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Understanding Young People's Use and Non-Use of Condoms And Understanding young people’s use and non-use of condoms and contraception A co-developed, mixed-methods study with 16-24 year olds in Scotland Final report from CONUNDRUM (CONdom and CONtraception UNDerstandings: Researching Uptake and Motivations) Ruth Lewis & Carolyn Blake (Co-Principal Investigators) Christina McMellon Julie Riddell March 2021 Cynthia Graham #ProjectCONUNDRUM Kirstin Mitchell @theSPHSU Understanding young people’s i Contents Foreword .................................................................................................................................... iv Executive Summary ...................................................................................................................... v Thanks and Acknowledgements ................................................................................................... x A note on terminology used in this report.................................................................................... xi List of Figures and Tables ........................................................................................................... xii Study background ........................................................................................................................ 1 Study design: a co-developed, systems-informed approach ........................................................... 1 Co-developing the study ............................................................................................................................... 1 A systems approach ...................................................................................................................................... 3 Study methods .............................................................................................................................................. 5 Study findings .............................................................................................................................. 8 Perceptions and use of condoms and contraception: an overview ............................................. 9 Condom use .................................................................................................................................................. 9 Contraception use ......................................................................................................................................... 9 Self-evaluation of agency regarding STI prevention and pregnancy ........................................................... 11 How do young people negotiate condom and contraception use with sexual partners? ........... 13 Sexual risk communication prior to intercourse ......................................................................................... 14 Reasons for not using a condom ................................................................................................................. 15 Gender inequities in contraception work ................................................................................................... 21 How do young people engage with diverse information about condoms and contraception? ... 25 School-based information and support regarding condoms and contraception ........................................ 25 Finding, understanding, evaluating and applying information ................................................................... 26 Most likely sources of information about condoms and contraception ..................................................... 26 Trust in different sources of information .................................................................................................... 27 Perceived influences on contraceptive choices .......................................................................................... 31 How do young people perceive and experience free condom and contraception services? ....... 34 Knowledge of free condom services ........................................................................................................... 34 Perceived barriers to use of free condoms ................................................................................................. 35 Preferred points of access for free condoms .............................................................................................. 37 Experiences of accessing STI testing and contraception services ............................................................... 39 Preferences for accessing contraception services ...................................................................................... 41 Discussing contraception with a health professional .................................................................................. 43 Accessing and using condoms and contraception during COVID-19 .......................................................... 48 Recommendations ..................................................................................................................... 52 Further research .................................................................................................................... 54 References ................................................................................................................................. 55 Appendices ................................................................................................................................ 56 Appendix A: Co-developing CONUNDRUM with young people and multi-sector stakeholders .. 56 Co-developing study priorities and research questions .............................................................................. 56 Co-developing the online survey................................................................................................................. 66 Co-developing the study recommendations ............................................................................................... 66 Appendix B: Further methodological details ........................................................................... 68 Small group discussions .............................................................................................................................. 68 Online survey .............................................................................................................................................. 68 Appendix C: Detailed summary of co-produced recommendations .......................................... 70 ii Suggested citation: Lewis, R., Blake, C., McMellon C., Riddell J., Graham C., Mitchell K. (2021). Understanding young people’s use and non-use of condoms and contraception: A co-developed, mixed-methods study with 16-24 year olds in Scotland. Final report from CONUNDRUM (CONdom and CONtraception UNDerstandings: Researching Uptake and Motivations). MRC/CSO Social and Public Health Sciences Unit: University of Glasgow. iii Foreword I am delighted to welcome this timely and vital research, carried out by the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, and co-produced with young people, on their experience of using condoms and contraception. Condoms and contraception are essential foundations of good sexual and reproductive health and wellbeing for our young people, and understanding their views and attitudes toward them help us to better offer them the support that they want and need. In Scotland we have much to celebrate in the good progress made over the last 10 years in our support for young people around pregnancy choices, and the positive impact this has made. However there is still much more for us to improve in relation to the sexual health of young people in particular. Increases in sexually transmitted infections such as gonorrhoea and chlamydia and socio-economic inequalities in relation to unplanned pregnancy and its outcomes remain of great concern. In this context it is notable that young people’s use of condoms and the most effective methods of contraception have decreased in recent years. Understanding the reasons for these decreases is crucial to ensuring that we can shape service and information provision to best meet the needs of our young people and support their right to good sexual health and relationships. This has never been more important as we work towards recovering sexual health provision from the impacts of the COVID 19 pandemic. This research was initiated in 2019 prior to the pandemic, and the research team have done an excellent job in adapting both the research methods and the content of the research to the current context of living with COVID 19, ensuring that young people’s voices are still being heard. As with many health services, COVID 19 has been the catalyst for significant and in some cases positive changes in service access models for providers of contraception and condoms such as sexual health services, pharmacies and GP practices. However, it has also highlighted pre-existing barriers to access which the pandemic has compounded, and we have much work still to do to address these. To ensure we are fully supporting our young people, it’s absolutely vital that their voices are heard and meaningfully acted upon. This research, which has been fundamentally based on the participation of young people, as well as stakeholders from policy and practice, provides rich and essential insights into the needs of young people. It has also helped us to better understand what value young people place on their sexual health and wellbeing, and how we can work with them towards improved engagement
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