"Why not ask the doctor?" Barriers in help-seeking for sexual problems among older adults in Poland

The development of an online-based rural community of practice framework for addressing health issues among rural citizens: a grounded theory approach

BACKGROUND

Health literacy facilitates an individual's ability to interpret and utilize medical information, thereby influencing their quality of life. Despite the benefits, the current oversaturation of information necessitates the support of healthcare professionals. Help-seeking behavior (HSB) is a term that describes the actions taken to assuage health concerns, and timely medical consultations are critical, especially for older individuals in rural areas who often face barriers to accessing care. These challenges are exacerbated by the perceived psychological distance from medical services in rural settings due to past negative experiences; however, the emergence of social media has helped form a bridge, allowing for direct communication with physicians. While consultations with artificial intelligence (AI) do occur, interaction with human physicians remains the gold standard. Thus, this study sought to understand social media's role in facilitating health consultations in rural areas and the implications for primary care education among physicians.

METHODS

This qualitative study, conducted from September 2022 to June 2023, employed a grounded theory approach to analyze information about a social network-based consulting system that utilized the LINE application. Residents posted anonymous health-related concerns, and comments were extracted. Two researchers coded and assessed the data; another specialist reviewed the findings.

RESULTS

A total of 621 citizens participated, generating 10,432 posts. The grounded theory approach identified five major themes regarding health-related social networking in rural settings: (1) mutual exploration for information sharing highlighted distrust toward primary care physicians; (2) temporary collaboration resulted in superficial health discussions and relationship-building through empathy; (3) conflicts arising from differing health perspectives and misinformation sharing led to intense debates; (4) anxiety was resolved through shared illness experiences and increased empathy, enhancing psychological safety; and (5) a mutual assistance community was created, characterized by improved health dialogues and HSB among participants.

CONCLUSIONS

The high engagement with the social network-based consulting system in rural Unnan City highlights technology's pivotal role in facilitating health dialogue and community engagement, despite challenges related to misinformation and health literacy complexities. As a reflection of the community's health perceptions and dynamics, future adaptations should incorporate strategies to combat these challenges while preserving collaboration and support.

Nurses' Provision of Sexual and Reproductive Health to Community-Dwelling Older Adults: An Integrative Review

PURPOSE

To explore barriers and facilitators to nurses' provision of sexual and reproductive health (SRH) care to community-dwelling older adults.

METHOD

An integrative literature review was performed using Whittemore and Knafl's method. Three databases were searched for research conducted between 2012 and 2023, and the Mixed Methods Appraisal Tool was used to determine the quality of included studies.

RESULTS

Nine studies were ultimately included for analysis, and themes were Barriers to SRH Care and Facilitators of SRH Care. Barriers to SRH Care included: nurses' lack of knowledge about older adults' sexual health, discomfort discussing sexual topics, age-related stereotypes regarding older adults' sexuality, and older adults' lack of knowledge of and reluctance to discuss sexuality and sexual health issues. Facilitators of SRH Care included: gender of health care provider, nursing education on effective communication strategies, encouraging open dialogue to challenge ageist perceptions, and sexual education for older adults.

CONCLUSION

Findings underscore the impact of stigma and negative ageist assumptions on whether discussions about SRH occur between nurses and older adults. There is a need for comprehensive education for nurses and older adults about SRH to recognize sexual health needs and promote open and constructive conversations. Moreover, research about how to best facilitate older adults' SRH is needed. [Journal of Gerontological Nursing, 50(10), 17-23.].

Men's views on causes and consequences of erectile dysfunction or premature ejaculation in a primary care population: a qualitative study

OBJECTIVE

To explore men's views on the causes and consequences of two common sexual dysfunctions - erectile dysfunction and premature ejaculation - and how this affects physical and mental health as well as social life and intimate or close relations.

DESIGN

A qualitative design with semi-structured interviews using open-ended questions was employed. Individual interviews were conducted, audio recorded and transcribed, and a qualitative content analysis of the text was performed.

SETTING

Informants were recruited from an outpatient primary care clinic in Sweden that offers consultation about sexual health to primarily younger men, age 20 years and above.

SUBJECTS

A total of 18 participants were included in the study, ten with erectile dysfunction and eight with premature ejaculation or both.

MAIN OUTCOME MEASURES

Using the content analysis, different views and strategies of erectile dysfunction and premature ejaculation were presented to illustrate a range of perceptions.

RESULTS

The main theme emerged as 'Striving to understand and deal with the problem', which was divided into four categories: 'Reasons for seeking healthcare', 'Own perceptions/images about the problem and its cause', 'Experienced consequences on sex life' and 'Relationship qualities'.Participants experienced their problems in relation to a partner. Feelings of shame and fear of not being fit for desired sexual practices were common. They thought that underlying physical illness or previous sexual activities could have caused their problems. Decreased sexual desire and low self-esteem were seen as consequences, and participants wished for both medical treatment and counselling as support.

CONCLUSION

Sexual dysfunction impairs general health and relationships with partners. While counselling is the basic treatment, those who are offered pharmaceutical treatment need follow-up concerning effectiveness and potential concerns.

A mixed methods systematic literature review of barriers and facilitators to help-seeking among women with stigmatised pelvic health symptoms

BACKGROUND

Women's pelvic health is a globally important subject, included in international and United Kingdom health policies, emphasising the importance of improving information and access to pelvic health services. Consequences of pelvic symptoms are intimate, personal, and varied, often causing embarrassment and shame, affecting women's quality of life and wellbeing.

AIM

To understand the experience of seeking healthcare for stigmatised pelvic health symptoms by synthesising all types of published primary research and mapping the results to behavioural theory, to identify potential targets for intervention.

METHODS

Systematic search of MEDLINE, CINAHL, PsycINFO, SocINDEX, PubMED databases, CDSR and CENTRAL registers, from inception to May 2023 for all types of research capturing women's views and experiences of seeking help with stigmatised urogenital and bowel symptoms. Studies only reporting prevalence, predictors of help-seeking, non-health related help-seeking, or written in languages other than English, German, French, Spanish and Swedish were excluded. Reference checking and forward citation searching for all included studies was performed. A results-based synthesis approach was used to integrate quantitative and qualitative data. Themes were mapped to the Common-Sense model and Candidacy framework. The Mixed Methods Appraisal Tool was used for critical appraisal. Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative research for assessing certainty of review findings.

RESULTS

86 studies representing over 20,000 women from 24 high income countries were included. Confidence was high that barriers to help-seeking were similar across all study types and pelvic symptoms: stigma, lack of knowledge, women's perception that clinicians dismissed their symptoms, and associated normalising and deprioritising of low bother symptoms. Supportive clinicians and increased knowledge were key facilitators.

CONCLUSIONS

Using the Common-Sense Model to explore women's help-seeking behaviour with stigmatised pelvic symptoms reveals problems with cognitive representation of symptom identity, emotional representations of embarrassment and shame, and a subjective norm that women believe their symptoms will be trivialised by clinicians. Together these barriers frustrate women's identification of their candidacy for healthcare. Addressing these issues through behavioural change interventions for women and clinicians, will help to achieve universal access to pelvic healthcare services (United Nations Sustainable Development Goal 3.7).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021256956.

A Missing Piece of Occupational Therapy Education: Attitudes About Sex

Following a lecture on sexual health and function, occupational therapy students were surveyed regarding their past sex education and their comfort level with the topic of sex. Students indicated a lack of sexual education received from parents/guardians and a prevalence of fear-based education from formal or informal sources. Results reflected a significant increase in students' perceived comfort level with the topic following the lecture from a provider trained and certified in sexual health. As sexuality falls within the domain of occupational therapy, these results suggest a need for comprehensive sex education taught to students by qualified instructors.

The Role of Ageist Sexual Stereotypes in the Network of Sexual Difficulties, Sex and Relationship Satisfaction Among Adults Aged 50

As people age, their sexual activity, including sexual and relationship satisfaction, may change due to the onset of health and sexual difficulties and the activation of internalized ageist sexual stereotypes. We studied whether ageist sexual stereotypes were relevant for the importance of sex for people aged 50+ and how sexual and relationship satisfaction are interlinked with health and sexual difficulties when ageist sexual stereotypes are considered. Data for the network analysis were collected from a sample of 897 Czechs and Slovaks aged 50-96 (52% men, mean age = 62.01). Two models were analyzed - with and without the inclusion of ageist sexual stereotypes. The findings indicated that ageist sexual stereotypes play an important role in the sexuality of women and men aged 50 + .The fewer ageist sexual stereotypes people had, the less sexual difficulties they reported and the more they perceived sex as important. The inclusion of stereotypes into the models, however, weakened the negative link between sexual difficulties and the importance of sex for both women and men. These findings show that the effect of ageist sexual stereotypes are likely complex in the sexual lives of people aged 50 +.

Trajectories of intimacy in later-life: a qualitative study of Czech and Polish narratives

Intimacy has been identified as an important component of satisfying sexual activity in later life. While the existing literature reports that the importance of intimacy increases with age, the mechanisms behind this process have not been extensively researched. Even less is known about later-life sexual intimacy among women and men from former communist countries. This study explored the nuances of sex and intimacy by interviewing 50 Polish and Czech women and men aged 60 to 82. Data were analysed thematically using an inductive approach. Three main themes were developed to represent the extent to which intimacy was part of participants' lives: 1) lifelong representation of sex as an intimate connection between individuals; 2) later-life shift towards intimacy-oriented sex for two main reasons: health-related necessities and a new relationship context; and 3) no intimacy whatsoever. The study findings indicate that a later-life refocus from an instrumental, penetrative-oriented view of sex towards a wider variety of intimate behaviours may be beneficial, not only for improving quality of sexual life, but also to gain new ways to express emotional connections between the partners.

Women's knowledge and attitudes to the menopause: a comparison of women over 40 who were in the perimenopause, post menopause and those not in the peri or post menopause

OBJECTIVES

To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the peri or post menopause (other).

METHODS

A 35 question online survey was advertised on social media to evaluate women's attitudes and knowledge of the menopause. Three groups of women were compared: perimenopause, post menopause and those women not in either the peri or post menopause (other).

RESULTS

Most women were completely uninformed or only had some knowledge of the menopause before the age of 40. Most women thought that the menopause should be taught at school, but over 80% had received no menopause education at school themselves. The most popular sources of menopause information were independent websites and friends. Perimenopausal women were significantly more likely than postmenopausal women to use online resources for menopause information. The perimenopausal and postmenopausal groups had more positive attitudes towards the menopause than the other group. 57.5% of postmenopausal women found the menopause difficult or very difficult. Most women were happy about no longer menstruating, although some expressed sadness regarding fertility loss.

CONCLUSIONS

Most women had limited knowledge and negative attitudes towards the menopause, leaving them unprepared to cope with the physical and psychological changes associated with this stage of life. Improved menopause education is required to improve quality of life during the menopausal transition and a most positive narrative of life postmenopause.

Help-seeking challenges for female sexual concerns: a qualitative study from Iran

BACKGROUND

To effectively manage sexual health, people must have access to sexual health services. A small percentage of women with sexual concerns seek professional help. Hence, the need to explain the help-seeking challenges is felt from the perspective of women and health care providers.

METHODS

This study explored Iranian women's challenges when seeking help for sexual concerns. Using a purposive sampling method, 26 in-depth interviews were conducted in Rasht in 2019-2020. The participants included sexually active women of reproductive age over 18 years old and 8 health care providers. The recorded interviews were transcribed and analyzed through content analysis.

RESULTS

From the description of 17 subthemes provided by the participants, two main themes were achieved, "Unfavorable sexuality development context" and "Inefficient sexual health services."

CONCLUSIONS

According to the results, it is suggested that policymakers pay more attention to the challenges women and health care providers face in help-seeking and promote sexuality education and sexual health services to achieve a higher level of help-seeking among women.

A Systematic Review on Psychological Interventions for Sexual Health in Older Age

Objectives

The present review aims to identify the existing evidence on outcome-treatment studies of psychological sexual health interventions in older age.

Methods

A systematic search was conducted for studies published until October 2022. Data search was conducted on EBSCO, MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials databases.

Results

From 30,840 screened records, 12 reports were selected. Results were grouped into four categories according to the intervention that was implemented.

Conclusions

Despite results presenting some bias concerns, this review suggests that educational and cognitive-behavioral approaches seem to be effective for promoting sexual health in older age.

Sexual Difficulties in People 50+: A Content Analysis of Sex-related Queries Posted on Professional Counseling Websites

Although sexual activity has been found to be both important and challenging for people aged 50+, relatively little is known about the concerns that they have with respect to their sexual lives and how help-seeking behavior manifests on counseling platforms. A sample of 293 sex-related queries that Czechs aged 50+ posted on professional counseling websites were subjected to a quantitative and qualitative content analysis. The majority of posts were written by men and their dominant issues were erectile difficulties, partner's lack of interest in sex, and drug use/interaction when treating sexual difficulties and other ailments. Using a thematic analysis, the study showed that sex-related concerns were based within the context of worries about maintaining relationships and re-partnering in mid- and later life, and probing for the normal aspects of aging and the associated changes in sexual health. The online setting of the counseling websites facilitated the posting of both general and personalized queries to get oriented in problems, to triangulate with previous information, and to check the treatability of difficulties when past treatments failed. These findings suggest that online counseling puts a great demand on professionals' knowledge and understanding of the specifics of later-life sexual health.

Guidelines, Policies, and Recommendations Regarding the Sexuality of Individuals with Severe Mental Disorders in Psychiatric Units, Institutions, and Supported Housing Across Europe: A Systematic Review

Sexual behavior of psychiatric inpatients is often inadequately addressed within psychiatric institutions. This systematic review aimed to identify existing policies, guidelines, and recommendations regarding inpatient sexual behavior in psychiatric units, institutions, and supported housing across Europe in existing literature. It also aimed to assess the attitudes held by mental health professionals (MHPs) and inpatients toward existing policies, guidelines, and recommendations. Nine databases were searched in seven languages for articles published between 2000 and 2020. Double-blind bias assessment was performed on 10 articles. Five thematic categories emerged from the selected studies: (1) types of policies and guidelines; (2) MHPs' and inpatients' attitudes toward inpatient sexual behavior; (3) impact and strategies related to inpatient sexual behavior; (4) barriers to inpatient sexual behavior; and (5) facilitators to inpatient sexual behavior. Most screened publications reported implicit norms addressing inpatient sexual behavior among the staff. Surveyed MHPs and inpatients typically showed opposing attitudes regarding inpatient sexual behavior, with MHPs generally deeming such behavior unsafe and inpatients emphasizing it as their human right. The aims of this systematic review were partially fulfilled as articles reported little or no policy documents and guidelines and, therefore, did not allow for the assessment of policy impact. MHPs' attitudes toward inpatient sexual behavior were addressed and trends in several countries outside of Europe addressing inpatient sexual behavior were discussed. Finally, capacity to consent with respect to inpatient sexual behavior is discussed in the context of human rights.

Help-Seeking Behaviors Among Older Adults: A Scoping Review

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

Multidimensional Sexual Well-being Scale for Older Adults: Validity Evidence from a Polish Sample

Here, we report the results of a Polish adaptation of the Multidimensional Sexual Well-being Scale (MSWBS) for older adults. The MSWBS is a short self-report scale for assessing the five dimensions of an individual's sexual well-being: frequency of caressing, sexual intimacy, sexual compliance, sexual satisfaction, and sexual distress. The aim of our adaptation was to examine the utility of the scale in a country with conservative views on the sexuality of older people, which will help health care providers and researchers to better understand the sexual needs of older people. The study included 507 participants, aged 60-92. We found the reliability of the scale to be satisfactory (Cronbach's alpha = .71-.87). Confirmatory factor analysis (CFA) showed a good fit of the data to a five-factor model. This study demonstrates that the MSWBS-PL is connected to general life satisfaction and diversity of sexual activity, confirming the scale's validity.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1991535.