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Psychotherapeutic Interventions for Sexual Problems Delivered Via the Internet: Effectiveness, Acceptability

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Psychotherapeutic Interventions for Sexual Problems Delivered Via the Internet: Effectiveness, Acceptability Psychotherapeutic interventions for sexual problems delivered via the Internet: Effectiveness, acceptability and reach Lorna Jane Hobbs University College London Submitted for the degree of Doctor of Philosophy December 2015 1 Declaration I, Lorna Jane Hobbs confirm that the work presented in this thesis is my own. Where information has been derived from other sources I confirm this has been indicated in the thesis. Supervision This PhD was supervised by Professor Elizabeth Murray (UCL Primary Care and Population Health) and Dr Julia Bailey (UCL Primary Care and Population Health). Funding This PhD was funded by a NIHR National School for Primary Care Research studentship. 2 Acknowledgements First and foremost I would like to express my deepest gratitude to my supervisors Professor Elizabeth Murray and Dr Julia Bailey for their constant support and encouragement throughout the process of doing this PhD. Their warmth, enthusiasm, vast knowledge and experience, attention to detail, and seemingly infinite levels of patience and belief in me were instrumental in me completing this PhD. I have learned so much from their insightful comments on my work and I will be forever grateful to them for providing me with such great supervision. I am also incredibly grateful for the experience of working with the Natsal team, whose members provided a really inspiring and supportive learning environment. I would like to thank Dr Cath Mercer, Phil Prah and Dr Rebecca Geary for answering my endless stream of questions about statistics and epidemiology, and Dr Kirstin Mitchel for her careful and thoughtful feedback during the write up phase. I would like to thank Dr Karen Gurney and Dr Naomi Adams from Central and North West London NHS Foundation Trust (the developers of Sextherapylondon.nhs.uk) for sharing their vast knowledge of sexual difficulties and of the Sextherapylondon website. I am extremely grateful to all my fellow PhD students and colleagues at UCL for their support along the way, and a special thanks goes out to those that took the time to read chapters of my thesis and provide me with such thoughtful and helpful feedback: Ghadah Alkhaldi, Ann Liljas, Dr Caroline Clarke and Clare Oakland. Last, but not least, I would like to express my gratitude to my wonderful and supportive friends and family, who cheered me on and encouraged me every step of the way. 3 Abstract Background There is a high prevalence of people with sexual difficulties and many do not seek help for them. Sexual difficulties can have a negative impact on sexual and psychological wellbeing and interpersonal relationships. Interactive Digital Interventions (IDIs) for sexual difficulties have the potential to provide a convenient, wide-reaching and cost- effective alternative to face-to-face therapy, but research in this area is in its infancy. Currently little is known about their effectiveness, reach and acceptability. Aim To investigate the use of the internet to deliver psychotherapeutic interventions for sexual difficulties, and determine their effectiveness, reach and acceptability Methods 1. A systematic review of the effectiveness of IDIs for adults with sexual difficulties. 2. A secondary data analysis of the data from the third National Survey of Sexual Attitudes and Lifestyles to investigate the potential reach of IDIs and explore the characteristics of people who seek help for their sex lives 3. A qualitative interview study to explore users’ views of an IDI for sexual difficulties before and after using one. Results IDIs can be effective for sexual difficulties, but the current evidence-base is small, and contains studies that are methodologically flawed, so more research is needed to be sure of these effects. With approximately 427,000-762,000 British people reportedly distressed about their sex lives and looking for information and support online, it appears that IDIs have considerable potential to reach their intended audience. The sextherapylondon website appeared to be acceptable to users as it met many of their wants and needs with regards to features, design, usability, user experience and perceived outcomes. Conclusion Overall, this thesis suggests that IDIs could have a valuable place in providing an alternative help source for people with sexual difficulties, especially in the light of further cuts to sexual health services. 4 Conference presentations Hobbs, L., Bailey, J., & Murray, E. (2014, November). Users’ views on interactive digital interventions for sexual problems: A qualitative study. Oral presentation at Medicine 2.0 World Congress on Social Media, Mobile Apps, Internet/Web 2.0, Maui, USA. Hobbs, L., Bailey, J., Ross, J., & Murray, E. (2013, November). The effectiveness of interactive digital interventions for sexual problems in adults: A systematic review. Poster presentation at Public Health Science, London, England. Hobbs, L., Bailey, J., Ross, J., & Murray, E. (2013, September). The effectiveness of interactive computer-based interventions for sexual problems in adults: A systematic review. Poster presentation at Medicine 2.0 World Congress on Social Media, Mobile Apps, Internet/Web 2.0, London, England. Hobbs, L., Bailey, J., Ross, J., & Murray, E. (2013, September). Interactive computer- based interventions for sexual problems in adults: A systematic review. Poster presentation at the Division of Health Psychology Annual Conference, Brighton, England. Hobbs, L., Bailey, J., Ross, J., & Murray, E. (2013, May). The effectiveness of interactive computer-based interventions for sexual problems in adults: A systematic review. Poster presentation at the International Society for Research on Internet Interventions (ISRII), 6th Scientific Meeting, Chicago, USA. 5 Contents Page Declaration ................................................................................................................... 2 Acknowledgements ....................................................................................................... 3 Abstract ........................................................................................................................ 4 Conference presentations ............................................................................................. 5 List of Tables .............................................................................................................. 11 List of Figures ............................................................................................................. 14 Abbreviations and Glossary ........................................................................................ 16 Chapter 1 Introduction ................................................................................................ 19 1.1 Chapter overview .......................................................................................... 20 1.2 Sexual difficulties .......................................................................................... 21 1.3 Why are sexual difficulties worth studying? ................................................... 21 1.4 Prevalence .................................................................................................... 22 1.5 Harms resulting from sexual difficulties ......................................................... 23 1.6 Available treatments and their impact............................................................ 24 1.7 Evidence of effectiveness.............................................................................. 26 1.8 Evidence of unmet need ............................................................................... 26 1.9 IDIs ............................................................................................................... 27 1.10 Advantages of IDIs ........................................................................................ 28 1.11 Disadvantages of IDIs ................................................................................... 28 1.12 Evidence of effectiveness (in other areas of physical and mental health) ...... 28 1.13 Evidence of effectiveness (in sexual difficulties) ............................................ 29 1.14 Gaps in the evidence .................................................................................... 29 1.15 Effectiveness ................................................................................................. 29 1.16 Potential reach and user characteristics ........................................................ 30 1.17 Acceptability .................................................................................................. 30 1.18 A health service research perspective ........................................................... 30 1.19 Rationale for choice of methods .................................................................... 31 1.20 Overall aim .................................................................................................... 31 Chapter 2 What are sexual difficulties? An introduction and literature review .............. 33 2.1 Chapter overview .......................................................................................... 34 2.2 What do we mean by sex and sexuality? ...................................................... 35 6 2.3 The importance of sex and sexuality ............................................................. 35 2.4 Sexual motivation and expectations .............................................................. 35 2.5 A brief history of the scientific study of sex and sexual difficulties
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