get card by post 83 (42) 17 (7) 6 Phone freephone number, get card by post 87 (42) 13 (3) 7 % Good 94 6 13 -15 98 3 16 -19 % Bad 94 6 20 -25

Triggers to Use 18% are using the scheme l Friends talking about it l To save money from buying condoms l Better protection for the girls from getting pregnant l 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 l Fear of unknown l Lack of awareness – lack of advertising or posters l Embarrassment l Need to talk about sex lives “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 l Expect older person running the programme/scheme may judge them l Assume it is for older people l Don’t know how to go about getting a card “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 “They should tell people how easy it is and it’s not as bad as they think. ” Female 16

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

Opening Hours l Service restricted by availability of staff and opening times of venues. l Greater access required out of hours, in particular for youth clubs when it is more discreet and less people there. l Abuse of the service by younger users means in some cases the service is restricted to giving at the end of the session. l 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 l The preferred venues are private and out of the way of the main areas. l 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 l On the whole there were no issues with the C-Card staff. In general they were liked, felt to be approachable and trustworthy. l What could be a very embarrassing process was made comfortable by the staff and their matter of fact approach. l A fine balance needs to be achieved – matter of fact, no silly jokes but not too serious. l Mature, friendly, trustworthy, knowledgeable (especially where trained nurses) l Some try to joke/ break the ice which is not liked l Younger – someone who can relate to them l Older staff – fear of being judged especially during registration l Female staff member for girls & male for boys l Known to staff (i. e. from school etc. ) l Reassurance; l Can talk to them about or ask them anything l Privacy/confidentiality l Matter of fact “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 “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

Accessing Condoms l Generally no problems. l The process worked best when; “We dare each other to ask for them cos its embarrassing. ” Female, 15 l Where no set procedure/time slotembarrassed to raise the question in the first place as not sure how to broach the subject (e. g. at Youth Clubs). l Private room, ‘Off the beaten track’ l Designated time – you go in that room to ask for condoms therefore not worried about bringing up the subject. “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 l No privacy - given out in front of others – too exposed, hassle from boys, needs to be more private and discreet. l Option of getting them after school when club not running (Platform 1) • 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 l Not currently being used very often for advice either because; l Didn’t feel like needed it l In some venues only a male available – girls reluctant to talk l Some staff members less approachable, immature, joking l Received initial leaflet – throw away, read once if at all. l Males preferred verbal information so they could ask questions l Females preferred information to take home l In some cases there was a feeling that they would feel comfortable getting advice, but others were less comfortable depending on the venue. “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 “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

Advice and Information – Ideal The Challenge l Potential to provide information differently for 13 -15 s vs 16+ years • Wide age range l A website would help to target information • Some already had lots of information – feel like they know it all. l They felt some information should be given out but very basic, bullet points with pictures/diagrams/ step by step instructions. • Or are older and feel like they know it all. l Straightforward language but not ‘cool’ language and try to avoid silly diagrams e. g. a condom with a name and a smiling face. • 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 l Short leaflets and posters were felt to be the best way of communicating. l Face to face information for under 16 s is essential – especially for younger, disengaged boys who are unlikely to read a leaflet and need face to face interaction to gain attention.

The Card l Younger users more likely to hide the card and forget about it when they needed it. l Older users more likely to carry it with them 18% have a card. Where is it now? 50% 21% ? 17% Lost “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 13%

Brands l Pasante is not a well known brand. Even C-Card users struggle to recall the brand name of their free condoms. l 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. l Most however would accept any brand that was given away by the NHS. % Disagree I would trust the condoms given out by 26 the NHS even if don’t recognise brand Don’t mind what make it is as long as its safe I’d only trust Durex 19 % Agree 69 64 14 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. . Too embarrassed/ Desire to have a choice of condoms/ uncomfortable discussing other products (young people and staff) “I always go for a mixed bag its just easier. ” Female 17 Most get a mixed bag “He just gives you a selection, you don’t get to choose but I’d like to. ” Male 16 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; l Non latex l Lubrication – a few use currently. Not everyone understands why they would want to use it but are interested in the prospect. l Sensitive (thin) l Different sizes l Pleasure increasing l Extra strong/ safe l Femidom l Dental dams “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

Packaging l Generally happy with small purple unbranded bags. l Some boys felt the colour could be less bright and more unisex l Reasonably discrete l Suggestion for a small wallet style packaging l Easy to hide • Packaging wasn’t felt to be very important to the overall choice of accessing condoms • It needs to be small, plain and discrete. • Small paper bags were felt to be fine. • Other free condom schemes were giving out theirs in pick and mix bags. These were felt to be ok too. “There’s nothing on and to be honest most people just put them straight in their pockets anyway so no one can seem them. ” Girl 14 “It’s a bit girlie and bright. What about a wallet or something less obvious. ” Male 17

Future Ideas For CCard

Kiosks 93 ü Convenience % Good 85 ü Don’t have to speak to anyone 87 ü Access when required “It’s a great idea but you know some idiots would get loads and start blowing them up all over the car park and there’d be none left for anyone that needs them. ” Male 14 × Potential for abuse 47% × Vandalism × Limit set on how many condoms can be accessed × Need to register for C-Card (Inconvenient and hassle) 8 % Bad 13 -15 15 16 -19 14 20 -25 41% • Females more likely to rate the kiosk idea as bad vs males. Hard to Reach groups rated the kiosks even more highly than general 93% vs 84% • Mixed response to thumbprint idea. Mostly positive, easier to use, don’t need to carry a card, already used for school dinners. • Negative - Big Brotherish, worries about use of data

Kiosk Sites % l Consider the ‘embarrassment’ factor within these venues. l Still sensitive about who sees them. Ideally place them next to toilets or in toilets l Library and bus stops. l Too quiet and out of the way l For some not a part of their lives Less popular venues… “You wouldn’t want everyone watching as you got them out. ” Female 16

Free Chalmydia Tests From Kiosks % Good 97 100 93 Why is it good? • Many already experienced so know what to expect • PLUS All the benefits of access via the kiosk “Everyone goes to that clinic at Margaret Street. Everyone in college is going. I think it’s a really good idea” Female 19 13 -15 16 -19 % Bad 20 -25 Why is it bad? • Uncertain how it would work. • The idea of accessing free chlamydia tests via the kiosks received very positive reactions. • Step by step communication regarding how to actually conduct the test is required.

Conclusions & Recommendations

Conclusions and Recommendations l Young people need all the help they can get to have safer sex. l They are starting to have sex young, emotionally immature, often under the influence of alcohol and without the skills or knowledge to aid their decision to have safer sex. l There are varying degrees of knowledge of STIs but most is vague and confused, particularly for the older age range (20 -25) where sex education when they were at school was even more hit and miss than it is now. l There are three big stumbling blocks to overcome in getting young people to use condoms…….

Conclusions and Recommendations 1. Accessing Condoms C-Card is helping to tackle this BUT requires; Higher awareness of the scheme itself and its venues. Increased accessibility – the kiosk idea will work very well to improve this aspect. 2. Carrying condoms Dispel myths/stereotype Sex is not usually planned, they’re no good in the cupboard at home C-Card Scheme Accessibility Knowledge Confidence Emotional Support 3. Using condoms The biggest hurdle. Increased understanding of seriousness of STIs will increase usage. Being prepared for the situation – drunk, partner doesn’t want to wear one, having the confidence to discuss it It’s not enough to be on the pill Options for boys who don’t like wearing them l Accessibility is only one aspect in the process of using a condom. l Advice and information is crucial to help young people get over the others.

support is essential and optional for 16+ years Conclusions and Recommendations Venues/Opening Hours Include an option of website registration for 16+ year olds Maintain educational, matter of fact approach. Don’t make it test like. Emphasise it is a 2 -way process – a chance for them to ask questions they’d normally be too embarrassed to ask. Health buses are important for the hard to reach/younger range. Current scheme widened to Chemists and more schools/colleges – important to spread to as many schools as possible. More structure required in youth club type venues – set room/time and increased privacy All C-Card rooms within venues need to be out of the way of main corridors/thorough fare. Current C-Card Service Choice/Range Important to offer choice. Young people should be able to choose their own – sensitive, pleasure, flavours, sizes and non-latex. Also lubricant. Easy to manage at clinics (pick n mix style) but careful control required at youth clubs to prevent abuse. Potential to hand in order form at the beginning of the night and collect at the end? Potential to change current packaging to white.

popular and would increase accessibility and use. Conclusions and Recommendations Venues It is recommended that the C-Card goes ahead with this method of distribution if possible. Communication at the kiosk regarding website address, alternative venues and the process of registering for a card will be important. Young people would access the kiosks in a large number of venues – Supermarkets, Wakefield Centre (suggested near cash machines, out of the way), and in schools/colleges were the most popular options. Local shops and the Ridings Centre were also popular. Where ever the kiosks are situated they need to be privately located e. g. toilets. Future C-Card Service Potential abuse/vandalism Free Chlamydia Testing This was felt to be a very good idea and should be included with condoms in the kiosks where possible. Communication on the logistics of the tests, information on where to get advice and on other STIs should be distributed with the tests.

Conclusions and Recommendations Ideally select younger staff in these roles as they are perceived to relate better with their needs. Option of males/females – different shift times? There were experiences of good and bad practise amongst C-Card staff currently. Training needs to encourage a matter of fact , educational approach. No tests or embarrassing jokes.

Conclusions and Recommendations Written Information/Advice • • Information needs to be less wordy and official looking. Consider the use of; • Diagrams • Bullet points • Pictures / graphics (not cartoon condoms) • Step-by-step information • Flowchart • Summary – to the point. Information needs to cover STI Facts (not just chlamydia) • Symptoms • Seriousness • Prevalence • Frequently asked questions/ Urban myths. • List of venues, website address, other support available. • Mobile phone technology for updates on new venues, opening times, reminders etc.

chance to ask questions, discuss any worries. Where? Conclusions and Recommendations The more advertising the better according to the young people themselves. Signage to have better standout – current signs blend in easily. The most impactful places are thought to be; School/College Website Pub-toilets Email Leisure Centres Local newspapers/magazines Wakefield Centre Cinema Drop in – no need to make an appointment or sign up online. Email marketing campaign to participating schools/colleges (where academic addresses available) Marketing Encourage Word of Mouth. Give ‘tell a mate’ leaflets out to new registrants Relaxed, friendly service, no need to be embarrassed Range available including pleasure increasing, non-latex – choose your own. Only

Conclusions and Recommendations 2. POSTERS/SIGNAGE 1. WEBSITE 3. FACE TO FACE Key Messages Why pay when you can get them for free – join the C-Card Scheme. Carry condoms – don’t hide them. Very few people plan when they’re going to have sex. You never know when you might need one. Empowerment for girls/girls getting tough – it’s under your control. He’ll wear it if he’s worth it (if partner says he doesn’t like wearing them) STIs are serious – its not just a baby that could ruin your life. The pill only protects against pregnancy – what about STIs? Condoms don’t have to be uncomfortable – there are choices, lubrication etc.

Conclusions and Recommendations 1. WEBSITE Ideas for the Website How to register/registration form. Information that would be talked through in the registration process available – step by step process of putting on a condom, how to make it easier, kitemark safety etc. . Venue list and opening times – find your closest venue by entering postcode? Live professional advice available via chat forum Blog/messageboards Send to a friend button

Contact Jo. cliff@platypusresearch. com Phil. cliff@platypusresearch. com Tel : 01924 474734