BACKGROUND:Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools. METHODS:A cluster-randomised trial of 'Positive Choices' compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners' equal willingness or contraception). RESULTS:Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved 'good' fidelity; two achieved 'adequate' fidelity across components. 11 achieved 'adequate fidelity on selected components' (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI -0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student). CONCLUSION:Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools. TRIAL REGISTRATION NUMBER:ISRCTN16723909.

Whole-school relationships and sexual health interventions represent promising approaches to promoting healthy sexual development. However, data from a randomised controlled trial of the Positive Choices whole-school intervention demonstrate these may be challenging to implement in English secondary schools. We draw on qualitative data to examine staff perspectives on the implementation of the intervention and the factors affecting delivery. Interviews were conducted with 52 staff in 22 schools. Analysis was guided by May's General Theory of Implementation, focussing on how processes of sense making, cognitive participation, collective action and reflexive monitoring were shaped by intervention capability, school capacity, and staff potential. Quality training, materials and support, alongside a strong commitment to delivery of statutory relationships and sex education promoted curriculum implementation. However, whole-school components were viewed as more challenging to implement and often beyond the 'core business' of schools. Successful implementation of whole-school components was facilitated by a supportive school culture, school leads having the authority to enable collective action and close alignment with school priorities and institutional processes. For whole-school interventions to succeed, sufficient time and resources must be allocated. A pragmatic approach might be to develop whole-school approaches that address health more holistically and build effectively on existing provision.

AIM:This scoping review mapped quantitative evidence on men's preconception care (PCC) focusing on: (1) knowledge, (2) behaviours and attitudes, (3) reproductive intentions and (4) outcomes of educational or counselling interventions. The review also sought to identify evidence gaps and inform future policies and practices to enhance male engagement in reproductive health. METHODS:Quantitative studies involving men aged ≥18 years from high- and upper-middle-income countries were included. Studies focusing on couples, non-English-language publications, qualitative research, reviews and commentaries were excluded. Quantitative designs were prioritised to map measurable determinants and outcomes of engagement in PCC. Searches were conducted across seven databases in September 2025, following the PRISMA-ScR framework. No critical appraisal was performed, consistent with scoping review methodology. RESULTS:Fourteen studies (n=18 733 men) were included, most of which were observational. Findings indicated low fertility awareness, inconsistent engagement in preconception behaviours, and minimal use of supplements or healthcare services. Differences were noted by age, education and fatherhood status. One intervention improved knowledge but did not address systemic barriers. CONCLUSIONS:Men remain underrepresented in PCC. Gender-transformative, system-level reforms integrating men into primary care, health education and public messaging are needed. Future research should test context-specific, equity-oriented interventions to promote inclusive PCC for all.

Comprehensive sexuality education (CSE) is a fundamental adolescent right and key strategy for sexual and reproductive health and rights (SRHR). However, implementation remains uneven globally, particularly regarding gender-transformative CSE targeting boys. This study adapted, implemented, and evaluated “Si Yo Fuera Juan,” a gender-transformative CSE intervention for adolescents in Uruguay (2020–2023), highlighting two implementation strategies: (1) co-design with adolescents and multi-sectoral stakeholders, and (2) deliberate focus on male engagement. Using a rights-based approach, adolescents, teachers, parents, health professionals, policymakers, and civil society actors collaborated to culturally adapt, co-design and evaluate “Si Yo Fuera Juan.” The pilot intervention was implemented and evaluated in formal and non-formal educational settings across middle and low socioeconomic contexts in Uruguay. Mixed-methods data collection (virtual and in-person due to COVID-19) included focus groups and questionnaires with adolescents, workshops with families, and focus groups with teachers were conducted between 2020 and 2023. Qualitative data underwent deductive-inductive thematic analysis; quantitative data were analyzed descriptively by gender and socioeconomic status. The intervention demonstrated high acceptability and feasibility across all stakeholder groups. Key findings included: strong support for the gender-transformative approach; identification of adolescents’, parents’, and teachers’ needs and recognition of gaps in current CSE provision; and the consensus that a cultural adaptation of the original intervention "If I Were Jack" was essential, requiring modifications to reflect Uruguayan social norms and institutional structures. Adolescents found the intervention emotionally engaging and realistic, facilitating critical reflection on gender roles and reproductive decision-making. Teachers valued the interdisciplinary approach and the innovative focus on boys. Implementation challenges included limited institutional time, insufficient teacher training, and infrastructural gaps. “Si Yo Fuera Juan” demonstrates successful adaptation of a gender-transformative CSE intervention through participatory co-design with multiple stakeholders. The intervention effectively engages boys in adolescent pregnancy prevention and has been integrated into national CSE policies in Uruguay. Sustained scaling requires institutional commitment, comprehensive teacher training, and strengthened intersectoral linkages between educational institutions and the health system. Comprehensive sexuality education (CSE) helps young people make informed decisions about their sexual and reproductive health. However, many CSE programs focus mainly on girls, leaving boys out of important conversations about pregnancy prevention and shared responsibility. This study describes how we adapted and tested "Si Yo Fuera Juan" (If I Were Juan), a sexuality education program designed to engage both boys and girls in Uruguay. Between 2020 and 2023, we worked with adolescents, teachers, parents, healthcare professionals, and government officials to create the adapted intervention to fit Uruguay's culture and educational system. The program uses an interactive video drama that shows realistic situations where young people face decisions about sexual and reproductive health and unintended pregnancy. This is combined with classroom activities that encourage discussion and critical thinking about gender roles and corresponsibility. We tested the program in schools and community settings with adolescents from different socioeconomic backgrounds. We collected information through surveys, focus groups, and workshops to understand what participants thought about the program. Results showed that adolescents, teachers, and parents found the program engaging and relevant. Young people appreciated the realistic scenarios and the safe space to discuss difficult topics. Teachers valued the focus on boys as an innovative approach to promote shared responsibility. However, teachers also noted challenges like limited time in school schedules and need for better training. The program has been incorporated into Uruguay's national sexuality education policies. To expand it successfully across the country, schools will need more support, including teacher training programs and better connections between schools and health services.

Previous trials of whole-school relationships and sexual-health programmes have not reported on fidelity, reach or acceptability, despite the importance of these factors for interpreting outcomes. Our trial of the Positive Choices whole-school relationships and sexual-health programme found limited effectiveness in secondary schools in England. We aimed to understand whether sub-optimal fidelity, reach or acceptability might explain the results. A process evaluation was nested within a parallel-arm, cluster randomised-controlled trial in 49 schools from 2021 to 2025. Using staff log-books, researcher observations, student surveys and staff interviews, we assessed the delivery of the programme in 24 schools and awareness and acceptability among students, including subgroup differences. While most schools delivered lessons, fewer completed 'whole-school components', such as school-health promotion councils, sexual-health services reviews and student-led campaigns. No school reached a pre-defined level of 'good fidelity' across all components, and only 11 schools achieved 'adequate fidelity for selected components'. Evidence of programme acceptability and awareness among students was weak, with higher awareness among sexuality- and gender-minority students, and higher acceptability among white students. Findings highlight difficulties implementing whole-school programmes focused on relationships and sexual health. More holistic whole-school programmes addressing multiple health issues, including sexual health, may be more feasible.

Background:Artificial intelligence (AI) tools based on large language models (LLMs) are being increasingly used by researchers and may play a role in health-related research priority-setting exercises (RPSEs). However, little is known about how these tools may differ in the types of research priorities they generate. Methods:We examined research priorities aimed at improving treatments for four diseases: cancer, COVID-19, HIV, and Alzheimer. We compared the outputs from five AI tools (DeepSeek, ChatGPT, Claude, Perplexity, and Gemini) using SBERT-BioBERT embeddings and cosine similarity scores, and assessed the stability of differences between them by re-running identical prompts and slightly modified versions. Results:We found that the outputs produced by Gemini were highly similar to those produced by the other tools. The two most different outputs were those produced by DeepSeek and Perplexity, whereby the former tended to emphasise technical medical issues, while the latter emphasised public health concerns. This substantive distinction between DeepSeek and Perplexity remained stable across repeated and tweaked prompts. Conclusions:Our exploratory analysis suggests that Gemini performs well for researchers who prefer to generate health-related research priorities using a single AI model. For those planning to draw on multiple models, Perplexity and DeepSeek offer complementary perspectives.

Introduction Sexually transmitted infections (STIs) are a major global health concern, with millions of new cases occurring annually, particularly among young adults. These infections can lead to serious health complications, including infertility and increased risk of HIV, and are compounded by social stigma and mental health challenges. There have been significant global increases in STI diagnoses in recent years. The objective of this systematic review is to synthesise evidence on the predictors of trends in gonorrhoea, chlamydia, syphilis, and HIV over the last ten years. We aim to provide insight into the multifaceted drivers of the recent increasing STI diagnosis rates. Methods We have developed a comprehensive search strategy that includes searching for relevant published literature and grey literature. We will include studies that contain evidence of longitudinal associations between changes in the incidence of diagnoses of four targeted STIs (i.e., gonorrhoea, chlamydia, syphilis, and HIV) during the last ten years. In addition, we will explore changes in sociodemographic and behavioural variables during the same time among representative samples of national populations. We will conduct a narrative analysis of the included studies. Discussion The proposed synthesis plan is part of a larger research project that has been designed in response to the priorities of sexual health policymakers in Ireland. It will provide useful information regarding recent international trends in diagnoses of gonorrhoea, chlamydia, syphilis, and HIV, which will inform further efforts to understand the recent increases in STI diagnoses in Ireland. We acknowledge that it will be limited by publication bias, the biases affecting the included studies, a potential lack of data on important sub-populations, and restrictions related to testing availability across countries. Ultimately, trends in STI diagnoses are best understood through the design of comprehensive behavioural surveillance systems, which this review may usefully inform.

IntroductionThe school environment influences adolescent health through both individual experiences, such as one’s own engagement with school, and broader school-level factors, such as aggregate student levels of engagement, affecting all students. For mental-health outcomes, existing evidence more consistently supports individual-level influences than school-level effects. In relation to depression, negative student-level educational experiences have been associated with increased symptoms, while evidence for school-level associations remains limited and often methodologically weak. We aimed to address this gap through a secondary analysis of longitudinal data from a trial involving 49 English secondary schools.MethodsStudent-reported educational experiences (school belonging, educational commitment, participation at school, relationships with teachers and expectation of university) as well as family affluence were measured at baseline (ages 12–13) and depressive symptoms were assessed at follow-up (ages 15–16). Associations were examined at both the individual student and aggregate school level of educational experiences.ResultsForty-five schools were retained at endline and 4,601 students comprised our analytical sample. At the student level, greater school belonging (beta coefficient = −0.24; 95% confidence interval = −0.29, −0.19) and educational commitment (beta coefficient = −0.19; 95% confidence interval = −0.29, −0.08) were associated with lower risk of depressive symptoms in fully adjusted models. At the school level, only overall educational commitment was associated with reduced depressive symptoms in a partially but not fully adjusted model (beta coefficient = −1.02; 95% confidence interval = −1.86, −0.18).DiscussionThese findings suggest that educational experiences influence depressive symptoms primarily through individual-level mechanisms, for example involving students’ sense of belonging, engagement, participation and relationships) but the general level of educational commitment within a school may also play a meaningful role. (249 words).

Introduction Sexually transmitted infections (STIs) are a major global health concern, with millions of new cases occurring annually, particularly among young adults. These infections can lead to serious health complications, including infertility and increased risk of HIV, and are compounded by social stigma and mental health challenges. There have been significant global increases in STI diagnoses in recent years. The objective of this systematic review is to synthesise evidence on the predictors of trends in gonorrhoea, chlamydia, syphilis, and HIV over the last ten years. We aim to provide insight into the multifaceted drivers of the recent increasing STI diagnosis rates. Methods We have developed a comprehensive search strategy that includes searching for relevant published literature and grey literature. We will include studies that contain evidence of longitudinal associations between changes in the incidence of diagnoses of four targeted STIs (i.e., gonorrhoea, chlamydia, syphilis, and HIV) during the last ten years. In addition, we will explore changes in sociodemographic and behavioural variables during the same time among representative samples of national populations. We will conduct a narrative analysis of the included studies. Discussion The proposed synthesis plan is part of a larger research project that has been designed in response to the priorities of sexual health policymakers in Ireland. It will provide useful information regarding recent international trends in diagnoses of gonorrhoea, chlamydia, syphilis, and HIV, which will inform further efforts to understand the recent increases in STI diagnoses in Ireland. We acknowledge that it will be limited by publication bias, the biases affecting the included studies, a potential lack of data on important sub-populations, and restrictions related to testing availability across countries. Ultimately, trends in STI diagnoses are best understood through the design of comprehensive behavioural surveillance systems, which this review may usefully inform.

Whole-school interventions go beyond classroom education, promoting health by modifying school environments. These can be effective in delaying sexual debut and increasing contraception use but mechanisms are poorly understood. Qualitative research within realist evaluation can explore mechanisms via building 'context-mechanism-outcome configurations', describing how interventions trigger mechanisms that interact with context to generate outcomes. We explored these for the Positive Choices whole-school sexual health intervention within the intervention arm of a randomised trial conducted 2021-2025. Using 'dimensional analysis', we analysed 52 interviews with teachers and 40 focus-groups involving 266 students from 22 English secondary schools. Our results suggest seven mechanisms through which whole-school interventions might 'work': improving knowledge using diverse pedagogies; improving confidence and ability to talk by normalising talk about sexual health; changing gender attitudes through challenging stereotypes and providing insights and empathy with others' perspectives; promoting access to sexual health and other services via helping students understand their needs and entitlements; building school engagement by providing new student roles on decision-making groups; increasing inclusion of sexual-minority students by normalising consideration of non-heterosexual identities and practices; and reducing sexual harassment and abuse by helping students understand consent and when to intervene in harassment. Contextual contingencies included: high initial student needs; teacher skills and commitment; and school commitment and capacity. Our research suggests novel mechanisms via which whole-school interventions might promote sexual health. Quantitative analyses will now be conducted to examine these mechanisms and contingencies.

To help achieve the goals of accountability and research excellence, funding organisations often utilise evidence from research priority setting exercises (RPSEs), which distil, from data gathered from relevant stakeholders, a systematic and 'objective' rank-order of research priorities. RPSEs are, however, costly and labour-intensive. Also, critics of RPSEs have highlighted certain limitations: insufficient representation of difficult-to-reach stakeholders, especially in low- and middle-income countries; a lack of genuine stakeholder engagement; wide variation in the extent to which exercises are documented; a lack of specificity in the identified priorities; and minimal impact of the priorities. Artificial intelligence (AI) tools such as ChatGPT may potentially help, valuably complementing conventional RPSEs. While the opacity of AI decision-making is a limitation, advantages include speed, affordability, and highly inclusive distillation of the vastness of existing human knowledge. We encourage research identifying the extent to which AI can replicate conventional RPSEs. We suggest that AI tools could complement conventional approaches either at the initial question generation stage or in generating supplementary insights for reflection at the data analysis stage. Also, under conditions of high existing stakeholder engagement and an extant prevalence of conventional RPSEs, AI-only studies may be valuable.

International student mobility (study abroad) as a method to enhance students’ education, cultural awareness, and competency has gained support from numerous national governments and higher education institutions. The aim of this systematic review is to synthesize the evidence on the experiences of international healthcare postgraduate students who study abroad. A systematic search of five databases using a pre-defined search strategy was conducted on published research with no time restrictions, up to December 31st, 2023. Following data extraction, the review utilised a deductive thematic analysis approach, guided by pre-defined research questions, including identifying perceived advantages and disadvantages of international programs, challenges faced by students and educational providers, the experiences of postgraduate healthcare students traveling with families, and any additional emerging themes. Search yielded 1500 records and 22 articles met the inclusion criteria and were included. Sixteen studies used qualitative methods, four used mixed methods, one was a quantitative nonexperimental exploratory study,and for one study the research design was unclear. Two studies were excluded at quality appraisal stage. The findings identified benefits from the perspectives of postgraduate students, such as improved language skills, cultural awareness, and professional development. Common challenges included language barriers, academic difficulties, and cultural adaptation. One study highlighted the unique experiences of students with families, emphasizing a need for opportunities for social integration and support networks. The research suggests a mix of benefits and challenges among postgraduate healthcare students studying abroad. Further research is needed to better understand the experiences of students who are accompanied by their families in studying abroad.

Background Universal health coverage (UHC) is crucial for achieving Sustainable Development Goal (SDG) 3: Good Health and Well-being. This study projects UHC progress in seven South Asian countries by 2030, focusing on two crucial underpinning components, primary healthcare (PHC) service coverage and financial risk protection.Methods We applied Bayesian random-effects models to project UHC indicators linked to PHC and financial risk protection including the Composite Coverage Index, catastrophic health expenditures (CHE) and impoverishing health expenditures. Data were sourced from the WHO Global Health Observatory, Demographic Health Surveys, National Health Surveys and the WHO Global Health Expenditure database. Projections were made from 2000 to 2030, with PHC and government health expenditures as key predictors.Results The analysis showed notable disparities in current and projected service coverage and financial protection across the region. Health service coverage is projected to increase from 53.5% in 2000 to 81.5% by 2030, with Bhutan and Sri Lanka expected to achieve higher levels. However, Afghanistan and Pakistan will likely remain below the SDG target of 80% coverage. Despite progress in coverage, financial protection is a challenge, with CHE expected to rise from 7.2% in 2000 to 18.6% by 2030. Bhutan and Sri Lanka show strong protection measures, while Afghanistan and India will face higher CHE and impoverishment rates due to high out-of-pocket spending.Conclusion This is the first study to project trends towards UHC in South Asia using Bayesian estimates of both health coverage and financial risk protection. Progress towards UHC requires advances in both service coverage and health financing reform. Although service coverage is improving, financial protection remains insufficient, particularly in rural and conflict-affected areas. Targeted PHC investment, context-sensitive financing reforms and stronger risk-pooling mechanisms are essential—drawing lessons from stable settings (Bhutan, Sri Lanka) to guide strategies in fragile contexts (Afghanistan, Pakistan).

Adolescence is a pivotal stage for sexual and reproductive health and rights (SRHR). Young adolescents (aged 10-14 years) undergo sexual and reproductive maturation, yet research on their SRHR lags behind that of older adolescents. To address this gap, WHO commissioned a research priority-setting exercise focused on the SRHR of young adolescents using an adapted mixed-methods Child Health and Nutrition Research Initiative methodology. Over 300 stakeholders from more than 60 countries-including academics, policy makers, advocates, and youth advisors-participated in defining and evaluating research priorities against two evaluation criteria: answerability and impact. 30 research priorities were identified, with top-ranked priorities focusing on the role of social media in young adolescents' SRHR, mental health challenges, and disparities in SRHR needs among marginalised subpopulations. The findings highlight the importance of ethical engagement with young adolescents and implementation of tailored comprehensive sexuality education. The identified research priorities emphasise the need for scalable interventions and policies that align with young adolescents' developmental needs and the needs of their caregivers while addressing sociocultural barriers. The research priorities also reflect a clear ambition to develop and implement co-designed, age-appropriate, and scalable SRHR education and health interventions for young adolescents, laying the foundation for long-term wellbeing.

There is little research on sexual harassment among younger adolescents or on how rates vary by gender and other student/school characteristics. Drawing on data from 50 English schools, we explored the prevalence and patterning of victimization in the past year among students aged 12-13. Of 7,060 participants, almost a tenth had experienced sexual harassment. Girls, non-binary students, and sexual-minority students reported the highest rates. Student commitment to school was associated with reduced victimization, particularly among straight students and in higher-attaining schools. Sexual harassment is a priority area for intervention, particularly for students facing the highest risk.

The quality of sex education varies. In England from 2020, the government attempted to improve provision by making lessons a statutory requirement. We assessed implementation in 25 secondary schools in 2022-23, framed by May's general theory of implementation. This identifies processes of sense-making, cognitive participation, collective action and reflexive monitoring, influenced by an intervention's capability, stakeholder potential (individual and collective commitment), and institutional capacity (norms, and material and cognitive resources). Interview data from staff leading relationships and sex education (RSE) were coded thematically informed by May's concepts. Those leading implementation 'made sense' of statutory guidance, finding it relevant and clear. 'Cognitive participation' among participants was strong, promoted by individual support for RSE but undermined by social norms prioritising academic attainment, limited skills among non-specialist teachers, and lack of 'collective commitment' among some staff and students. 'Collective action' varied across schools, influenced by availability of material resources and specialist staff. Schools undertook internal the 'reflexive monitoring' of provision, supported by school leaders' awareness work would be assessed by government inspectors. On its own, statutory status is likely insufficient to achieve a step-change in RSE implementation. Other forms of support may be needed including training and offering support to more specialist teachers.

Engaging men and boys in sexual and reproductive health and rights (SRHR) and doing so in a way that challenges harmful masculinities, is both neglected and vital for improving the SRHR of both women and men. To address this gap, WHO commissioned a global research priority setting exercise on masculinities and SRHR. The exercise adapted the quantitative child health and nutrition research initiative priority setting method by combining it with qualitative methods. Influenced by feminist and decolonial perspectives, over 200 diverse stakeholders from 60 countries across all WHO regions participated. The exercise forges a collaborative research agenda emphasising four key areas: gender-transformative approaches to men's and boys’ engagement in SRHR, applied research to deliver services addressing diversity in SRHR among men and women and to generate gender-equality, research designs to support participation of target audiences and reach to policy makers, and research addressing the priorities of those in low-income and middle-income countries.