education could be presented in alternative ways. The questionnaire responses were analysed quantitatively where appropriate and the qualitative free text responses were analysed thematically. The focus group responses were audio recorded and thematically analysed. The first focus group was analysed separately by both researchers. A coding frame was agreed which was used to analyse the remaining two focus groups, which were also analysed separately. There was strong agreement between both researchers on the themes which arose from the three focus groups. Very similar themes arose from all three focus groups, which allowed the researchers to be confident in the representativeness of the views expressed. The qualitative responses from the questionnaires concurred with the focus group themes, although the emphasis and ‘strength’ of the views differed. For example more emphasis was placed on the need for informational leaflets in the questionnaire responses, whilst the importance of seeing CaSH advice given in practice was a stronger theme in the focus groups. WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 67 Findings and discussion Eighty six questionnaires were returned representing 83% of the 3rd year students (N=104) who were eligible to take part. Fifty six percent of the sample (n=48) were under 24 years when starting the programme. Forty three percent of the sample (n=37) were 24 years or older on starting their midwifery education (one respondent did not state age). All but one respondents were female. The findings are presented under two subheadings relating to Questions 6 and 7 of the questionnaire. These are, factors affecting confidence, and factors which would increase confidence. Findings against the third element of the research question, regarding the participants’ views on delivery of the pre-registration programme, were very closely entwined with the findings on factors which would increase confidence, and therefore the findings for these two elements have been combined. What are the factors affecting confidence to give advice? The questionnaire included the opportunity for participants to give qualitative responses to two questions regarding the factors which affect how confident they felt giving advice, and what they considered would improve their confidence. Table 1 summarises four factors which affect the confidence of the student midwives to give CaSH advice. The percentages of responses refer to the questionnaire responses only, since it is not possible to quantify focus group themes in this way. Knowledge level was the factor reported by more respondents than any other factor, suggesting this was the most immediate and pressing concern for most participants. Fifty one per cent (44/86) of questionnaire respondents commented that lack of knowledge or education on contraception and sexual health affected their confidence, and 69% (59/86) commented that more knowledge or education/training would increase their confidence. The participants also identified that the setting could affect confidence, with reduced confidence when time was limited and reduced confidence when in the presence of another family member apart from the woman and newborn child. For example the participants stated that they might be inhibited by the presence of a partner, but they were also inhibited by the presence of other family members such as the father of the woman. The participants reported increased confidence if they had received guidance from mentors in practice settings, but reduced confidence if they had not experienced mentors giving CaSH advice. Finally, the participants identified that factors relating to the client/patient herself could affect confidence, particularly noting that their confidence was greater if the woman showed interest in CaSH. (QR1-07 = Questionnaire response cohort 1, respondent 07 FG2 = Focus group cohort 2) WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 68 Table 1. Factors reported in questionnaire as affecting confidence in giving sexual health advice (Q6). Theme focus (% of questionnaire responses including theme) Responses within this theme Examples from the questionnaire data Knowledge (51%) (44/86) Confidence is affected by the knowledge of the midwifery student, this includes theoretical knowledge, practical knowledge and personal experience ‘Knowledge around the subject area (of contraception and sexual health)’QR1-07 ‘I feel more confident when I know I have used the contraceptive too’ QR3-13 Client (20%) (17/86) Confidence in giving advice is related to the woman receiving the advice, for example her age and her attitude or responsiveness ‘age of woman’ QR1-01 ‘Age esp. if teenager.’ QR3-05 ‘How open they are themselves about contraception’QR2-08 ‘Whether I have met the woman previously and the relationship I have with her’ QR1-17 Setting (19%) (16/86) Confidence is affected by the setting, for example the location in which advice is given and the amount of time available ‘Who you are talking in front of’ QR3-11 ‘Depending on who is with woman e.g. mother or partner’ QR2-07 ‘lack of time restricts the amount of detail I can give’QR1-14 ‘Time given for