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Understanding sexual health need

Understanding sexual health need. Dr Anne McNall - Senior Lecturer Pathway Leader Sexual Health Faculty of Health & Life Sciences Northumbria University With acknowledgement to Alice Wiseman. This session aims to give;. A brief overview of; The concept of need

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Understanding sexual health need

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  1. Understanding sexual health need Dr Anne McNall - Senior Lecturer Pathway Leader Sexual Health Faculty of Health & Life Sciences Northumbria University With acknowledgement to Alice Wiseman

  2. This session aims to give; A brief overview of; The concept of need Common frameworks for health needs assessment The drivers for public and patient involvement and engagement The impact of stigmatising issues on involvement and engagement. The diversity of approaches required to understand sexual health need

  3. The dimensions of need (Bradshaw • Epidemiological need: • measurements of health status to analyse what interventions and services could be beneficial now and in the future • Normative need: • professional and expert’s views of the interventions and services which would benefit the public • Comparative need: • experience and examples from other settings which demonstrate benefits to the public • Felt need: • public and users views of services and actions which would be beneficial to them • Expressed need: • Public and users views that become publicly known through research, lobbying or other means

  4. Iceberg of Need (Donaldson 1993) Services available and needs are being met Unmet needs exist because people are either not using services which can help them or because appropriate services are not available that adequately respond to health need

  5. What is HNA? ‘Health Needs Assessment (HNA) is a systematic way for reviewing the health issues facing a population, leading to agreed commissioning priorities that will improve health and wellbeing and reduce inequalities’ (GBDH 2007 pg7)

  6. Why undertake HNA? Underpinning the whole HNA process are three principles: • Improvement of health and inequalities by making changes that improve the most significant conditions or factors affecting health, then targeting the population groups with the most to gain, and those services that can make the most difference to their needs. • Integrationof this improvement in health into the planning process used by those services, so that the identified changes are implemented in their plans. • Involvement of: • people who know the health issues in a community • people who care about those issues • people who can make changes happen

  7. Source: Cavanagh, S. Chadwick K (2005) Health Needs Assessment: A Practical Guide. NICE

  8. Standardised approach to HNA From Cavanagh & Chadwick (2005)

  9. Legal requirement for PPI Section 11 of the Health and Social Care Act (DH 2001): • places a legal duty on the NHS to involve and consult patients and public in the planning and development of health services and in making decisions that affect the way those services operate • this duty has been a legal requirement since January 2003 The National Health Service Act. (DH 2006) • Section 242 places a duty on NHS trusts, Primary Care Trusts and Strategic Health Authorities to make arrangements to involve and consult patients and the public in the planning and organization of services

  10. Recommended Standards for Sexual Health Services Commissioners and Services should: • “Promote active user participation and involvement in the planning and organization of services. • Develop their understanding of the various communities they serve. • Recognize and respond to social exclusion, discrimination and power imbalances (such as those between genders or individuals) in a way that enhances access, and promotes effective use of services. • Ensure all staff involved in sexual health services are committed to non-discriminatory working practices and delivery of care” (MedfASH 2005, p33)

  11. Rapid Review existing data: Reports, surveys and analysis Existing data: Service data and context data Intelligence gathering Gap analysis Comprehensive Establish an expert panel Review existing data: Reports surveys and analysis Existing data: Service data and Context Data Stakeholder analysis and service mapping Key informants Discussion Involve Users and Potential Users Gap Analysis Sexual Health Needs Assessment :A how to guide (Design Options 2007)

  12. A hierarchy of participation (Hart 1996)

  13. Why do people access sexual health services? A range of reasons which may include; • Sexually transmitted infection • Sexually assault/ abuse • Unintended pregnancy, may want an abortion • Sexual difficulty, eg. erectile dysfunction • Contraception/ Condoms • HIV positive • Just as many people with sexual health need never access services (NATSAL 2000)

  14. What is known about the needs of service users in the context of sexual health? • Comparatively little is known about sexual health service user views • Studies* identify expressed sexual morbidity, perceived stigma, unmet needs and dissatisfaction with the diagnosing health care providers counselling on emotional and sexual issues • Sexual health patients can feel responsible that their problem(s) result from their own behaviours or inadequacies, commonly feel guilt and shame, perceive stigma and are reluctant to give negative feedback, and therefore could reasonably be defined as disempowered (silent discourse). * Evans & Farquhar (1996), Duncan et al (2001), Scoular et al (2001), Nack (2001), Dixon- Woods (2001)

  15. DH (2010) Equality Impact Assessment for National Sexual Health Policy • Known sexual health inequalities in and within various communities, eg. • Young people • concerned about confidentiality, often access services after sexual debut, access more difficult for <16s, like one stop shops with multiple services provided, non judgemental service • BME communities • stigma and lack of culturally appropriate information and services is a barrier to access/ engagement. Under use of services by core groups of the BME community, LGBT BME YP less likely to discuss • Mac an Ghaill & Hayward (2005) Samayanga (2007) Serrant- Green (2005) DH (2007) • Men who have sex with men (MSM) • Prisoners & young offenders • Commercial sex workers......and all groups with known inequalities

  16. Which methods are used to identify need in the context of sexual health? • Reliance on; • Epidemiological evidence (statistics) • Surveys/ questionnaires to demonstrate satisfaction with what is offered • Some use of mystery shoppers to evaluate existing services • Limited number of studies which explore experiences of specific groups • Known limitations on getting such research into practice • (McNall 2012, Baraitser 2003) • There is little evidence that what is known leads to significant change in the information and services provided • Within any community there is great diversity of need – one size does not fit all! • Participatory approaches are needed to supplement epidemiological evidence of need.

  17. Impact of needs led commissioning

  18. Published March 2013

  19. Source: GBDH (2013)

  20. References Department of Health (2010b) Equality Impact Assessment for National Sexual health Policy. London. Department of Health. Health and Race Equality Forum (2010) Young people from some black and minority ethnic communities in North East England share their views of health services, Newcastle upon Tyne: Government Office for the North East Mac an Ghaill M and Haywood C (2005) Young Bangladeshi people’s experience of transition to adulthood, Newcastle University Medical Foundation for AIDS and Sexual Health (2005) Recommended Standards for Sexual Health Services. London, MedFASH Medical Foundation for AIDS and Sexual Health (2008) Progress and priorities: Working together for high quality sexual health, Produced for the Independent Advisory Group on Sexual Health and HIV, London: MedFASH Samangaya M (2007) Access to sexual health services for young BME men, Nursing Times 103, 43, 32-33 Sekhon P. (2010), BME communities, sex and the law: Mobilising BME communities for sexual health, London: Naz Project, http://www.naz.org.uk, accessed 19 September 2011 Serrant-Green, L (2005) Breaking traditions: Sexual health and ethnicity in nursing research: a literature review. Journal of Advanced Nursing 51(5) 511 -9 Serrant-Green, L. (2011) The sound of ‘silence’: a framework for researching sensitive issues or marginalised perspectives in health. Journal of Research in Nursing 16, 347  Simkhada P, van Teijlingen E, Yakubu B, Mandava L, Bhattacharya S, Eboh W, Pitchforth E (2006) Systematic Review of Sexual Health Interventions with Young People from Minority Ethnic Communities, Project Report, University of Aberdeen Teenage Pregnancy Unit (2000) Guidance for developing contraception and sexual health advice services to reach black and minority ethnic (BME) young people, London: Department of Health

  21. References/ further reading • Baraitser, P et al (2005) Involving service users in sexual health service development. Journal of Family Planning & Reproductive Health Care 31, 4 • Dixon- Woods, M. Stokes, T. Young, B. Phelps, K, Windridge, K Shukla, R. (2001) Choosing and using services for sexual health : a qualitative study of women’s views. Sexually Transmitted Infections. 77 (50 p 335- 343) • Duncan, B Hart, G. Scoular, A. Bigrigg, A. (2001) Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis : implications for screening. British Medical Journal.322.(7280) 195-199 • Evans, D. & Farquhar, C. (1996) An interview based approach to seeking user views in genitourinary medicine. Genitourinary Medicine 72. 223-226 • Hart R (1996) Children’s Participation: The Theory and practice of Involving Young Citizens In Community Development and Environmental Care, UNICEF • Hodge, S. (2005) Participation, discourse and power: a case study in service user involvement. Critical Social Policy 25 (2) 164-171 • Lawlor, D. et al. (1999) Rapid participatory appraisal of young people’s sexual health needs: an evaluation of meta-planning. Health Education Journal 58, 228-238. • McNall, A (2010) Developing thetheory and practice of public involvement and engagement in developing sexual health services. The Centre for Translational Research in Public Health: Quarterly Research Conference. 18 January 2010. Newcastle University • McNall, A (2012) An emancipatory practice development study: using critical discourse analysis to develop the theory and practice of sexual health nursing workforce development. Thesis submitted for the award of Doctorate in Nursing. Northumbria University • Nack, A. (2001) Damaged Goods. The sexual self-transformations of women with chronic STD’s. Unpublished PhD thesis. University of Colorado • Philip, K. (2001) Young people’s health needs in a rural area: lessons from a participatory rapid appraisal study. Youth & Policy (71), 5-24. • Scoular, A. Duncan, B. Hart, G. (2001) “That sort of place…where filthy men go…” : a qualitative study of women’s perceptions of genitourinary medicine services. Sexually Transmitted Infections. 77 (5) p 340-347

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