practice Analysing the data, the researchers identified that ‘time’ was an important element. There was agreement from participants that giving CaSH advice was part of the midwife’s role, but there was also agreement that time was not allocated to this within their curriculum and nor was time available within the work setting to give CaSH advice adequately. The time dedicated to learning about CaSH in the undergraduate curriculum for these participants was felt to be much too little and too early. Students expressed a need for the subject to be taught and then reinforced in subsequent sessions: ‘It was like a half day session in our first year. We got loads of information, lots of in depth stuff, and then you go out into the community and you work with the midwives who don’t say a lot and it tends to sort of get pushed to the back when you’ve got all the other stuff you’re trying to remember’ WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 73 (FG1). ‘Our curriculum reflects how much midwives give out information, we get one day on it and they say one sentence on it, I think it is quite relative to one another. We don’t get a long period on it and then when you’re working with mentors who don’t discuss it as well it kind of becomes your norm’ (FG1). The difficulty of finding an appropriate time to give contraception and sexual health advice to women was captured in a statement from one participant: ‘the discharge chat …takes 35 to 40 minutes anyway and if you’ve got 7 women in your bay that you need to get home, and they all want to go home soon...like each subject is really rushed’ (FG1). ‘I would like to have a role (in giving CaSH advice) but I just don’t know where it would fit very well because women don’t listen immediately post-natally. They wouldn’t really listen ante-natally. You could address it in antenatal classes if you had a longer period of time but they are so short now with post natal visiting and antenatal classes they’re lucky if they get any. They have to cram so much in about pain relief and everything that they can’t address that…’ (FG3). Thus there was a perception from the participants that there was insufficient time allocated to learning about CaSH and insufficient time within the discharge interview to give CaSH advice to women. Participants strongly agreed that part of their professional role involved giving CaSH advice but this view was not always shared by mentors or by the women whom they were advising: ‘I don’t think the women see it as our role. They do dismiss us. Many times the women said like ‘oh don’t worry I’ll go back to my Family Planning Clinic. And because they’re not seeing it as our role it’s very hard to get them to listen to us’ (FG1). ‘I still don’t think that it’s actually seen as a major part of the midwife’s role, the actual midwives don’t see it as a major part and I think we’re not going to have the opportunity to practice it and deliver it anyway. Because when you’re there the midwives are not doing it’ (FG1). Our findings therefore indicate that the participants lacked confidence in providing CaSH advice but had strong views about how that confidence could be improved by making changes to the delivery of the pre-registration midwifery curriculum in the higher education setting and in the practice setting. Drawing together the findings regarding factors affecting confidence to give CaSH advice, and factors which would improve confidence in giving advice, the data obtained from the questionnaires and focus groups showed that participants reported a lack of confidence in their knowledge levels, too little time devoted to the subject in their undergraduate curriculum, and insufficient reinforcement or development of their knowledge in practice. As a result opportunities for sexual WALKER & DAVIS: LEARNING AT WORK AND UNIVERSITY: MIDWIFERY STUDENTS AND SEXUAL HEALTH ADVICE 74 health education with women were not usually exploited. The limited time available to undertake sexual health education of the women in their care meant that the quality of advice given was restricted, and confidence could not be developed in the skill. Participants expressed considerable interest in making changes to the curriculum to improve both their knowledge and their confidence to use that knowledge. The changes they suggested require different strategies for theoretical delivery and practical learning. Suggested changes included spacing of sexual health education throughout the three years of the pre-registration curriculum, and opportunities to rehearse this knowledge in practice with teachers who could guide and support them. Opportunities to rehearse communication of sexual health information were also needed. Discussion These findings reinforce those of Corlett et al. (2003), showing the complexity of learning the theory of sexual health education and relating it to practice. The student midwives who were participants in our study are suggesting that they needed to learn theory and practice together, simultaneously rather than separately, in an iterative style, with practice reinforcing theory and generating new interest in theoretical learning. The mentor’s role was identified as very significant in supporting the development of any newly acquired theoretical knowledge in the practice setting. This echoes the