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SHIFT - Sexual health in the Over Forty-Fives

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There is a lack of knowledge/tools for health services on sexual health of over 45s and of socio-economically disadvantaged groups. This is due to these groups not necessarily perceiving a need for services due to lack of knowledge and the taboo nature of the subject, so the rationale of the SHIFT project is to show that these groups have a need and should be able to access services. This answers the research question how to engage people aged 45+ and of socio-economically disadvantaged groups in sexual health and wellbeing.

This project focuses on generating the following outputs, that will be shared across and beyond the project partners, to the workforce of healthcare professionals and to the target group of the project

  • Sexual Health & Wellbeing Model to engage with people aged 45+
  • Tailored sexual health & wellbeing strategy to adapt the model to engage with people 45+ to those experiencing 1 or more socio-economic disadvantage
  • Two sexual health and wellbeing training  programmes, 1 for sexual health professionals & 1 for the wider workforce

Methodology

  • Attitude survey in 45+ (detailed needs assessment)
  • Focus groups to discuss local outcomes, compare similarities and differences and decide how this will feed into the development of the model
  • Scoping literature review covering people aged 45+, with a particular focus on socio-economically disadvantaged groups
  • Mixed method evaluation of the model
  • Develop refined needs assessment of health care professionals and gap analysis through focus groups (WP 3- AP is in the lead of this WP)
  • Co-creation of a comprehensive training programme for professionals (WP 3 – AP is in the lead of this WP)
  • Mixed method evaluation of the training programme for professionals (WP 3 – AP is in the lead of this WP)

Common challenge
Studies in/beyond Europe (eg WHO’s Sexual Health Throughout Life) highlight the need for older people to have better access to sexual health support/care. These identify that older age groups are rarely a focus in European &  omestic policies across the 2Seas area. The correlation is clear between this gap in services & the rise in Sexually Transmitted Infection (STI) rates. The over-45s at risk are generally those entering new sexual relationships after a period of monogamy, often post-menopause (removing the issue of pregnancy, without thought to STIs). Our engagement with relevant services suggests lack of knowledge/tools for health services approaching the issue and offering information/treatment. Within this target group, partner research has shown that groups with one or more socio-economic disadvantages (homeless people/sex workers/non-native language speakers/migrants) are at even greater risk of being unaware of their sexual health and unable to access the appropriate services

Overall objective
The objective of the project is to empower people aged over 45 to participate in sexual health services & improve their sexual health & wellbeing, with an additional and specifically adapted focus on socio-economically disadvantaged groups across the 2Seas area. The empowerment will avoid assumption by using insight gathering & testing existing evidence. In co-creating a service redesign, the healthcare systems currently in place will be adapted to provide services that are properly suited to these groups. Consequently, SHIFT will improve awareness in the target groups and access to sexual health services, therefore increasing wellbeing, testing for STIs and HIV & avoidance of undiagnosed communicable STIs & HIV amongst the over 45s and socio-economically disadvantaged groups. This will lead to improving the quality of life of people aged over 45 (with specific focus on vulnerable groups) & a decrease in health inequalities.

Main outputs 1 – A co-created & piloted model for future service provision to improve sexual health amongst the target groups, including techniques for engaging with hard-to-reach groups. A first model will be designed for people aged over 45. SHIFT will use a confidential web-based process to self-assess/be advised on next steps, but co-creation will ensure those less at ease with technology are fully engaged with the model. Using PPs 4&8 expertise, and by identifying organisations who work directly with socio-economically disadvantaged groups, the model will be adapted to reach these groups. Mobile units will access homeless people and others who do not/cannot access local public health services. Services will be multilingual and culturally/subject sensitive to reach groups such as migrants and sex workers. 2 – A jointly produced & piloted training programme relevant to all parts of the 2Seas area, based on extensive engagement with healthcare professionals, implemented via existing services.

What is new?
Currently, state-provided sexual health advice/testing is on request/by invitation & face-to-face, with potential stigma. SHIFT's approach will provide greater awareness & stigma-free anonymous/online engagement. Issues around sexual health & wellbeing are embarrassing for the over-45s & their lack of interest in these demonstrates the need for a new approach. A Global Study ‘STI epidemiology in the global older population: emerging challenges’ supports this. Safe sex campaigns target youth but little is done to raise awareness amongst those 45+ & other socially/economically vulnerable groups at high risk. Sexual health is a vital part of wellbeing but is overlooked in older people despite rising divorce rates & increasing numbers of sexual partners. SHIFT will work closely with the target groups as well as sexual health care providers to co-create an effective service provision where none currenly exists across the 2Seas region.

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