A New Measure of Sexual Wellbeing for Community Surveys: Development and Validation of the The Natsal-SW

Background: Sexual wellbeing is intrinsic to public health but long-standing conflation of sexual health and sexual wellbeing has limited our ability to address everyday sexual issues. This study proposed a seven-domain model, and developed and validated a brief measure for community surveys. Method: Domains of sexual wellbeing were determined through critical engagement with wide-ranging literature and 40 semi-structured interviews to explore resonance with lived experiences. Measure development involved 7 cognitive interviews and two web-based surveys of general population samples (n=590, n=814), to assess performance of individual items, conduct exploratory and confirmatory factor analysis, and examine whether the resultant measure was associated with external variables as hypothesised. A sub-sample (n=113) completed the survey again after two weeks to test re-test reliability. Results: We proposed seven domains of sexual wellbeing: security and safety; respect; self-esteem; resilience; forgiveness of past sexual experiences; self-determination and comfort. Semi-structured interviews confirmed the relevance of these domains to lived experiences of sex and sexuality. Drawing on the semi-structured and cognitive interviews we drafted a 25-item measure to capture these domains. Based on individual item assessment and exploratory and confirmatory factor analyses, we trimmed the measure to 13-items. The 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 groups, genders, sexual orientation and relationship status. The final measure was associated with external variables in the directions hypothesised (all p<0.001), including sexual functioning (coefficient = 0.924), mental wellbeing (0.454), self-esteem (0.564), sexual esteem (0.563), 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). Conclusion: Our conceptual model and 13-item measure distinguishes sexual wellbeing from sexual health and enables sexual wellbeing to be quantified and understood within and across populations