title: Preparing the sexual health workforce to deliver integrated services: is education the answer? A qualitative study exploring the impact of sexual health education on developing integrated policy and practice.
abstract: Aim This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky's account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed.
  
  
  
  In order to achieve the United Nations' goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success.
  
  
  
  Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Findings Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health.
authors.affiliation: 1Lecturer in Health Visiting,School of Health Sciences,Division of Health Services Research and Management,City University London,Northampton Square,London,UK.
authors.forename: Judy
authors.initials: J
authors.lastname: Brook
authors.affiliation: 2Deputy Dean,School of Health Sciences,City University London,Northampton Square,London,UK.
authors.forename: Debra
authors.initials: D
authors.lastname: Salmon
authors.affiliation: 3Associate Dean for Education Technology and Innovation,School of Health Sciences, City University London,Northampton Square,London,UK.
authors.forename: Rachael-Anne
authors.initials: RA
authors.lastname: Knight
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D009726:Nurses / Q000706:statistics & numerical data*; D016730:Program Development / Q000379:methods*; D036301:Qualitative Research; D000074384:Sexual Health / Q000193:education*; D006113:United Kingdom
keywords: education; integrated services; leadership; sexual health nurses