CoTSIS Study Overview

Robust population-level data on sexual heath, practices, and behaviours are needed in order to ensure adequate services are available for all persons across the life course. Issues to do with sexuality and sexual activity are often overlooked, marginalized, or neglected, and there have been few cross-country surveys of these topics, resulting in limited availability of relevant data globally.

In 2019, WHO-SRH/HRP was funded by the Wellcome Trust to review available, quality, nationally representative sexual health/practices data from around the world and determine what was needed to improve existing—and generate new—data. In June 2019, HRP convened a meeting of experts in sexual health research and data analysis, as well as experts with specific experience in conducting nationally representative surveys on sexual health/practices. Participants reviewed the available data and confirmed that heterogeneity made cross-national and global comparisons difficult. Even within well-resourced national surveys, survey leads approached identical sexual health/practices thematic areas with different questions, response options, or time-points measured.

Meeting participants identified a need for a global standard instrument for assessing sexual health-related practices and behaviours in a consistent manner. Additionally, participants indicated that other sexual health/practices researchers would benefit from a ‘go-to’ short survey instrument, with standardized items that could be incorporated into their study instruments. As a result of these recommendations, a multi-stage, globally consultative process was undertaken to develop a survey instrument that would satisfy these needs.

The development of this instrument has been a collaborative, transparent process drawing on the expertise of researchers from all six WHO regions and largely using existing items from validated survey tools. Ideally, a final instrument would be able to be easily adapted with minimal content modifications between sites, so that data collected from different sites can be easily compared. However, many of these survey items were established in high-income settings. Therefore, an important next step to ensure that the final instrument has global applicability is to establish the extent to which this ‘standard’ instrument can be implemented with fidelity among general population groups worldwide.

This is a qualitative study that will use cognitive interviewing to pre-test and refine the draft survey instrument. Each of the 19 participating country sites will implement the study in the following steps: 

This study will have 19 countries participating globally, reflecting a broad range of political and cultural perceptions of sexuality and certain sexual activities and practices.