Barriers and facilitators to accessing sexual health services among middle-aged and older adults in the UK, including those with disabilities: a qualitative analysis.

Physical obstacles in sexual health service settings were cited as significant barriers to access for middle-aged and older adults with disabilities.

• Specific physical barriers mentioned included narrow corridors and other structural hindrances in clinical environments.
• Physical assistance and accommodations were noted by participants as factors that could enhance accessibility.
• The study used Levesque et al.'s framework of healthcare access as a theoretical guide for analysing these barriers.
• 22 participants aged 45 and older were interviewed, including disabled people across different disability types.

Pervasive stigma surrounding sexual health in older adults was identified as a major barrier to accessing sexual health services.

• Healthcare providers were noted by participants to presume asexuality among older adults, compounding stigma-related barriers.
• Stigma was described as a 'pervasive' issue within this demographic context.
• Psychological and social barriers were identified as interconnected with stigma, requiring multi-faceted solutions.
• Sexual minorities with intersectional needs were specifically included in the study to capture overlapping stigma experiences.

Middle-aged and older adults in the UK, including disabled people and sexual minorities, experience unmet sexual health needs alongside multiple intersecting barriers to care.

• The study sample had a mean age of 59 years, with 15 men and 7 women among the 22 participants.
• Participants included people of different ethnicities (White British, Black African, and White mixed), disabilities, and sexualities.
• Recruitment was conducted via social media, primary care clinics, and community-based organisations to capture diverse experiences.
• Individual, social, and environmental issues were all identified as categories of barriers discouraging access.

Greater involvement of disabled older individuals in the co-design of sexual health services was identified as a key facilitator for improving accessibility.

• Participants advocated for a 'collaborative approach' believed to 'expedite the development of age-responsive clinical services.'
• Co-design was framed as fostering 'inclusivity and accessibility while simultaneously addressing psychological and social barriers.'
• This finding emerged through semi-structured interviews that were audio-recorded and transcribed, then analysed using thematic coding.
• Sub-themes of barriers and facilitators were mapped onto Levesque et al.'s healthcare access framework after initial coding and theme generation.

Increased healthcare provider training, further research, and supportive policies were identified as necessary steps to improve sexual health service delivery for older adults including those with disabilities in the UK.

• The authors conclude that training for healthcare providers is needed specifically to address assumptions of asexuality among older adults.
• Policy-level interventions were highlighted alongside clinical and individual-level changes.
• The study was qualitative in design with 22 participants, limiting generalisability but providing in-depth experiential data.
• The study explicitly included disabled people and sexual minorities to address intersectional needs that are often overlooked in sexual health research.