Title: Sexual health among older adults in China and the United Kingdom: A multi-disciplinary study
Funder: Economic and Social Research Council

Abstract: This proposed study is guided by five primary research questions:(1) What are sexual health needs among older adults, including those with disability? (2) What are barriers and facilitators to older adults accessing sexual health services? (3) What are older adult preferences for sexual health services and what attributes are most important? (4) What are ideas from older adults about how to improve sexual health? (5) What actions can be taken from the policy perspective to improve sexual health and wellbeing among older adults? Aim 1 uses a cross-sectional survey to understand sexual health and wellbeing (e.g., sexual functions, sexual satisfaction, risky sexual behaviours, HIV/STIs infections status), accommodating people with disabilities in China, in comparison to the UK NATSAL 3 database. Aim 2 uses a patient-centred approach by directly involving older adults in identifying their preferences for sexual health services (including sexual health information, sexual function services, HIV/STIs testing), resulting in evidence to support more effective health program development and recommendations for how best to implement these strategies. Aim 3 will conduct parallel crowdsourcing challenge contests in the two countries to solicit contributions from older adults that can be used to inform sexual health interventions. Aim 4 will generate policy recommendations based on the research findings in both the UK and China.

Lay abstract: People who lived beyond the age of fifty years were uncommon in the mid-1800s. Remarkable advances in medicine have created substantial demographic changes, resulting in larger numbers of older adults, defined in this application as 50 years and older. This greying of the world's population has important implications for sexual health. An increasing number of older population sustain vibrant sexual lives and intimate relationships for a long period, needing support and medical advice on optimizing their sexual health. At the same time, a range of related frailties and disabilities alongside power imbalances may increase the risk of unprotected sex and HIV/sexually transmitted infections among some older adults. Sexual health is an increasingly important topic among elderly individuals across the world, but our conventional disciplinary approaches shy away from the topic. Much of the sexual health research has focused on youth, ignoring the tremendous demographic changes underway and incorrectly assuming that "age is a condom." Our UK-China joint team has a rich experience in behavioural science, sociology, anthropology, medicine, and public health. The common greying of the population in the UK and China demands innovative solutions to identify needs and barriers relevant to sexual health and gaps in sexual health services and ensure that they are inclusive, empowering, and reliable. Leveraging our multi-disciplinary team, we propose the following specific aims: Aim 1: Using an epidemiological study to understand sexual health and wellbeing among older adults in China, in comparison to existing data from National Survey of Sexual Attitudes and Lifestyles (NATSAL 3) in the UK. Aim 2: Determine preferences for sexual health services among diverse older adults, using discrete choice experiments (DCEs). Aim 3: Identify high-quality messages to promote uptake of inclusive sexual health services among older adults in China and the UK through two parallel crowdsourcing contests. Aim 4: Create policy recommendations about how to make sexual health services more adaptive to older adults' needs and preferences in diverse settings. DCEs are a survey-based method that quantifies participants' preferences for health care delivery, evaluating which attributes are most important to participants by observing how participants trade-off between various attributes. A crowdsourcing contest allows a group to solve a problem and then shares solutions with the wider public. Crowdsourcing interventions have successfully engaged marginalized groups in HIV testing program development, improved HIV test and condom use.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;INFECTION