Rapid review of definitions and measures of sexual wellbeing

PI: Karen Lorimer
CI: Jenny Dalrymple (GCU)
Funding: Chief Scientist Office (CSO) Catalytic Grant

A WHO/UNFPA working group met in September 2007 to elaborate on sexual health indicators, at which the term ‘sexual wellbeing’ was discussed. In short, there was little agreement among participants about what sexual wellbeing was, nor how to measure it. Participants of that meeting concluded that ‘more research was needed to explore the various dimensions of ‘sexual well-being’ in order to draw up an appropriate set of indicators.’

Aim: To assess what is known from existing literature about how sexual wellbeing has been operationalised and measured.

Research questions:

  1. Do any measures of sexual wellbeing exist?
  2. If any measures of sexual wellbeing exist, what attributes of the concept were used and why?
  3. How has sexual wellbeing been defined and assessed across empirical studies?
  4. What factors are associated with sexual wellbeing?

This catalytic grant funding underpins a larger grant application to a research council, to de-risk the larger project.

World Health Organisation, Measuring sexual health: Conceptual and practical considerations and related indicators. 2010: Geneva, Switzerland.

Measuring patient experience and outcome in health care settings on receiving care after sexual violence: a systematic review

Measuring patient experience and outcome in health care settings on receiving care after sexual violence: a systematic review

PI: Dr Rachel Caswell (University Hospitals Birmingham NHS Foundation Trust)
CI: Dr Karen Lorimer, GCU; Prof Jonathan Ross (University Hospitals Birmingham NHS)
Funding: Sexually Transmitted Infections Research Foundation

The objectives of this review are

– to determine how patient reported outcomes measures (PROMS) and experiences (PREMS) have previously been defined and measured for men and women attending health care settings after experiencing sexual violence.
– to identify whether a “gold standard” measure of PROMS and PREMS exists for this group of patients, and if so how has it been defined in terms of reliability (are the results reproducible and consistent), validity (has an assessment been made of what patients consider to be important measures of quality and are they accurately evaluated), acceptability and feasibility;
– to identify key themes regarded by patients as priorities for delivering a high-quality service for individuals who have experienced sexual violence

Systematic review: intervening after a HIV- test

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative HIV test in men who have sex with men (MSM): systematic review and intervention development

PI: Prof Paul Flowers, (GCU)
Funder: NIHR HTA

Background: MSM experience significant inequalities in health and wellbeing. They are the group at highest risk of acquiring HIV within the United Kingdom. Guidance relating to both HIV prevention in general and individual level behaviour change interventions in particular is very limited.

Objective(s): To conduct an evidence synthesis of the clinical effectiveness of behavioural change interventions to reduce risky sexual behaviour after a negative HIV test in MSM. To identify effective components within interventions in reducing HIV risky related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention.

Data sources: All major electronic databases were searched between January 2000 and December 2014.

Review methods: systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique taxonomy, theory coding assessment, mode of delivery and proximity to testing event. Data were summarised in narrative review and meta-analysis were carried out where appropriate. Supplemental analyses for the development of the candidate intervention focussed upon post hoc realist review methods, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of acceptability and optimisation.

Results: Overall, trials included in this review (n=10) reported positive findings and suggest individual level behavioural change interventions are effective in reducing key HIV risk related behaviours. However, there were considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75; 95% CI 0.62, 0.91). Additional stratified analyses suggested effectiveness may be enhanced through face-to-face, immediately post-test delivery, theory based content and behaviour change techniques drawn from ‘goals and planning’ and ‘identity’ groups. All evidence collated within the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways the candidate intervention could be optimised to enhance UK implementation.

Limitations: There was a limited number of primary studies, all from outside the UK, and within them considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must be treated with caution, and may only be used for hypotheses generating. In terms of assessing intervention content and delivery, findings are limited by uncertain intervention fidelity, an overreliance upon published papers rather than intervention manuals, and the use of innovative methodologies.

Conclusions: The limited evidence regarding the effectiveness of behaviour change interventions does suggest they are effective in changing behaviour associated with HIV transmission. However, there are uncertainties around the generalisability of these findings to the UK setting. UK experts found the intervention acceptable and provided ways of optimising the candidate intervention.

Future work There is a need for well-designed, UK-based trials of individual behaviour change interventions which clearly articulate intervention content and demonstrate intervention fidelity.

Study registration: The study was registered as PROSPERO no.CRD42014009500

Funding details: The National Institute for Health Research Health Technology Assessment programme.

Final report can be found HERE

HIV prevention evidence synthesis on MSM

PI: Dr Karen Lorimer
CIs: Lisa Kidd, Maggie Lawrence, Kerri McPherson, Flora Cornish,
Funder: NHS Health Scotland

The aims of this systematic review of reviews was to identify, appraise, synthesise and contextualise a range of guidance, review-level evidence of effectiveness of HIV prevention interventions for MSM.

The paper from this project:
Citation: Lorimer, K., L. Kidd, M. Lawrence, K. McPherson, S. Cayless and F. Cornish (2013). “Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men.” AIDS Care 25(2): 133-150.