Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample
Louise Bourchier
A * , Meredith Temple-Smith B , Jane Hocking A , Helen Bittleston A and Sue Malta A
A
B
Abstract
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.
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.
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.
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.
Keywords: ageing, health promotion, internet survey, older adults, public health, recruitment, sexual health, survey methods.
References
1 Freak-Poli R, Kirkman M, De Castro Lima G, Direk N, Franco OH, Tiemeier H. Sexual activity and physical tenderness in older adults: cross-sectional prevalence and associated characteristics. J Sex Med 2017; 14(7): 918-927.
| Crossref | Google Scholar | PubMed |
2 Heywood W, Lyons A, Fileborn B, Hinchliff S, Minichiello V, Malta S, et al. Sexual satisfaction among older Australian heterosexual men and women: findings from the Sex, Age & Me study. J Sex Marital Ther 2018; 44(3): 295-307.
| Crossref | Google Scholar | PubMed |
3 Fisher L. Sex, romance, and relationships: AARP survey of midlife and older adults. Washington, D.C.: AARP; 2010. Available at http://www.aarp.org/research/topics/life/info-2014/srr_09.html [cited 25 November 2019]
4 Gott M, Hinchliff S. How important is sex in later life? The views of older people. Soc Sci Med 2003; 56(8): 1617-1628.
| Crossref | Google Scholar | PubMed |
5 Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357(8): 762-774.
| Crossref | Google Scholar |
6 Fileborn B, Thorpe R, Hawkes G, Minichiello V, Pitts M, Dune T. Sex, desire and pleasure: considering the experiences of older Australian women. Sex Relation Ther 2015; 30(1): 117-130.
| Crossref | Google Scholar | PubMed |
7 Santos-Iglesias P, Byers ES, Moglia R. Sexual well-being of older men and women. Canad J Hum Sex 2016; 25(2): 86-98.
| Crossref | Google Scholar |
8 Lee DM, Nazroo J, O’Connor DB, Blake M, Pendleton N. Sexual health and well-being among older men and women in England: findings from the English Longitudinal Study of Ageing. Arch Sex Behav 2016; 45(1): 133-144.
| Crossref | Google Scholar | PubMed |
9 Ševčíková A, Sedláková T. The role of sexual activity from the perspective of older adults: a qualitative study. Arch Sex Behav 2020; 49: 969-981.
| Crossref | Google Scholar | PubMed |
10 Schick V, Herbenick D, Reece M, Sanders SA, Dodge B, Middlestadt SE, et al. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med 2010; 7(S5): 315-329.
| Crossref | Google Scholar |
11 Palacios-Ceña D, Carrasco-Garrido P, Hernández-Barrera V, Alonso-Blanco C, Jiménez-García R, Fernández-de-las-Peñas C. Sexual behaviors among older adults in Spain: results from a population-based national sexual health survey. J Sex Med 2012; 9(1): 121-129.
| Crossref | Google Scholar | PubMed |
12 Malta S. Love, sex and intimacy in new late-life romantic relationships. Swinburne University of Technology; 2013. Available at https://researchbank.swinburne.edu.au/file/3db6aba6-fd1b-4c99-a9cf-166bce839a92/1/Sue%20Malta%20Thesis.pdf
13 Bourchier L, Malta S, Temple-Smith M, Hocking J. Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018. Sex Health 2020; 17(6): 517-524.
| Crossref | Google Scholar |
14 Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2022. Sydney: Kirby Institute, UNSW; 2018. Available at https://www.kirby.unsw.edu.au/sites/default/files/documents/Annual-Surveillance-Report-2022_STI.pdf [cited 1 December 2023]
15 Bodley-Tickell AT, Olowokure B, Bhaduri S, White DJ, Ward D, Ross JDC, et al. Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system. Sex Transm Infect 2008; 84(4): 312-317.
| Crossref | Google Scholar |
16 Minichiello V, Rahman S, Hawkes G, Pitts M. STI epidemiology in the global older population: emerging challenges. Perspect Public Health 2012; 132(4): 178-181.
| Crossref | Google Scholar | PubMed |
17 Poynten IM, Grulich AE, Templeton DJ. Sexually transmitted infections in older populations. Curr Opin Infect Dis 2013; 26(1): 80-85.
| Crossref | Google Scholar | PubMed |
18 Cheng Y, McGeechan K, Bateson D, Ritter T, Weisberg E, Stewart M. Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service. Sex Health 2018; 15(3): 223-231.
| Crossref | Google Scholar | PubMed |
19 Bateson DJ, Weisberg E, McCaffery KJ, Luscombe GM. When online becomes offline: attitudes to safer sex practices in older and younger women using an Australian internet dating service. Sex Health 2012; 9(2): 152-159.
| Crossref | Google Scholar | PubMed |
20 Stewart M, Ritter T, Bateson D, McGeechan K, Weisberg E. Contraception – what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service. Sex Health 2017; 14(6): 533-539.
| Crossref | Google Scholar | PubMed |
21 de Visser RO, Badcock PB, Rissel C, Richters J, Smith AMA, Grulich AE, et al. Safer sex and condom use: findings from the Second Australian Study of Health and Relationships. Sex Health 2014; 11(5): 495-504.
| Crossref | Google Scholar | PubMed |
22 Fileborn B, Lyons A, Heywood W, Hinchliff S, Malta S, Dow B, et al. Talking to healthcare providers about sex in later life: findings from a qualitative study with older Australian men and women. Australas J Ageing 2017; 36(4): E50-E56.
| Google Scholar | PubMed |
23 Malta S, Hocking JS, Lyne J, McGavin D, Hunter J, Bickerstaffe A, et al. Do you talk to your older patients about sexual health? Health practitioners’ knowledge of, and attitudes towards, management of sexual health among older Australians. Aust J Gen Pract 2018; 47(11): 807-811.
| Crossref | Google Scholar |
24 Malta S, Temple-Smith M, Bickerstaffe A, Bourchier L, Hocking J. ‘That might be a bit sexy for somebody your age’: older adult sexual health conversations in primary care. Australas J Ageing 2020; 39(S1): 40-48.
| Crossref | Google Scholar |
25 Lyons A, Heywood W, Fileborn B, Minichiello V, Barrett C, Brown G, et al. Sexually active older Australian’s knowledge of sexually transmitted infections and safer sexual practices. Aust N Z J Public Health 2017; 41(3): 259-261.
| Crossref | Google Scholar | PubMed |
26 Bourne C, Minichiello V. Sexual behaviour and diagnosis of people over the age of 50 attending a sexual health clinic. Australas J Ageing 2009; 28(1): 32-36.
| Crossref | Google Scholar | PubMed |
27 Heywood W, Lyons A, Fileborn B, Minichiello V, Barrett C, Brown G, et al. Self-reported testing and treatment histories among older Australian men and women who may be at risk of a sexually transmissible infection. Sex Health 2017; 14(2): 139-146.
| Crossref | Google Scholar | PubMed |
28 Fileborn B, Lyons A, Hinchliff S, Brown G, Heywood W, Dow B, et al. Improving the sexual lives of older Australians: perspectives from a qualitative study. Australas J Ageing 2017; 36(4): E36-E42.
| Crossref | Google Scholar | PubMed |
29 Richters J, Badcock PB, Simpson JM, Shellard D, Rissel C, de Visser RO, et al. Design and methods of the Second Australian Study of Health and Relationships. Sex Health 2014; 11(5): 383-396.
| Crossref | Google Scholar |
30 Lyons A, Heywood W, Fileborn B, Minichiello V, Barrett C, Brown G, et al. The Sex, Age, and Me study: recruitment and sampling for a large mixed-methods study of sexual health and relationships in an older Australian population. Cult Health Sex 2017; 19(9): 1038-1052.
| Crossref | Google Scholar | PubMed |
31 Grulich AE, de Visser RO, Badcock PB, Smith AMA, Richters J, Rissel C, et al. Knowledge about and experience of sexually transmissible infections in a representative sample of adults: the Second Australian Study of Health and Relationships. Sex Health 2014; 11(5): 481-494.
| Crossref | Google Scholar | PubMed |
32 Watchirs Smith L, Guy R, Degenhardt L, Yeung A, Rissel C, Richters J, et al. Meeting sexual partners through internet sites and smartphone apps in Australia: national representative study. J Med Internet Res 2018; 20(12): e10683.
| Crossref | Google Scholar |
33 Badcock PB, Patrick K, Smith AMA, Simpson JM, Pennay D, Rissel CE, et al. Differences between landline and mobile phone users in sexual behavior research. Arch Sex Behav 2017; 46(6): 1711-1721.
| Crossref | Google Scholar | PubMed |
34 Malta S, Temple-Smith M, Hunter J, McGavin D, Lyne J, Bickerstaffe A, et al. Could an online or digital aid facilitate discussions about sexual health with older Australians in general practice? Aust J Gen Pract 2018; 47(12): 870-875.
| Crossref | Google Scholar |
35 Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res 2004; 6(3): e34.
| Crossref | Google Scholar | PubMed |
36 Australian Bureau of Statistics (ABS). 2017 postcode to 2016 remoteness area. Canberra; 2018. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July%202016?OpenDocument [cited 5 August 2022]
37 Australian Bureau of Statistics (ABS). Postal area, indexes, SEIFA 2016. Canberra; 2018. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012016?OpenDocument [cited 5 August 2022]
38 Levin I. Living apart together: a new family form. Curr Soc 2004; 52(2): 223-240.
| Crossref | Google Scholar |
39 Kelfve S, Kivi M, Johansson B, Lindwall M. Going web or staying paper? The use of web-surveys among older people. BMC Med Res Methodol 2020; 20(1): 252.
| Crossref | Google Scholar | PubMed |
40 Australian Bureau of Statistics (ABS). 2018 survey of disability, ageing and carers: use of information technology. Canberra; 2019. Available at https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release [cited 11 August 2022]
41 Australian Institute of Health and Welfare (AIHW). GEN aged care data snapshot 2020 – third release. Canberra: GEN; 2020. Available at https://gen-agedcaredata.gov.au/Resources/Access-data/2020/October/Aged-care-data-snapshot%E2%80%942020
42 Australian Bureau of Statistics (ABS). General social survey: summary results, Australia. 2021. Available at https://www.abs.gov.au/statistics/people/people-and-communities/general-social-survey-summary-results-australia/2020 [cited 9 October 2021]
43 Wilson T, Temple J, Lyons A, Shalley F. What is the size of Australia’s sexual minority population? BMC Res Notes 2020; 13(1): 535.
| Crossref | Google Scholar | PubMed |
44 Rahman Q, Xu Y, Lippa RA, Vasey PL. Prevalence of sexual orientation across 28 nations and its association with gender equality, economic development, and individualism. Arch Sex Behav 2020; 49(2): 595-606.
| Crossref | Google Scholar | PubMed |
45 Malta S. Using online methods to interview older adults about their romantic and sexual relationships. In: Leontowisch M, editor. Researching later life and ageing: expanding qualitative research horizons. London: Palgrave Macmillan; 2012. p. 146–172. Available at https://doi.org/10.1057/9781137271372
46 Australian Communications and Media Authority (ACMA). Communications and media in Australia: how we communicate. 2021. Available at https://www.acma.gov.au/publications/2021-12/report/communications-and-media-australia-how-we-communicate [cited 7 December 2022]
47 Harfield S, Elliott S, Ramsey L, Housen T, Ward J. Using social networking sites to recruit participants: methods of an online survey of sexual health, knowledge and behaviour of young South Australians. Aust N Z J Public Health 2021; 45(4): 348-354.
| Crossref | Google Scholar | PubMed |
49 Whitaker C, Stevelink S, Fear N. The use of Facebook in recruiting participants for health research purposes: a systematic review. J Med Internet Res 2017; 19(8): e290.
| Crossref | Google Scholar | PubMed |
50 Corey KL, McCurry MK, Sethares KA, Bourbonniere M, Hirschman KB, Meghani SH. Utilizing Internet-based recruitment and data collection to access different age groups of former family caregivers. Appl Nurs Res 2018; 44: 82-87.
| Crossref | Google Scholar | PubMed |
51 Remillard ML, Mazor KM, Cutrona SL, Gurwitz JH, Tjia J. Systematic review of the use of online questionnaires of older adults. J Am Geriatr Soc 2014; 62(4): 696-705.
| Crossref | Google Scholar | PubMed |
52 Malta S, Williams SB, Batchelor FA. ‘An ant against an elephant’: retirement village residents’ experiences of disputes and dispute resolution. Australas J Ageing 2018; 37(3): 202-209.
| Crossref | Google Scholar | PubMed |
53 Australian Bureau of Statistics (ABS). National, state and territory population, June 2021. Canberra; 2021. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release
