“Save The Ball”: The impact of Co-production on the implementation of an educational resource in schools for adolescents on testicular torsion

Abstract

Background
Testicular torsion is a time-critical medical emergency with a peak incidence in adolescent males. Delayed presentation often leads to testicular loss however awareness of this condition is low among adolescents and their caregivers. This study uses implementation science to investigate how co-production can impact the implementation of a school-based health lesson on testicular torsion, aiming to improve health outcomes by addressing barriers to consistent delivery of effective education.

Methods
First, a scoping review that followed the (Arksey & O’Malley, 2005) approach was carried out to review existing literature on co-production of health interventions amongst health professionals and adolescents. Second, a qualitative study was undertaken to assess the acceptability of a co-produced educational video and webpage. This involved a mini focus group of 3 adolescent males and semi-structured interviews with 10 teachers. Thematic analysis of the transcripts from these interviews was carried to identify key themes.

Results
Overall, the scoping review revealed a lack of literature regarding co-production of health resources with adolescent males. The review identified that co-production fosters trust, improves understanding and promotes autonomy of adolescents engaging with the process, all of which are key drivers of adherence. The qualitative study found the co-produced resources to be highly acceptable to both teachers and students who praised the clarity, tone and credibility of the health message. Healthcare professional involvement and the NHS brand were seen as vital markers of credibility. However, significant systemic barriers to implementation were identified, including the inconsistent delivery of the PSHE curriculum across the UK and varying level of in-school health support.

Conclusion
While the co-produced resource is effective at communicating the critical health message for testicular torsion, its successful widespread implementation is challenged by systemic issues within the current UK education system. Male adolescents are a difficult population to reach as they infrequently have reason to engage with their health, making school-based education crucial. Future work must focus on developing a comprehensive support package for teachers and navigating educational policy to ensure this vital, organ-saving information can be delivered and accessed by young people across the country.

Date of Award	2025
Original language	English
Supervisor	Sion Williams (Supervisor) & Lorelei Jones (Supervisor)