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Sex Education: Sexuality, Society and

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Knowledge and attitudes of secondary

school teachers regarding sexual health
education in England
a a
Jo Westwood & Barbara Mullan
a
School of Health Sciences , UK
Published online: 26 Apr 2007.

To cite this article: Jo Westwood & Barbara Mullan (2007) Knowledge and attitudes of secondary
school teachers regarding sexual health education in England, Sex Education: Sexuality, Society and
Learning, 7:2, 143-159, DOI: 10.1080/14681810701264490

To link to this article: http://dx.doi.org/10.1080/14681810701264490

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 Sex Education
Vol. 7, No. 2, May 2007, pp. 143–159

Knowledge and attitudes of secondary

school teachers regarding sexual health
education in England
Jo Westwood* and Barbara Mullan
School of Health Sciences, UK
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Objective To assess the sexual health knowledge of teachers who contribute to secondary school
sexual health education in order to determine whether teachers are adequately prepared to
implement present government education and public health policies.
Design Results were obtained from a questionnaire as part of a two-phase intervention study.
Setting Nineteen mixed-sex, state secondary schools in central England.
Participants One hundred and fifty-five teachers (94 female, 61 male) participated.
Main outcome measures The questionnaires were distributed to teachers to assess their
knowledge of sexual health, contraception and sexually transmitted infections. In addition,
teachers’ attitudes on the subject of sex and relationships education were evaluated.
Results The results suggest that teachers have insufficient sexual health knowledge to effectively
teach sexually transmitted infections or emergency contraception, although their general sexual
health knowledge was good. Therefore, at present teachers do not have adequate specialist
knowledge in sexual health to contribute to current recommendations for sex and relationships
education in secondary schools. There were no statistically significant differences in the results
regarding location of school, area of residence, gender or age of the participant.
Conclusions Many teachers are being expected to contribute to secondary school sexual health
education programmes at a time when they do not have sufficient knowledge to provide young
people with adequate sexual health education and when they do not feel prepared to teach, and in
many cases would prefer not to teach, these programmes.

Background literature
Comprehensive sexual health education has come to be regarded as an essential
component of personal, social and health education (PSHE) (Department for
Education and Employment [DfEE], 2000). The sex and relationship education
guide in England (DfEE, 2000) sets out clear markers to be attained during
each stage of statutory educational development relating to knowledge, attitudes

*Corresponding author. School of Health Sciences, 52 Pritchatts Road, Edgbaston, Birmingham

B66 4EB, UK. Email: [email protected]
ISSN 1468-1811 (print)/ISSN 1472-0825 (online)/07/020143-17
# 2007 Taylor & Francis
DOI: 10.1080/14681810701264490
 144 J. Westwood and B. Mullan

and beliefs concerning sexual health and relationships. However, a review of sex
and relationships education (SRE) by the Office for Standards in Education
(OFSTED, the statutory schools inspection body) found that, in secondary
schools, teaching about sexual health, including sexually transmitted infections
and the law in relation to sex, was inadequate (OFSTED, 2002). Despite some
studies concluding that sex education is effective (Song et al., 2000), much
research suggests the opposite (NHS Centre for Reviews and Dissemination,
1997; Guyatt et al., 2000). Indeed, a review of reviews undertaken by Swann
et al. (2003) reinforces the findings of Guyatt et al. (2000) by concluding that
there is ‘mixed evidence for the effectiveness of school-based and/or teacher
delivered sex education’ (Swann et al., 2003, p. 41) and that, in addition,
the data pool is small and of poor quality (Swann et al., 2003). Indeed, the
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publication of the DiCenso et al. (2002) review found no evidence for the
effectiveness of any intervention, with the exception of one multi-faceted
intervention. Furthermore, the work of DiCenso et al. (2002) remains pivotal as
it does provide one of the most up-to-date overviews regarding sexual health
education and its effectiveness in the light of current Governmental health and
education policy (Social Exclusion Unit [SEU], 1999; Department of Health
[DoH], 2001; DfEE, 2000).
It has been suggested that the majority of young people gain their sexual health
knowledge from school (NHS Centre for Reviews & Dissemination, 1997; Graham
et al., 2002) and thatthis is provided primarily by teachers (Walker, 2001).
Although many teachers consider it their responsibility to teach SRE (Wight et al.,
2002; Smith et al., 2003), there are many gaps in teachers’ sexual health
knowledge (Graham et al., 2000) and their training can be considered limited
(Wight et al., 2002). A recent randomised trial evaluated teacher delivered sex
education comparing a specifically designed programme (intervention group) with
an existing sex education programme (control group). Wight et al. (2002) found
that there was no difference in the sexual activity or sexual risk-taking behaviour of
the pupils involved in the study. It concluded that teacher-delivered sex education
does not provide young people with the knowledge and skills deemed necessary to
negotiate sexual relationships. This was despite the intervention group receiving an
up-to-date five-day training programme relating to sexual health and relationships
(Wight et al., 2002). This study supports what DiCenso et al. (2002) were
claiming—namely, that ‘primary prevention strategies evaluated do not delay the
initiation of sexual intercourse, improve use of birth control among young men and
women, or reduce the number of pregnancies in young women’ (DiCenso et al.,
2002, p. 1427). The review of SRE undertaken by OFSTED (2002) further
asserted that the subject should be taught by teachers who have the ‘necessary
knowledge and teaching expertise and who want to participate in this demanding
subject’ (OFSTED, 2002, p. 33). However, with recent changes to the state
secondary school curriculum, the importance of PSHE has declined (Hilton,
2003), and as a result sex education often suffers by having its allocation cut from
the timetable (Best, 1999). Therefore, sex education is subjected to indifference by
 Knowledge and attitudes of secondary school teachers 145

many staff as it remains a non-assessed component of the curriculum (Hilton,

2003) despite OFSTED recommendations that the subject be assessed, as
weaknesses in teaching were often related to poor assessment (OFSTED, 2002).
However, some teaching initiatives have been positively received; for example, the
Adding Power and Understanding in Sex Education (A PAUSE) programme from
Exeter University (Mellanby et al., 1995). An independent review of this
programme has recently been undertaken by the National Foundation for
Educational Research (NFER, 2004), who found that students receiving the A
PAUSE programme, which encourages peer-led SRE, were more positive about
SRE than the control group of students (NFER, 2004). That said, only tentative
links were found between reported use of contraception and students who
completed the A PAUSE programme (NFER, 2004). This finding is supported by
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the work of Stephenson et al. (2004). In addition, the review of the A PAUSE
programme found no significant differences between the intervention and control
groups regarding attitudes to sex and regretted sexual activity (NFER, 2004).
Furthermore, all participating schools said they would not be able to continue with
the programme without external funding and, in view of the fact that the report
goes on to suggest that schools should not use A PAUSE in isolation (NFER,
2004), long-term financial concerns may affect the future development of this
programme (Naish, 2004).
Not only are teaching methods proving to be a problem, influential too are the
legal challenges schools face with the tenuous relationship observed between
Government legislation and schools’ sexual health education provision (British
Medical Association, 1997; Hilton, 2003). Consequently teachers are sometimes
unsure of what they can and cannot teach for fear of complaint, or, worse still,
litigation (Hilton, 2003). Although the guidelines on sex and relationship education
(DfEE, 2000) provide schools with a structure under which teachers and governors
can plan and deliver a sex and relationships programme, the subject matter remains
non-statutory and parents have retained their right to withdraw their child from any
non-statutory elements of sex education (Hilton, 2003). Again this leaves teachers in
an uncertain position regarding the content of compulsory and non-compulsory
elements of SRE. This in turn has an impact on the quality of the education being
delivered (Johnson, 1998; Kingston, 1998).
Current UK Government policy to tackle the high rates of teenage conceptions
and sexually transmitted infections among young people (Public Health Laboratory
Service [PHLS], 2001; UNICEF, 2001) advocates a multi-agency approach to
adolescent sexual health (SEU, 1999; DoH, 2001). This is in light of substantial
evidence to suggest that teacher-led sexual health programmes are not effective
(Imrie et al., 2001; DiCenso et al., 2002; Wight et al., 2002) and more evidence that
teachers may not be the most appropriate single profession to deliver sexual health
information (Graham et al., 2002), particularly those who do not specialise in PSHE
(Revell, 2000). However, it would seem that despite various attempts to provide a
multi-agency approach to SRE (Mellanby et al., 2001, 2002), many teachers are still
being expected to teach the subject in isolation.
 146 J. Westwood and B. Mullan

Aims
The aimes of the study were:
N To investigate the knowledge of teachers regarding sexual health.
N To measure the attitudes of teachers regarding sexual health.
N To explore the knowledge of teachers regarding sexual health education.
N To assess attitudes of teachers regarding sexual health education.

Questionnaire design
To assess teachers’ knowledge of, and attitudes towards, sexual health and sexual
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health education, a questionnaire was designed to ask mainly closed questions

concerning contraception, sexual health and SRE. This was based on current
knowledge (NHS Centre for Reviews & Dissemination, 1997; Kirby, 2001; DiCenso
et al., 2002). Focus groups were set up to provide supplementary material from
which the questionnaire was developed. The chief rationale for the focus groups was
to complement literature search findings (SEU, 1999; PHLS, 2001; UNICEF,
2001; OFSTED, 2002) and present qualitative data for issues associated with sexual
health education where little or no research could be found; for example, questions
pertaining to how SRE lessons could be improved.
The knowledge section of the questionnaire included three sections. The first
consisted of questions related to contraceptive use, access to contraceptive
services and the most suitable contraceptive methods; for example, ‘do you need
parental/guardian consent to obtain contraception for under 16s?’. The second
part of the questionnaire asked questions on the subject of sexually transmitted
infections; for example, ‘can you be unaware that you have a sexually transmitted
infection?’. The third section questioned teachers about the relationship between
contraception and sexually transmitted infections; for example, ‘do all methods of
contraception protect you from sexually transmitted infections?’. A table of
common sexually transmitted infections in addition to some other medical
conditions was presented and teachers were asked to identify those that were
sexually transmitted infections. These three sections (total knowledge) consisted
of 28 questions.
The next part of the questionnaire related to teachers’ attitudes towards SRE and
asked how much knowledge/information they had received regarding sexual health
education; for example, ‘do you feel that you have sufficient knowledge/information
to teach sexually transmitted infections?’. This section of the questionnaire consisted
of nine questions.
In the final section teachers were asked to highlight, using six visual–analogue
scales, how they rated teaching SRE; for example, ‘do you think young people learn
a lot about relationships as part of their SRE lessons?’, ‘do you enjoy teaching SRE?’
and ‘do you find it embarrassing to teach SRE?’. This gave an indication of their
attitudes towards sex education teaching.
 Knowledge and attitudes of secondary school teachers 147

Sample
Of a total of 35 secondary schools within a largely rural county in the
United Kingdom, 34 were invited to partake in the study. One of the schools
was excluded because it had assisted with the pilot study. Schools that did
not agree to participate gave reasons such as time restrictions, burden of
extra work on teaching staff and forthcoming school inspections. The 19
secondary schools that did agree to participate included one semi-rural school,
12 rural schools and six urban schools. A review of GCSE results
(examinations taken when pupils are 16 years old) for the county indicated
that they were typical of those for pupils throughout England (Education
Advisory Service, 2001), thus suggesting that although the teachers surveyed
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might or might not have been representative of all teachers, their pupils were.
In addition, schools that did not participate were similar to those that did in
terms of location, number of pupils, record of academic achievement and
proportion of pupils, pupils requiring school transport and free school meals
(Education Advisory Service, 2001). It can therefore be asserted that there
were relatively few differences in the schools that chose not to participate and
those that did.
When initial meetings were held between the headteachers and the researchers
to see whether the school would be interested in participating it was made clear
that teachers who actually contributed to SRE were to complete the questionnaire.
It was not assumed that all teaching staff taught this particular area of the
curriculum. Participating schools were then requested to inform the researchers of
the total number of questionnaires required. For example, in one school all form
tutors provided SRE, which gave a total of 53; however, another school had a
specialist team of five teachers to deliver all SRE. A final figure could be calculated
from the schools that agreed to participate giving a total of 456 teachers who were
invited to participate in the study. Of the 155 who responded, 94 were female and
61 were male; 65% were employed within rural communities and the remaining
55% were employed within urban communities, and the largest proportion of
respondents were over the age of 40 (22% were aged 20–29 years old, 13% were
30–39 years old, 35% were 40–49 years old and 30% were 50–59 years old).
Teacher participation mainly involved classroom (i.e. subject) teachers or
classroom teachers who were also form tutors. All teachers who responded
contributed to SRE; however, only a small number actually coordinated SRE as
part of the PSHE programme. Other than science, it appeared that English,
mathematics and physical education teachers were the main contributors to PSHE.
Only one school had a teacher who taught PSHE only. The total number of
teachers who completed the questionnaire made a response rate of 44%. While it
could be claimed that this is a low response rate, a review of the literature in this
area (Krosnick, 1999) disputed the argument that high response rates must be
obtained for results to be representative. Indeed, it has been found that substantive
conclusions of a study generally remained unaltered by an improved response rate
(Krosnick, 1999).
 148 J. Westwood and B. Mullan

Ethics
Although formal ethical approval is not a requirement for research being under-
taken within an educational setting, Multi Research Ethics Committee approval was
obtained as the findings from this study form part of a larger sexual health education
study being undertaken in secondary schools. The researcher distributed ques-
tionnaires to each individual school and provided a presentation to all teaching staff
discussing the aims and objectives of the study. This ensured that staff were fully
informed about the research and could therefore make a valid decision regarding
participation. Additionally, participants were asked to fill in a consent sheet, which
was attached to the front of the questionnaire. If any teacher did not wish to
complete the questionnaire they could either indicate this on a consent sheet or
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return the questionnaire uncompleted. Oral consent to undertake the research in

secondary schools throughout the county was gained from the local education
authority. However, any school’s inclusion was completely at each individual
headteacher’s discretion.

Analysis
The data were analysed using SPSS version 11.5 for Windows. The 33 knowledge
questions were coded to allow the arithmetic mean (total knowledge score) to be
calculated for all participating respondents. Descriptive statistics were performed
initially in addition to statistical tests, which included t-tests, Mann–Whitney tests
and chi-squared tests. Parametric data were analysed using t-tests as they satisfied
the accepted criteria of parametric tests, which take account of the data being of a
ratio level, the variances of both variables being homogeneous (Bryman & Cramer,
1997) and to date having a ‘normal’ distribution (Pallant, 2003). This was validated
by the Kolmogorov–Smirnov test (Pallant, 2003; Bryman & Cramer, 1997).

Results
Figure 1 shows the range of teachers who participated. Only 8% of respondents were
PSHE coordinators. Science teachers were the main contributors to PSHE, with
English, mathematics and physical education teachers also contributing substantially
(Figure 2). One school had a specific teacher who taught PSHE only (included in the
‘other’ category in Figure 2—additional subject areas included in the ‘other’ category
were, for example, textiles (one respondent), drama (one respondent), art (two
respondents) and special needs (five respondents)).

Total knowledge scores

Knowledge of all teachers was generally good, with 84% attaining 20 and above out
of a total of 28 on the knowledge score and only 17% scoring less than 20 (Figure 3).
Eighty-five (55%) of the respondents incorrectly answered the question on how
effective the emergency contractive pill is, which meant that less than one-half of the
respondents knew that the emergency contraceptive pill is effective up to 72 hours
 Knowledge and attitudes of secondary school teachers 149
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Figure 1. Role of teachers who taught SRE in addition to their other teaching duties

following unprotected sexual intercourse (Guillebaud, 2001). Similarly, only 43

respondents (28.3%) knew that the emergency contractive pill is reported to be 85%
effective if correctly used (Guillebaud, 2001).
Section three of the questionnaire, where teachers were requested to positively
identify known sexually transmitted infections, posed some difficulties as some of the
teachers identified non-existent sexually transmitted infections such as hepatitis H
and coxiella. Furthermore, some of the respondents failed to highlight non-specific
vaginitis, non-specific urethritis or hepatitis B as sexually transmitted infections
(Table 1).

How much information/training teachers receive for teaching SRE

The results in Table 2 suggest that teachers do not feel they have adequate
information on sexually transmitted infections, access to sexual health services and
children’s rights. Sixty-six per cent of respondents reported that they either do not
have enough or have no information regarding sexually transmitted infections, and
43% lack information on contraception. Similarly, 73% of teachers do not feel that
they have adequate knowledge regarding how to access local sexual health services.

Who teachers think should teach SRE

Table 3 shows that 38% of teachers agree or strongly agree that the current provision
of sex education in their school is OK; 45% neither agree nor disagree and 17%
 150 J. Westwood and B. Mullan
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Figure 2. Main subjects taught by those teachers who contributed to SRE

Figure 3. Teachers’ total knowledge scores

 Knowledge and attitudes of secondary school teachers 151

Table 1. Teachers’ knowledge of possible sexually transmitted infections

Right (%) Wrong (%)

Genital herpes 95 5
Chlamydia 91 9
Giardia 96 4
Genital warts 63 37
Hepatitis B 47 53
Syphillis 97 3
Heterophyes 98 2
Non-specific vaginitis 30 70
Gonorrhoea 98 2
HIV 94 6
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Genital crabs 71 29
Coxiella 78 22
Macrocheilia 96 4
Hemimelia 99 1
Non-specific urethritis 42 58
Hyphedonia 98 2
Hepatitis H 71 29
AIDS 28 72
Pelvic inflammatory disease 31 69

either disagree or strongly disagree. Forty-six per cent agreed or strongly agreed that
nurses and other healthcare professionals should teach all SRE; 24% neither agreed
nor disagreed, while 29% disagreed. Forty-five per cent of teachers agreed or
strongly agreed that SRE should be taught by other agencies from outside school.
Only six per cent of respondents agreed or strongly agreed that teachers should teach
all SRE, 28% were not sure and 66% either disagreed or strongly disagreed. Eighty-
three per cent felt that SRE should be taught by a combination of teachers,
healthcare professionals and other outside agencies. Thirty-seven per cent of
teachers either agreed or strongly agreed that SRE should involve older students/
peer educators, yet 23% disagreed or strongly disagreed that older students/peer

Table 2. How much information teachers receive for teaching SRE

Information to teach adequately Too much Right amount Not enough None
(%) (%) (%) (%)

Reproduction 4 73 19 4
Sexually transmitted infections 1 33 61 5
Contraception 2 55 39 4
Assertiveness skills 1 40 52 7
Accessing sexual health services 0 27 66 7
Parenting skills 7 52 32 9
Morality 2 68 28 2
Human rights/children’s rights 2 35 59 4
Legal issues/age of consent 2 47 49 2
 152 J. Westwood and B. Mullan

Table 3. Who teachers think should teach SRE

Strongly Agree Uncertain Disagree Strongly

agree (%) (%) (%) (%) disagree (%)

Sex education is OK as it is 4 34 45 14 3
Sex education should be taught by nurses 18 28 24 28 1
and other healthcare professionals
Sex education should be taught by other 15 29 35 18 3
agencies from outside school
Teachers should teach all of sex 1 5 28 42 24
education
Sex education should be taught by 46 37 9 5 3
a combination of people
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Sex education should involve older 9 28 41 15 8

students/peer educators

educators should be involved. There was no statistical difference observed between

the descriptive results of rural and urban schools reporting the above views.

What teachers think about current SRE

The majority of teachers find teaching SRE useful to pupils. In all the categories
presented in Table 4, approximately 25% of teachers gave a negative response; for
example, feeling that pupils learn little about relationships and that the lessons are
boring. Furthermore, approximately one-third of teachers do not like teaching sex
and relationships lessons.
The majority of teachers felt they had inadequate resources to teach SRE.
Approximately 10% of respondents said they have adequate resources to teach most
of SRE, although teenage pregnancy, parenthood, termination, testicular and
cervical cancer, breast awareness and abstinence proved to be areas where resources
were poorest. When asked what the preferred choice of resources for teaching SRE
are, the majority identified videos, quizzes, worksheets and verbal communication.
Teachers preferred pupils to work as part of the whole class, with only 12% of
them preferring them to work in pairs and 15% preferring them to work in small

Table 4. How teachers rate SRE

Mean values for how teachers rate SREa

Useless to useful 72
Embarrassing to unembarrassing 75
Boring to interesting 70
Pupils learnt nothing about sexual health to learnt a lot 72
Pupils learnt nothing about relationships to learnt a lot 64
Hated the lessons to enjoyed the lessons 68

Note: a15negative response, 1005positive response.

 Knowledge and attitudes of secondary school teachers 153

groups. The majority of teachers prefer to teach students in mixed groups, with only
five per cent of teachers preferring to teach in single-sex classes. Eighteen per cent
would prefer to use outside speakers for SRE in years seven to nine; this decreases to
five per cent for year groups 10 and 11. Seventy per cent of teachers do not update
their resources regularly.
There were no statistical significant differences found between the location of
school, area of residence of participant, gender or age of participant for any of the
questions asked.

Discussion
Knowledge was generally good although specific knowledge regarding sexually
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transmitted infections and use of the emergency oral contraceptive pill was poor.
This is happening at a time when the United Kingdom has the highest rate of
teenage conceptions in Western Europe (SEU, 1999) and is observing a continuing
increase in the rates of sexually transmitted infections, particularly in people aged
between 15 and 25 years (Fenton et al., 2001; Moens et al., 2003). This would
suggest that the current provision of sexual health education in UK secondary
schools does not adequately prepare young people to negotiate sexual relationships,
which supports the findings of the systematic review undertaken by DiCenso et al.
(2002). Furthermore, knowledge of sexually transmitted infections was poor, with
many teachers not identifying well-known sexually transmitted infections such as
hepatitis B, genital warts and non-specific urethritis. This supports the findings of
Moens et al. (2003), PHLS (2001) and recent DoH reports (DoH, 2001, 2002).
Again, this would suggest that sexual health education is not providing secondary
school aged pupils with the knowledge they need in order to protect their own sexual
health, particularly in light of recent statistics that show that, of the 11.1 million 15–
24 year olds living in the United Kingdom, there are 1900 females and 4000 males
living with the HIV/AIDS virus (UNAIDS/UNICEF/WHO, 2002; Population
Reference Bureau, 2000). Furthermore, recent research findings have shown that
pupils have inadequate sexual health knowledge also (Westwood & Mullan, 2006)
and report that SRE in school in unsatisfactory (Westwood, 2004). This would
indicate an association between poor teaching and learning outcomes, and is further
exemplified by the results for knowledge regarding chlamydia. This also highlighted
a concern, with one in 10 teachers not correctly identifying an infection that is
reported to be the most common sexually transmitted infection seen in genito-
urinary clinics, with an increase of approximately 10% in 2001 (PHLS, 2001) from
the 2000 figures. Poor knowledge regarding sexually transmitted infections,
contraception and safer sex is likely to have an impact on the acquisition of a
sexually transmitted infection and the associated complications of having such an
infection and unintended pregnancy (Fenton et al., 2001; Hughes et al., 2001;
Moens et al., 2003).
There was confusion between HIV and AIDS, with the majority of teachers
stating that AIDS is a sexually transmitted infection, which technically speaking it is
 154 J. Westwood and B. Mullan

not (Kumar & Clarke, 2002). This discrepancy maybe due to misinformation.
However, 60% of the teachers were aged 40 and above, and this age group was
exposed to the mass HIV/AIDS campaign of the 1980s (DoH, 2001). Information
and education received then would be outdated now and this lack of specific HIV/
AIDS knowledge calls into question what information teachers have received during
the past 20 years regarding HIV/AIDS. Furthermore, it supports the findings from
OFSTED who found that HIV education was receiving less attention than in the
past (OFSTED, 2002). In addition, the results substantiate what other studies have
found—namely, that teachers have poor knowledge regarding sexually transmitted
infections and HIV/AIDS (Vanhegan & Wedgwood, 1999; DoH, 2001; OFSTED,
2002).
The other area where most teachers lacked knowledge was emergency contra-
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ception. Current UK Government initiatives advocate access to emergency

contraception, with the development of on-site school clinics and access to
pharmacists (SEU, 1999; DoH, 2001; OFSTED, 2002; Baraitser et al., 2003).
This is in an attempt to reduce the high rates of unplanned/unintended pregnancies
(SEU, 1999; DoH, 2001) and to provide sexual health services for those who are
seen to be particularly disadvantaged; for example, young people living in isolated
areas and those in lower socioeconomic groups who may not be able to afford to pay
for transport to centrally located sexual health services (SEU, 1999; DoH, 2001;
UNICEF, 2001). It is well documented that early pregnancy and teenage
parenthood are typically associated with less education and disadvantage for young
mothers (SEU, 1999; UNICEF, 2001). However, poor sexual health knowledge of
those who teach SRE may be hindering the implementation of current UK
Government sexual health policies as embodied in the national sexual health and
HIV strategy (DoH, 2001) and educational guidelines (DfEE, 2000).
Similarly, teachers felt ill prepared to teach SRE. Indeed, three-quarters of
respondents had not received up-to-date information regarding sexually transmitted
infections. Again, a large proportion of them say they do not have adequate
knowledge concerning access to local sexual health services. However, this type of
information has been made readily available by the local teenage pregnancy strategy
group, sexual health services and the school nursing service. This therefore raises
questions about whose responsibility it is to ensure that teachers’ sexual health
knowledge is up to date. Certainly out-of-date teaching is going to have implications
not only for pupils’ sexual health knowledge, but also for the implementation of local
and national sexual health initiatives. This may further be compounded by the
possibility that, despite training, some teachers may have more limited information
regarding aspects of sexual health because of the subjects they teach. For example, it
could be hypothesised that science teachers have been exposed to greater knowledge
about the physical aspects of sexual health education whereas humanity teachers
may have an improved knowledge of the social aspects of the subject; this needs
further investigation.
The feeling of being ill prepared to teach SRE perhaps says something about the
largest proportion of teachers, agreeing with suggestions made by DiCenso et al.
 Knowledge and attitudes of secondary school teachers 155

(2002), whose findings advocated a multi-faceted approach to SRE. Only a small

number of respondents felt it was their role to teach all of SRE. Recent research and
UK Government policies promote a multi-agency approach to SRE (DfEE, 2000;
DoH, 2001; DiCenso et al., 2002; Swann et al., 2003), and the results suggest that
this is something that the majority of teachers would welcome.
Only one-third of teachers felt that older students/peer educators should
contribute to SRE. Some of the schools who participated in this research have
been involved with the now terminated (in the research area) A PAUSE programme
from Exeter University (Mellanby et al., 1995). However, a recent review of the
programme found little evidence of links between reported contraceptive use and
students who completed the A PAUSE course (NFER, 2004). In addition, schools
who initially subscribed to the programme within the research area failed to
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continue with it because of time and financial constraints (Naish, 2004). Together
with what other research is currently suggesting (UNICEF, 2001; DiCenso et al.,
2002; Wight et al., 2002; Swann et al., 2003) it would be unwise to assume its
legitimacy as the single most appropriate sexual health programme, since what
evidence there is recommends a multi-faceted approach to sexual health education
as the most effective (NHS Centre for Reviews and Dissemination, 1997; Grunseit
et al., 1997; Cheesbrough et al., 1999; UNICEF, 2001). Certainly current
Government policy regarding young people and sexual health emphasises inter-
agency working between health and education (DfEE, 1999, 2000; SEU, 1999;
DoH, 2001).
Despite some negative responses, particularly regarding access to information and
poor resources, the majority of teachers feel that SRE is useful to pupils. However,
many pupils criticise their school-based sex education as being ‘too little, too late’
(Salihi et al., 2002) and as being too biologically factual and not relating enough to
the emotional or informative side of relationships (Measor et al., 2000; Buston &
Wight, 2002). It has been argued that social and emotional aspects of SRE are
increasingly being dealt with, despite the fact that provision differs between and
within schools (Buston & Wight, 2001; Buston et al., 2002). Nevertheless, one-third
of teachers do not like teaching SRE and this has implications for those pupils who
receive SRE from teachers who prefer not to teach the subject. A study undertaken
by Buston et al. (2002) found that teachers’ lack of confidence about tackling
sensitive matters may be exacerbated by the low-level priority that SRE typically has,
general issues raised within PSHE, competition for curriculum time and teachers’
lack of confidence about using certain teaching materials (Buston et al., 2002).
Indeed, Figure 1 highlighted the fact that most schools in the county do not have a
specific PSHE teacher who solely teaches and manages the SRE programme. For the
majority of schools, the PSHE programme is managed by a teacher who has other
responsibilities; a PSHE coordinator is typically a classroom teacher who is also a
form tutor. Teachers who are form tutors are potentially placed in an awkward
position in terms of possible embarrassment and confidential disclosures (Forrest
et al., 2002). Indeed, this may account for teachers’ apparent lack of empathy and
reticent approach to some individual pupils (Forrest et al., 2002).
 156 J. Westwood and B. Mullan

The results of this study found that the majority of teachers do not feel they have
adequate resources to teach SRE. This could again be attributed to the low-level
priority that SRE receives in many secondary schools (Hilton, 2003). In addition,
scarcity of funding often means that resources are not updated or replaced. Teachers
stated that their preferred resources are videos, quizzes and worksheets yet these
materials require regular updating, and if worksheets/quizzes are being developed
by the teachers themselves it would seem that their sexual health knowledge is
inadequate to do so; furthermore, teachers reportedly do not feel sufficiently
prepared to teach many aspects of SRE. Yet previous research suggests that teaching
methods adopted in providing SRE can have an impact on satisfaction levels and
learning outcome (Forrest et al., 2002). Certainly, pupils who receive active learning
methods from their teachers report the most satisfaction (Forrest et al., 2002),
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although it is difficult to ascertain how interactive videos are as a teaching resource.

Despite this, pupils have also reported videos as their favourite resource (Westwood,
2004). This may say something about levels of indifference in relation to teacher-led
SRE lessons and that many pupils learn more about sex outside the school setting
(Stephenson et al., 2004), resulting in pupils, and teachers, wanting the easiest
teaching option. Indeed, it has been argued that teacher-led SRE lacks motivation
and commitment (Forrest et al., 2002) and that perhaps if teachers adopted a
broader range of teaching styles pupils would be more satisfied. Conversely, only
18% of teachers would prefer to use outside speakers for year seven pupils, and this
figure drops to five per cent for year 10 and 11 pupils. Yet, as aforementioned, one-
third of teachers do not like teaching SRE and perhaps do not have sufficient sexual
health knowledge to teach, in particular, sexually transmitted infections, which for
year 10 and 11 pupils is of paramount importance given the rise in reported cases of
sexually transmitted infections and unplanned/unintended teenage pregnancies
(SEU, 1999; PHLS, 2001; UNICEF, 2001).

Conclusion
Despite the sexual health knowledge of the teachers in this study being generally
good, their knowledge of sexually transmitted infections and emergency contra-
ception is poor, and this in turn has implications for both young people and current
UK Government sexual health strategies. In addition, SRE is often a neglected
subject within the school curriculum and many schools do not have a full time PSHE
coordinator, which may account for many teachers not feeling adequately prepared
in terms of knowledge and resources to teach SRE. Furthermore, most teachers do
not feel that teachers should teach all of SRE and would prefer a multi-agency
approach to the subject, although this does not appear to be happening in many
schools and where it has time and financial constraints have influenced its
effectiveness. If teachers are going to continue to be expected to contribute to
SRE, a greater emphasis must be placed on continuous professional development
and updating of both teaching skills and knowledge base. What is more, encouraging
teachers who actually enjoy teaching the subject must be taken into consideration
 Knowledge and attitudes of secondary school teachers 157

when planning SRE as those that have no interest or lack the confidence to
contribute to the lessons only ensure that pupils continue to have inadequate sexual
health knowledge, which plays a part in the high teenage pregnancy and sexually
transmitted infection rates that continue to be observed in the United Kingdom.

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