Abstract
Background: Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been undertaken decennially since 1990 and provide a key data source underpinning sexual and reproductive health (SRH) policy. The COVID-19 pandemic disrupted many aspects of sexual lifestyles, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the impact of COVID-19 on the nation's SRH and assessed the sample representativeness. Methods: Natsal-COVID Wave 1 data collection was conducted four months (29/7-10/8/2020) after the announcement of Britain's first national lockdown (23/03/2020). This was an online web-panel survey administered by survey research company, Ipsos MORI. Eligible participants were resident in Britain, aged 18-59 years, and the sample included a boost of those aged 18-29. Questions covered participants' sexual behaviour, relationships, and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British general population. Participants meeting criteria of interest and agreeing to recontact were selected for qualitative follow-up interviews. Comparisons were made with contemporaneous national probability surveys and Natsal-3 (2010-12) to understand bias. Results: 6,654 participants completed the survey and 45 completed follow-up interviews. The weighted Natsal-COVID sample was similar to the general population in terms of gender, age, ethnicity, rurality, and, among sexually-active participants, numbers of sexual partners in the past year. However, the sample was more educated, contained more sexually-inexperienced people, and included more people in poorer health. Conclusions: Natsal-COVID Wave 1 rapidly collected quasi-representative population data to enable evaluation of the early population-level impact of COVID-19 and lockdown measures on SRH in Britain and inform policy. Although sampling was less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022).
Highlights
Britain’s National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been undertaken decennially since 1990 and provide a key data source underpinning sexual and reproductive health (SRH) policy
Qualitative follow-up Semi-structured qualitative follow-up interviews were conducted with 45 selected Natsal-COVID participants to explore three types of experience reported in the survey, chosen for their public health importance: (1) sexual contact with someone living outside their household, (2) needing, but being unable to access SRH services, and (3) increased arguments and reduced support from their partner since lockdown
Natsal-COVID is a large, national study that was rapidly undertaken in Britain at a time when data were urgently required to understand the impact of the pandemic for SRH clinical and public health policy and decision-making
Summary
Methodology of Natsal-COVID Wave 1: a large, quasirepresentative survey with qualitative follow-up measuring the impact of COVID-19 on sexual and reproductive health in Britain [version 1; peer review: 1 approved with reservations]. Dema 1, Andrew J Copas[1], Soazig Clifton[1,2], Anne Conolly 1,2, Margaret Blake[3], Julie Riddell[4], Raquel Boso Perez 4, Clare Tanton 5, Chris Bonell[5], Pam Sonnenberg 1, Catherine H Mercer[1], Kirstin R Mitchell4*, Nigel Field1*.
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