Why GOALS?
There are missed opportunities…
1
6%
of primary care providers take a sexual history at every visit
55%
take a sexual history as part of the annual exam
76%
take a sexual history if relevant to the chief complaint
Sexual health is a priority for patients
2,3
85%
of patients report wanting to talk about sexual health concerns with their providers
71%
said primary care providers should ask all patients if they have sexual health concerns
68%
reported fear of embarrassing their provider as a reason for not broaching sexuality
The GOALS framework was developed in response to four key findings from the sexual health research literature:
Universal HIV/STI screening and biomedical prevention education is more beneficial and cost-effective than risk-based screening
1.
4,5
Emphasizing benefits—rather than risks—is more successful in motivating patients toward prevention and care behavior
2.
6-8
Positive interactions with healthcare providers promote engagement in prevention and care
3.
9-11
Patients want their healthcare providers to talk with them about sexual health
4.
2,3
Wimberly YH, Hogben M, Moore-Ruffin J, et al. Sexual history-taking among primary care physicians. J Natl Med Assoc 2006;98(12):1924-1929. [PMID: 17225835] https://pubmed.ncbi.nlm.nih.gov/17225835
1
Marwick C. Survey says patients expect little physician help on sex. Jama 1999;281(23):2173-2174. [PMID: 10376552] https://pubmed.ncbi.nlm.nih.gov/10376552
2
Ryan KL, Arbuckle-Bernstein V, Smith G, et al. Let's talk about sex: A survey of patients' preferences when addressing sexual health concerns in a family medicine residency program office. PRiMER 2018;2:23. [PMID:
32818195] https://pubmed.ncbi.nlm.nih.gov/32818195
3
Eckman, M. H., Reed, J. L., Trent, M., & Goyal, M. K. (2021). Cost-effectiveness of sexually transmitted infection screening for adolescents and young adults in the pediatric emergency department. JAMA pediatrics,
175(1), 81-89.
4
Keenan, M., Thomas, P., & Cotler, K. (2020). Increasing sexually transmitted infection detection through screening at Extragenital sites. The Journal for Nurse Practitioners, 16(2), e27-e30.
5
Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. Psychol Bull 2014;140(2):511-543. [PMID: 23731175]
https://pubmed.ncbi.nlm.nih.gov/23731175
6
Schüz N, Schüz B, Eid M. When risk communication backfires: randomized controlled trial on self-affirmation and reactance to personalized risk feedback in high-risk individuals. Health Psychol 2013;32(5):561-570.
[PMID: 23646839] https://pubmed.ncbi.nlm.nih.gov/23646839
7
Weinstein ND, Klein WM. Resistance of personal risk perceptions to debiasing interventions. Health Psychol 1995;14(2):132-140. [PMID: 7789348] https://pubmed.ncbi.nlm.nih.gov/7789348
8
Flickinger TE, Saha S, Moore RD, et al. Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr 2013;63(3):362-366. [PMID: 23591637] https://pubmed.ncbi.nlm.nih.gov/23591637
9
Alexander JA, Hearld LR, Mittler JN, et al. Patient-physician role relationships and patient activation among individuals with chronic illness. Health Serv Res 2012;47(3 Pt 1):1201-1223. [PMID: 22098418]
https://pubmed.ncbi.nlm.nih.gov/22098418
10
Bakken S, Holzemer WL, Brown MA, et al. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in
persons with HIV/AIDS. AIDS Patient Care STDS 2000;14(4):189-197. [PMID: 10806637] https://pubmed.ncbi.nlm.nih.gov/10806637
11