Stage 2 – Surveys

Based on analysis of the interview data and relevant background literature, two surveys were constructed. The Promotion Survey focused on student leaders who either currently, or potentially could, play a role in sexual health promotion in Australian universities. The Student Survey investigated current university students’ experiences with sex and sexual health promotion, using the Australian National University as a case study.

3.4.2.1 The Promotion Survey

The Promotion Survey (distributed as the University Sexual Health Promotion Survey) targeted peer educators and other student leaders from universities across Australia. While the interview stage was a productive means of establishing the topics and issues that were most relevant to investigate for peer educators, its impact was limited by its geographic specificity. As all those peer educators who chose to participate came from a single university in the ACT, there was the potential that these participants would not fully reflect the diversity of sexual health promotion in Australian universities. While there were considerable differences between the interview participants, their proximity and shared university guidelines made it far more likely that they would face similar issues and adopt similar approaches.

In order to rectify this issue and ensure that responses were truly representative of peer educators from a range of Australian universities, a survey was developed based on preliminary analysis of the interview responses and relevant literature. The orienting concepts, as per Layder’s (1998b) approach, included university groups, student leaders, sexual health, collaboration and training, success and failure and participation. This survey was then piloted with five students and colleagues for clarity and to ensure the survey fit

within the twenty minutes described in the participant information. To distribute the Promotion Survey, a list of 304 potentially relevant campus groups across Australia was compiled by searching for accommodation, student associations/unions and queer groups for each Australian university. Notable exclusions were Ally programs (which generally include a majority of heterosexual and cisgender “allies” rather than self-identified LGBTI students), accommodation that wasn’t solely student focused and accommodation that only had a number for leasing enquiries and no other contact information.

Initially, these organisations were called rather than emailed in an attempt to facilitate finding relevant peer educators to contact. However, as the contact details provided for accommodation were most commonly for administrative staff rather than student services, this approach was unsuccessful. Some university accommodation services had a blanket policy against outside surveys, resulting in the exclusion of University of Technology Sydney and Monash University students. In the other universities, staff seemed hesitant to forward on a survey that was related to sex and this concern was no doubt exacerbated by the fact that initially the survey would disqualify anyone who said they weren’t a student with a role related to sexual health. This resulted in four of the first six responses being disqualified, and without being able to see the survey themselves, it is understandable that staff would be unwilling to pass it on. It was also difficult to explain the number of roles that could be relevant to the survey, given the different position titles that are used across Australian universities.

To remedy these issues, a new approach was devised with emails that stressed that the survey did not ask any questions about the sexual behaviour of the participants and was focused on how student leaders (not necessarily those in roles solely focussed on sexual health) could teach other students about sexual health. The email was also designed to be appropriate for both staff members wanting information and students wanting to participate, in order to facilitate dispersal by making it as simple as forwarding the initial email. While the majority of cases were first contacted by email, some instances (such as only having one general contact listed for multiple residences) were still contacted by phone to find out the most appropriate email contact.

Alongside these changes to the contact method, the survey was also altered slightly so that instead of disqualifying staff members and students who did not have a role in sexual health promotion, it simply split them into different categories. This resulted in a much more positive response rate, with 100 submissions collected, and allowed staff members’ results to be excluded from the analysis in order to focus on the experiences of students. The survey was open from Wednesday 29/10/2014 and closed on Friday 28/11/2014 and the final version is included in Appendix B.

3.4.2.2 The Student Survey

The Student Survey (circulated as the Sex and Health Survey) was distributed to a random stratified sample of 2998 students from the Australian National University as an approved, non-core survey via email from the Planning and Performance Measurement Division. Although the Promotion Survey drew from many universities across Australia, the Student Survey was only distributed at the Australian National University, which has a single main campus. This approach was taken in order to make use of randomised email deployment and avoid the selection bias of user-shared surveys. An illustration of the impact of the latter dispersal method can be seen in two recent Australian studies. In these surveys 30% of respondents identified as LGBTI despite 97% of men and 96% of women in Australia considering themselves to be heterosexual in a nationally representative survey (Adam et al., 2011; Giordano and Ross, 2012; Richters et al., 2014). While men who have sex with men have indeed been identified as a priority population in need of special attention in the context of sexual health (Australian Government Department of Health, 2014), the Student Survey was focussed on finding the most accurate representation of university students as a whole. For the same reason, the email invitation and the survey both made it clear that prior sexual experience was not necessary to take part in the survey. The Student Survey was open from the 26/03/2015 and closed on 30/04/2015. The initial invitation to participate was sent on 26/03/2015 and one reminder was sent on 23/04/2015.

Prior to sending, the survey was piloted with five students and colleagues for clarity and to ensure the survey fit within the five to ten minute timeframe described in the participant information. This short time frame was chosen to try and maximise the number of responses to the survey, and was considered especially important given that there was no

incentive associated with completion. Partly for this reason, and partly to minimise potential discomfort regarding sexual content, the survey made extensive use of skip logic to pass over irrelevant questions. For instance, respondents who said they had never had sexual experiences were not asked any of the questions relating to sexual acts. The survey included four main types of questions based on a series of orienting concepts as described by Layder (1998b). These orienting concepts were based on the results from previous interviews with peer educators and professionals and from the relevant literature. The concepts included sexual health education experiences, barriers to and incentives for participating, sexual behaviour and STI testing. In the survey students first answered basic demographic information such as age, gender, sexual orientation and whether they were a domestic or international student. The second section of the survey investigated their previous sexual experiences, including numbers of previous sexual partners and use of contraception. The third section asked about the student’s experiences with sexual health testing and facilitators and barriers to access. The fourth looked at sexual health promotions, including preferences, previous exposure to high school sexual health education and participation in university programs.

Many of the questions in the survey were based on those used in the Australian Study of Health and Relationships (de Visser et al., 2003). While not targeted specifically towards university aged students, these methods were appropriate to draw on as they allowed for comparison between Australian university students and the broader Australian population. For instance, the two timeframes chosen for the number of sexual partners (lifetime and within the past 12 months) were used in order to make this data easily comparable with the relevant age groups from the recent second Australian Study of Health and Relationships (Grulich et al., 2014a; Rissel et al., 2014).

For a number of questions the survey asked what happened at the last instance of an event rather than what “usually” happened. For example, instead of asking how frequently participants used condoms during intercourse, the survey asked “did you use a condom the last time you had sex…?” In this particular case the use of “condom use at last sex” is widely accepted within sexual health research and has been found to be a suitable proxy for use over longer periods (Younge et al., 2008). Additionally, using the “at last instance” approach allows a good representation of usual sexual behaviour with less impact from faulty

memory, provided a large enough sample is used (Rissel et al., 2014). The complete list of questions is included in Appendix C.

One of the complicating factors in designing the survey was attempting to create options that were relevant to a broad variety of sexual orientations and practices without overwhelming respondents with unnecessary detail. While ‘having sex’ may seem like a simple term, it is well established within sex research that different individuals will have different personal definitions of what sex entails (Schick et al., 2015). For example, while over 94.8% of respondents to an American survey considered penile-vaginal intercourse as sex, 72.9% of the respondents also considered receiving oral sex as having sex (Sanders et al., 2010). Similarly in Australia, 65.7% of respondents to the second Australian Study of Health and Relationships agreed that they would describe two people who had oral sex as having had sex (de Visser et al., 2014c). Finding an agreed upon definition for sex is even more complicated when trying to accommodate multiple different sexual orientations within the same survey. To take just one example, women are likely to define a broader range of behaviours as constituting sex when performed with another woman than with a man (Schick et al., 2015). As the Student Survey asked about sex and oral sex as distinct categories, this may have been a point of confusion for women who have sex with women. This could be avoided in future surveys through more extensive use of skip logic. However it is unlikely to have impacted outcomes within this thesis as the main measure of partner numbers (denoting higher or lower risk respondents) was based on a minimum of partners for either intercourse or oral sex rather than using only one of those categories.

As the diverse nature of university student groups creates different needs, the results were analysed in four sections, to align with research question two: “How can university sexual health promotion events better reach different groups of students?” Each section focused on a demographic that was found to have notably different needs according to interview respondents and the literature. These sections were focused around the following comparisons: higher and lower risk status (based on number of sexual partners), international and domestic students, LGBTI and heterosexual cisgender respondents, and female and male students. Statistical analysis was performed using SPSS software. Chi square tests were used to determine statistically significant differences (p < 0.05) between groups. For responses where there were matching data sets showing what students wanted

compared to what was being offered, each student sub-group was individually compared with the event responses from the Promotion Survey. For questions where event responses were not available (such as student motivations to attend events), comparisons were made directly between the student sub-groups.