Health Promotion in UK Schools: A Review

This assignment presents a protocol for a realist systematic review focusing on research and experiences related to health promotion in schools across the United Kingdom. The protocol outlines the methodology and aims to synthesize findings from diverse sources to understand the effectiveness of various interventions.

Sexual Health
(To understand the importance of sexual health
promotion in reducing teenage pregnancies and
sexually transmitted diseases in UK)

ABSTRACT
Sexual health promotion is basically concerned with maintaining a person's emotional,
mental and physical well-being so that he/she can perform different activities in day to day life. The
dissertation chapters have discussed various issues related to promotion of sexual health and have
also focussed on the importance of promoting sexual health in UK. First chapter of dissertation is
based on the introductory part which has discussed a brief overview of promotion of sexual health
in UK. Next chapter has systematically reviewed various researches and studies that have been
conducted by different authors. It has helped in completing dissertation in an effective way. Further,
research methodological part have been included which has discussed research philosophy,
inclusion, exclusion criteria, ethical considerations and data extraction strategies that have been
used in the research. The dissertation has been concluded by discussing the results,
recommendations and conclusion.

TABLE OF CONTENTS
1. INTRODUCTION ...........................................................................................................................3
2. SYSTEMATIC REVIEW.................................................................................................................6
3. METHODOLOGY ........................................................................................................................11
3.1 Analysis and justification for Systematic Review (SR)...........................................................11
3.2 SR Protocol..............................................................................................................................11
3.3 Literature Search Strategy........................................................................................................11
3.4 Quality assessment strategies...................................................................................................13
3.5 Positivism philosophy..............................................................................................................14
3.6 Validity and reliability..............................................................................................................14
3.7 Ethical issues............................................................................................................................15
3.8 Data extraction strategy...........................................................................................................15
4. RESULTS ......................................................................................................................................16
5. DISCUSSION, CONCLUSION AND RECOMMENDATIONS..................................................20
Discussion......................................................................................................................................20
Recommendations..........................................................................................................................21
Conclusion.....................................................................................................................................23
REFERENCES...................................................................................................................................26

1. INTRODUCTION
Promotion of sexual health in UK is necessary because it will help in reducing the risk of
sexually transmitted diseases and teenage pregnancies to a high extent (Eldredge and et.al., 2016).
Sexual health is also associated with broad range of health issues which are very important to be
addressed. Hence, it is necessary to encourage service uptakes in promoting sexual health so that
emotional, mental and physical health of all individuals can be restored. According to survey
conducted by health organisation, it has been stated that UK has maximum number of teenage
pregnancies which has also increased the number of individuals suffering from sexually transmitted
disease. During recent times, high number of gonorrhoea and syphilis are detected specially in
teenagers of UK (Nguyen and et.al, 2013). Apart from teenagers, there are many other people who
are at greater risk of encountering serious sexual health issues such as disabled people, individuals
with learning difficulties, refugees and asylum seekers. For promoting health, it is necessary to
adopt various effective strategies so that health and well-being of people can be improved in a better
way. It is important for all people of UK to have prompt access to different types of sexual health
services that are initiated by the UK government. Promotion of sexual health should not only reduce
teenage pregnancies and risk of sexually transmitted disease but it should also increase awareness
and knowledge about promotion of sexual health in UK (Wight and Fullerton, 2013).
For promoting sexual health in UK, it is essential for the government to adopt certain
strategies that can successfully lead to improved health and welfare of citizens. At initial level, it is
necessary to eliminate narrow sexual health inequalities that exist in the nation. Inequalities in UK
are the result of social exclusion, ethnic background and sexual orientation which is directly linked
to teenage pregnancies. It is also essential to take preventive initiatives so that inequalities can be
reduced. For improving general health and sexual health in citizens of UK, it is necessary to impart
sexual health education to youngsters at school so that their awareness can be increased (McNeely,
Nonnemaker and Blum, 2012). This will help in ensuring that all individuals have equal rights to
access information related to sexual health and its relationships. According to a national survey of
sexual attitude and lifestyle, it was reported that 68% of individuals tend to develop sexual
relationships before the age of 16 years. This data also produced a major difference in sexual health
behaviour in both urban and rural areas of various parts of UK. Apart from other nations in Europe,
UK accounts for the highest rates of teenage pregnancies and conceptions in between the age of 15-
19 years. Teenage pregnancies in UK are more than 72% in 2015 which have increased from 68%
in 2011. UK is not only highest in recording teenage pregnancies but it is also reported to have more
than 8% of under-age pregnancies in between 13-15 years (Onwuegbuzie and Leech, 2015). It is
important to reduce the number of teenage pregnancies because it leads to many other heath issues
to both mother and the child. It is noticed that generally a teenage tends to have poor mental and

physical health which has a negative effect on both the individuals.
Also, the child born from teenage mother is reported to be of low weight which increases
the risk of mortality in early years of birth. One of the major drawbacks of teenage pregnancies is
that, chances of dissolving a relationship after pregnancies increases (Galliers and Land, 2007). This
ultimately affects the future of child. The rates of teenage pregnancies in UK are considerably high
as compared to any other nation due to various reasons. One common reason of increased teenage
pregnancies in UK is low expectations in the field of education and job markets. Due to lack of
proper environment and high levels of crime emerging in UK, teenagers pursue having a child at
early age as a positive sign for continuing a relationship. Another reason is lack of knowledge about
contraception and protection during sex. 25% of teenage individuals who become mothers in their
teen years are initially unaware about contraception which is likely to be used during sexual
activities (Benbasat, 2014). Abortion rate in UK has also consistently increased in the recent years.
The rate was 13 terminations per 1000 women which have risen by 2% in 2011 and 5% after the
implementation of Abortion act UK. In Wales, highest rate of abortion ranges from the age group of
20-24 years and the rate or pregnancy termination from 2010 has increased by 12 % and in 2015, it
has crossed to 15%. Based on a survey report, it was concluded that 78 out of 100 terminations were
performed on single mothers whereas only 20 out of 100 were conducted on married women (Petty,
Thomson and Stew, 2012). 50% of mothers were reported to have no earlier children when they
underwent first termination. However, 18% women underwent second abortion. Apart from teenage
pregnancies, there is an increased risk of people encountering sexually transmitted disease in the
early years of life (Jenkins, 2015). More than 25% of total population of UK is infected with
sexually transmitted diseases at the age of less than 25 years. It is not only an issue with youngsters
but it is also common in older men and women at the same rate. Different types of sexually
transmitted diseases in UK are chlamydia, genital wart virus, genital herpes, gonorrhoea and AIDS.
Hence, it is necessary to adopt effective strategies that can help in lowering down the number of
teenage pregnancies and sexually transmitted disease to minimum.
Aim:
To understand the importance of sexual health promotion for reducing teenage pregnancies
and sexually transmitted diseases in UK
Objectives:
 To understand the concept of sexual health promotion.
 To determine the major role of sexual health promotion for reducing teenage pregnancies in
UK.
 To critically analyse the role of sexual health promotion for reducing sexually transmitted

diseases in UK. To suggest different methods to promote sexual health among teenagers in UK.
Research Question
PICO framework will be used to design research question for the ongoing study. It helps in
formulating and answering questions in the desired manner.
 P: Patients (Teenage individuals)
 I: Intervention (Sexual health promotion)
 C: Comparison (None)
 O: Outcome (Reduction in teenage pregnancies and sexually transmitted disease)
1. Why it is important to promote sexual health among teenagers in UK?

2. SYSTEMATIC REVIEW
Increase in teenage pregnancies and adverse sexual health outcomes have been a major
problem in United Kingdom (Bonell and et.al., 2012). More number of medical terminations and
sexually transmitted diseases has been noticed in UK which has lead to decrease in conception
rates. Adolescent pregnancies, birth, abortion and sexually transmitted disease rates are much higher
in both developing and developed countries. According to the government statistics or nationally
representative survey data of UK, it has been reported that UK has the highest rate of teenage
pregnancies, abortion and still births after US. Adolescent childbearing has become more common
and 19% of teenage girls are reported to conceive their first child before the age of 16 years.
Although the government of UK has adopted many interventions in order to reduce this issue but it
has been ineffective to a far extent (Bonell and et.al., 2013). Rather than improving and promoting
sexual health in UK, interventions which have been adopted by various local authorities and
healthcare organisation had made the condition worse. Although lower proportion of teenage
pregnancies is resolved by medical termination in UK but as the rate of teenage pregnancies is high,
rate of abortion is also considerably high.
Even though it is directed in schools to provide sexual health education to pupils so that
awareness increases but the outcome of sexual health promotion has only been limited to the use of
condom. Girma and Paton, (2015) have stated that rather than decreasing the rate of teenage
pregnancies; it has consistently reduced the conception rate due to increase in teenage pregnancies.
This has produced adverse effects on the mental and physical health of all teenage females in UK.
In this article Melnick and et.al., (2016) produced a report on the effects of a theoretically based
teacher who delivered sex education programme (SHARE) which was based on conception and
termination of pregnancies. The research was based on identifying two different groups in which
one group was the case group and the other group was control group. Based on the results, it was
concluded that 95% individuals in between the age group of 16-22 years preferred pregnancy
termination and 274 out of 300 control groups had more than 88% of confidence interval during the
analysis. The results from these studies also concluded that there is an urgent need of adopting
effective strategies so that sex education among teenagers can be increased. Aslam and et.al, 2015
has stated that evidence of effectiveness is mixed but it is important to increase the knowledge so
that teenage pregnancies and sexually transmitted diseases among them will be reduced. Further,
Sorhaindo and et.al., (2016) also revealed that different strategies such as promoting availability,
proper use of condoms and intake of emergency pills do not guarantee the reduction of pregnancies
and medical termination.
In another article, Acosta and et.al., (2014) stated that through proper sex education and
programmes, teenagers are likely to delay their initial experience of sex which will result in positive

outcome. This will also encourage the teenagers of UK to have safe sex so that they would not
encounter sexually transmitted diseases. Maternal involvement in providing sex education also
plays an important role in promoting sexual health in UK. However, it is also necessary to have the
influence of father so that they can safeguard their child from involving in sexual activities until
adulthood. Single parenting also has a negative impact on the growth and development of teenagers
in early years. As compared to any other country apart from UK, there is low rate of single
parenting which has promoted sexual health to a high extent. DeSmet and et.al., (2015) have stated
that UK has been reported to have the largest number of teenagers who are under single parenting.
Due to this, they are not able to get proper knowledge and education related to sex which increases
the rate of teenage pregnancies and sexually transmitted diseases in them (Marston and Lewis,
2014). As Netherlands has the lowest rate of single parenting as compared to other countries in the
world, a collective questionnaire based survey was conducted on teenagers of Netherlands and UK.
Based on the survey, it was concluded that 39% of teenagers in UK were involved in sexual
activities in their initial teenage years because they were not given with any kind of guidance and
knowledge about sex in their growth years (Gascoyne and et.al., 2016). This was also a negative
impact of single parenting which is very common in UK as compared to any other countries of the
world. Sexual health issues are very common in adolescents and young adults because they lack
knowledge related to sex which is necessary in initial teenage years. If parents do not provide sex
education or if schools and education centres are not imparting them proper knowledge then the
chances of teenage pregnancies and termination increases.
Elliott and et.al., (2013) have stated that the age of adolescence is a time when sexual risk
taking and experimentation with life probably increases. But this is also the time when vulnerability
among individuals especially teenagers is increasing day by day. Hence, it is very important for
parents to be alert and aware so that they can help in decreasing the rate of pregnancies termination
and sexually transmitted diseases in youngsters. The chance of a person encountering sexually
transmitted infections from one individual to another certainly increases when a sexual activity is
initiated without taking effective care and precautions. Sonnenberg and et.al., 2013 has included
that when a patient presents a medical issue to a general physician with symptoms of sexually
transmitted infections such as arthritis, hepatitis and rash then it becomes the responsibility of
physician to investigate all risks associated with the infection so that it would not spread further.
Physicians should also ask the patients about sexual risk that can be caused due to unsafe sex during
the beginning of adolescence. Physicians can suggest individuals to undergo the test for sexually
transmitted infections as well as for pregnancies so that it can be reported in the initial period
(Wight and Fullerton, 2013). Generally, it has been noticed that patients do not prefer to undertake
diagnosis for diseases which are caused due to sexual activities but it is the duty of healthcare

professionals to guide them for test so that any infection can be detected at early stage only.
Similarly, O'Brien and et.al., (2014) have stated that knowing the sexual history and consent
of patients for further diagnosis should be core medical skills which should be developed in all the
healthcare professionals so that they can easily convince patients for undergoing various tests for
detecting sexually transmitted diseases. According to the report generated by NHS, UK has been
noticed to have maximum number of unintended pregnancies and infections have consistently
increased in recent years. Rate has increased from 27% in 2012 to 39% in 2015 which has
developed a negative impact on the teenagers of UK (Herrick and et.al., 2014). In such cases, it has
become very important for the health organisations of UK to promote sexual health so that they
would be able to considerably decrease the alarming rate of teenage pregnancies and infections to a
higher extent. In this research, study was based on randomised controlled trials in which random
sample of teenagers and other individuals in the age group of 15-24 years were selected which were
reported to be pregnant in their adolescence. A questionnaire was prepared which helped in
conducting the studies in a successful manner (Lottes, 2013). According to the results drawn from
survey, it was noticed that 7% of teenage individuals were reported to suffer from one or more
sexually transmitted disease and 13% of them were on the extent of encountering these infections
due to unsafe sex.
According to the report generated by world health organisation (WHO), it was stated that
more than 15,000 adults aged 16-74 years participated in the interviews which were conducted from
September 2013 to August 2015 so that data on sexual behaviour, attitude and health can be
presented. From that study, it was reported that 30% of individuals under the age group of 16-24
years revealed that they were involved in sexual activities with someone of opposite sex before the
age of 16 years (Marriott, Hamilton‐Giachritsis and Harrop, 2014). The rate of having first sex at
the age of 24 years has been consistently declined and now the age of first sex in UK has been
recorded to be 16 years. In order to avoid such types of infections and teenage pregnancies, it has
become necessary for the government of UK to adopt various effective strategies so that unintended
pregnancies and transmission of infections can be reduced to minimum (Oliffe and et.al, 2013).
Child sexual exploitation is also one of the major issues which need to be addressed by UK so that
those children would not be neglected. According to the National working group, child sexual
exploitation can be defined as involvement of children below the age group of 18 years in various
sexual activities. This is generally done so that young people can get food, cigarettes, drugs or gifts
in return for this. It is an abuse of power by those exploiting by virtue of their age (Bonell and et.al.,
2013). This issue has been brought into public attention in the recent years because cases of child
sexual exploitation have been consistently increased. For promoting sexual health in UK, British
government and the medical association for sexual health and infections have developed a proforma

so that all healthcare professionals working in primary care centres can easily detect
cases of child sexual exploitation. Although, it is very intrusive to ask questions in cases of sexual
exploitation but it is necessary because it provides a clue about various issues that are linked with
the child sexual exploitation.
In another study, Slater and Robinson, (2014) have stated that sexuality is the integral part of
being human. But sexuality not only has positive impacts but also produces negative impacts on
human beings. An open discussion about sexuality issues have become a more serious concern
because if it is not discussed then it will not help in promoting sexual health in citizens of UK.
Bungay and Vella-Burrows, (2013) revealed that common sexuality problems in people can be
reproductive system disorders, infertility issues, Gynaecologic problems, including endometriosis,
pelvic inflammatory disease and premenstrual syndrome, urinary tract infections, sexually
transmitted disease and sexual dysfunction including erectile dysfunction (ED), painful intercourse
and loss of sexual desire. Other issues can be unusual lifestyles and behaviour among various
individuals. For sexual health promotion, it is necessary for all teenagers and other individuals to
maintain their health by different means (Wellings and Johnson, 2013). There are different ways of
promoting sexual health such as HIV testing, diagnosis and treatment of sexually transmitted
disease and imparting knowledge about sex education so that all individuals would be aware about
various consequences related to sexual issues. Providing information about diet and exercise is also
necessary because this also has both positive and negative impacts on the lifestyle of a person. Also,
it is important to protect the sexual health of women so that chances of unintended pregnancies and
medical termination can be avoided (Bauer and et.al., 2013). In order to promote sexual health in
women, it is necessary to provide them pregnancy testing and counselling so that their knowledge
and awareness would get increased. Routine gynaecological diagnosis is also essential so that it can
help in detecting various medical conditions. Further, PAP Smears, Sexually transmitted infection
screenings, Contraceptive counselling should also be provided to them so that the rate of infections
and other diseases will be minimized. The issues related to sexuality are generally noticed in
teenagers. Hence, it is essential for them to provide information about contraception so that
unwanted pregnancies can be avoided (Cornish and et.al., 2014). This can also help in promoting
sexual health in many ways. There are various barriers which do not allow the promotion of sexual
health in both men and women in UK. In order to remove all those barriers, it is significant to
provide health education in schools and clinics so that more people would become aware about
sexual issues and sexuality in UK. By reinforcing and supplementing various stages of health
promotion, parents and teachers can provide proper education to children. In UK, it is still
predominantly a patriarchal society where gender imbalance and discrimination can create a
negative impact. But when it comes to sexual health promotion, they basically target females

(Pearson and et.al., 2012).
The overall concern of promoting sexual health in UK is to reduce the rate of teenage
pregnancies and sexually transmitted disease so that they can live a better life (Oliffe and et.al.,
2013). Based on the report, it was stated that contraception reduced the chances of pregnancy by
89% but the type of contraception also matters to a high extent. The importance of sexual health
promotion will help all teenagers to get a positive approach so that they can have a healthy sexual
life. There are different types of approaches which can be adopted by all individuals so that sexual
health can be promoted. Dual protection refers to the strategies that can be implemented to
safeguard a person from unnecessary pregnancies and sexually transmitted diseases (Bonell and
et.al, 2013). Further, dual shield strategy can also be adopted which involves use of condoms along
different forms of contraception which can decrease the extent of conception.
A case study was conducted so that comparability can be maximized in order to get more
authentic data on teenage pregnancies and sexually transmitted diseases in citizens of UK. The
report included different tables which were based on teenage sexual behaviour, contraception use,
birth and abortion as well as pregnancy rates (Marriott, Hamilton‐Giachritsis and Harrop, 2014). All
these factors were also differentiated on the basis of socio-economic measures which are present in
the society. Although effective data on all tables was not available but basic information about
sexual behaviour and other aspects were determined. Data on age at first intercourse and age at first
birth of child were also recorded which reported that usually the age of first intercourse in teenagers
in UK is between 15-17 years which is followed by delivery of first child at the age of 19 years
(Wellings and Johnson, 2013). Although 12% of teenagers make use of different contraception at
the end of last intercourse but this percentage is not greater than teenage pregnancies which is
recorded every year. This has also increased the rate of abortion to a considerably high rate.
As children and young people are the most important assets of all parents, it is necessary for
all the parents to safeguard them so that negative impact on their health can be reduced (Bauer and
et.al, 2013). Different policies should be implemented so that it can help all teenagers of UK to
respond to various sexual health issues in a positive manner. Sexual health promotion in teenagers
has become a central matter which should be addressed effectively so that sexual health can be
promoted in a better way. Sexual health promotion will help in achieving the most favourable
sexual health and sexual identity if it is conducted at proper age. This will later on help in reducing
the rate of sexually transmitted infections, HIVs, teenage pregnancies and sexual violence in UK
(Cornish and et.al, 2014). Hence, it can be concluded that is important for the government of UK to
promote sexual health to a higher extent so that people would get safe from all negative
consequences that can occur due to poor sexual health. As the risk of encountering sexually
transmitted disease is higher in females, they should be provided with special guidelines and

awareness so that they would not become prone to different diseases (Pearson and et.al., 2012).

3. METHODOLOGY
3.1 Analysis and justification for Systematic Review (SR)
The ongoing study is based on promoting sexual health in UK by reducing the rate of
teenage pregnancies and sexually transmitted diseases (Colina-Coca and et.al, 2014). To complete
this study, author has used systematic review which is one of the most effective methods to perform
research in health and social care sector. For the completion of this dissertation, different articles
related to qualitative studies, cohort studies, case control, randomized controlled trials and
systematic reviews have been selected. Analysis and justification of systematic review has also
helped in developing validity and reliability.
3.2 SR Protocol
Systematic review protocol provides basic guidelines so that all the aspects of dissertation
get completed in a successful manner (Creswell, 2013). This is helpful because it provides
transparency for developing various methods. The most common and effective protocols that are
used in conducting this research are literature search strategy, search terms, inclusion and exclusion
criteria, various database sources and data extraction process.
3.3 Literature Search Strategy
To obtain overall credibility of literature review, well defined literature strategy has been
used. This will help in ensuring a more focussed research towards the completion of dissertation
(Garner and Scott, 2013). After developing research questions, the next rtask is to select relevant
articles which can help in systematic review of the studies. Hence, various kinds of strategies will
be used so that research will be conducted in a proper manner. Systematic review has applied for the
current study because it is quicker and proves to be cost effective for researcher. Including this, it is
more reliable and accurate than individual studies. So, author has applied systematic review for the
same which is one of the important ways to analyse the role of vitamin in dementia.
Search terms
It is necessary to formulate proper keywords so that various articles can be selected on that
basis (Gay, Mills and Airasian, 2011). This will help in selecting relevant articles which will help in
completing the study in a successful way. Various search terms are as follows:
TERM 1: Sexual health promotion, sexual illness
TERM 2: Teenage pregnancies, sexually transmitted disease
Inclusion and exclusion criteria
This is the criteria which help in selecting appropriate articles which are relevant to the
studies. This method will be more effective in choosing all those articles which will help in
gathering information related to the research topic.

Inclusion criteria: Based on these criteria, only those articles will be selected that would be
printed in English language. Also, articles that would get printed after 2007 will be chosen (Kriz,
Gummesson and Quazi, 2013).
Exclusion criteria: Articles that has not been printed in English language will not be added
in the study along with those which have been published before the year 2007.
2.2 Sources
For the completion of study, relevant online databases have been used in order to ensure that
right kind of information is chosen related to the topic of dissertation (Li, Zhao, and Chen, 201). For
getting reliable information, these sources are very useful and will help in providing the necessary
information regarding promoting sexual health and reducing the rate of teenage pregnancies. Along
with information available from online database sources, all sources maintain their own digital
records so that it would become convenient and will be easy for the researcher to access information
from any place at any point of time. Major database source that will be used in completing the
dissertation will be British Nursing Index, PubMed, CINHAL PLUS, Science direct, Google
Scholar, Emerald Insight and Cochrane library (McMillan and Schumacher, 2014).
2.3 Database decisions
Detailed discussion of the above listed database sources have been discussed as below:
Database selected Descriptions
PubMed It contains more than 35 million literatures based
on medical and health issues. It is also provides
full access to the information without any
subscription (Sunil and et.al, 2014).
CINAHL PLUS This database is also associated with journals
and research papers related to medicines and
general health. There are wide variety of articles
present which can help in completing different
projects and assignments (Ye and Lai, 2012).
Google scholar It is one of the most common online database
that provides access not only to medical and
healthcare research papers but it also gives
access to fields related to sociology marketing,
finance and business (Bhattacharyya, 2009).
Science direct All the articles related to science fields are

available on Science direct. There are more than
12000 journals related to chemistry. Physics,
botany, zoology and medicinal chemistry.
Emerald insight This database has access to various portfolios
related to health and social care. Along with that,
journals related to different medical fields are
present in emerald insight (Daniel and Sam,
2011).
BioMed Central This is one of the most common UK based
publications that is also referred as BMC. All
articles and journals on this database are
reviewed so that only updated information will
be present in the articles (Fiegen, 2010).
British Nursing Index Articles related to midwifery, nursing and health
are present in this database (Flick, 2011). This is
also a UK based database source that provides
access to the complete information without any
subscription from the user.

3.4 Quality assessment strategies
3.4.1 Boolean operators:
Boolean operators have been used by researcher at the time of searching articles for the
completion of dissertation (Goddard and Melville, 2004). Different Boolean operators as well as
simple words such as AND, OR, NOT and ANDNOT, etc. were used so that relevant articles can be
selected. These operators helped in getting more articles which can complete the research in a
successful manner. Further, this also saved time and efforts by eliminating all those articles whose
keywords did not match the studies. These operators only scan those research papers that are
appropriate for the studies.
3.4.2 Prisma flow chart
3.5 Positivism philosophy
Research philosophy can be broadly defined as a paradigm that is helpful in conducting
various studies based in subjective as well as objective aspect. Generally, research philosophies can

be broadly divided into two types, that is, Positivism and interpretivism (Kumar, 2014). In this
ongoing dissertation, author has chosen positivism philosophy because the dissertation has mainly
focused on objective aspect rather than considering the subjective matter of research. This has
helped in meeting the objectives and aim of study successfully. Further, dissertation based on
medical topics is easily conducted by adopting this research philosophy because it helps in writing
systematic review effectually.
3.6 Validity and reliability
It is necessary to check the reliability and validity of all articles so that appropriate results
will be obtained (Martin and Guerin, 2006). If it is not checked then it may not produce valid
findings and results related to the research. For checking validity and reliability of all articles,
researcher has used various criterions such as inclusion, exclusion criteria, Boolean operators and
prisma flow chart. It has helped in improving the validity of data which has been collected. Further,
author also needs to focus on reliability so that can be is ensured that study has produced error free
information. For maintaining the reliability, researcher has utilised most authentic databases from
various sources so that systematic review will be conducted. Hence, both validity and reliability has
been maintained in the study (Sobh and Perry, 2006).
3.7 Ethical issues
It is very necessary to take into account the ethical considerations so that research can be
conducted in a fair manner. As this study will include systematic reviews, it is important to
paraphrase the complete content systematically so that plagiarism can be avoided (Whiteley and
Whiteley, 2006). If they are paraphrased properly, issue of plagiarism will not occur. Further, it is
also essential to cite overall information with the help of respective citations so that ethics can be
maintained in complete research.
3.8 Data extraction strategy
Data extraction strategy can be broadly defined as the method through which data about
promoting sexual health and reducing rate of teenage pregnancies can be retrieved. It is helpful in
resolving issues related to data extraction from various unstructured sources (Vaivio, 2008). For
successful extraction, author has used inclusion and exclusion criteria so that various articles can be
searched for conducting systematic review. Different keywords have also been used so that it would
help in searching the relevant articles appropriately. Therefore, data extraction is helpful in
excluding all those articles which do not support the dissertation topic.

4. RESULTS
From the systematic review of various articles, it can be stated that it is necessary to reduce
the burden of sexually transmitted diseases, unplanned pregnancies and conception rate in between
the age group of 16- 18 years. According to the article stated by Eldredge and et.al., (2016), it is
become important to support and facilitate national and local partners in UK so that they will be
able to deliver increased HIV testing in areas and communities where the prevalence of HIV is
more than 0.5%. Based on the results retrieved from various articles, it can be concluded that the
prevalence rate of individuals encountering HIV in UK has been consistently growing with a rate of
(>7:1000). This has also increased the health concerns in UK due to increase in sexually transmitted
diseases. On the other hand, according to the survey conducted by World Health Organisation, it
was reported that in 2014, more than 6500 people in UK were diagnosed with HIV infection and
more than 90,000 individuals were already living with HIV accessed care (Nguyen and et.al., 2013).
This percentage has been increased by 5% from the previous year. From the results, it can be stated
that overall percentage of people living with HIV has increased from 17% to 22% which is
considerably high as compared to any other countries of the world. It was also reported that more
than 18000 people in UK are still unaware about their infection and are unknowingly transmitting
the infection if they are involved in sexual activities without any sort of physical or chemical
barriers. The increased rate of sexually transmitted diseases in UK is due to lack of education and
awareness about promotion of sexual health. This has increased the mortality rate to a high extent.
People who are diagnosed with sexually transmitted infections at later stages of life have increased
risk of death in the same year as compared to individuals who are diagnosed early. Majority of HIV
transmission cases are reported due to developing sexual contact between people of same or
opposite sex (McNeely, Nonnemaker and Blum, 2012). These diseases are not only caused due to
sexual contacts but this is also spread through injections for drug use, nosocomial infections
developed through hospitals and other infected persons and mother to foetus transmission.
Another issue which has been present in UK is increased rate of unplanned and teenage
pregnancies. According to national survey conducted for women, it was reported that 57% females
in the age group of 16-44 years had unplanned pregnancies and majority of them resulted in medical
termination (Onwuegbuzie and Leech, 2015). Only 6% of overall pregnancies are carried for full
term, rest all the pregnancies are terminated in the first trimester. It has also been noticed that
unplanned and teenage pregnancies are often associated with poor sexual health outcomes and tends
to increase the risk of maternal mental health problems in later stages of life. There are many
reasons which have contributed towards increased unplanned and teenage pregnancies in UK.
Based on different studies, it is revealed that women in the age group of 16-19 years have the
highest production of pregnancies that are not planned at the initial level. It has accounted for more

than 45% of pregnancies in 2015. This percentage has increased by 7% in 2015 as compared to
2013. Further, it is also stated that the most unplanned pregnancies take place in females who are
under the age group of 20-34 years. Unwanted pregnancies have been commonly noticed in those
women who either have two to three children or who do not bear any child. First sexual intercourse
before the age of 16 years, current smoking or use of non-cannabis drugs are some major factors
that are directly associated with unplanned pregnancies in teenagers (Galliers and Land, 2007).
According to studies present in various articles, it is estimated that rates of abortion are highest
among teenagers because their pregnancies are not planned prior to the conception. Further, it can
also be stated that many individuals chose the way of terminating pregnancies due to adverse health
outcomes and increased risk to health. There are various ways which can be adopted rather than
using the method of termination because it leads to poor sexual health and also increases different
health issues related to conception of child at later stages of life. According to the report designed
by UK government, it has been noticed that the highest abortion rate in women in those who are in
between the age group of 16-24 years (Benbasat, 2014). This accounts for more than 31 per 1000
women who have conceived. Among all the conceptions that take place in marriage, the age of
abortion is 20-24 years. The proportions of females who have abortion in 2013 were 33% but it
increased by 16% in 2015 and rose to 49%. This rate has been consistently increased due to various
factors such as barriers to access services and obtaining necessary information about different
contraception choices. If a person is not having access to useful information about contraception
then it can lead to unwanted pregnancies and various infections that can be transmitted from one
person to another. Hence, it is important for local authorities and other healthcare organisations to
provide access to different information so that sexual health can be promoted. This will also help in
enhancing mental and physical health of all individuals in UK.
To provide access to information, local authorities and faculties of sexual and reproductive
health state have adopted the strategy of providing contraception tablets to individuals, both from
GP services and alternative specialist provider (Jenkins, 2015). This will also help in cutting down
the cost incurred in aborting child. In 2012, majority of cost that was incurred by UK government in
healthcare was based on unplanned pregnancies and abortion. This resulted in an estimated cost of
£193 million on direct medical issues and £143 million were incurred on induced abortions. In order
to encourage individuals for taking contraception, it is necessary for national health services and
other authorities to provide information about all these methods so that they can choose one of the
best methods which also include long acting reversible contraception methods. Further, NHS
England has also announced the assessment of commissioning of maternity services. This review
will help in assessing various care provisions that are required to meet the changing needs of
women and children (Bonell and et.al., 2012).

Another major issue in UK that has declined sexual health is the increase in rate of
conception in between the age group of 16-18 years. Teenagers have the highest rate of unplanned
pregnancies which have a negative outcome on their mental, physical and emotional well-being
(Gascoyne and et.al, 2016). Teenage mothers and young fathers, they are not able to treat their child
properly due to lack of knowledge and lack of financial resources to fulfil their demands. Although,
conception rate under the age group of 18 years declined in the starting of 20th century but, later it
increased to 33% by the end of year 2015. Today, the conception rate in between the age group of
18 years is 24 per 1000 women and this ratio varies between local areas of United Kingdom.
However, becoming a parent is positive for many individuals but, parenthood in teenage years is
often linked to poor sexual, mental and physical health of mother and child. According to the report,
it is concluded that a child born to teenage mother has higher mortality rate as compared to children
who are born to mothers who are more than 21-24 years (Herrick and et.al., 2014). Teenage
pregnancies also result in low birth rate which is followed by asphyxia and long term complications.
Further, girls who give birth to children in their teenage years are likely to suffer with postnatal
depression which can last up to 3 years after the birth of child. They are less likely to attain
complete education which can result in various consequences such as adult poverty and
unemployment. As parents are not able to get complete education, this decreases the chance of
getting employed in private as well as government sectors in UK. This also led to level of
deprivation and due to this; children born to teenage parents have increased the rate of living in
poverty for rest of their lives. Teenage conception that leads to live births produces a very negative
impact on future employment and long term earning potential of both mother and child. As the child
is already born to teenage mothers, there are more chances of incurring more medical expenses as
compared to any other expenses in UK. Poverty, disengagement from school and poor academic
progress are the factors that are associated with pregnancy before the age of 18 years (Lottes, 2013).
However, it has also been noticed that majority of conceptions that are before the age of 18 are
without any specific risk factors related to mental, physical and emotional health of a person. Based
on the survey, it was concluded that teenage pregnancies are often associated with consumption of
alcohol and it later on increases the likelihood of sex at a very young age. These are the reasons
which lead to teenage pregnancies in UK.
Developing strategies to promote sexual health in UK has become a necessity because in the
recent years, there has been increased number of cases of teenage pregnancies, sexually transmitted
disease and conception rates in the age of 16-18 years (Marriott, Hamilton‐Giachritsis and Harrop,
2014). To eradicate these issues, local authorities of UK has made it compulsory to commission
comprehensive sexual health services at both local and national level so that they would be able to
successfully control these issues to a high extent. As sexually transmitted diseases such as HIV have

been consistently growing in UK, government of UK has made it compulsory for all individuals to
get diagnosed for the disease so that they can be prevented from various infections. For further
assistance, consultation, diagnostics tests and prescribed treatment for sexually transmitted disease
has been made free of charge for all the users irrespective of residency, age and status. Central to
prevention of transmission of all diseases, government of UK has recommended early diagnosis
with the help of screenings so that they can be given with treatment on time. Further, they also
advice them to make use of contraception and condoms for safer sex so that sexual health can be
promoted among teenagers (Oliffe and et.al, 2013). For promoting sexual health in UK, it is
important to develop an effective strategic planning so that they will be able to address various
issues related to sexual health. As there are many local and national health authorities in UK, it is
essential for the government of UK to assign various tasks to all authorities so that they would be
able to promote sexual health in a better way. This will also help in reducing the mortality rate
which has recently increased due to sexually transmitted diseases such as HIV and other infections.
Building knowledge and resilience is also one of the key factors which need to be addressed in
order to decrease poor sexual health in UK. It has been noticed that due to lack of information and
knowledge, there have been increase in medical issues. 42% of individuals who have encountered
with sexually transmitted diseases are unaware about various contraception and barriers that can be
used to have safe sex (Bonell and et.al., 2013). Hence, it is significant to provide them proper
knowledge so that their awareness about promoting sexual health will be increased. This will also
help them in maintaining proper mental, physical and sexual health in later stages of life. It is also
important to prioritise prevention so that infection would not spread. Although, sexually transmitted
diseases are not contagious and do not spread from one person to another through physical contact,
but, it is necessary to be careful so that infection would not reach at the stage of severity.
Further, reducing the rates of unintended pregnancies is also important because if mother is
not healthy then she will not be able to provide proper care to her child. This will lead to increase
infant mortality rate (Wellings and Johnson, 2013). Moreover, it will also produce a negative impact
on the mental and physical health of a person. Based on the articles, it is also noticed that
conception rate among teenagers have consistently increased which has produced ill effects on the
health of both mother and the child. Hence, it is essential to provide them guidance and awareness
so that they would not conceive children before the age of 22-24 years. The local health authorities
in UK should also understand that people's sexual health needs, risk and challenges vary with age.
Hence, it is necessary to adopt health promotion strategies according to different needs of
individuals so that they would get satisfied.

5. DISCUSSION, CONCLUSION AND RECOMMENDATIONS
Discussion
A framework for the improvement and promotion of sexual health is necessary so that all
individuals would be able to live a healthy and secured life. Based on various reports and surveys
conducted by the government of UK, it can be easily seen reducing the rate of HIV transmission,
acquisition and death caused due to infections is necessary. Further, an increase in rate of unplanned
pregnancies has also become a necessity because it has been noticed that unplanned and unintended
pregnancies lead to abortions which have a negative impact on both mental and physical health of a
person. Hence, it is important for health organisation and other local authorities to guide and
increase the knowledge of all individuals so that they would not conceive children before a
considerable age. This will also help in maintaining physical, mental and sexual health. In order to
improve and promote sexual health in UK, it is significant to address various issues which create a
hindrance in promoting sexual health. One of the major issues that are present in UK is inequalities
and discrimination among people. It has been noticed that people are discriminated on the basis of
colour, creed, religion and gender which creates a problem in delivering care services to all the
patients and service users.
To improve sexual health conditions, for the government of UK to adopt various strategies
that helps in eradicating inequalities among various individuals is needed. This will be beneficial
because it will help in delivering equal care services to all the service users in UK. The second issue
which exists in UK is that an open and honest culture is not developed between service users and
care providers. This results in lack of information which is necessary to understand relationships
and sex. Building up an open and honest culture will have a positive impact on all the citizens
because it will allow all people to make informed and responsible choices that can be favourable to
their relationships and sexual life. It is also important to understand the fact that sexual health not
only affects a particular individual but it often affects various parts of the society. For example; if a
person is suffering from sexually transmitted disease and is not able to get proper treatment, then
his condition will automatically deteriorate and will lead to death. This will increase the mortality
rate in UK due to poor sexual health. This is significant for the government of UK to appoint
various local and national authorities in the field of healthcare so that they can manage the work
effectively. It is important to ensure that all local and national healthcare authorities are functioning
properly so that promotion of sexual health can be initiated in the best possible way.
High quality commissioning should design appropriate systems and strategies so that they
can provide education and awareness to all individuals in UK. This will help in planning
pregnancies so that all parents can provide the best care to their child. Certain population and group
of individuals are severely affected by poor sexual and reproductive health. Hence, it becomes

necessary for government of UK to develop specific targets based on the communities so that they
will be able to effectively understand the feelings of all individuals and can reduce down the level
of discrimination and stigma which is caused to citizens of UK. Main issues of sexually transmitted
diseases have also widened in UK due to increased level of sexuality between same sexes of
individuals. According to the survey conducted, it was recorded that number of people having
sexual activities between same sexes was 11% in 2011 which has increased by 9% in 2015. Such
types of people who have sex with same sex individuals have dis-proportionality high burden of
encountering various sexually transmitted infections and HIV. Health promotion activities should be
implemented by local and national authorities so that they would be able to prevent the transmission
of various diseases which can increase the mortality rate to maximum level. Sexual health can be
promoted by encouraging all citizens to use condom so that they can also prevent sexually
transmitted disease and unintended pregnancies. Promoting safer sex, regular testing and screening
are also some key objectives that are needed to be fulfilled in order to promote the sexual health in
UK. Only a single local or national authority cannot make an overall change in UK. Hence, it is
necessary to understand that systemic approach is required in order to combat stigma,
discrimination and inequalities which exist in UK. Main action plan has been formulated by the UK
government so that they can design effective strategies and methods which can maintain both
mental and physical well-being of all individuals in the nation. It is important to consider the
reproductive age of women because 20-44% of population of UK conceive children before attaining
complete reproductive age. This produces a poor impact on reproductive health of an individual.
Further, it leads to unplanned pregnancies, poor maternal and child outcomes and physical and
mental instability. All women who are under the reproductive age should have full access to various
types of contraception that can help in preventing unwanted pregnancies and conception. Moreover,
awareness should also be provided to citizens of UK so that age of conception or first sexual
intercourse can be increased. This will also help in maintaining reproductive health so that poor
maternal and child outcome would not be produced. There are key targets and universal health
promotion approaches that have been enacted by the government of UK so that sexual, mental and
physical health can be promoted.
Recommendations
Main purpose of promoting sexual health should be to enhance sexual, emotional, physical
and mental well-being so that various infections and diseases can be prevented from spreading.
Sexual health is not only about avoiding unwanted pregnancies and reducing the rate of sexually
transmitted disease but is also about developing better sexual health so that all people can live a
healthy and disease free life. For initiating and encouraging service uptakes, it is necessary to
provide open and discreet access to all risk groups including teenagers and minority groups so that

they can increase the awareness about promotion of sexual health. Before promoting sexual health,
to underpin sexual health needs and risk factors that are associated with sexual health issues is
required. Detecting and managing STDs such as HIV and other genital infections can be helpful in
reducing the number of infections in UK. Pregnancy testing and support should also be provided to
individuals who have conceived so that they can be given with effective care and services. This will
help in maintaining mental and physical health of both mother and the child. It is also necessary to
address issues related to infertility because if it is not solved in earlier stages then it may result in
major fertility problems. There are many other issues associated with sexual health in UK.
Psychological problems such as decreased self-esteem and dependant personalities are some major
issues which need to be resolved in order to improve the sexual health conditions in UK.
Apart from identifying sexual health needs, it is also important to identify various risk
factors that can also lead to poor health in citizens of UK. Specific actions are required so that
health organisations are able to meet the needs and requirements of particular group of people. If
these risk factors are not eradicated then it will definitely lead to poor maternal and child outcomes.
Young people who are contemplating and turning out to be sexually active are the most vulnerable
adults because this increases the chances of unintended pregnancies to a higher level. Due to this
reason, the teenage conception and abortion rates remain consistently high which affects the mental
and physical health of a person. Rising number of sexually transmitted diseases have also increased
the mortality rate and it has been noticed that majority of people who are infected with these
diseases are in their teenage or in early twenties. Hence, it has become necessary for the
government to adopt various strategies that are effective in resolving various issues related to sexual
health in UK. Various recommendations have been discussed which will help in improving and
promoting sexual health in UK. In order to promote sexual health, it is important for people to have
complete access to full range of sexual health facilities and to comprehensive information on local
and National Health Service provisions. It is also recommended providing them necessary
information about the support and access to all services so that they would be able to use all these
services effectively. Promotion of sexual health should be able to enhance emotional, mental and
physical health so that they are able to keep themselves healthy and fit. These will help in avoiding
unwanted pregnancies and various infections. In most of the cases, it has been noticed that as teens
grow they become sexually active and this leads to increase in conception at a very young age.
This not only produces a negative impact on mother's health but it also has dreadful
consequences on foetus in the womb. Individuals should not plan a conception until and unless they
are able to provide proper care to the child. If a mother is not physically and mentally fit then this
will certainly affect the growth and development of child at early or later stages of life. Hence, it
has become essential to promote and improve sexual health by reducing the conception rate of

teenage individuals in UK. In many cases, it has been noticed that there are individuals who are
unaware about infection which is caused to them due to unsafe sexual contact. 14% of the citizens
of UK are not aware that they have encountered with sexually transmitted disease. This increases
the mortality rate and hence, it is necessary to provide them knowledge about those diseases so that
they would not have unsafe sexual contact. This will probably help in reducing rate of mortality and
will also decrease the number of people that are infected with sexually transmitted disease in UK.
Imparting education in schools will also help in increasing awareness among teenagers and they
will learn to adopt various measures which can promote sexual health in the best possible manner.
Various sexual health promotion campaigns are also conducted in every six months so that more
people can participate in the campaigns. This will help in providing information and knowledge
about the ways which can be implemented so that a positive improvement in sexual health can be
noticed. Effective communication is also required between service users and the healthcare
professionals because if they are not able to communicate information and their problems then the
issues related to sexual health will not be solved. Moreover, it is also necessary to involve service
users in decision making because this can help in producing better health outcomes. In order to
improve the sexual health issue, it is essential to identify those individuals who are infected or have
poor health.
Services which are provided to them should be able to ensure that it leads to encouragement
because if they are not able to motivate individuals then it may lead to their dissatisfaction. For
improvement, it is highly significant to make them satisfied so that better results can be gained.
Building up a strong sexual health network is important because this will assist in facilitating more
prompt and equitable access and coordination between services which are provided to all service
users. This will also help in developing integrated care pathways and plans so that all patients
would get satisfied with the facilities and services provided to them. Hence, it is highly
recommended initiating steps that could help in improving and promoting sexual health in UK.
Conclusion
The overall dissertation is based on promoting sexual health in UK. Based on the overall
dissertation, it can be concluded that there is urgent need of promoting sexual health because there
has been increased number of teenage pregnancies, unplanned pregnancies and sexually transmitted
disease which have increased the mortality rate in UK. The overall dissertation was completed in
various sub parts in which the initial part was introduction which discussed the prevalence of sexual
health issues in United Kingdom. This part also discussed that more than 23% of the total
population of UK has been suffering from sexually transmitted disease due to unsafe sexual
activities. Further, it also stated that as teenagers indulge in sexual activities at an early age, this has
resulted in increased number of teenage pregnancies. To avoid these circumstances, they undertake

the process of abortion or termination of pregnancies which produces negative consequences on
both the mother and her child. Hence, various strategies have been implemented so that ratio of
unintended pregnancies can be reduced to maximum level. Another major problem which is
prominent in UK is the conception age. As youngsters and other individuals in UK have first
intercourse at an early age, chances of conceiving child increases by 45%. It was also included in
the dissertation that conception age in UK is in between 16-18 years which have increased various
issues related to promotion of sexual health.
For tackling this problem, government of UK has formulated many local and national health
authorities so that they would be able to address these issues with effectiveness. Although,
government has formulated many ways which can increase the age of conception in UK but in spite
of many efforts, this issue has not been resolved. Due to this, many negative impacts have been
produced on individuals who conceive at an early age. If a person is not able to maintain her mental
and physical health then they should not undergo with any sexual activities. This can lead to major
issues which can deteriorate both mental and physical stability of a person. The major part of
dissertation was literature review which was based on reviewing all previous studies that have been
conducted on promoting sexual health in UK. According to those articles, it was concluded that UK
is ranked as the second highest in world because it has more than 40% of the pregnancies in
teenagers. It also concluded that due to increased number of teenage pregnancies, number of
abortions have also increased consistently. Government of UK has strived to increase the level of
sex education that is provided in schools so that children and young adults can understand the
importance of promoting sexual health. This will moreover also help in reducing down unintended
pregnancies which is a result of unsafe and unprotected sex. Transmission of various infections
through sex has also been recorded to be at maximum level in UK. Based on the literature review, it
was noticed that major number of cases which are diagnosed of sexually transmitted diseases in UK
are found in teenagers and individuals who are under their twenties. This percentage has increased
in the recent years because many individuals are not aware about different types of contraception
that can be used to avoid the spread of sexually transmitted diseases. Patients and other service
users should also be involved in decision making because this is one of the best methods that can
produce better health outcomes. This will also help in creating awareness so that people can be
saved from various infections and diseases.
The dissertation also included various strategies that can be adopted in order to mitigate
sexually transmitted diseases in people. Further, this will also help in reducing the mortality rate and
will assist in promoting sexual health in a better way. It has also discussed that it is necessary to
provide proper information about various contraception that are available by which people can be
saved from encountering sexually transmitted diseases. Lastly, it has concluded that building up a

strong sexual health network is important so that various agencies will share information and
measures between them. This has also helped in designing various strategies that can effectively
help in promoting sexual health among the citizens of UK.

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