Browsing by Author "Mitchell, Kirstin R."

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    Development and Validation of a Brief Measure of Sexual Wellbeing for Population Surveys: The Natsal Sexual Wellbeing Measure (Natsal-SW)
    (Taylor & Francis, 2025) Mitchell, Kirstin R.; Palmer, Melissa J.; Lewis, Ruth; Bosó Pérez, Raquel; Maxwell, Karen J.; MacDowall, Wendy; Reid, David; Bonell, Chris; Mercer, Catherine H.; Sonnenberg, Pam; Fortenberry, J. Dennis; The Natsal-4 team; Pediatrics, School of Medicine
    Sexual wellbeing is an important aspect of population health. Addressing and monitoring it as a distinct issue requires valid measures. Our previous conceptual work identified seven domains of sexual wellbeing: security; respect; self-esteem; resilience; forgiveness; self-determination; and comfort. Here, we describe the development and validation of a measure of sexual wellbeing reflecting these domains. Based on the analysis of 40 semi-structured interviews, we operationalized domains into items, and refined them via cognitive interviews, workshops, and expert review. We tested the items via two web-based surveys (n = 590; n = 814). Using data from the first survey, we carried out exploratory factor analysis to assess and eliminate poor performing items. Using data from the second survey, we carried out confirmatory factor analysis to examine model fit and associations between the item reduced measure and external variables hypothesized to correlate with sexual wellbeing (external validity). A sub-sample (n = 113) repeated the second survey after 2 weeks to evaluate test–retest reliability. Confirmatory factor analysis indicated that a “general specific model” had best fit (RMSEA: 0.064; CFI: 0.975, TLI: 0.962), and functioned equivalently across age group, gender, sexual orientation, and relationship status. The final Natsal-SW measure comprised 13 items (from an initial set of 25). It was associated with external variables in the directions hypothesized (all p < .001), including mental wellbeing (0.454), self-esteem (0.564), body image (0.232), depression (−0.384), anxiety (−0.340), sexual satisfaction (0.680) and sexual distress (−0.615), and demonstrated good test–retest reliability (ICC = 0.78). The measure enables sexual wellbeing to be quantified and understood within and across populations.
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    What is sexual wellbeing and why does it matter for public health?
    (Elsevier, 2021-08) Mitchell, Kirstin R.; Lewis, Ruth; O'Sullivan, Lucia F.; Fortenberry, J. Dennis; Pediatrics, School of Medicine
    Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.