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The sponsor (University of Glasgow) played no role in study design, collection, analysis and interpretation of data, writing of report and decision to publish. KM wrote the first draft of manuscript with no external paid assistance.The STASH intervention offers an innovative approach to SRE which exploits mechanisms of social influence to spread norm and attitude change. It is novel in engaging peer-led use of social media in conjunction with face-to-face conversation. The intervention appears broadly feasible and acceptable in Scottish secondary schools, and there is evidence of broader benefits (Peer Supporter confidence and skills) beyond sexual health. The pre-conditions, key contextual influences and mechanisms of change hypothesised in the programme theory are largely confirmed by process data.

Smith MU, Dane FC, Archer ME, Devereaux RS, Katner HP. Students together against negative decisions (STAND): evaluation of a school-based sexual risk reduction intervention in the rural south. AIDS Educ Prev. 2000;12(1):49–70. All students in the intervention year group were eligible for selection as Peer Supporters; however, only those nominated as ‘most influential’ by their peers were invited to recruitment sessions. Individual informed written consent was obtained for the Peer Supporter role. Milburn K. A critical review of peer education with young people with special reference to sexual health. Health Educ Res. 1995;10(4):407–20. https://doi.org/10.1093/her/10.4.407.

THRIVE-SVR: StraTified Medicine Research to Support Hepatocellular Carcinoma ScReening DecIsions for HCV Cirrhosis PatiEnts after Sustained Viral Response

Most school staff were positive about STASH, and no major acceptability issues arose (green progression target 3b met; Table 2). They valued the leadership opportunities and the ethos of openness about sexual matters (source 6); they were impressed by the rapport between trainers and Peer Supporters: the trainers had ‘a really good handle on the kids’, who ‘would have felt that they were respected and listened to.’ Another noted the excellent quality of delivery that enabled trainers to ‘get a lot of information into a short space of time’ (Teacher, source 6). Swanton R, Allom V, Mullan B. A meta-analysis of the effect of new-media interventions on sexual-health behaviours. Sexual Transmitted Infect. 2015;91(1):14–20. https://doi.org/10.1136/sextrans-2014-051743. THRIVE-SVR: StraTified Medicine Research to Support Hepatocellular Carcinoma ScReening DecIsions for HCV Cirrhosis PatiEnts after Sustained Viral Response (2020-2023) Social network interventions commonly draw on diffusion of innovation theory [ 27, 28]. This posits that innovative ideas can be disseminated through a social network by influential members (‘early adopters’) of that network. There are four key elements: the innovation itself (in this case positive sexual attitudes and risk reduction), the channel of communication (in this case influential peers via conversation and social media), the differential response to the innovation (ranging from early enthusiasts to laggards) and the social system (in this case, school). The pace of adoption is said to be influenced by compatibility of the proposed innovation with existing values, the perceived relative advantage of adopting the new behaviour and the degree to which the new behaviours are straightforward to adopt, easy to try out and visible to others [ 28].