Table 2 Recommendations for inclusive sexual health research involving general populations

General

Eliminate question ambiguity by identifying the true aim of each question and the type of data you wish to collect. To achieve this, ensure questions are specific, clear and use defined time periods

Avoid language that assumes participants are heterosexual or cisgender, or that certain behaviours are ‘normal’

Use language that is culturally appropriate

Avoid forced-choice, single option items and binary categorisations where possible

Avoid skip patterns based on participants’ recorded gender or sexual identity; these require assumptions about participants’ attraction, identity, behaviour and genitals

Routinely update questions based on cultural changes, feedback and relevant research while still considering data comparability across time

Consult with GSD people and organisations if unsure of best wording of questions – avoid making assumptions

Check relevancy and appropriateness of questions, particularly if space or your budget is limited, and aim to balance these considerations with making language as inclusive as possible

Be aware of your own biases and knowledge limitations as a researcher

Carefully consider all recommendations within the context of the research (including location and audience)

Gender/sex

Determine whether your research is interested in sex assigned at birth, gender identity, neither, or both

If interested in sex and gender, consider a two-step process, i.e., asking for sex and gender separately

When asking for participants’ gender identities, use open-ended or free text options if possible. If free-text is not an option, ensure options are more diverse than ‘female’ and ‘male’. Include recognition of transgender participants, non-binary/genderqueer participants, and other gender identities. Allow selection of multiple options or be specific with wording

Ensure gender/sex questions are optional

Avoid treating gender as binary (male/female) throughout the survey, including avoiding language implying a binary such as ‘both genders’ or ‘opposite sex’

Avoid conflating gender and sex and be consistent with terminology

Ask about intersex variations separately from sex and gender

Sexual orientation

Consider sexual orientation in terms of identity, attraction and behaviour, if relevant

When asking about sexual identity, use open-ended or free text options where possible. If free-text is not an option, avoid ‘othering’ participants by including a range of sexual identities and options such as ‘I don’t know’ or ‘I don’t label myself’.

Consider selection of multiple identities

Sexual behaviour

Avoid defining ‘sex’; instead, be specific to the sexual behaviour of interest

Clearly identify when questions are referring to STI transmission risk, risk of pregnancy, or other objectives

Consider appropriate skip patterns for questions that may be irrelevant to participants based on previous response patterns (this will also help reduce participant fatigue)

Consider respectful and appropriate inclusion of sexual behaviours beyond penetrative sex