Abstract
ABSTRACTBACKGROUNDComprehensive sexual health education (SHE) reduces risky sexual behavior and increases protective behavior in adolescents. It is important to understand how professionals responsible for implementing SHE policy interpret state and local policy and what influences their commitment to formal SHE policy implementation.METHODSThis descriptive study explored content and delivery of SHE policy in a rural, southwestern state with high levels of poverty, unintended adolescent pregnancy, and sexually transmitted infections. The social ecological model (SEM) was used to better understand levels of influence on the implementation of SHE policy.RESULTSWe conducted telephone surveys with 38 teachers, 63 nurses, and 21 administrators in public secondary schools. There was substantial local variability in the scope and content of SHE curricula. Respondents identified significant barriers to the delivery of SHE content and minimal evaluation of whether educational objectives were met. Based on participant responses, community and organizational SEM levels had the greatest influence on SHE policy implementation, although examples of all SEM levels were identified.CONCLUSIONSGiven perceived challenges regarding subject matter, successful SHE implementation at the local level requires committed stakeholders working in concert at the school and community levels, backed by strong policy commitment at the state level.
Highlights
Policy ImplementationPolicies enacted through legislation or executive order generally define a problem or objective and specify theThe Journal of School Nursing XX(X)organizations responsible for carrying out the policy
The objective of this article was to describe the role of school nurses in the implementation of policies related to health education in schools, sexual health education (SHE)
School nurses operate as street-level bureaucrat (SLB) working directly with the public, often with inadequate resources, ambiguous expectations pertaining to policy goals, and unclear performance measurements (Gilson, 2015)
Summary
Policy ImplementationPolicies enacted through legislation or executive order generally define a problem or objective and specify theThe Journal of School Nursing XX(X)organizations responsible for carrying out the policy. Details of policy implementation are commonly the responsibility of the agencies charged with executing and overseeing those efforts (Mazmanian & Sabatier, 1989). Lipsky (2010) created the term street-level bureaucrat (SLB) to characterize individuals engaged in the front lines of policy implementation efforts, with a bottom-up implementation perspective. These frontline individuals have the most direct engagement with the public and have varying degrees of discretion about how to implement a policy. Frontline workers (in this case, school nurses) might have to interpret or reconcile vague or conflicting policy objectives and expectations with professional standards and personal beliefs due to those constraints
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