Preferences for Sexual Health Services Among Middle-Aged and Older Adults in the United Kingdom, 2023

Sexual health is integral to overall well-being, yet the needs and desires of middle-aged and older adults are often overlooked. This study aimed to understand the sexual health service preferences of adults aged 45 and older to enhance service accessibility in the UK. We conducted a Discrete Choice Experiment (DCE) in three stages: concept elicitation, refinement, and implementation. Attributes and levels were determined through 22 semi-structured interviews, followed by pilot testing. The DCE survey was implemented using Qualtrics XM with conjoint project features. We employed a random parameters logit model to estimate attribute importance and level preferences, and a latent class model to identify groups with similar preferences. The analysis included 200 responses (62.5% female, 35.5% disabled, 26.0% sexual minority; median age was 53). Service utilisation preferences were primarily influenced by delivery mode (Relative Importance (RI): 32%), location (RI: 18%), and cost (RI: 16%). Participants preferred face-to-face interactions at sexual health clinics and showed a willingness to pay for private services. Extra support and consultation style had minor impacts. No preference differences were found among disabled people, while sexual minorities preferred conventional messaging. Middle-aged and older adults prioritise face-to-face consultations at sexual health clinics over cost considerations. Aligning service delivery with these preferences could significantly improve the accessibility and uptake of sexual health services for adults aged 45 and older in the UK.

People who lived beyond the age of fifty years were uncommon in the mid-1800s. Remarkable advances in medicine have created substantial demographic changes, resulting in larger numbers of older adults, defined in this application as 50 years and older. This greying of the world's population has important implications for sexual health. An increasing number of older population sustain vibrant sexual lives and intimate relationships for a long period, needing support and medical advice on optimizing their sexual health. At the same time, a range of related frailties and disabilities alongside power imbalances may increase the risk of unprotected sex and HIV/sexually transmitted infections among some older adults. Sexual health is an increasingly important topic among elderly individuals across the world, but our conventional disciplinary approaches shy away from the topic. Much of the sexual health research has focused on youth, ignoring the tremendous demographic changes underway and incorrectly assuming that "age is a condom." Our UK-China joint team has a rich experience in behavioural science, sociology, anthropology, medicine, and public health. The common greying of the population in the UK and China demands innovative solutions to identify needs and barriers relevant to sexual health and gaps in sexual health services and ensure that they are inclusive, empowering, and reliable. Leveraging our multi-disciplinary team, we propose the following specific aims: Aim 1: Using an epidemiological study to understand sexual health and wellbeing among older adults in China, in comparison to existing data from National Survey of Sexual Attitudes and Lifestyles (NATSAL 3) in the UK. Aim 2: Determine preferences for sexual health services among diverse older adults, using discrete choice experiments (DCEs). Aim 3: Identify high-quality messages to promote uptake of inclusive sexual health services among older adults in China and the UK through two parallel crowdsourcing contests. Aim 4: Create policy recommendations about how to make sexual health services more adaptive to older adults' needs and preferences in diverse settings. DCEs are a survey-based method that quantifies participants' preferences for health care delivery, evaluating which attributes are most important to participants by observing how participants trade-off between various attributes. A crowdsourcing contest allows a group to solve a problem and then shares solutions with the wider public. Crowdsourcing interventions have successfully engaged marginalized groups in HIV testing program development, improved HIV test and condom use.

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