Lorraine K. McDonagh

A Systematic Review of Sexual Dysfunction Measures for Gay Men: How Do Current Measures Measure Up?

The measurement of subjective components of sexual functioning is of increasing importance in clinical research and practice. Differences have been reported in prevalence rates and experiences of sexual difficulties between heterosexual and gay men. The aim of this article is to identify reliable and valid measures of sexual dysfunction suitable for use with gay men. Seven measures were reviewed; details about item development, dimensionality, reliability, and validity are provided. Heteronormative and heterosexist wording were evident throughout. Several areas of concern emerged in relation to psychometric properties (e.g., questionable validity). No psychometrically robust sexual function measure was identified for use with gay populations.

Ameliorating transnegativity: assessing the immediate and extended efficacy of a pedagogic prejudice reduction intervention

ABSTRACT We demonstrate that pedagogic interventions utilising mediated contact and the parasocial contact hypothesis provide an effective means of instantiating both an immediate and long-term reduction in prejudice towards transgender people. Through application of the parasocial contact hypothesis, our quasi-experiment demonstrates that exposure to the combined intervention of a panel presentation and a trans-themed film resulted in a significant reduction of self-reported prejudice immediately after exposure and this effect persisted up to 6 weeks later in a sample of 66 female university students. In addition to testing this effect, we also assess the relationship between prejudice towards transgender people and other forms of prejudice, including old-fashioned and modern prejudice towards gay men and lesbian women. In doing so we demonstrate that prejudice towards trans people appears to be conceptually related to prejudice towards gay men and not lesbian women. Limitations and directions for future research are explored.

Development and Psychometric Evaluation of the Gay Male Sexual Difficulties Scale

Sexual difficulties (i.e., disturbances in normal sexual responding) have the potential to significantly and negatively affect men’s social and psychological well-being. However, a review of published measurement tools indicates that most have limited applicability to gay men, and none offer a nuanced understanding of sexual difficulties, as experienced by members of this population. To address this omission, the Gay Male Sexual Difficulties Scale (GMSDS) was developed using a sequential mixed-methods approach. The 25-item GMSDS uses a 6-point frequency Likert-type response format and examines: difficulties with receptive and insertive anal intercourse (5 items each); erectile difficulties (4 items); foreskin difficulties (4 items); body embarrassment (4 items); and seminal fluid concerns (3 items). The measure’s scale score dimensionality, assessed using both exploratory and confirmatory factor analyses, as well as scale score reliability and validity (e.g., known-groups and convergent) was tested and deemed to be satisfactory. Limitations of the current series of studies and directions for future research are discussed.

Facilitators and barriers to chlamydia testing in general practice for young people using a theoretical model (COM-B): a systematic review protocol

Introduction Chlamydia is a key health concern with high economic and social costs. There were over 200 000 chlamydia diagnoses made in England in 2015. The burden of chlamydia is greatest among young people where the highest prevalence rates are found. Annual testing for sexually active young people is recommended; however, many of those at risk do not receive testing. General practice has been identified as an ideal setting for testing, yet efforts to increase testing in this setting have not been effective. One theoretical model which may provide insight into the underpinnings of chlamydia testing is the Capability, Opportunity and Motivation Model of Behaviour (COM-B model). The aim of this systematic review is to: (1) identify barriers and facilitators to chlamydia testing for young people in general practice and (2) use a theoretical model to conduct a behavioural analysis of chlamydia testing behaviour. Methods and analysis Qualitative, quantitative and mixed methods studies published after 2000 will be included. Seven databases (MEDLINE, PubMed, EMBASE, Informit, PsycInfo, Scopus, Web of Science) will be searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. Risk of bias will be assessed using the Critical Appraisal Skills Programme. Data regarding study design and key findings will be extracted. The data will be analysed using thematic analysis and the resultant factors will be mapped onto the COM-B model components. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethics and dissemination Ethical approval is not required. The results will be disseminated via submission for publication to a peer-review journal when complete and for presentation at national and international conferences. The review findings will be used to inform the development of interventions to facilitate effective and efficient chlamydia testing in general practice.

“I Want to Feel Like a Full Man”: Conceptualizing Gay, Bisexual, and Heterosexual Men’s Sexual Difficulties

Current understandings of sexual difficulties originate from a model that is based on the study of heterosexual men and women. Most research has focused on sexual difficulties experienced by heterosexual men incapable of engaging in vaginal penetration. To better understand men’s perceptions and experiences of sexual difficulties, seven focus groups and 29 individual interviews were conducted with gay (n = 22), bisexual (n = 5), and heterosexual (n = 25) men. In addition, the extent to which difficulties reported by gay and bisexual men differ from heterosexual men was explored. Data were analyzed using thematic analysis applying an inductive approach. Two intercorrelated conceptualizations were identified: penis function (themes: medicalization, masculine identity, psychological consequences, coping mechanisms) and pain (themes: penile pain, pain during receptive anal sex). For the most part, gay, bisexual, and heterosexual men reported similar sexual difficulties; differences were evident regarding alternative masculinity, penis size competition, and pain during receptive anal sex. The results of this study demonstrate the complexity of men’s sexual difficulties and the important role of sociocultural, interpersonal, and psychological factors. Limitations and suggested directions for future research are outlined.

Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review

Background Caring for someone with dementia is one of the most challenging caring roles. The need for support for family caregivers has been recognized for some time but is often still lacking. With an aging population, demand on health and social care services is growing, and the population is increasingly looking to the internet for information and support. Objective In this review, we aimed to (1) identify the key components of existing internet-based interventions designed to support family caregivers of people with dementia, (2) develop an understanding of which components are most valued by caregivers, and (3) consider the evidence of effectiveness of internet-based interventions designed to support family caregivers of people with dementia. Methods We conducted a systematic search of online databases in April 2018. We searched reference lists and tracked citations. All study designs were included. We adopted a narrative synthesis approach with thematic analysis and tabulation as tools. Results We identified 2325 studies, of which we included 40. The interventions varied in the number and types of components, duration and dose, and outcomes used to measure effectiveness. The interventions focused on (1) contact with health or social care providers, (2) peer interaction, (3) provision of information, (4) decision support, and (5) psychological support. The overall quality of the studies was low, making interpretation and generalizability of the effectiveness findings difficult. However, most studies suggested that interventions may be beneficial to family caregiver well-being, including positive impacts on depression, anxiety, and burden. Particular benefit came from psychological support provided online, where several small randomized controlled trials suggested improvements in caregiver mental health. Provision of information online was most beneficial when tailored specifically for the individual and used as part of a multicomponent intervention. Peer support provided in online groups was appreciated by most participants and showed positive effects on stress. Finally, online contact with a professional was appreciated by caregivers, who valued easy access to personalized practical advice and emotional support, leading to a reduction in burden and strain. Conclusions Although mixed, the results indicate a positive response for the use of internet-based interventions by caregivers. More high-quality studies are required to identify the effectiveness of internet interventions aimed at supporting family caregivers, with particular focus on meeting the needs of caregivers during the different stages of dementia.

Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review

BackgroundChlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model.MethodsQualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsFour hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma).ConclusionsThis systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed.Trial registrationPROSPERO CRD42016041786

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study

BACKGROUND Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. OBJECTIVES To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). DESIGN A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. SETTING Twelve general practices and three community settings in London. MAIN OUTCOME MEASURE HIV SSK return rate. RESULTS Stage 1 - the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 - of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. LIMITATIONS Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. CONCLUSIONS Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. FUTURE WORK Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. FUNDING The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.

Handbook of adult resilience, edited by John W. Reich, Alex J. Zautra, and John Stuart Hall

In a contemporary world fraught with economic and socio-political turmoil as well as great uncertainty about the role (or capacity) of the state to look after the needs of its citizens, there is increasing interest in the attributes that enable people to survive the rigors not only of traumatic, catastrophic, and stressful life experiences, but also of daily life as it is normally lived. Developmental psychologists have traditionally (although perhaps unconsciously) examined resilience factors when studying the adaptations required by transitions from childhood to adolescence and from adolescence to adulthood; similarly, clinical and health psychologists have created a resilience-shaped niche out of person and social factors that assist with stresscoping in ways that boost well-being. However, as noted by the Resilience Solutions Group (RSG) at Arizona State University, psychology as a whole has been slow to draw these disparate strands together in order to shape a unified understanding of resilience as it manifests itself in the typically developing adult. The present volume, edited by three of the RSG’s most distinguished members, represents a noble effort in synthesizing these concepts, providing readers with a thorough, thoughtful, and varied treatise of psychological resilience in adulthood. As with any attempt to corral a disparate literature within a putatively new paradigm (or, to use the editors’ own analogy, when attempting to progress the science of resilience toward a Kuhnian revolution), one conspicuous challenge to contributors is to achieve an agreed vocabulary. Significantly, there exists no one consensually agreed definition of the notion of resilience. Previous attempts to address the concept have variably conceived of it as a stable disposition (perhaps heritable at a genetic level), a systemic process (inherently contingent on the interaction between environment and personal actions), or a commodified resource (amenable to transmission across individuals in the form of ‘resilience-building’ skills interventions). Nonetheless, whatever approach is taken, most scholarly treatments of resilience encapsulate either the ability to recover quickly from stressful experiences, or the ability to accumulate a continuing enhancement of personal function over time as ordinary life is encountered (with or without the occurrence of stress), or both. Such nuances echo those faced by social support theorists some 20 years ago, when speculating as to whether social interactions exert stress-buffering or direct effects on recipient well-being. It is not yet clear whether the present editors’ Kuhnian revolution has succeeded, however, as the accumulated contributions to this volume appear to retain a substantial degree of inter-disciplinary balkanization: how resilience is defined for research purposes largely continues to depend on the disciplinary position of those conducting the research. It is also unclear whether considerations of the dispositional nature of resilience are fully reconciled with extant psychological theory. Laudably, the volume includes perspectives that run the gamut of the behavioral sciences, including biological, cognitive, behavioral, and social psychology, as well as applied subdisciplines spanning organizational, cultural, and health contexts. Such heterogeneity is very much a strength of the present volume. Notably, for a topic that lends itself to psychologization, the chapters on its biological substrates are particularly strong. The chapter of Feder, Nestler, Westphal, and Charney presents a physiological background to resilience functionality, while the chapter by Lemery-Chalfant outlines its genetic aspects. These authors are to be commended in retaining the specificity of neural and genetic vocabulary while presenting the material in a manner that is comprehensible to a more general scholarly readership (however, it is a little surprising that the implications of resilience for physical health are not covered in more detail, as might be derived from the extensive literature in psychoneuroimmunology that links coping to beneficial health outcomes). In a novel way, the quasi-biological theme of adaptive ecosystems is continued in the chapter by Denhardt and Denhardt, which ostensibly examines the nature of resilience in organizations. While noting that what is positive for an organization might not be positive for the individual actors within it, these authors attempt to outline ways of building resilience in workforce members in ways that contribute to group-level efficiency. With considerable insight, they conclude that organizational