From leadership research to district action: Experiences of school health professionals in implementing structured assessments of sexual health and experiences of violence among youth in Sweden using the SEXual health Identification Tool (SEXIT): a qualitative sequential study

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Evidence and transfer

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Original authors’ abstract, reproduced under the source license:

Abstract Introduction Poor sexual and reproductive health (SRH) is a global public health concern, particularly among adolescents. While school health services (SHS) play a crucial role in preventative care, professionals are inconsistent in addressing SRH issues. This study explored school health professionals’ (SHPs) experiences of an implementation of structured assessments of sexual health and experiences of violence among youth in Sweden using the SEXual health Identification Tool (SEXIT). Methods A qualitative sequential study was conducted from October 2023 to January 2024 to explore the experiences of 57 SHPs trained in the SEXIT method. Data collection included a questionnaire with open-ended questions, group discussions and individual interviews, analysed using qualitative content analysis. Results Addressing sexual risk taking and violence was considered a priority to help youths make informed SRH choices. SEXIT aided SHPs in acting as educators to promote SRH and freedom from violence, normalised conversations about sensitive topics, facilitated the identification of students needing support, and could be integrated as a routine part of preventive work within SHS. However, hindering factors for effective implementation included a lack of supportive leadership and a unified approach among involved organisations to clarify roles, responsibilities and referral pathways. Furthermore, it is essential to further adapt SEXIT and train SHPs to meet the specific needs of vulnerable youths and perpetrators, ensuring equitable support. Conclusions SEXIT offers unique opportunities for SHPs to discuss SRH and violence with school youths, a priority part of their preventive work; however, it is not routinely used, underscoring the need for supportive leadership and a unified approach among organisations.

Study methods

This study had a qualitative sequential design16 based on a qualitative questionnaire with open-ended questions, group discussions and individual interviews, to explore the experiences of SHPs trained in the SEXIT method in one county in Sweden (figure 1). The study was planned and reported according to the Consolidated Criteria for Reporting Qualitative Research Checklist.17

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Miranda Håkansson; Sanny Söderström; Marlene Makenzius. Experiences of school health professionals in implementing structured assessments of sexual health and experiences of violence among youth in Sweden using the SEXual health Identification Tool (SEXIT): a qualitative sequential study. BMJ Public Health (2024-11-26). https://doi.org/10.1136/bmjph-2024-001667

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.