Wirral Residents' Sexual Health Outcomes and their Experiences and Preferences of Using Sexual Health Services
To support the development of Wirral’s commissioning plan for sexual and reproductive health services in Wirral, the Qualitative Insight Team gathered insights on people's experiences and preferences with sexual health service provision. The insights also show the gap between people’s knowledge of available services and their preferences.
Insights gathered: December 2022 - April 2023
Insights gathered by
Qualitative Insight Team, Public Health, Wirral Council.
Aim
To support the development of Wirral’s commissioning plan for sexual and reproductive health services in Wirral and the delivery of the Health and Wellbeing Strategy, particularly Priority 2, the Qualitative Insight Team gathered insights on people's experiences and preferences with sexual health service provision. The Qualitative Insight Team gathered qualitative insights into people's experiences and preferences around STIs (sexually transmitted infections) and STI testing, particularly Chlamydia; HIV; unplanned pregnancies; teenage conception; and cervical screening.
People engaged with
Insights were gathered from 97 people including professionals in sexual health services and people from four target groups. The four target groups were identified as at risk of poorer sexual health outcomes in the sexual and reproductive health Joint Strategic Needs Assessment (JSNA) and other key strategic documents. These groups comprised of young people aged 15–24; people in the LGBTQIA+ communities, with a particular focus on men who have sex with men; people living in deprived areas; and ethnic minority communities.
Methods
A range of methods were used to gather insights, including: two focus groups with professionals; four focus groups with young people; eight in-depth conversations with women involved in sex work; two semi-structured interviews with women in the LGBTQIA+ community. In addition, 51 informal conversations were carried out with people across the four target groups. The conversations were captured and recorded on research grids (a set of predetermined questions). Researchers also employed participation observation through attending seven events, including various HIV Week events, support groups, and women’s health events.
Key insights
Groups at a higher risk of poorer sexual health outcomes:
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The JSNA and other official documents that laid the foundation for this qualitative piece had identified four groups of people at higher risk of poorer sexual health outcomes: young people aged 15–24; people in the LGBTQIA+ communities, with a particular focus on men who have sex with men; people living in deprived areas; and ethnic minority communities.
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The research findings complemented the existing insights. Professionals were asked to identify who they consider to be ‘underserved’ or at risk of poorer sexual health outcomes. The professionals identified the four groups above, as well as five more groups: women engaged in sex work/drug use, women experiencing abusive relationships, refugees, people with learning disabilities and older people living with HIV.
STIs and STI testing, particularly Chlamydia:
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Young people were clear on their preferences of how they want to be engaged and where they would want to go for testing and to access services, but they did not feel confident in their knowledge of where to access those services.
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Young people had limited understanding of the different types of STIs, symptoms, testing and treatment. It appeared there were factors that influenced their amount of knowledge, such as: access to sex education at high school, personal experience with sex and relationships, having family members in health care jobs, and relationships with parents and friends.
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A case study of a young woman who had tested positive for Chlamydia was also a useful tool to illustrate some of the key themes around STIs. The case study demonstrates young people’s lack of understanding of STIs and testing, misconceptions about how STIs are transmitted, the stigma around STIs, and preference for discreteness. It highlights how online information about STIs, and testing can be confusing.
HIV:
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Low prevalence of HIV in the borough but relatively high incidences of late diagnosis.
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An organisation that focuses on pop-up clinics and STI and HIV testing reported that in the past 12 months, after testing hundreds of people, they had only come across two HIV positive cases.
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The reasons provided for late diagnosis were quite varied. One of the key reasons identified was that people assume they are not at risk of contracting HIV.
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The young people had limited knowledge of HIV.
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Another key finding from conversations on HIV is that there is still stigma regarding HIV and people in the LGBTQIA+ communities, particularly men who have sex with men. The stigma reflects the perceived lack of information and education around HIV.
Unplanned pregnancies and teenage conceptions:
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Young women aged 15–24 perceived that there is inadequate information on the types of contraception available and their side effects, and they don’t feel confident making choices.
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Engagement with women aged 24+ revealed that these women also perceive there to be a lack of adequate information, but their experience is different from the younger women in that most of them know what contraception options are available, but the biggest hurdle is not knowing how to access the contraception.
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Professionals that work with people the LGBTQIA+ communities said that the language around contraception options can be limited as its too male-focused with too much emphasis on male condoms.
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With regards to abortion, women of all ages were not confident in their knowledge.
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Post-natal contraception also stood out as a key theme in the research around unplanned pregnancies – professionals identified that women are not confident about the contraception available to them after they have just given birth.
Smear testing (cervical screening):
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Barriers around smear test appointments included waiting times, location, and cis-normative language in online booking systems. It appears that there is a small window of opportunity where women are motivated to book and attend an appointment, and so having to wait can be a deterrent.
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Professionals working with people in the LGBTQIA+ communities said that transgender people can be discriminated against during the online booking system for smear tests. Transgender people can struggle to access services for their gender assigned at birth. For example, a trans-male who was assigned female at birth can’t book a smear test because once he selects ‘male’ as his gender on the form, smear tests are not listed.
Quotes
“Is there contraception that doesn’t have long lasting side effects? Some of the methods we use and that we have access to say that they could potentially cause long-term infertility. That is a big decision to make at this age.”
“Most of the forms are cis-normative and the language is gendered…and most of it references to penetrative sex”.
How have the insights been used/shared?
The insights contributed to a wider collation of new and existing insights (both qualitative and quantitative) on residents' sexual health outcomes and their experiences of using sexual health services. Together, the insights supported the commissioning of a coordinated and resident focused sexual health services offer that incorporates the voices of different communities. Ultimately also aiding the delivery of the Health and Wellbeing Strategy, particularly Priority 2, through ensuring residents have easy and timely access to services shaped around them and addressing differences in health outcomes.
Online links
To see the full report of qualitative insights, visit: https://www.wirralhealthwellbeingknowledgehub.co.uk/media/vobj03g0/sexual-health-qualitative-report-v1-restored-and-final-jh-13-06-23-v1-accchkd.pdf
To see the 2023 sexual and reproductive health JSNA, visit: https://www.wirralhealthwellbeingknowledgehub.co.uk/media/ca0hlbk2/final-wis-jsna-sexual-and-reproductive-health-170523-accchkd.pdf