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Understanding Heterosexual Mature Adult Protective Sexual Behaviours

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Understanding Heterosexual Mature Adult Protective Sexual Behaviours BACK ON THE MARKET: UNDERSTANDING HETEROSEXUAL MATURE ADULT PROTECTIVE SEXUAL BEHAVIOURS Natalie Erin Bowring Master of Public Health (Health Promotion) Bachelor of Mass Communication Submitted in fulfilment of the requirements for the degree of Master of Business (Research) School of Advertising, Marketing and Public Relations QUT Business School Queensland University of Technology 2020 STATEMENT OF ORIGINAL AUTHORSHIP The work contained in this thesis has not been previously submitted to meet requirements for an award at this or any other higher education institution. To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made. Signature: QUT Verified Signature Date: 30/06/2020 i ABSTRACT Sexual health continues to be a socially complex problem in Australia with sexually transmitted infections (STIs) such as chlamydia, gonorrhoea and syphilis rates continuing to rise despite extensive government and social marketing initiatives (Firestone, Rowe, Modi, & Sievers, 2017). The number of over-50s contracting chlamydia, gonorrhoea and syphilis has nearly doubled in Queensland over the past four years increasing form 541 reported STIs to 1,078 cases in 2017 (National Notifiable Diseases Surveillance System, 2020). Heterosexual Mature Adults (HMAs) aged 50 years and older have a distinctive life history which has resulted in a consumer market that is confident in who they are and what they want from sexual experiences but have little awareness of the changing health environment (DeLamater & Koepsel, 2015; Marshall, 2011a; Quine, Bernard, & Kendig, 2006). These adults are therefore re-entering the dating market with liberal sexual attitudes, limited risk perceptions and possibly no experience of condom use or negotiation (Gewirtz-Meydan et al., 2019). Current social marketing interventions ignore this growing group of consumers and instead focus on youth, homosexual, indigenous and ethnic minorities as they are incorrectly deemed more likely to engage in higher risk sexual behaviours (Dimbuene, Emina, & Sankoh, 2014). Evidence demonstrates that condoms are not designed for use by mature consumers who have physiological barriers that decrease positive experiences of condom use (Messelis, Kazer, & Gelmetti, 2019b). Traditionally sexual health and social marketing condom interventions focus on individual insights and the social psychological barriers with little understanding of the mature customer experience. This dominant emphasis in practice and scholarship on individual behaviour reveals a significant gap in the social marketing literature pertaining to condom use. Specifically little is known about the lived customer experience of condom use by HMAs and the complexity of shared experiences (Johnston & Kong, 2011; Palmer, 2010). This research aimed to understand how psychosocial scripts influence condom use behavior and how lived experiences contribute to the success or failure of condom use behaviour. ii A qualitative research method was selected where social reality is constructed thorough subjective and consensual meanings (Denzin & Lincoln, 2011). This perspective focuses on understanding the construction of knowledge and local truths within a specific culture and or context (Yilmaz, 2013). A purposeful national sample of 24 adults aged 50 years and older who self-identified as heterosexual and were not in a committed relationship were invited to participate. There was an even distribution of males and females within the sample and their ages ranged between 50-70 years old. Due to the sensitive nature of the topic a semi-structured interview approach with the use of projective bubble drawings was used allowing exploration of intimate thoughts and feeling in a painless unobtrusive way (Donoghue, 2000). The process elicited rich data on the complexity of sexual experiences and how the customer experience of condom use connects to their anticipated experience and sexual outcome. Thematic analysis of verbal transcripts and visual data was conducted using NVivo and followed an inductive deductive approach (Fereday & Muir-Cochrane, 2006). The analyses revealed that the purpose of having sex (connection, desire and gratification) was the key determinate of condom use by HMAs and that their lived experiences underpin the positioning and practice of condom use behaviour. The theoretical contributions of this research include: 1) the customer experience elements of condom use form the process and outcome of the behaviour, 2) the value spheres framework has been extended to include the shared sphere and 3) the Anti-Experience: products and services that inhibit or distort the experiential objective. This research provides valuable insights on HMA sexual behaviours and understanding of complex behavioural experiences that involve more than one person. It also provides potential strategies to enable social marketers and sexual health partitioners to develop effective and efficient interventions to increase condom usage by mature consumer markets. Key words: Social marketing, customer experience, sexual health, heterosexual mature adults, shared sphere, anti-experience, value, condom use. iii ACKNOWLEDGEMENTS I dedicate this thesis to my late grandfather Dr. Alywn Galwey a lifelong learner and supporter of higher education. I would firstly like to sincerely thank my principle supervisor, Professor Rebekah Russell Bennett for going on this very long but rewarding journey. Your faith, guidance and encouragement has made this thesis possible. You have presented me with invaluable and unique opportunities, and I cannot thank you enough. Dr Sven Tuzovic thank you for coming on board as my associate supervisor and reading my drafts and providing supportive and timely feedback. I would also like to thank Adjunct Professor Judy Drennan who started on this journey with me and literally got to sail off into the sunset. Your enthusiasm, passion and support were instrumental in shaping this work. To my friends Sandy Sergeant, Nicholas Grech, Jenna Campton, Libby Horwood and Christine Pike thank you for your support and suffering with me. Thank you for letting me use you as sounding boards, coffee dates and distractions. I would have truly lost my mind without you. To my little study buddies Bella and Paddy your furry faces and companionship during the hours and hours stuck at the computer is greatly appreciated. Mable you were only a distraction. Finally, I must express my very profound gratitude to my parents Nigel and Darolyn Harris and to my husband Paul and daughter Abigail for providing me with unfailing support and continuous encouragement throughout my years of study and through the process of researching and writing this thesis. This accomplishment would not have been possible without you. Thank you. iv Table of Contents Statement of Original Authorship ............................................................................................ i Abstract ................................................................................................................................... ii Acknowledgements ................................................................................................................ iv List of Figures ....................................................................................................................... vii List of Tables ......................................................................................................................... ix Glossary of Terms ................................................................................................................... x Chapter 1: Introduction ...................................................................................... 1 1.1 Sexual Health a Socially Complex Problem ................................................................. 2 1.2 Context: Protective Sexual Behaviours and Heterosexual Mature Adults ..................... 4 1.3 Sexual Health and Heterosexual Mature Adults ............................................................ 6 1.4 Research Gaps and Research Questions ........................................................................ 7 1.5 Theoretical Frameworks ............................................................................................... 8 1.6 Scope of Thesis ........................................................................................................... 10 1.7 Research Design ......................................................................................................... 11 1.8 Contribution to Theory and Practice ........................................................................... 11 1.9 Chapter Summary and Thesis Outline......................................................................... 13 Chapter 2: Literature Review ........................................................................... 14 2.1 Introduction ................................................................................................................ 14 2.2 Disciplinary Lens ........................................................................................................ 14 2.3 Social Marketing Lens ................................................................................................ 16 2.4 Sexual Health Lens ..................................................................................................... 17 2.5 In Bed Together: Social Marketing and Sexual Health ..............................................
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