Sex Transm Infect: first published as 10.1136/sextrans-2020-054822 on 12 April 2021. Downloaded from http://sti.bmj.com/ on April 26, 2021 at UCL Library Services. Protected by copyright. - - - - - - 1 ). 1 25,26 22 sentative sentative figure 29 5 10 repre 14 The purpose of The sented, such as as such sented, These surveys often often surveys These 23 24 1,30 invite individual partic invite individual repre 7–14 Lale Say, Nicole Prause, 4 21 Additionally, most existing most existing Additionally, Nathalie Bajos, 17 13 17 Ariane van der Straten, Ariane van ated outcomes focus on high- focus outcomes ated 13 Alice Welbourn, However, these instruments go go instruments these However, rel Also, social acceptance and cultural cultural and acceptance social Also, 13 ome countries (LMICs), some key key some (LMICs), countries ome and improve sexual health systems. systems. health sexual and improve onal comparison difficult. In low- and and In low- difficult. comparison onal 6 Chimaraoke Izugbara, Chimaraoke 15 16 inc 18–22 8,9 nati Chantal Smith, Joseph D Tucker Joseph D ome countries (HICs). countries ome 5 Juliana Anderson, 20 Many national population- national Many middle- use different sexual health measures, making making measures, health sexual different use cross- national standardised in captured are indicators Health and Demographic the as such surveys, Cluster Indicator Multiple and (DHS) Surveys Surveys. understand social norms related to gender and and gender to related norms social understand sexuality, inc However, such data on sexual health are limited. are health on sexual data such However, behaviours practices, sexual assessing surveys health- and cators on sexuality. cators beyond sexual behaviours and collect few indi few collect and behaviours sexual beyond METHODS Three key methods were employed including a crowdsourcing for ideas, a hackathon and open call ( exercise Delphi iterative modified an ipants or groups with a wide range of backgrounds to offer a solution, identify solutions and share community. the wider with Crowdsourcing open calls survey instruments were created by experts by experts created were instruments survey from LMIC feedback limited HICs with from subgroups Certain or communities. researchers under- particularly are disa with and people minorities sexual women, bilities. beliefs towards sexual health and practices vary vary practices and health sexual towards beliefs Thus, groups. social and regions geographical by health sexual for a domains of key priorities Further countries. across greatly differ survey varies, collection data of means to access more, espe instruments of long administration making These settings. LMIC some in difficult cially consulta expert for global need a indicate issues should measures what on a consensus to seek tion instrument health sexual global in a included be implementation. on its guidance and the crowdsourcing open call was to solicit survey was to solicit the crowdsourcing open call 2,3 Soazig Clifton, Meggie Mwoka, Peter Muriuki, Peter 16 28 - , 24 Evelyn Gitau, 12 better better 3–5 Chelsea Morroni, 7 representative Megan L Srinivas, Amanda Gesselman, 1 . We present a We . a hackathon, and a a hackathon, as achieved through an The inclusive process The sentative data can help help can data sentative national comparative data national comparative level sexual health income countries (LMICs), income countries (LMICs), Lianne Marie Gonsalves, 18,19 Kathryn A O’Connell, Kathryn , 17 Wendy V Wendy Norman Jennifer T Erausquin, Jennifer Georgina Y Oduro, Georgina 27 repre 15 23 11 Dan Wu, Noor A Ahmad, 1 Understanding sexual practices practices sexual Understanding 6 day hackathon to harmonise a This is the first global consensus on This 1 2 income and LMICs. eing. b The brief, comprehensive sexual health brief, The step process (an open call, onal, population- onal, item consensus statement and a brief sexual health Catherine H Mercer, Richard de Visser, Martha Nicholson, Osmo Kontula, iterative, modified Delphi process that included three iterative, entire process resulted in a The rounds of online surveys. 19- identified priority domains for improvement and can inform the design of sexual and reproductive health data for comparable and contextually relevant programs research across countries. BACKGROUND health overall part of an integral is health Sexual and well- survey instrument. survey instrument. a sexual and reproductive health survey instrument that cross- can be used to generate in both high- ABSTRACT comprehensive in health surveys are rarely Population and population- addressing sexual health, sexual health survey instrument and implementation for population- considerations research. developed via a survey and consensus statement was multi- domains, The survey items, modified Delphi process). and implementation considerations entire instruments, to develop a sexual health survey were solicited via a open call received The global crowdsourcing open call. review Following 175 contributions from 49 countries. 18 finalists and eight of submissions from the open call, facilitators with expertise in sexual health research, especially in low- and middle- were invited to a 3- Consensus w survey instrument. Eneyi E Kpokiri, surveys often lack standardised measures for collecting data across countries comparable Development of an international sexual and Development of an international sexual and results from reproductive health survey instrument: WHO/HRP consultative Delphi process a pilot and behaviours are necessary to design appro to design necessary are behaviours and to monitor and populations for services priate cross- Comparable, interventions. of impact the nati of health, determinants social to address Amanda Gabster Adesola Olumide, Michele Andrasik, No . med. Day NC. use 1136/ er@ et al See rights Epub ahead 10. 054822). use. jdtuck org/ . please include Kpokiri EE, Kpokiri EE, doi 2020- dx. DW and MLS are joint first edu Additional material is To cite: cite: To Srinivas ML, Wu D, Infect Sex Transm [ of print: doi:10.1136/ Month Year]. sextrans-2020-054822 or numbered affiliations see © Author(s) (or their © Re- employer(s)) 2021. permitted under CC BY- commercial re- Published and permissions. by BMJ. Original research ► EEK, authors. LMG and JDT are CHM, NB, joint senior authors. Received 6 October 2020 2021 Revised 16 January 2021 Accepted 22 January unc. Correspondence to Correspondence School of Tucker, Dr Joseph D University of North Medicine, Carolina at Chapel Hill School NC Chapel Hill, of Medicine, 510095, USA; sextrans- F end of article. published online only. To view, view, To published online only. please visit the journal online (http:// Kpokiri EE, et al. Sex Transm Infect 2021;0:1–6. doi:10.1136/sextrans-2020-054822 Sex Transm Infect: first published as 10.1136/sextrans-2020-054822 on 12 April 2021. Downloaded from Figure 1 Key components of the consensus process. components (items, domains and instruments) and to identify Sexual Health in October 2019. The call was translated into interdisciplinary sexual and reproductive health experts to join Spanish and not other languages. At the same time, we accepted a hackathon. A hackathon or designathon is a sprint- like event contributions in all six official languages of the WHO (Arabic, that brings together individuals with diverse backgrounds to Chinese, English, French, Russian and Spanish). solve a problem.25 A hackathon can tap into participants' expe- At the end of the call, all contributions were screened for riences and expertise to generate high-quality outputs in a trans- eligibility and judged using prespecified criteria (online supple- parent and systematic way.26 The purpose of this sexual health mental file 2). The HRP open call received 175 total submissions hackathon was to harmonise entries received during the open from 49 countries, of which 59 submissions were received from call and deliberate on key items to be included in the survey, LMICs. Participants came from all six WHO regions, including aiming to assemble a draft brief sexual health survey at the end the Americas (85), Europe (38), Africa (25), Eastern Mediter- of the hackathon. Participants were told that the module needed ranean (10), Southeast Asia (10) and Western Pacific (8). We to be designed for integration with existing research infrastruc- received six entries in Spanish and two entries in French, all of ture. National surveys with existing focus on sexual practices which were translated into English for screening and judging. could incorporate this module as a part of a more extensive After initial screening, 139 unique entries were eligible for survey instrument. The module could also complement other judging. Twelve independent judges (sexual health researchers, population- based surveys. The goal average completion time leaders and officers at WHO/HRP) reviewed submissions. Of http://sti.bmj.com/ was 10 min. The intended participant is a member of the popu- 12 judges, 11 had experience with LMIC sexual health research lation aged 15 years or older. The process favoured single items and 8 were women. Judges had expertise in epidemiology, that had been used before in population surveys. demography, sociology, anthropology, clinical medicine, health The Delphi method is an iterative multistage process used behaviour and management. Each submission was reviewed by to achieve expert consensus on a subject.27 The purpose of this at least four judges and numerically scored on a 1–10 scale, 10