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RESEARCH ARTICLE (Open Access)

Co-creating inclusive sexual health services for middle-aged and older adults, including disabled people, in England: an innovative participatory approach within the field of sexual health

Hayley Conyers https://orcid.org/0000-0002-2059-0402 A # , Yoshiko Sakuma https://orcid.org/0009-0004-3751-0837 A # , Tracey Jannaway B , Alex Cowan B , Joseph D. Tucker https://orcid.org/0000-0003-2804-1181 A C , Eneyi E. Kpokiri https://orcid.org/0000-0003-1180-1439 A and Dan Wu https://orcid.org/0000-0003-0415-5467 A D *
+ Author Affiliations
- Author Affiliations

A London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

B Independent Living Alternatives, London, UK.

C University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

D Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 140 Hanzhong Road, Gu Lou Qu, Nan Jing Shi, Jiang Su Sheng 210029, China.

* Correspondence to: danwu@njmu.edu.cn

# These authors contributed equally to this paper

Handling Editor: Megan Lim

Sexual Health 22, SH25022 https://doi.org/10.1071/SH25022
Submitted: 1 February 2025  Accepted: 9 July 2025  Published: 11 August 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY)

Abstract

Background

Middle-aged and older adults, including disabled people, are rarely engaged in helping to develop sexual health services to meet their needs. We used co-creation as a promising participatory strategy to develop ideas to inform more inclusive sexual health services for middle-aged and older adults in England.

Methods

During April and May 2023, we recruited participants to take part in our co-creation workshops and interviews. The research team partnered with active community leaders with lived experience to co-design and co-organise sessions. Discussion topics were developed iteratively, centred on participant input, to ensure the sessions were accessible and appropriate for the focus population. Implementation of the co-creation workshops and one-to-one interviews was evaluated by gathering community facilitators’ reflections on how they felt about their experience as facilitators and the success of the workshops.

Reflections

Overall, co-creation activities are well-accepted and highly valuable means to engage middle-aged and older adults. We are identifying three strengths and four challenges worth noting. As for strengths, they entail: (1) shared informed decision-making; (2) co-leadership for conducting the research activities; and (3) importance of co-facilitation; and for challenges: (1) ensuring the venue/information is accessible to all; (2) recruitment of middle-aged and older adults for a stigmatised research topic; (3) need more time for co-creation sessions to make sure equal opportunity to contribute; and (4) integrating co-creation into existing community activities.

Conclusion

Co-creation is crucial for inclusive health services, but underexplored in sexual health research involving middle-aged, older and disabled individuals. This study emphasises shared ownership, which enables the offering of practical guidance for researchers and healthcare professionals.

Keywords: co-creation, disability, inclusive research, interview, middle-aged and older adults, participatory research, sexual health, social innovation.

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