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BackgroundHealth services are increasingly using digital tools to deliver care, and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care.AimTo identify and understand the unintended consequences of online consultations in primary care.Design and settingQualitative interview study in eight general practices using online consultation tools in South West and North West England between February 2019 and January 2020.MethodThematic analysis of semi-structured interviews with 19 patients and 18 general practice staff.ResultsConsequences of online consultations were identified that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with, and whether practices used online consultations as their preferred method for patients to contact the practice. Consequences were identified that limited increases in practice efficiency by creating additional work, isolation, and dissatisfaction for some staff.ConclusionUnintended consequences often present operational challenges that are foreseeable and partly preventable. However, these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Process changes tailored to local circumstances are critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated information exchange that leads to diffuse relationships and a more transactional style of medicine.

The International Index of Erectile Functioning (IIEF) has been widely used to measure gay men's erectile functioning. However, the IIEF was initially developed using a sample of men whose sexual orientation was unspecified. Using scales not validated for specific populations can result in inaccurate assessments. The purpose of the current study was to evaluate the dimensionality, reliability, and validity of the IIEF with a large sample of gay men. One thousand and eighteen men self-identifying as "exclusively gay" completed an online survey consisting of demographics, the IIEF, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale 4 (PSS4), and the Gay Male Sexual Difficulties (GMSD) erectile difficulties sub-scale. The replicability of the IIEF factor structure with a gay male sample was determined using exploratory and confirmatory factor analyses. Additionally, the HADS, PSS4, and GMSD were used to determine the validity of the IIEF. The current study was unable to replicate the IIEF factor structure. Four items required deletion and the factor solution differed from the original. Thus, reinterpretation of the latent variables was deemed necessary. Although the resultant 12-item IIEF evidenced model fit, validity, and reliability, it is not recommended for use with gay men. The revised IIEF is unable to accurately measure gay men's erectile functioning as the content of the items fail to capture their sexual behaviors (i.e., insertive and receptive anal sex).

ObjectiveThe objective of this study was to explore young people’s perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)).MethodsTwenty-eight semistructured individual interviews were conducted with 16–24 year olds from across the UK. Purposive and convenience sampling methods were used (eg, youth organisations, charities, online platforms and chain-referrals). An inductive thematic analysis was first conducted, followed by thematic categorisation using the BCW.ResultsParticipants identified several barriers to testing: conducting self-sampling inaccurately (physical capability); lack of information and awareness (psychological capability); testing not seen as a priority and perceived low risk (reflective motivation); embarrassment, fear and guilt (automatic motivation); the UK primary care context and location of toilets (physical opportunity) and stigma (social opportunity). Potential intervention functions raised by participants included education (eg, increase awareness of chlamydia); persuasion (eg, use of imagery/data to alter beliefs); environmental restructuring (eg, alternative sampling methods) and modelling (eg, credible sources such as celebrities). Potential implementation strategies and policy categories discussed were communication and marketing (eg, social media); service provision (eg, introduction of a young person’s health-check) and guidelines (eg, standard questions for healthcare providers).ConclusionsThe BCW provided a useful framework for conceptually exploring the wide range of barriers to testing identified and possible intervention functions and policy categories to overcome said barriers. While greater education and awareness and expanded opportunities for testing were considered important, this alone will not bring about dramatic increases in testing. A societal and structural shift towards the normalisation of chlamydia testing is needed, alongside approaches which recognise the heterogeneity of this population. To ensure optimal and inclusive healthcare, researchers, clinicians and policy makers alike must consider patient diversity and the wider health issues affecting all young people.

Background STI/HIV testing is lower among heterosexual-identifying men who have sex with men (heterosexual-MSM) than bisexual or gay men. We aimed to understand attitudes towards sexual healthcare among heterosexual-MSM in England, to improve service design and uptake among this overlooked population. Methods Semi-structured individual interviews were conducted with 15 heterosexual-MSM in England in January-March 2020. Participants ranged in age from 22–69 years. All but one reported current or previous relationships with women. Data were analysed using an inductive thematic analysis. Results Frequency of STI/HIV testing varied widely between participants, reflecting how some men felt they lacked sufficient or accurate information about testing guidelines and options, including the possibility of home-sampling/testing. Among men with female partners, concern for the health and wellbeing of these partners was a motivator for testing. However, privacy and discretion were important factors in the use of home-sampling/testing kits for men living with female partners or family; their ability to use these services was limited when their privacy needs were not accommodated. Their heterosexual identity meant some felt services intended for gay and bisexual men were not appropriate for them. If asked by sexual health clinicians, most heterosexual-MSM interviewed reported feeling comfortable disclosing the sex they have with men, describing the impersonal nature of consultations and perceptions of non-judgement and discretion as facilitators for disclosure. However, this comfort with disclosure did not always extend to GPs, due to fears their behaviour would be exposed to others. Conclusion For the heterosexual-MSM in this study, privacy and discretion were of utmost importance. These must be guaranteed by sexual healthcare services, whether in-clinic or home-sampling/testing, to appeal to MSM regardless of their personal circumstances. Trust in clinician confidentiality and non-judgement facilitate disclosure. Further work is needed to identify ways for sexual health services to appeal to, and reach, this population.

Introduction An expanding area of research within the realm of body image is its role in human sexual functioning, which denotes people’s overall satisfaction with their performance during a specific sexual encounter. Traditionally, studies investigating the association between body image and sexual functioning have focused on women. The Male Body Image Self-Consciousness Scale (M-BISC) was developed to exclusively assess male body image self-consciousness during sexual activity using a sample consisting primarily of heterosexual men. Aim The purpose of the current study is to evaluate the dimensionality, reliability, and validity of the M-BISC with a sample of gay men. Research suggests that sexual difficulties and body image concerns can overlap and interrelate. Therefore, 2 subscales (erectile difficulties and body embarrassment) from the Gay Male Sexual Difficulties Scale (GMSDS) were used to assess the validity of the scale. Methods 1,930 men self-identifying as “exclusively gay” completed an online survey consisting of demographics, the M-BISC, and the GMSDS (erectile difficulties and body embarrassment subscales). Main Outcome Measure The replicability of the M-BISC factor structure with a gay male sample was determined using an exploratory and confirmatory factor analysis. Additionally, the GMSDS (erectile difficulties and body embarrassment subscales) was used to determine the validity of the M-BISC. Results Exploratory and confirmatory factor analyses revealed that, following the removal of 3 items, the M-BISC was unidimensional. Scale score reliability for the 14-item M-BISC was good. Finally, as predicted, scores on the M-BISC correlated with scores on the GMSDS (ie, greater sexual difficulties). Clinical Implications The results indicate that assessment scales developed using samples consisting primarily of heterosexual men may not be appropriate for use with gay men in their original form. Thus, limiting the accuracy of the measurement and increasing the risk of misdiagnoses. Strength & Limitations Strengths of this study include a large sample of exclusively gay men and the utilization of best-practice statistical analysis for assessing factor structure, validity, and reliability of measures. Limitations include the assumption that the M-BISC should be used in lieu of a novel scale developed exclusively for gay men. Further, the study utilizes an Internet sample consisting primarily of Caucasian gay men. Conclusion Results of the current study illustrate that the M-BISC is a valid tool to measure gay men’s body concerns during intimacy. More importantly, it also highlights gay men’s elevated body concerns during intimacy and the need to understand the etiology of these apprehensions. Currently, there is a noticeable gap in the literature regarding the cause of gay male body concerns that have potential clinic implications.

Background Syndemic theory highlights the potential for health problems to interact synergistically, compounding impact. Young adults not in education, employment or training (NEET) are more likely to experience disadvantage and poorer general health outcomes. However, there is little research on their sexual health, or the extent to which this clusters with mental and physical health outcomes. Methods Analysis of data from 16 to 24 year olds (1729 men, 2140 women) interviewed 2010–12 for Britain’s third National Survey of Sexual Attitudes and Lifestyles. Natsal-3 is a national probability sample survey using computer-assisted personal interviewing with computer-assisted self-interviewing. Participants were classified as workers, students or NEET. We used multivariable logistic regression to examine associations between being NEET (relative to worker or student) and risk behaviours and outcomes in physical, sexual and mental health domains. We then examined how risk behaviours and poor health outcomes cluster within and across domains. Results 15% men and 20% women were NEET; 36% men and 32% women were workers; and 49% men and 48% women were students. Young people who were NEET were more likely to report smoking and drug use (men) than other young people. There were few differences in sexual health, although NEETs were more likely to report condomless sex, and NEET women, unplanned pregnancy (past year). Risk behaviours clustered more within and across domains for NEET men. Among NEET women, poor health outcomes clustered across mental, physical and sexual health domains. Conclusions Harmful health behaviours (men) and poor health outcomes (women) clustered more in those who are NEET. This points to a possible syndemic effect of NEET status on general ill health, especially for women. Our paper is novel in highlighting that elevated risk pertains to sexual as well as mental and physical health.

IntroductionIn most sub-Saharan African countries iron deficiency anaemia remains highly prevalent in children and this has not changed in the last 25 years. Supplementation with iron hydroxide adipate tartrate (IHAT) was being investigated in anaemic children in a phase two clinical-trial (termed IHAT-GUT), conducted at the MRC Unit The Gambia at LSHTM (MRCG). This qualitative study aimed to explore the personal perceptions of the trial staff in relation to conducting a clinical trial in such settings in order to highlight the health system specific needs and strengths in the rural, resource-poor setting of the Upper River Region in The Gambia.MethodsIndividual interviews (n=17) were conducted with local trial staff of the IHAT-GUT trial. Data were analysed using inductive thematic analysis.ResultsPotential barriers and facilitators to conducting this clinical trial were identified at the patient, staff, and trial-management levels. Several challenges, such as the rural location and cultural context, were identified but noted as not being long-term inhibitors. Participants believed the facilitators and benefits outnumbered the barriers, and included the impact on education and healthcare, the ambitious and knowledgeable locally recruited staff and the local partnership.ConclusionWhile facilitators and barriers were identified to conducting this clinical trial in a rural, resource poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. To effectively implement a nutrition intervention, the local health systems and context must be carefully considered through qualitative research beforehand.

Background Young gay, lesbian, bisexual, transgender, and other sexuality/gender minority identities (LGBT+) exhibit poor sexual health outcomes (e.g., higher STI/HIV rates). In the UK, there is currently an effort to shift high-volume, low-cost testing (i.e., asymptomatic STI testing) away from expensive specialist settings and into primary care. The aim of this study was to explore young LGBT+ people’s experiences and attitudes towards STI/HIV testing in primary care. Methods 39 individual-interviews were conducted with young LGBT+ people (16–24 years; N=19 transgender). Study materials were developed through expert and lay consultation. Participants were recruited via LGBT+ organisations and social media websites. Data were analysed using an inductive thematic analysis. Results Many participants preferred sexual health clinics to primary care for STI/HIV testing due to expectations of stigma, fear of judgement, heteronormative assumptions, and experiences of misgendering. Some lesbian participants were concerned over receiving relevant STI tests - many felt they had little knowledge regarding protection against STIs; their discussions around sexual health with general practitioners rarely surpassed contraception. Some transgender participants reported body dysphoria feelings and perceived STI testing as invasive making physical examinations difficult. Others felt primary care services were too restrictive for transgender patients with some tests unavailable for those registered as being a specific gender. Potential strategies to improve STI/HIV testing in primary care were suggested, such as increased awareness of minority identities in healthcare settings (e.g., leaflets/posters in waiting and consultation rooms) and staff sensitivity training (e.g., use of inclusive language). Conclusion Barriers to STI/HIV testing in primary care (at individual, interpersonal, and structural levels) were identified for young LGBT+ people. Healthcare professionals and policy makers must consider patient diversity to ensure healthcare is both optimal and inclusive. Addressing the health issues affecting this population is a crucial part of improving national public health and eliminating HIV/STIs. Disclosure No significant relationships.

Background Repeat chlamydia infections are common, and the risk of receiving complications increases with the number of lifetime infections. However, retesting rates in the UK remain low and interventions to increase retesting have had variable effects. In order to change behaviour (e.g., to increase retesting), behavioural-science theoretical models may help identify influential factors. One such model, the COM-B Model proposes behaviour results from an interaction between capability, opportunity and motivation. The aim of this study was to identify theoretically-based demographic and psychosocial factors associated with retesting behaviour and intentions to retest amongst those previously diagnosed with chlamydia. Methods An online questionnaire was developed, based on a comprehensive literature review and expert and lay consultation. Participants were 263 young people (16–24 years) in the UK who had been diagnosed with chlamydia (via healthcare settings or online platforms). In addition to demographic questions, each measure was representative of COM-B components: susceptibility and severity, fear, stigma, shame, knowledge, social support, social norms, perceived advantages/disadvantages of retesting. Results 35% had not retested, the most common reason for which was unawareness of the need to retest (31%). In those who had not retested, moral norms, injunctive norms, and STI knowledge significantly predicted intentions to retest (F[1,53]=6.20,p=0.016,R2 =0.45,AdjR2=0.42). Retesters were slightly older and more likely to have had other STIs. The most common location of retest was a sexual health clinic (57%), followed by general practice (14%) and online services (11%). Multivariable regression demonstrated that social norms (injunctive, descriptive, and moral) significantly predicted having retested (F[1,171]=7.44, p=0.007,R2 =0.12,AdjR2=0.10]. Conclusion This research has identified potential targets for public health campaigns aimed at eliminating STIs. Specifically, future interventions should focus on social (e.g., social approval one expects from others for engaging in a responsible sexual health action) and psychological (awareness and education) to increase retesting rates. Disclosure No significant relationships.

Background Sexual behavioural and health differences are known to exist between gay and bisexual men, but less is known about heterosexual-identifying men who have sex with men (MSM). We conducted a systematic review of articles reporting on this population to inform public health interventions. Methods We searched six databases for articles reporting sexual behaviour and health outcomes in heterosexual-identifying MSM in Western Europe, Australia, New Zealand and North America, from 2008 to January 2018. All were screened by a primary reviewer, 10% were screened by a second independent reviewer. Results From 3126 articles identified, 42 were quantitative and included in a narrative synthesis (40 reported on studies conducted in the USA). The majority reported data from MSM-focused studies; five were general population studies. HIV prevalence for heterosexual-identifying MSM (range across studies: 4.6–11.4%) was lower than for gay (11.2–43.8%) or bisexual (12.4–29.8%) MSM, however, fewer heterosexual-identifying MSM reported recent testing for HIV (40–49% vs 64–68% of gay men, 56–62% of bisexual men) or STIs. There was no difference by sexual identity in MSM’s reporting of recent condomless sex with casual male partners (42%–52% of those reporting recent sex with casual partners) or insertive condomless sex, however heterosexual-identifying MSM were less likely than gay MSM to report receptive condomless sex. They reported fewer recent male partners than gay or bisexual MSM, more recent female partners than gay MSM, and similar numbers of lifetime partners of either sex compared to gay or bisexual MSM. Conclusion Heterosexual-identifying MSM report fewer male partners than gay or bisexual MSM, however similarities in risk behaviours indicate a group at risk of poorer sexual health than the general population. The data also suggest inadequate sexual health service use by these men such that additional targeted approaches to health promotion and infection control for this population may be warranted. Disclosure No significant relationships.

Patient and public involvement (PPI) refers to research carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them.1 PPI can include patients, carers, service users and the public, referred to here as ‘lay advisors’ (can also be called PPI experts, public advisors, stakeholders, experts by experience). PPI entails contributing in varying degrees to the design, development, conduct, data analysis and dissemination of research.2 Involvement can be consultative (single episode), collaborative (ongoing) or user controlled (actively controlled, directed, and managed by service users).3 PPI is now commonly required in research funding proposals. There are national UK standards for conducting PPI,4 and considerable guidance on how to identify and engage with lay advisors (eg, tailoring PPI to the needs of the study and the willingness of representatives),5 and how to evaluate the impact of PPI.6 7 Most guidance addresses PPI in the context of intervention studies and/or long-term conditions (including long-term stigmatised conditions)8 where lay advisors are sought through regular clinic attendance, patient support groups or charities. In contrast, there is little guidance or precedence on conducting PPI for episodic infection involving singular attendance (eg, chlamydia), for studies which seek to describe population characteristics or risk factors, or for study populations defined by stigmatised behaviours.9 Much sexual health research fits within one of these scenarios, making PPI in this field challenging.9–11 The aim of this paper, therefore, is to share experiences of conducting PPI in sexual health research. Successes and failures from four studies are discussed (see table 1 for an overview of each study). Lessons learnt are presented in relation to three stages of PPI activities: (1) determining who to include as lay advisors; (2) identifying where to access lay advisors; and (3) engaging with those …

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. [J Med Internet Res 2018;20(6):e216]

Current understandings of sexual difficulties originate from a model which 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. Additionally, the extent to which difficulties reported by gay and bisexual men differ from heterosexual men was explored. Data were analysed using thematic analysis applying an inductive approach. Two intercorrelated conceptualisations were identified: penis function (themes: medicalization, masculine identity, psychological consequences, and coping mechanisms) and pain (themes: penile pain and 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.

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.

Introduction: Chlamydia is a key health concern, with high economic and social costs. There were over 2 00 000 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 is an ideal setting for testing for multiple reasons; yet, testing here remains low. 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). This model proposes that behaviour (getting/providing a chlamydia test) is the result of capability, opportunity, and motivation. The aim of this review is to identify barriers and facilitators to chlamydia testing for young people in general practice, and use the COM-B Model to explore the theoretical mechanisms of action among these factors. Methods Seven databases were searched to identify peer-reviewed qualitative, quantitative, and mixed methods studies published after 2000. Data regarding study design and key findings were extracted. Data were analysed using thematic analysis and resultant factors were mapped onto the COM-B Model. Results 315 papers were identified and screened; 28 were included for review. Results indicate that testing can be attributed to facilitators/barriers at the patient level (e.g., knowledge), provider level (e.g., time constraints), and system level (e.g., practice nurses). Regarding the COM-B Model, results suggest that knowledge of testing can be classified within the capability component; social stigma can be classified within the opportunity component; and personal beliefs about testing can be classified within the motivation component. Conclusion The findings have relevance to healthcare professionals, policy-makers and commissioners in informing how best to improve the sexual health of young people.

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.

The present research further examines the psychometric properties of the Motivation to Control Prejudiced Reactions Scale (MCPRS). Particular attention is paid to the replicability of its factor structure and its factorial equivalence across samples of university students from Western Canada (n = 235), Eastern Canada (n = 556) and the mid-Western United States of America (n = 404). Confirmatory factor analysis and invariance analysis were carried out using the Analysis of Moment Structures (AMOS) 7.0. Results showed that while the two-factor structure of the MCPRS was replicated across samples, the original model required refinement to produce acceptable model fit (i.e., each sample had a slightly different model). Partial measurement invariance also was demonstrated for a subset of items on the MCPRS. The implications of the results, in terms of future use of the MCPRS are discussed, and limitations of the current study are outlined.

Handbook of adult resilience, edited by John W. Reich, Alex J. Zautra, and John Stuart Hall, New York, Guilford Press, 2010, 540 pp., US$80.00 (hardback), ISBN 978-1-60623-488-4 In a contemporary w...

Using a sample of male participants (N = 136) from the Republic of Ireland, the aim of this study was to develop a psychometrically sound measure of male body image self-consciousness during physical intimacy (i.e., The Male Body Image Self-Consciousness Scale, M-BISC). As predicted, participants' body image self-consciousness correlated positively with their sexual anxiety and motivation to become more muscular, and correlated negatively with their sexual esteem, body esteem, and self-rated physical attractiveness. Limitations of this study and directions for future research are outlined.

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.