The Rural Sexual Health in Youth Framework (RuSHY) Framework


2015 - 2019




Approved by the Curtin Human Research Ethics Committee (HR96/2015-06)


Dr Carl Heslop (Curtin University), Associate Professor Sharyn Burns (Curtin University), Dr Roanna Lobo (Curtin University), Dr Ruth McConigley (Curtin University)

Brief overview

The Rural Sexual Health in Youth Framework (RuSHY) Framework was developed as a practical document within a PhD research project following prolonged engagement by the lead researcher with a rural community, PAR and iterative feedback. It represents the culmination of a collaborative development process with stakeholders and young people that examined local realities and constructs to produce solutions and knowledge relevant to the setting that could be further transferred beyond that setting. It aims to improve coordination of sexual health in small towns and provide guidance to rural communities in how to meet the needs of young people (age 16-24) in their towns. With limited literature about relationships and sexuality education (RSE) and health provision in rural Australia, this study gives voice to rural workers providing these services – at times through circumstance rather than planning.


The overall aim of this study was to use a participatory action research (PAR) methodology to develop and validate a framework for planning, implementing and evaluating community-based youth sexual health interventions in the rural setting. To achieve this aim, the study comprised the following objectives:

1. Conduct an analysis in relation to evidence-based practice, settings, key stakeholders and interventions to understand the context of the setting.

  • Conduct community consultation to identify and assess key settings, stakeholders, activities, and interventions that are currently active or planned to promote youth sexual health
  • Identify needs, gaps, weaknesses and opportunities that currently exist within the setting.

2. Develop a framework in consultation with key stakeholders and the target group for planning, implementing and evaluating community-based youth sexual health interventions in the rural setting using a PAR methodology

3. Evaluate the validity of the framework

  • Validate the framework with key stakeholders within the setting using a Delphi technique.
  • Evaluate the acceptability and validity of the framework through wider consultation with youth-focussed professionals using a Delphi technique.

PAR methodology was adopted as it was identified as an effective methodology for engaging community. This enabled the researcher to work with the community, empower participants and give them a voice. PAR allowed the project to be developed from community-voiced concern; to involve stakeholder analysis of the issues faced by community and to focus on finding a solution to the current situation.




This project developed and validated a Framework for planning, implementing and evaluating multi-level community-based sexual health interventions for young people in the rural setting. The methodology allowed the opportunity to test the application of embedded Delphi studies within PAR, contributing to a growing body of literature that utilises PAR in the rural Australian setting as a research methodology that connects with the rural population; encourages action within that community and provides a platform for an authentic rural voice. The Framework represents the output of a collaborative development process that produced localised knowledge with value to the wider community following a community expressed need to address youth sexual health. Implementation of the Framework in new communities is possible providing there is care in addressing the limitations of the Framework and acknowledgement that further testing will enhance inter-contextual reliability.

The RuSHY framework has been evaluated for potential usefulness and the ability to be transferred to other settings by rural-based stakeholders. In its current form, it is recommended for immediate testing and utilisation within rural settings. It is acknowledged that the RuSHY Framework has been developed for a specific community and new communities should acknowledge and evaluate their setting specific considerations in terms of population demographics, service provision and local policy. This framework aligns closely with several key action areas within the Fourth National Sexually Transmissible Infections Strategy 2018 – 2022 to address the priority youth population and provides a practical document for the rural workforce.


Developing a Framework for Community-Based Sexual Health Interventions for Youth in the Rural Setting


Heslop, C. W., S. Burns, R. Lobo and R. McConigley. (2017). Developing a framework for community-based sexual health interventions for youth in the rural setting: protocol for a participatory action research study. BMJ Open 7(5).

Heslop, C. W., S. Burns and R. Lobo (2018). Managing qualitative research as insider-research in small rural communities. Rural and Remote Health, 18(3). 

Heslop, C. W., S. Burns and R. Lobo (2019). Everyone knows everyone’: youth perceptions of relationships and sexuality education, condom access and health services in a rural town. Sex Education: 1-17. 

Heslop, C. W., S. Burns and R. Lobo (2019). "Stakeholder perceptions of relationships and sexuality education, backlash and health services in a rural town." Sex Education: 1-16.