Tonight the UK will see the first television advert for abortion services. Shown at 10.10pm on Channel 4 the advert for Marie Stopes will highlight for viewers where to get help and advice about pregnancy. The advert has already been opposed by charity Life and will not be shown in Northern Ireland (where termination of pregnancy is illegal).

Despite following a public consultation about advertising condoms and termination services on television, some quarters of the media have responded to this advert as though it was automatically going to entice all young women to have abortions – even if they weren’t pregnant! Before the advert had even been made available some journalists were expressing outrage that such messaging could be shared, and were referring to the campaign as ‘the abortion advert’ (rather than an advert for an advice service). Although there was also balanced coverage elsewhere.

One key question that the advert has raised is why do we need to promote services offering termination on television? A common theme in discussing this case has been that those who want a termination would know how to get one so why should there be a television advert talking about this issue?

Unfortunately we know there are many myths about termination of pregnancy which include what terminations actually involve, how you go about getting one, when you can seek a termination, do you have to pay, and what happens afterwards (you can find answers to these questions here courtesy of Living Well/NHS and Patient UK).

We have to remember not everyone has access to the internet and signposting to reproductive health services is generally poor. So it is not always obvious what services are out there or how you might access them.

Some people agreed the advert should be shown, but felt it ought to be screened earlier in the evening so as to reach a younger audience. While I agree with this there is the stereotype we need to challenge that the only people who have/need terminations are teenagers and young adults. Terminations are sought by women of all childbearing ages and for a variety of reasons and with a variety of outcomes. This is why we need clear signposting as it may be older women, young women, unmarried or single women assume such services are not open to them.

We know through research women often make up their mind about having a termination before seeing a doctor but do benefit from prompt referral to termination or maternity care services (depending on the choice they make). But we do also know that women worry about making the move to discuss their options (having or not having a baby) for fear of being judged or concerns over confidentiality. Making it clear there is a service out there who can offer advice and support can be a step towards reassuring women and their partners.

Another issue raised was that having an advert on television ‘trivialised’ the topic of termination or made it into entertainment. This is obviously reliant on how the advert was presented, but generally having information about reproductive health made available on prime time television is beneficial because it is targeting an audience who may otherwise miss the information. Our problem remains if we decide some issues cannot be mentioned in public information adverts on television or in the cinema, where are we able to share them? And if we decide to only have information accessible online or in pamphlets at the GP surgery how many people will we be excluding?

In discussing the proposed advert the media rehearsed several of the stereotypes we’ve grown used to in relation to termination. That it’s only young girls who have unplanned pregnancies, that terminations are only for unplanned/unexpected pregnancies, that everyone who experiences a termination suffers regret (or should feel shame), and that most terminations are carried out at a very late stage. Having such views expressed but not challenged remains a problem – and causes distress for many people with either experience of termination or general problems with fertility. It is unfortunate in the run up to screening the advert there were not more opportunities taken to challenge such myths or provide accurate information.

Having advertising that helps people find advice services for termination of pregnancy is important – particularly since all evidence suggests an early intervention (if one is going to take place) is preferable. While I welcome the advert for Marie Stopes International I would prefer to see a far greater effort made to improve the general signposting to our reproductive health services, the funding for such services and more information about what is available. In particular highlighting contraception choices and getting access to family planning services is vital to women and men and equally as important as having adverts showing where to get advice in the case of considering whether or not to continue with a pregnancy.

Hopefully having this advert screened will pave the way for more opportunities to highlight reproductive and sexual health services and for us to lobby for better sex education and family planning care within our communities.

Here is the advert, see what you think…

Further help can be found at

Family Planning Association has advice and information about what to do if you are pregnant
I’m not sorry is for women who have had positive abortion experiences to share their stories
Health Talk Online (DIPEX) focuses on the feelings and reactions people have when ending a pregnancy over a fetal abnormality

One thing that has marked this election is the growing focus on science issues. This has partly been down to the interest of some politicians in the subject, and mostly due to the activism of a number of scientists (natural and social), science journalists and bloggers.

The focus of these discussions has been around tackling key issues around science (funding, support, listening to expertise etc). And while it is really important these topics are being debated, I’d invite a step back to think a little bit more about the way politicians understand and use ‘evidence’ from science and healthcare in practice. Otherwise we may miss opportunities to work with politicians and inform political thinking – and in turn help the public on key issues around health, education, innovation and technology.

In order to explore some of these core issues I’d like to reflect on my experiences of working with the Department of Health (DH) on their sexual health campaigns, where I had the chance to see where there are major barriers to using, applying and understanding good approaches to sound science. Which results in misleading information and a lot of money wasted.

I began volunteering on the DH campaigns in 2001 and between then and 2008 I increased the work I was doing, eventually becoming both a consultant and spokesperson on the public sexual health campaigns RUThinking, Playing Safely, Want Respect? Use A Condom (see also their great ad campaign), and Condom Essential Wear. Most of which have now been updated for Sex and Young People and Sex, worth talking about (where I currently volunteer for NHS Choices answering questions on psychosexual health topics).

This work involved identifying core evidence to underpin key messaging and liaising with civil servants, ministers and PR companies to ensure accurate, accessible and engaging messages were shared at a variety of different audiences in diverse formats (print, online and broadcast media as well as live events like music festivals).

I came to this work through my background as an academic who teaches healthcare practitioners and policymakers internationally how to access, critically appraise and understand evidence. And through my research which has focused on the sex and relationships health topics of education, service improvement of reproductive health, and addressing psychosexual problems, with a particular interest in media and public health campaigning. All of which I apply via advice giving through educational events, practitioner training and the media.

I was honoured to be part of the campaigning work and believe there were a number of key areas where major achievements were made around getting sex talked about within the media, and particularly with young people. There were some great examples of innovative practice and in the activities I was involved in we ensured work was ethical, based on sound evidence, while still being engaging.

However, during the seven years of working on the campaigns I noticed a number of core problems. I don’t know if these are repeated within other government departments, but it would be worth investigating whether the issues outlined below are happening elsewhere. My hunch is they’re not unique to health.

It was for that reason I asked the Guardian’s Science Test of politicians (by Martin Robbins) to clarify how political parties intended to oversee and manage public health campaigns and associated PR companies.

Here are the key areas I noticed problems around the application and interpretation of research and evidence:

Bidding for contracts
The majority of public engagement activity run by the government (and via political parties) is organised through PR companies. That in itself is not problematic, PR companies are experts in ensuring messages reach the right people in a timely fashion. What is problematic is for health, education and other campaigns there seems to be frequent bidding process orchestrated by different government departments. Meaning several months on any contract will be spent preparing to bid to renew it (in competition with other PR companies). And until any bids have been renewed no new activity can take place. Which restricts the amount of work you can do to reach the public.

There is also the difficulty posed when a PR company is replaced. Where the company who has held the contract has built up their own contacts, messages, experience in delivering information and goodwill among the media. Because they are a commercial organisation this information remains with them if they lose the contract. Meaning the incoming agency has to begin from scratch building up these contacts, there is no organisational memory, and a lot of time lost in repeating activities. It also means experience built up on campaigns can be lost.

Uncertainty of messaging
During the time I worked on the DH campaigns there were periods where ministers were unsure about the direction in which they intended to go. That was not because they were engaged in a systematic review of the evidence which might help them decide, but because they were anxious about media and public responses to their messages. Particularly relating to sensitive issues like contraception, teenage pregnancy and STIs. It took three years to move the more fragmented ’sex lottery’ campaign of 2003 into the national media run ‘Condom Essential Wear’ launched in 2006. [This was the first widespread government-backed public media campaign on STIs since the HIV/AIDS one of the 1980s]. Fear over how the press/public will respond led to haphazard delivery of messaging, also hampered by a limited budget.

It has also led more recently to overlooking evidence of good practice – which is about easier access to services, accessibility of testing and treatment, combined with prevention messaging. Instead the government has opted far more towards promoting testing, and has moved away from their 2006 approach which suggested prevention based messaging/normalising condom use. This appears to be based around cost decisions and attempts to deal with rising STI rates. While it is right that we alter messages depending on new information from research and evaluation, it is problematic if politicians and civil servants do not understand this process, or ignore it in favour of activity that is based around anticipated public opposition or healthcare spending cuts. And equally worrying given it muddles the public and healthcare staff around what they should be doing.

Reinventing the wheel
In the past decade our public sexual health campaigns have begun with the Sex Lottery, which became Playing Safely, which morphed into Condom Essential Wear and is currently Sex, worth talking about. And that’s just the campaign aimed at young adults. Teen campaigns for sexual health, general health and pregnancy have also morphed in similar ways. This has included new websites, logos, branding and core messaging for each iteration of the campaign. And within each development an additional range of agencies working on digital, creative, and marketing tasks. While material written for the web has been reused for some of these campaigns, in many cases new content has had to be created although again not always based on core evidence. It results in confusion to the public who are presented with different names, brands, and websites to find. Individual NHS trusts paying for their own sexual health websites that replicate content found on government ones wastes additional money. All of which results in a lot of activity, a lot of money spent, but no real sense of outcomes – the impact such campaigns have had. Sadly the focus of evaluation is often reduced simply to mentions within the media or visits to the campaign websites. Again indicating a lack of awareness of how to fully assess activity undertaken.

Flashy, gimmicky, but has it worked?
One aspect of the public sexual health campaigns has been a focus on getting young people involved. That has included viral videos, myspace pages, interviews with celebrities and texting services. More recently England’s Sexual Health Quiz was launched. Critics have questioned why this uses a kids vs parents approach (given evidence indicates competitive based education in this area is rarely successful). Other concerns have been expressed about the accuracy of the questions (particularly relating to cancer) and whether knowing how much water a condom holds really tells you anything about your ‘knowledge’ of sex and relationships, or your sexual health needs.

All of these activities are clearly costly, and most of them are focused online, which excludes large numbers of the population. We also have no idea how much they have cost, or what impact they have had. When asked, the Department of Health’s response to me was the latest quiz encourages ‘friendly conversation’ between parents and teens and provides right and wrong information. They had no information about whether this approach had been successfully piloted or was working to increase communication between parents and young people.

We have no idea whether, post election, the current quiz will still exist, or whether the data will be used to inform public health campaigning in the future.

Activity that doesn’t make the headlines
While we may be concerned over the quality of public engagement activity, there is the additional problem of campaigns that are paid for, but fail to reach the public or make much impact. For example one survey called ‘pulling pants’ was carried out for the DH by Tickbox which was to identify whether people chose ‘lucky pant’s to go out in. The survey indicated people spent time thinking about what underwear to wear – and clearly did have special undies they wore in the hope of pulling. But they did not put the same focus on taking condoms with them. This was a playful message, but actually quite important if you think about intentions to have sex. However, despite the survey being designed, run, data collected and the PR and polling company paid, it never made it to the media as ministers and civil servants were worried about the underlying messages. While I have a copy of the data, I do not have the costs for this particular project, but it would be equivalent to a standard public survey of 1000 participants spread across the UK.

Another activity that did make the headlines, but not in any great way, was the Alesha Dixon photospread run in 2008. It produced a series of gorgeous photos, but hardly any media outlets picked up on it (if memory serves only a couple of online editions of tabloid papers ran it). Which again represents a lot of money spent for very little return. [This is not a criticism of Ms Dixon who showed a genuine commitment to a campaign on a topic very few celebrities will be associated with]

It is not unusual within mainstream research or any public engagement activity for ideas to change, for messages to occasionally fail, or for problems to arise. But in relation to the cost of these campaigns – particularly when front line services are being cut – this is a worry. Not least when you add it to the fees for the more online activities, surveys run and time lost while rebidding for contracts.

Part of the problem of messaging being ineffective is the timing of them – Valentine’s Day, for example, is such a busy period to get any media pickup. But it’s also not a particularly good time to run public sexual health messaging – a better time would be around Christmas/New Year when people are more likely to have unprotected sex.

Policy/public health education and the role of the PR Company
By far the biggest problem around evidence-based approaches to public messaging is related to PR companies. In 2008 the Telegraph reported the government were spending approximately £1million per week on polls and focus groups and it may be the figure is far higher if you factor in consultations, and other public facing activity such as websites run by different government departments.

This issue has not really been fully explored and I think a canny journalists might be able to identify a far larger spend than already suggested.

These surveys and focus groups are not run to identify people’s key problems or needs, nor to improve services or our wellbeing. Instead they are run to collect information that will be used to inform media activity. Because nowadays most journalists won’t cover stories unless they can pin them to a survey or similar.

This wastes time and money on a number of levels. It firstly overlooks existing evidence on health, education or business that may well be useful to help us understand or deal with an issue. Peer reviewed research is rarely consulted or used to underpin such activity. Instead we see a number of leading questions used to get answers that in turn will generate headlines and discussions points for radio. Which can work if you have a spokesperson allied to a campaign that can translate that information into accurate and contemporary advice. But this is sadly not often the case given the use of PR companies of spokespeople who may not be the best qualified within an area to interpret and share information.

Research to inform public health is led by PR companies, not academics/practitioners
Over the years there has been a shift within public health campaigns where instead of being informed by key academics/practitioners about current evidence of best practice there is now the approach that the PR Company comes up with the idea for an activity as well as being responsible for promoting it.

A key example, and one that led me to resign from supporting the Department of Health’s sexual and reproductive campaign, came from the new PR agency they appointed. They had heard about some research covered in the Daily Mail where researchers counted the number of mentions of alcohol in the media. They suggested the same approach be used, but focusing on condoms.

Their recommendation was for someone (an academic) to observe the media over an unspecified period, and from that they could indicate how little condoms were mentioned in the media, and flag this up as a problem. They also incorrectly claimed no similar research had ever been conducted on this before (because they had not found any in searches they had undertaken).

Civil servants at the Department of Health seemed impressed with this idea. My opposition to it ran as follows. Such an activity if carried out correctly is very time consuming and costly. It would require very clear parameters around what media would be studied over what period. Given that we already know condoms are not mentioned much within mainstream media there is probably little point in doing such an in depth activity. But given we also know that integrating safer sex messages into mainstream media works see here and here and here and here, perhaps using that knowledge might allow us to bypass the research and focus instead on working directly with journalists – particularly in television where often plot lines in soap operas can be requested to focus on core issues (e.g. sexuality, bullying, teenage pregnancy). My advice was ignored.

On 20 February the Department of Health announced they had commissioned research that looked at media coverage of condoms in a report called ‘Mis Selling Sex’. The report still has not been publicly launched, and there is no clear information on who did the analysis, how it was conducted, and how much the activity cost. Moreover, there is no clear information on how the findings would be implemented outside of talking to television companies, which, as we already have seen, could have been done without having to do a full-scale study.

It is sadly a common problem within health research where people repeat studies, but in the case of a government department being advised they did not need to do this research – and could have used their money elsewhere – it is worrying such advice was ignored. If we do not see particular changes within mainstream media, this work will have been wasted. And even if we do see such messages in media they need to be sustained and supported.

What did I learn from my time in the field?
It would be wrong of me to imply those working on various government health campaigns are not doing their best or lack good intentions. My experience of working with ministers, civil servants and the PR companies behind the campaigns suggested a lot of well meaning people. There were also a few practitioners like me who volunteered our time and skills to inform campaigns and improve sexual health.

However, high staff turnover, fear of the response of the Daily Mail, a reliance on ‘desk based’ research and the focus towards ‘policy based evidence making’ rather than ‘evidence based policy making’ meant many good ideas were blocked, and weaker activities green lit.

Given sexual and reproductive health services are so underfunded, and yet given our equally worrying rising STI rates, it is vital any activity we undertake is cost effective, appropriate, built on evidence and evaluated. And that it directs people to the services they need. Spending money on campaigns that do not achieve this means people won’t go for help and while services continue to struggle with lack of funding.

I wonder how much better we may have done if money simply had been spent on improving services, and telling people where they could find them?

As mentioned I cannot speak for the rest of the activities run in different government departments but it is my belief that money and time has been wasted elsewhere. It is also my belief that politicians and civil servants will continue to struggle after the election because they are not supported by the public or by scientists/practitioners to use evidence to inform policies and services.

While we debate science and how important it is, we need to be aware of the real life problems encountered on the ground that means very often poor practice is allowed to continue because nobody is adequately checking what is being done, and few practitioners volunteer to ensure good services can be offered.

Please, while you’re campaigning for science, think about offering your services and scrutiny to ensure we can stop wasting time and money in the name of government backed health research and education.

Over the past few weeks I’ve been hearing about GMTV’s LK Today show’s forthcoming ‘sex week’, a series of morning programmes aimed at a mainly female audience to be run in the week before Valentines day.

It’s been an invaluable opportunity to observe how ‘sex’ is understood and constructed by programme makers, and how television journalists interact with sex educators, researchers and health practitioners. And ultimately what is chosen to count as content or ‘evidence’ for a programme.

It begins with a survey …
During the introduction to hearing about the forthcoming series I was told the programmes were going to be pinned around a ‘sex survey’. This is a predictable approach used by TV companies to create content and drive publicity. Fine if said surveys were well designed, reliable or valid, but usually they aren’t. Unsurprisingly the planned version of the GMTV sex survey wasn’t very good, but interestingly the programme makers were willing to accept feedback even if the final version wasn’t all that accurate.

The problem with using surveys to underpin programmes is they’re usually thrown together without much reflection by staff with no knowledge of survey design or much of an awareness of sex. Meaning results are either misleading or reinforce stereotypes. There is no real sense that researchers/practitioners like myself and others already know about such materials and can easily translate it into television-ready formats which we’re happy to offer if we’re approached during the planning phase of programme making.

TV sex programmes are led by two things – a ‘news’ agenda and the opinions of the producer – and it’s hard to argue with either
We all know that the media, less like education or research, is closely directed by a news agenda. The creation of GMTV’s ‘sex week’ was no exception, so during preparations for the programme it seemed production staff were keen to find sex addicts and those who’d been cheated on, presumably to fit stories tagged around celebrity sex addicts and cheaters currently in the headlines.

This does two things. It fits sex into a fairly narrow framework, but also restricts discussions towards gossip rather than actual evidence. Now undoubtedly with celebrity sex scandals there will be public interest and opinion. But this won’t help inform relationships unless we can move away from the celebrity angle and focus on the issues at hand. Even then we’d need the ability to do so accurately. So in the case of ‘sex addiction’ we’d need to take a completely different stance than that offered by a standard production angle – that sex addiction is real, here’s a celebrity example, and here’s a ‘real life’ case study to further illustrate the problem. Instead we’d need to look at how sex addiction isn’t really the problem made out by the media, who is promoting the ‘sex addiction’ agenda, and what people really need to worry about in relation to relationships – and how to solve relationship problems without medicalising behaviour.

In phone conversations I had with staff working on ‘sex week’ I was asked if I could help them find a sex addict, someone who was celibate, someone who had an STI, and recommend other experts who could join in panel discussions about sex and relationships. While I was happy to recommend a number of colleagues who I rate (and know would do a great job in talking confidently about sex and relationships to the viewers) obviously I couldn’t recommend case studies (it’s unethical to refer someone you meet in education/research to journalists).

It is unclear exactly what will feature within ‘sex week’ but if it follows the format being worked on over the past few weeks ‘sex’ will be problematised. This can be seen in the way GMTV framed sex in their introduction to their sex survey: “Valentine’s Day is upon us, but are you fed up with your sex life? Is your partner inattentive and unadventurous? Or was the last sexual compulsion you experienced many, many moons ago? Maybe you’re lucky enough to enjoy a passionate relationship with your partner. Whatever you’re getting up to between the sheets, share your sex stories and thoughts with us in our sex survey”. Through to focusing on people who do it too much (addicts) or with the wrong people (cheaters) or those who aren’t doing it enough (celibates).

Sex programmes on television will consistently fail to reach their potential if…
- The focus of any programming is defined and limited by top down approaches where producers set agendas and instruct junior staff to find experts, ‘statistics’ and case studies to support the beliefs and values of the producer. In the case of GMTVs sex week the staff I talked to were charming but were seeking answers to questions set by their producer (who of course didn’t bother speaking directly to any experts). As a result you’ve a constant interrupted dialogue where a producer sets an agenda, a junior has to find someone who’ll support this, and anyone who has a different view will be ignored. No programme will work if you’ve got junior staff negotiating with numerous key players but no authority to green light their inclusion and pressure from an editor to find tame contributors.

- Where ‘news’ (aka ‘gossip’) underpins all stories. Particularly when directly pinned on celebrity cases (with the emphasis on speculating about the celeb not wider issues). Ethically it is inappropriate for practitioners to judge celebrities or any case study and pinning stories so closely to celebrity cases will make it difficult for any ethical practitioner to contribute.

- Where poorly designed surveys are conducted as part of a programme but don’t inform it due to quality issues (or because the survey is conducted to generate publicity not content).

- Where searches for scientific evidence to inform a programme are only carried out on google and ‘evidence’ is understood in terms of some statistics to help stack up a story. A particular problem when staff are pressed for time, don’t understand evidence, and probably aren’t aware that there is a wider body of extensive information about sex they could be drawing on.

- When experts are used to inform content but where staff struggle to identify who is adequately qualified to contribute.

- Journalists (and particularly senior production staff) lack basic sex education so are unable to understand core critical issues about sex. Meaning the ‘sex week’ staff were unaware of any critical discussions of ‘sex addiction’ – they assumed it was real and accepted as a medical condition until told otherwise, and even then continued to work with it as a key contemporary sex issue. There was also the problem of staff accepting ideas that should seem nonsensical – for example one researcher called me asking if I could confirm whether celibacy was harmful to your health since one expert they’d talked to told them if you don’t have sex it could cause physical harm. As with many media encounters a large part of my discussions with staff for ‘sex week’ was about basic sex education (ie how sex won’t get rid of wrinkles or how not having sex won’t harm your body, and that celibacy and asexuality are not the same thing). No reputable sex educator will object to providing this service, but it demonstrates how programmes can’t be made accurately if staff are working from a position of ignorance and misinformation to begin with.

All of which raises serious ethical and practical dilemmas for anyone thinking about being involved in TV sex programmes
Reputable sex educators are always happy to give time to create accurate sex coverage for television. Sadly the approach taken by many production teams often creates barriers for those wanting to be involved. There is the general assumption that you will be willing to provide background information for free, very often to also contribute your time to the show/series for nothing, and the appearance on television is a privilege so you must unquestioningly fit in with the show’s agenda.

Given that many ‘sexperts’ working within the media do so as a means to advertise their products and services they’ll obviously say whatever’s asked for to get their time on television. However, genuine experts won’t be motivated in the same way. We will want to share accurate, sex positive information in an engaging way, not repeat what the producer wants to hear. For many of us schedules need reorganising if we’re going to be on TV (for ‘sex week’ we were asked to set aside two days for filming). That means patients, clients, colleagues and students timetables will also need restructuring. This is only worth it if you’re actually going to be able to share sex positive information.

Once you become aware there’s a show in development you want it to be as accurate as possible – regardless of whether you appear on the final edit. However, that in turn raises issues of how much you should be involved given you can provide lots of time and effort for nothing, have no record of your contribution, and ultimately not see any of your efforts inform the programming. (Which is sadly the case with ‘sex week’ where contributors including myself who’d been booked to appear were told at the last minute we weren’t needed as they’d be sticking with their resident TV doc and sexpert).

Because of these issues the end result of most TV sex shows currently means sex is always constructed in particular ways – usually limited, negative, problem-based with judgemental case studies pinned on celebrities. Expertise may well have been consulted, but may well not be understood or applied. And contributors may not end up on any programming leading to time being wasted and a lot of lost opportunities and bad feeling created.

Very often journalists complain they can’t put together decent programmes because they are up against limits of time or resources. Yet this case study and countless others like it indicate that’s just not true. There’s stacks of evidence, loads of qualified people who can talk about it in engaging ways, and a lot to be said that’s currently not talked about. The key problem is producers make specific decisions to frame sex and ‘sexpertise’ in particular ways. Meaning you get poor to average sex coverage when you could have had GREAT sex.

The tracking of GMTV’s sex week from programme outline to broadcast allows us to think about how sex programmes are constructed for mainstream prime time audiences. You’ve had the background from me, but you can explore this further by watching the programmes (run on ITV1 every morning this week from 9am GMT)

What will they discuss? Consider what they may have talked about and reflect on how much of the programme is linked to their sex survey (the results of which can be found here). You can also question what other evidence is used to underpin programme (and where might that have come from) and what other evidence could have been used. How much of ‘sex week’ will frame sex in a language of hormones, evolution, body language, and gender stereotypes (and how much of that coverage seems accurate or understood). You may want to reflect on who is and isn’t included in discussions (for example in terms of ability, age, ethnicity or sexuality) and how much of the series will be pinned around product placement (lingerie, sex toys etc). Finally you may want to consider how much of the series provides actionable information people can put into practice (rather than instructions on what we should be doing sexually).

As a sex educator my wish is always that quality sex information is provided to the public, so if GMTV manage to do this during ‘sex week’ then this is good news. My anxiety is the programmes won’t be as good as they could be (for reasons set out above) and this is common to most television shows about sex/relationships.

The questions remain about how we address this problem? Practitioners are keen to get involved and share good information but are restricted by many practical and financial barriers set up by television companies. Television companies are keen to continue to include sex content but are unwilling to improve content, particularly because they need to talk about sex but fear losing advertising revenue or viewing figures.

Perhaps the key to the puzzle is not to be found with journalists or practitioners, but lies with the public who can demand better programming (presuming they’re aware what’s currently on offer is inadequate). After all, no matter how eager or well meaning us practitioners can be, or how much evidence we can share, this is never going to be possible unless producers have a reason to provide it. If viewers want this – or if viewers will switch off if it’s not provided – then maybe our sex programming will get better.

Yesterday I wrote about the case of UK morning television show GMTV who’d got into hot water after hosting a biased survey about breastfeeding that had upset mums a lot. It resulted in the programme being publicly criticised for their actions.

I mentioned how I’d been approached by GMTV about a planned series on sex, which they wanted to base on a sex survey. I agreed in principle to take part, with the proviso I had some input to the survey. They sent me their draft questions and I gave feedback. I’ve not heard anything back from them (not even an acknowledgement they received my message), but looking at their sex survey (which is now live on their site) it seems they have listened to the feedback I provided.

Their original list of questions wasn’t too bad, although as with any survey they required reflection and change. For example they planned to ask ‘do you have a partner?’, but this is often misleading and folk who are either dating or married assume it doesn’t apply to them. So a better term (which I recommended) is ‘are you in a relationship?’ They also wanted to find out ‘is your sex life good’ which I suggested they change as ‘good’ is a difficult concept to measure (my standards for ‘good’ may be much more stringent than yours). Instead I recommended ‘how satisfied are you with your relationship?’ (and added asking about partner satisfaction was equally important). I recommended they drop questions that are difficult to reliably measure through a survey (like ‘how often do you think about sex?’) along with questions relating to ‘meeting a stranger online for sex’ (which seemed at odds with the rest of the questions and judgemental).

Based on their suggestions my rewrite looked something like this – aimed to be very basic and to get some general data that could be compared with existing studies and used as a talking point for their programme.

- Demographics: age, gender, location (I usually don’t start a survey like this as demographics are quite threatening, but given the rest of the questions were sensitive this wasn’t a bad place to begin).
- Are you in a relationship? If yes, how long have you been together?
- Are you happy with your sex life?
- Is sex important to your relationship?
- What things help you enjoy sex? (I suggested this might remain open ended or give multiple choices such as communication, willingness to explore new things, time to spend together, trusting each other)
- What are the main barriers to enjoying sex? (worries about body image, confidence issues, lack of partner support, relationship problems, health problems, fertility worries, tiredness, lack of privacy/kids in
the way, sleeping in separate beds)
- Do you have any questions about sex you would like us to answer? (open ended)

Looking at their live survey it seems many of these pointers have been taken on board. These include:

6. Are you happy with your sex life? Yes/No
7. Do you think your partner is happy with your sex life? Yes/No
8. Is sex important to your relationship? Yes/No

9. What would help you enjoy sex more?
Good communication
Willingness to explore new things
Spending time together
Trusting each other
I’m happy with our sex life

11. What prevents you having more sex?
Kids
Tiredness
Poor body image
Health problems
Partner’s sexual difficulties
Relationship problems
Sleeping in separate beds
I’m happy with how often we have sex

12. What things enhance sex for you?
Time together
Good communication
Confidence
Help around the house / childcare

13. Do you still find your partner attractive? Yes/No

If I were doing this study myself I’d have more space to talk about positive things that enhance sex and I’d combine questions 9 and 12. I’d allow more scope for participants to share what does/doesn’t work for them and I’d focus on relationships and intimacy as much as sex. However, the inclusion of factors that get in the way of desire which are very practical for most women (lack of time/privacy due to kids being around, body image etc) is important and will allow for a good discussion for the programme.

However, there are still major problems with the survey and the first one you spot on the welcome page which says “Valentine’s Day is upon us, but are you fed up with your sex life? Is your partner inattentive and unadventurous? Or was the last sexual compulsion you experienced many, many moons ago? Maybe you’re lucky enough to enjoy a passionate relationship with your partner. Whatever you’re getting up to between the sheets, share your sex stories and thoughts with us in our sex survey”.

Yes, it’s in media speak, but there are problems here around the aim of the study – is it about Valentine’s day or sex? It’s leading from the outset with the first statement asking whether people are fed up, or if their partner is inattentive or unadventurous, or sex is something that’s not happened for years. It’s hideously sex negative and likely to invite people who’re either having problems with their sex lives or want to prove they’re super sexual. It’s very bad practice to begin a sex survey with statements like this and no clear aims, but it’s another example of how little attention people give to even basic things like the way you begin your survey and invite participation. Sadly, this opening to the survey suggests it is likely to be as problematic and biased as the previously flawed one on breastfeeding.

At the close of the survey there are suddenly several questions about porn and paying for sex, which don’t really fit with the rest of the questions asked:

14. Do you use pornography? Yes/No
15. Does your partner use pornography? Yes/No
16. Would you ever pay for sex? Yes/No
This question is optional.

These are flawed questions because it’s unclear what does ‘use’ pornography mean? ‘Use’ as in something to turn you on during sex, or before sex with a partner? ‘Use’ to give you ideas for sex? ‘Use’ for masturbation on your own?

Not only do these questions not measure porn ‘use’ (because of a lack of explanation in the questions) but they also don’t tell us useful information like whether women are happy or not about porn or their partner looking at it. It’s almost as though this was tagged on at the end because porn might come up as part of the planned series on sex so there had to be some data on it. Because there wasn’t any thought about this (or using existing survey questions on porn, which again there are loads of) these are just wasted questions.

The buying sex one is also not clear in terms of why it’s being asked (on a reputable survey you’d always ask why you want someone to tell you something). Making the question optional is good, but it’s still not going to tell us anything more than whether people think they might consider buying sex, not whether they have and what their attitudes to paying for sex are. Because this question is placed above asking people for their name and a daytime contact number it makes the porn/paying for sex questions even more threatening – and less likely to be answered.

It’s a shame the introduction to the questionnaire and closing questions are so flawed as the questions in between aren’t too bad. You can easily see, however, that by not taking care throughout the research process, that you can unduly influence and potentially scupper an otherwise good piece of work.

As mentioned in yesterday’s blog, for many journalists (and for most people who’re novice survey designers) it’s common to think if you throw down a few questions on the back of an envelope your survey is good to go. I think from looking over this current survey that there’s an additional problem I often encounter when teaching survey design. Which is folk grasp they need feedback, but assume if they get a little bit then that’s the green light to run with a piece of work.

In fact, to make a good survey (and this applies whatever it is for) you need to find out whether other surveys already exist on the topic you’re interested in. Use or adapt them for your own study. Get feedback on them from colleagues. Amend the questionnaire accordingly. Pilot on a representative subsample. Amend as needed. Then proceed with your work.

This can be more time consuming than bunging down a few questions, but if you liaise with an expert it shouldn’t take long. And it means what you do produce is reliable and useful and far less likely to risk criticism or non completion.

I’m glad to see GMTV appear to have taken feedback on board, although sad to see that by not fully understanding how surveys work that errors in their existing sex survey means it’s not very reliable. Of course they will be able to use it to inform discussions, but the outcomes they get may not be all that representative and thus conversations may be skewed and not deliver what viewers really need.

After writing yesterday several journalists emailed me and asked what my tips were for them to create good surveys for use in features or programmes. I’d recommend following the steps for good survey design outlined above and also:
- get experts to help (they can tap into questionnaires quicker than you can)
- don’t be afraid to use existing measures
- don’t base programmes/features on a survey you’ve designed without going through steps outlined above (if you don’t have time commission someone to do this for you)
- may be better to use the findings from another survey as a talking point
- don’t make the mistake of seeing a survey as quick and easy
- if you get help and feedback then have a dialogue about it (don’t assume feedback equals a green light to proceed unless specifically stated)

People like myself should be willing to work more closely with journalists to improve practice around surveys – which might include training on how surveys work or survey design/analysis, or assistance with writing and disseminating surveys. I see it as a duty of care to make existing measures more accessible and to help journalists put together good quality surveys.

However, there is a problem around offering such a service. Who pays for it? Is it something journalists will expect for free? Is it part of wider public engagement duties we ought to be providing? If so do our institutions cover that cost or the media outlet we’re working with? What do we do if our advice isn’t heeded? How much time should we give to such ventures? And how do we measure ’success’?

For example I managed to get some questions changed from the original GMTV list. Or so it seems. I’ve had no further contact with them to confirm this (I can only go by what they originally sent, what I suggested, and seeing my suggested changed questions now appear on their website). So you could judge that a success. However, responding took time and you have to ask yourself is it worth providing such feedback if you’ve no guarantee the overall quality of a survey would be good (or represent the standards you’d expect in your usual practice). Is it worth doing if you get no feedback whatsoever? Or with no guarantees you’d be able to appear on television (or in print) to talk about the survey?

I’d really be interested to hear from journalists or health/social scientists/practitioners about this topic so please email me your thoughts.

Journalists – I’d love to know if you are interested in getting training on using/understanding surveys, or feedback on creating individual surveys well as the need arises. What kind of support (if any) are you bothered about?

Researchers/practitioners – I’m keen to hear what your experiences in dealing with the media around research have been. Do you think we should do more to encourage collaborative working or training? If not, why not? If so, how might this relationship be encouraged to avoid exploitation and overcome poor practice?

And to everyone reading, is it right to expose bad research in the way I’ve done in yesterday or today’s blog? Or best to keep discussions about research private?

I’ll feed back any comments in a future blog.

Recently a UK morning television show hosted an online poll about breastfeeding. Not a problem you might think. Breastfeeding is an important and topical issue and one that often creates anxiety for mothers. So finding out what women’s experiences are of breastfeeding is important.

However, if you are going to do this you also need to ask questions in a fair and unambiguous way. That’s just basic good survey design. If you ask questions in a leading, biased or confused way you’ll either find people won’t respond to you, or those who do won’t be representative so any resulting data is meaningless.

Unfortunately it seems GMTV hadn’t gone to the ‘survey 101’ class and posted a poll that included questions like:

“Do you think breasts should not be displayed in public for any reason?”
“Do you think women should use discretion when breastfeeding?”
“Do you think it’s a woman’s right to breastfeed in public?”

It also apparently asked whether it was “wrong” to breastfeed a child over 12 months.

These questions are a problem because they’re leading and negative. If you wanted to find out women’s views and experiences of breastfeeding (good and bad) you could ask them about where they feed, or whether they’ve encountered support or barriers when feeding at home or in public. You might ask them who gave them advice about breastfeeding and whether that was helpful (and if not why not), and focus on key issues like family/partner support.

You’d want to be sure anything you asked delivered a clear answer. For example for the question ‘is it wrong to breastfeed a child aged over 12 months’ someone might answer yes but meaning they felt it was wrong to feed an older child in public, but were not averse to the child being fed at home. Or they might answer yes to the question not believing it’s ‘wrong’ to feed a child over 12 months in public, just that they would feel uncomfortable doing so. Or their understanding of ‘wrong’ related to exclusively breastfeeding a 12 month old (although they might be fine with occasional feeds to a little one). With vaguely worded yet judgemental questions you can never be sure what someone’s responding to.

That’s not to say you can’t ask provocative questions, but you would do it in a way that was clear that was your aim. So you could say ‘some people believe the time to stop breast feeding is when baby is 12 months old?’ and ask people to agree or disagree with that statement. It is suggesting there’s a cut off time for feeding, but not that feeding or not over a particular age band is right or wrong.

Indeed good quality surveys are characterised by the fact that they can ask sensitive questions but in a way that does not suggest blame or moralising. Good social research is about finding out about peoples views, not imposing views on them or making them feel their beliefs are faulty.

Usually it’s just geeky social science types like me who get in a flap when dubious surveys hit the media, but on this occasion members of the website Mumsnet also noticed what was going on. As you can see from the linked thread members of the site were upset about the wording of the questions which they felt devalued breastfeeding and mothers who chose to do it. The discussion also alleged the reason for the dubiously worded survey was down to the show being sponsored by Nestle who manufacture baby milk.

Interestingly this story then hit the headlines (albeit more with a focus on the perceived anti breastfeeding angle rather than the duff survey design). However this is an important step forward in campaigning around shoddy surveys used within media as if the public notice and speak up against biased surveys we may be able to challenge more of their widespread use.

It’s clearly difficult to show a link between the dodgy GMTV survey and the show’s advertisers (Nestle claim they had no influence on the survey). So leaving aside the possibility that the advertisers played some role, why else might this situation have arisen?

Within media it’s very common to use surveys. These can be used as promotional tools to plug a magazine or television show, or to create content or a peg to hang a story on.

While there is huge amounts of data that exists that could inform stories (more on this shortly) most journalists assume to make their story/programme ‘unique’ they have to create a brand new survey to inform later content. Which might be an article using data/quotes gleaned from a survey, or a discussion based radio or television show based around your survey results.

My hunch is this was simply the case of a journalist writing down a few questions and getting their producer to approve them. Possibly sharing them with colleagues in the office but certainly not reflecting on them, sharing ideas about the question tone, or piloting in any way.

Generally journalists aren’t aware of the amount of work that needs to go into designing, delivering and analysing a survey, so a back of the envelope sketch of a few questions is enough to run with.

It’s a classic example of poor journalistic practice as not only are the surveys created usually slipshod and meaningless, they’re also unethical since they may well upset participants (as in this case) or mislead the public on key health/social issues.

Moreover it’s bad practice because it shows no research has been done. For pretty much any topic on health or social issues there will be a body of research investigating that. Studies that can be found if you search using Scholar or PubMed. In the case of breastfeeding not only are there countless surveys on attitudes towards breastfeeding, experiences of breastfeeding, feeding duration, partner support, impact on relationships, there are even journals specifically dedicated to lactation. So it’s not exactly an area where you couldn’t quickly find numerous existing and well designed surveys that could inform a programme. As an example here’s what comes up when you put in the very basic searches attitudes towards breastfeeding and breastfeeding experiences.

Sadly many journalists appear unaware these resources exist, or unsure how to search and find information. When I speak to journalists about such resources they often tell me they couldn’t use any pre-existing surveys because they have to design a ‘new’ one in order for it to be fresh for their programming. There is no sense that the very purpose of existing published research is to inform and underpin education and practice.

This is worrying in terms of practice, but also depressing since evidence is published in order to inform public understanding and practice. It is remiss not to make use of such information that could still provide a talking point/background for a story or programme, but would ensure what was discussed was accurate and based on the experiences of a wide range of people.

My guess is that GMTV hosted a sloppy survey for reasons set out above. However there is really no excuse for this practice to continue. They have had a very public warning that such activities are unacceptable.

More than that, I was contacted by GMTV last week who are planning a forthcoming series of programmes. They asked if I might be involved and told me they were basing the whole event around a survey. I explained I’d be delighted to be involved but I’d need to see the survey first. I was told the survey was based on a few questions they’d written down but they did agree to send me them and in turn I gave detailed feedback on how to reword the questions and add more meaningful ones.

To date I’ve heard nothing back so I can either assume they’re busy firefighting the breastfeeding debacle, never got my emails, or my approach to trying to ensure their survey was correct was not welcome and they’ve found another expert (perhaps one who doesn’t ask difficult questions about surveys). Experience tells me it’ll be the latter, but I’m happy to be proved wrong.

If I do hear anything I will let you know. Given this barrage of complaint against the programme and an offer from at least one experienced social scientist to help improve their survey design one might assume GMTV would be keen to get it right in future.

Let’s see what happens. And in the meantime let’s continue to name, shame and campaign each time we spot a shoddy survey.

Researchers working for a planned series for Sky TV have been busy this week trying to recruit participants:

Here’s the message they’ve been posting on various internet sites:

Would you like to take part in a SKY1 TV SERIES?

We look forward to hearing from you.

Unsurprisingly some people have complained about the tone of this ‘invitation’. In fact I heard about it by someone who saw it and was concerned about the tone of the approach. They felt it was demanding and hinted at potential exploitation of participants and wanted to know if, as a psychologist, I thought it was ethical.

If this was for a psychological research study then no, this approach would not be acceptable. It is pushy and leading and not likely to encourage a representative range of participants. However, this is for television where those issues are less important.

I was also asked about the involvement of psychologists in this show and at this time it is difficult to comment. Who knows who they will be? What roles they will be invited to play? Whether what they are required to do on the programme will contravene ethical standards that might apply in their usual practice? Or whether they will be genuinely qualified psychologists?

While relationships are definitely worth exploring, we don’t just use ‘experiments’ to assess them, and certainly don’t tend to use artificial scenarios to test out couples. So that may ring some warning bells about how psychology, relationships research, and experiments are understood. The inclusion criteria of guests aged 19-35 also is worrying given we don’t stop enjoying relationships in our mid-thirties (although this is a common cut-off age journalists like to use).

It could be this series might mimic the standard approach to misunderstanding psychological research, simplistic use of brain scanning, not following ethical principles, nor applying current evidence. It may introduce situations that distress participants and harm their relationship rather than encourage reflection.

But it may surprise us and give us an insight on relationships. The clumsy invitation may be hiding a genuine opportunity to explore relationships issues.

My hunch is the latter is unlikely, but let’s watch this space. I’m always happy to be proved wrong.

On 12 November 2009 the Policing and Crime (P&C) Bill went through Parliament. The hotly contested and controversial Clause 14 – originally proposed to prosecute anyone having sex with a prostitute who was ‘controlled for gain’ (a vague and unworkable term) – was changed so people will now only be prosecuted for paying “for sexual services of a prostitute subjected to force”. This will now become law.

New legal changes will also be coming into effect soon. According to the English Collective of Prostitutes these include “a new definition of
“persistence” for loitering and soliciting which makes street workers more vulnerable to arrest; removing “persistence” from the kerb-crawling law so that guilt can be proved on the first offence; compulsory ‘rehabilitation’ orders, though the government has had to limit to 72 hours the time street workers can be detained before they are brought to court for breaching the order; more powers to close premises where they suspect that certain prostitution offences are being committed, including someone being ‘controlled for gain’; more powers under the Proceeds of Crime Act to seize people’s assets and property and profit from them”.

These proposed legal changes have been subject to political debate for many years now, and the P&C Bill was noteworthy for the deliberate disregard by many politicians for independent evidence on prostitution. Many academics, sex workers and those campaigning for better health and social support for anyone involved in prostitution see the proposed changes as continuing to put prostitutes at risk, and will continue to challenge the current trend of policy making based on opinion rather than evidence.

Still on the topic of prostitution the unmasking of popular blogger Belle de Jour has been a media favourite over the past couple of weeks. In case you don’t know the history Belle de Jour is a blog about a high class call girl that proved so successful it led to a book deal and spin off TV series. It also led to some frankly astonishingly bad sex features in women’s magazines (where high class prostitution was mixed in with aspirational and commercial sex messages). And complaints from some quarters that the TV series in particular was glamourising prositution. All the while debates in mainstream media raged about whether Belle really was a prostitute, or whether she was a male journalist making up stories.

It turns out Belle is a scientist, Dr Brooke Magnanti. She was a prostitute for several months after submitting her PhD thesis (a time well known for being strapped for cash and in-between jobs). Having already been a science blogger, she then blogged about her sex work experiences. This would have remained secret but an ex boyfriend threatened to out Dr Magnanti who decided it was safer to tell her own story to the media.

This has led to a really odd mix of media coverage with journalists expressing surprise that a smart woman was also a prostitute, rehearsing sad stereotypes about prostitution, and in the name of ‘balance’ contrasting Belle as the happy hooker with dismal stories of drugs and disease. It’s been open season to revive the ‘glamourising prostitution’ argument – although now with added bite as critics have a named person to go after, rather than an anonymous blogger.

Channel 4 news did host an interesting discussion on the topic (albeit with the standard hat tip to high class prostitution vs. murdered prostitutes – an unhelpful comparison which does nothing to respect the memories of those prostitutes who have been killed or injured).

This whole case raises a number of issues for academics and universities. We know from bitter experience that academics involved in prostitution (or who support sex workers) have faced discrimination at work. I’ve written a short piece for the Times Higher on this topic, feel free to join in the conversation about this issue that’s running below this piece.

Many of those involved in the debates and campaigns around supporting sex workers identify as feminist. It was unfortunate, then, that a key component of Saturday’s Reclaim the Night march focused on celebrating Clause 14 (see above). Given the fact that many sex workers had felt excluded by radical feminism in this debate – and many academics also felt the agendas and so-called ‘research’ of such groups was given greater weight by the government – it’s a shame the divide was further emphasised on an event that should bring women together. Not least sex workers who are more likely to be at risk from sexual violence. Penny Red has a candid take on this story, while Sarah the bringer of tea explains why trans women are also excluded by some feminists involved with Reclaim the Night. Distressingly it seems that a woman was attacked while on the demonstration (which is both ironic and depressing).

I’ve no quibble with the right to protest against sexual violence or for women’s safety. My concern, however, with events like this is they don’t present a safe space for all women and often have the effect of alienating the very women those organising such activities are claiming to protect.

The National Chlamydia Screening Programme has been reviewed by Dr Ruth Hussey for the Department of Health. You can read the five page summary here. This indicates there are concerns over whether the programme will be continued, too many (and as a consequence confusing) sexual health branding messages (via websites etc). The report also reveals problems with funding, agreement on which services are responsible for delivering testing, and PCTs that are not aware of/up to speed on evidence and so are promoting ‘good ideas’ rather than evaluated best practice. Well worth a read if you’re a healthcare practitioner, health commissioner or anyone working in sex education.

Spot what’s unethical about this research. A Leeds University professor asks four of their female students to hang out in nightclubs and observe whether women pull more men if they’re wearing more revealing clothing.

Following on from recent research about the lack of evidence underpinning cosmetic genital surgery The Guardian has an interesting feature exploring issues about vulval ‘enhancement’. While Vagina Dentata takes a more sex positive view with some handy hints for some vulva-related gifts. Just in time for your Christmas list.

Cory Silverberg has details of what promises to be a fantastic online course about Disability, Sexuality and Rights which could be very useful to those of you working in healthcare, education or social care.

If you’re around tomorrow evening you may want to pop along to Westminster Skeptics in the Pub where a number of science bloggers will be debating What next for science activism in the new media?. Here’s a summary of what will be discussed:

The rise of science blogging and the effective exploitation by activists, scientists, and science writers, of online communication has been a significant but fairly recent phenomenon. This meeting, which is an unofficial sequel to the Science OnLine conference in London earlier this year, will focus on the strengths and weaknesses of this phenomenon, both now and in the future. A stellar panel of Martin Robbins, Petra Boynton, and Hauke Riesch, as well as the writer of Gimpyblog and a writer from Evidence Matters, will set out their views on the current problems and challenges facing science bloggers, activists, and online communicators. They will reflect on what has so far been achieved and also offer thoughts and insights on what can – and cannot – be achieved next. This will then lead into a general discussion and Q&A session.

Hope to see you there!

Finally, you may have noticed I’ve organised the links on the blogroll over to your right. I’ve had a number of emails from people asking me to link to their blogs. Please do feel free to let me know of any blogs on sex education, activism or science/psychology/journalism you think I’d be interested in. I won’t endorse blogs that are judgemental, sex negative, promote commercial or aspirational views of sex that are unrealistic, or endorse outdated or unhelpful ideas. But I am happy to link to blogs that are evidence based, represent critical thinking, and are accessible.