Trauma and resilience informed research principles and practice: A framework to improve the inclusion and experience of disadvantaged populations in health and social care research

Trauma, socio-economic, cultural and structural issues are associated with poor outcomes for most health conditions and may also make research participation difficult and onerous, perpetuating intervention-generated inequalities by generating evidence from those least in need. Trauma-informed and resilience-informed approaches to care may help address these concerns across health and social care research. These approaches take an empowerment-based response to adversity, and are suitable for integration and extension as Trauma and Resilience Informed Research Principles and Practice (TRIRPP) for studies beyond the topics of resilience and trauma. Four TRIRPP aims were identified: addressing the adversity context that may underpin the lives of research participants and the phenomenon under study; improving study accessibility and acceptability for individuals and populations facing adversity; recognising and addressing traumatisation in potential participants; and recognising and promoting resilience. Recommendations include interview participant control of recording devices, over-sampling of under-represented populations in population surveys, and actively seeking to engage disenfranchised individuals in patient and public involvement from design to dissemination. The practice of research has the power to address adversity and trauma or to perpetuate it at both an individual and a societal level. It is feasible and worthwhile to integrate trauma-informed and resilience-informed approaches across research topics and designs. Further work should extend the TRIRPP recommendations and evaluate their use.

Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature

BACKGROUND

The subject of gay and lesbian sexual health seems to be highly understudied, at least partially due to general limitations inherent in the studies of sexuality as well as heteronormative bias and difficulties in reaching out to these populations.

AIM

To critically review the studies on gay and lesbian sexual health in order to identify the existing gaps and biases in the scope and general construction of the published research.

METHODS

The dataset comprised 556 peer-reviewed articles identified through Medline search. Key studies characteristics were extracted according to the codebook developed for this study and analyzed descriptively.

OUTCOMES

The outcomes included: research methodology, study design, sampling, research topic and diversity inclusion in studied populations.

RESULTS

The majority of the studies were quantitative (70.5%), cross-sectional (83.6%) and used convenience sampling (83.2%). Most papers focused on HIV/STI risk behaviors, vulnerabilities and risk navigation (26.3%). The least often found topic captured the sexual function of gay and lesbian participants in older age (0.5%). Over 68% of papers relied on male samples and studies on female-only samples comprised less than 13%. Most studies did not recruit a specific age group (77.7%) and included information about ethnicity of study participants (62%). Information about education (58.7%) or other indicators of socioeconomic status (52.8%) was less often reported.

CLINICAL TRANSLATION

The methodological limitations of prevailing study designs, sampling procedures and the composition of samples, as well as extensive areas of omission confine the clinical utility of existing research.

STRENGTHS & LIMITATIONS

This study offers critical insights into the most significant challenges associated with studies on gay and lesbian sexual health. Medline-only database search, the inclusion of English-written papers exclusively and limited scope (gay and lesbian sexuality only) of the review constitute the most significant limitations.

CONCLUSIONS

Gay and lesbian sexual health is an understudied field characterized by primary focus on HIV/STI and paucity of higher quality research including diverse subpopulations. Mijas M, Grabski B, Blukacz M, et al. Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature. J Sex Med 2021;XXX:XXX-XXX.

Young adults' sexual health in the digital age: Perspectives of care providers

OBJECTIVES

This study examined care providers' views on young people's sexual health in the digital age. Young people have high rates of sexually transmitted infections (STIs), indicating sexual risk-taking behaviours. Adolescents transitioning to adulthood may be particularly at risk due to increased sexual behaviour and exposure to risk factors for unsafe sex, such as less parental monitoring. These risks may be accentuated in the digital age, where the availability of dating apps and pornography have potentially influenced young people's sexual behaviours. Care providers give a unique insight into sexual health in the digital age as they are able to identify changes over time.

STUDY DESIGN

Qualitative semi-structured interviews were conducted with general practitioners, nurses, counsellors and university residential college staff (N = 15, six female) who work with young people aged 17 and 18. Interviews took 20-40 min, and were recorded and transcribed verbatim. Transcripts were coded by the primary researcher and an independent coder using thematic analysis.

RESULTS

We identified four themes depicting predictors for sexual risk-taking among young people: media influence on norms (influence on sexual behaviours, relationships and appearance), transition to adulthood (independence, social opportunity), communication difficulties (gender and sexuality differences, greater fear of pregnancy than STIs), and impulsive behaviour (disinhibition, substance use).

CONCLUSION

Findings highlight targets for prevention of sexual risk-taking among adolescents, such as addressing changing norms depicted in media. Further, the complex interplay of contextual and individual factors highlights the need for more comprehensive theory and holistic approaches to STI prevention.