Helen Bittleston

Background: Despite not being a priority group in sexual health (SH) promotion, there is increasing interest, concerns, and knowledge gaps regarding older adults SH information needs. Methods: In 2021, the ‘SHAPE2’ online survey of Australians aged 60+ years old on SH information-seeking was conducted. Data was obtained from two questions: (1) the SH topics that participants wanted more information about; and (2) the most recent SH topic that participants sought information on since turning 60 years old. Quantitative data were collected as Topics and organised into Categories. Free-text comments were classified into Categories using Content Analysis. Data were analysed using descriptive statistics and chi2 test. Results: There were 1470 respondents (median age, 69 years old; gender balance between men and women). The Categories of most interest were ‘sexual anatomy and physiology’ (1043/1248, 83.6%; 95% CI: 81.4–85.6), ‘sex and ageing’ (942/1175, 80.2%; 95% CI: 77.8–82.4), and ‘sexual difficulties’ (937/1236, 75.8%; 95% CI: 73.3–78.2). The Topics of most interest were ‘ageing and libido (sex drive)’ (771/1175, 65.6%; 95% CI: 62.8–68.3), ‘ageing and sexual pleasure’ (766/1175, 65.2%; 95% CI: 62.4–67.9), and ‘ageing and sexual performance’ (765/1175, 65.1%; 95% CI: 62.3–67.8). Men were more likely to seek information (51.5% vs 30.6%, P < 0.001) and indicated higher levels of interest. Women were interested in and/or had sought information on a wider range of issues. Differences were observed between SH issues of interest and those that participants had sought information. Conclusion: Older adults are interested in a variety of SH topics. To improve their sexual wellbeing, the priorities of older adults needs consideration when designing SH promotion strategies.

Sexual expression is important to many older adults, but this population may be overlooked by sexual health campaigns and services. This study sought to understand the sexual health information-seeking behaviors and preferences of older adults, including whether and where they seek this information, the characteristics associated with seeking it, as well as satisfaction, preferences, and reasons for not seeking it. The data were gathered in 2021 via a cross-sectional online survey of Australians aged 60 and over. There were seven quantitative outcomes and one set of free-text comments. Quantitative outcomes were analyzed using descriptive statistics, chi² test, and logistic regression. The free-text comments were analyzed using qualitative content analysis. The survey sample was comprised of 1,470 respondents with an equal balance of men (49.9%) and women (49.7%) and a median age of 69 years (range of 60–92 years). Findings showed that 41.2% (602/1,461; 95%CI 38.7–43.7) had sought information, and 63.6% were satisfied with the information found. Being male, STI testing, online dating, age 70–79, and urban-living were associated with information-seeking. Healthcare providers were the most utilized and trusted information source, and many respondents were willing to look online. One in five did not seek information when they needed it, outlining various barriers preventing them from doing so. Many older adults seek sexual health information, and with some experiencing access barriers and one-third unsatisfied, there is room for improvement. Relevant, accessible information should be provided by healthcare professionals and credible websites.

Recruiting participants is a vital component of social research. Finding the right people (and the right number of them) at the right time to participate in your study can make or break its success; it can also challenge research budgets and requires considerable flexibility. Online recruitment strategies are becoming increasingly popular ways to recruit to both qualitative and quantitative studies. In this paper, we detail our experiences of using social media, primarily Meta platforms Facebook and Instagram, to recruit participants for our sexual and reproductive health research. Here, we provide a practical guide to using social media to recruit participants, and include examples throughout from our own research. We outline our triumphs and pitfalls in using this recruitment strategy, the challenges we have faced and the lessons we have learnt. In doing so, we hope to provide useful guidance for others wishing to use social media to recruit to their research studies.

Background: Chlamydia is one of the most common sexually transmissible infections globally and can lead to reproductive complications, including pelvic inflammatory disease and infertility. Interventions to reduce disease burden, including retesting for reinfection, partner management, and early detection of complications, are the focus of the Management of Chlamydia Cases in Australia (MoCCA) study, an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. This study aimed to identify factors influencing participation in and adoption of a multifaceted chlamydia management intervention within the general practice setting. Methods: We conducted semi-structured interviews with general practice staff (n = 13) from clinics (n = 9) participating in the MoCCA study. Data were analysed using inductive content analysis to identify facilitators and barriers to study participation and intervention adoption. Results: Participants felt that practice champions, motivated staff and interventions that improved workflow efficiency, integrated with existing processes and improved patient interactions, facilitated participation in, and adoption of, study interventions. A perceived lack of staff engagement related to time constraints, competing priorities, staff retention issues and interventions that were less convenient to use or had reduced patient uptake were identified as barriers to participation. Conclusions: Identifying perceived facilitators and barriers to successful implementation of a multifaceted chlamydia intervention enables public health practitioners to better support general practice in the ongoing uptake and use of evidence-based chlamydia management strategies, ultimately aiming to reduce the burden of chlamydia and its complications in Australia.

Background: Patient-delivered partner therapy (PDPT) involves providing a prescription or medication to a patient diagnosed with chlamydia to pass to their sexual partner/s. Barriers to PDPT include uncertainty about its integration into clinical practice and permissibility. In Victoria, Australia, the Department of Health provides clinical guidance for PDPT (updated in 2022). We explored health practitioner views on the usefulness of the updated guidance for providing PDPT. Methods: We conducted an online survey (12 December 2022 to 2 May 2023) of health practitioners who primarily work in Victoria and can prescribe to treat chlamydia. The survey displayed excerpts from the guidance, and asked closed and free-text questions about its ability to address barriers to PDPT. Quantitative data were descriptively analysed, complemented by conventional content analysis of qualitative data. Results: Of a total of 49 respondents (66.7% general practitioners), 74.5% were aware of PDPT, and 66.7% had previously offered PDPT. After viewing excerpts of the guidance, >80% agreed it could support them to identify patients eligible/ineligible for PDPT, and 66.7% indicated they would be comfortable to offer PDPT. The guidance was viewed as helpful to address some barriers, including complicated documentation (87.7%) and medico-legal concerns (66.7%). Qualitative data highlighted medico-legal concerns by a minority of respondents. Some raised concerns that the guidance recommended prescribing azithromycin, despite doxycycline being first-line chlamydia treatment. Conclusions: The guidance was largely viewed as supportive for PDPT decision-making. There is scope for further refinements and clarifications, and wider dissemination of the guidance.

Background: Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+ years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar ‘Sex, Age and Me’ study from 2015. Methods: We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook. Results: The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60–92 years (median 69 years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means. Conclusions: Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.

Background: Most sexual health care in Australia is provided through general practice. However, many young Australians experience barriers to accessing sexual health care. This research examines young Australians’ receptiveness to discussing sexual health with a general practitioner (GP). Methods: We conducted an anonymous online sexual health survey (open 2 May to 21 June 2022). Anyone living in Australia aged 16–29 years was eligible to participate. Participants were recruited via social media and asked whether they agreed with five statements exploring their receptivity to discussing sexual health with GPs. We explored characteristics associated with responses using multivariable logistic regression. Results: Among 1915 participants, 69.3% were cisgender women, with a median age of 20 years; 48.5% were heterosexual. Approximately one-fifth agreed they might not tell a GP the whole truth about their sexual history, would be worried about confidentiality when discussing their sexual history and would be too embarrassed to see their usual GP if they thought they had a sexually transmitted infection. Over half (55.8%) agreed they would be comfortable with a GP bringing up sexual health in an unrelated consultation, but 39.6% would be nervous to bring up sexual health in case they needed an intimate examination. Multivariate regression identified several characteristics associated with responses. Notably, having a school-based sex education and a usual GP were factors associated with increased receptivity to discussing sexual health. Conclusions: Young Australians were generally open to discussing sexual health with a GP. School-based sex education and GP–patient relationships are key to promoting sexual health among young people.

In early 2020, the Australian government implemented lockdown restrictions to prevent the spread of COVID-19. Our study aims to investigate the impact of lockdowns on sexual desire and enjoyment of sex among Australian women. We conducted an online survey in August 2020 when Victoria was in strict lockdown, but all other states/territories had minimal restrictions. Here, we report on responses from female participants aged ≥18 years. Respondents were asked whether COVID-19 had impacted their desire and/or enjoyment of sex (yes/no). Those who responded "yes" were asked to elaborate in a free-text question. Factors associated with desire were investigated using the chi-square test. Conventional content analysis was used to explore free-text responses. Of the 622 participants, 44.1% reported COVID-19 related impacts on their sexual desire. Women living in Victoria, who were not heterosexual, and whose employment was negatively affected by lockdown were all more likely to report an impact on their sexual desire. Free-text comments revealed that mental health, living arrangements, and a reduced ability to meet with sexual partners were key reasons behind these impacts. The COVID-19 pandemic and lockdown measures clearly impacted the desire and enjoyment of sex for many women, important factors of people's relationships, health, and wellbeing.