Use of a staff administered structured questionnaire to identify relevant life-style issues and social-health determinants in a sexual and reproductive health service.

OBJECTIVE: To evaluate a staff-administered questionnaire to identify life-style issues and social-health determinants. DESIGN: Structured questionnaire administered by a health professional after dealing with the primary reason for attendance. SETTING: Community-based UK sexual and reproductive health service. POPULATION: First 1329 selected clinic patients comprising 1018 women attending Family Planning and 161 women plus 150 men attending Genitourinary Medicine; 47% were aged under 25. MAIN OUTCOME MEASURES: Identification of relevant health-risk taking, life-style issues, and unaddressed health concerns. Participants were offered appropriate support, information and referrals. RESULTS: Two hundred and sixty-four (23%) of the Family Planning women and 83 (52%) of the Genitourinary Medicine women [plus 103 (69%) of the men] reported two or more sexual partners in the last year. A third of participants denied regular condom use. Six per cent of women and 5% of men questioned had previously been forced to have sex. Eleven per cent of men admitted to having paid for sex and 9% of women disclosed physical assault (one-quarter in the home). Eight per cent of women and 7% of men had unresolved issues relating to previous miscarriage, termination, or stillbirth. CONCLUSIONS: It is possible to identify relevant life-style issues and social determinants of health during routine practice using a staff-administered questionnaire. The resulting information may not otherwise have been disclosed and may impact significantly on health and care delivery. The information collected provides opportunities for both individuals and service planners to address wider health needs.

The Sandyford Initiative: creating added value to health and health care.

The Sandyford Initiative in Glasgow brings together Family Planning, Genitourinary Medicine and the Centre for Women's Health in a new partnership which aims to provide integrated health and social care in a manner which reflects a social model of health. The Steve Retson Project for Gay Men's Sexual Health is also situated within the Sandyford, providing clinical services within the context of a social model of health. The Initiative is managed by the Greater Glasgow Primary Care NHS Trust but has been developed as a result of joint working between three main services, Greater Glasgow Health Board, Glasgow City Council and a number of voluntary organisations. By working to a social model of health, the intention is to ensure that the detection and management of health problems takes into account the social and economic determinants of health and that the provision and practice of health care reflects the social needs of the user. As such the Initiative is expected to make a significant contribution to the sexual health of men and women and the general and reproductive health of women in the Greater Glasgow area and beyond. The core of the Initiative is housed in premises tailored to the needs of the services and their users although satellite services are being planned. In addition to the core clinical and non-clinical care there are services designed to respond to the needs of specific groups such as young people, black and ethnic minority communities and disabled people, in order to improve access and uptake by previously marginalised groups. It is recognised that often the relationship between health and social service providers and their users becomes strained. Implementation of the Sandyford Initiative is intended to inspire confidence and contribute effectively to improving health and managing complex health problems.

A community based lesbian sexual health service - clinically justified or politically correct?

Lesbian sexual health care is still a neglected issue. In order to address this, a needs assessment was carried out in Glasgow amongst the lesbian community and 200 responses were received. More than 40% of the respondents said they were unable to disclose their sexual orientation to their GP and were unable to discuss sexual health issues with them. Eighty-one percent said there was a need for a lesbian sexual health service and 71% said they would use such a service if it existed. Therefore a pilot clinic was set up in Glasgow and was co-ordinated by a multidisciplinary advisory group. The clinical component of the service was audited and it was found that gynaecology and fertility issues were the most common presenting condition (52%), followed by psychosocial issues (26%). Genitourinary problems, such as vaginal discharge, constituted 20% of presentations. Client satisfaction with the clinic was high. This pilot service showed that areas of sexual health care, such as the need for inclusion in cervical smear programmes and equality of access to assisted conception, are issues which are important to this minority group and which need to be addressed. The clinic is now ongoing as a result of the pilot scheme and is the only family planning based lesbian health service in the UK.

Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services.

OBJECTIVE: To evaluate client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services. METHODS: Evaluation involved questionnaire survey of clients and staff, one-to-one interviews with staff and review of routinely collected clinical activity data. RESULTS: The integration of the three services led to a reduction in stigma associated with attending sexual health services. Despite some staff concerns, the number of men attending the services did not decrease. There was increased satisfaction with the new service, especially the quality of facilities. There were increased numbers of referrals between clinical services in the Sandyford Initiative. CONCLUSIONS: Sexual, reproductive and women's services can be integrated to provide improved facilities for clients.