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Context. Volunteer involvement may support organizations to initiate and operationalize complex interventions such as advance care planning (ACP). Objectives. A scoping review was conducted to map existing research on volunteer involvement in ACP and to identify gaps in current knowledge base. Methods. We followed the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines. The review included studies of any design reporting original research. ACP was defined as any intervention aimed at supporting people to consider and communicate their current and future health treatment goals in the context of their own preferences and values. Studies were included if they reported data relating to volunteers at any stage in the delivery of ACP. Results. Of 11 studies identified, nine different ACP models (initiatives to improve uptake of ACP) were described. Most of the models involved volunteers facilitating ACP conversations or advance care directive completion (n ¼ 6); and three focused on ACP education, training, and support. However, a framework for volunteer involvement in ACP was not described; the studies often provided limited detail of the scope of volunteers' roles in ACP, and in three of the models, volunteers delivered ACP initiatives in addition to undertaking other tasks, in their primary role as a volunteer navigator. Increased frequency of ACP conversation or documentation was most commonly used to evaluate the effectiveness of the studies, with most showing a trend toward improvement. Conclusions. Current literature on volunteer involvement in ACP is lacking a systematic approach to implementation. We suggest future research should focus on person-centered outcomes related to ACP to evaluate the effectiveness of volunteer involvement.

Purpose There is a growing body of research into the utilisation of social networking sites (SNS) by alcohol marketers, but less research into how young people utilise SNS to create their own meanings of, and interactions with, alcohol. The purpose of this study was to explore young adults’ perceptions of the nexus between alcohol and SNS. Design/methodology/approach In total, 60 adults aged 18-21 years took part in an intensive data collection process over six months. All references to social media in the interviews, focus groups and written introspections were compiled and analysed. Findings Results showed social media use stimulates alcohol consumption and alcohol consumption stimulates social media use. Four main themes emerged: social engagement, identity, drinking culture and distancing. Participants reported being constantly exposed to, and often influenced by, images of their peers enjoying themselves while consuming alcohol, with little representation of negative outcomes. Research limitations/implications The relationship between SNS, social norms and drinking behaviours is complex; there is a need for further research into the dynamics of this relationship to inform social marketing interventions. Originality/value While there is a body of research into commercial references to alcohol on SNS, there is less research into the ways young people utilise SNS to create their own meanings of, and interactions with, alcohol. The consumer research that has been conducted to date has focused on quantifying references to alcohol and drinking behaviours, observing profiles or surveying users. This study addresses a key gap in the literature that is needed to inform social marketing interventions to reduce excessive alcohol consumption: when, why and how do young people post about alcohol.

ObjectiveSubstitute decision makers (SDMs) can be required to make difficult health care decisions on behalf of individuals lacking decision-making capacity. Online resources may be helpful in preparing and supporting SDMs. This study systematically explored the frequency, content and usability of Australian online resources containing health care substitute decision-making content written for consumers. MethodsIn April 2019, Google searches were conducted to identify online resources containing health care substitute decision-making content for consumers. Analysis comprised mapping resource characteristics, including target audience (individual-specific, SDM-specific, mixed) and thematic analysis of content. Usability was assessed using the Patient Education Materials Assessment Tool (PEMAT). ResultsOf the 61 resources identified, the most frequent were webpages (57%), individual-specific (43%) and those produced by government organisations (31%). Only 15 resources (24%) were written for SDMs. Content themes identified were: defining the scope of the SDM role (93%); recommended traits or characteristics of SDMs (80%); instructions or principles regarding standards for decision making (75%); duties of SDMs (70%); and supports (46%), rights (16%), barriers (8%) and benefits (5%) for SDMs. The median (interquartile range) PEMAT scores (out of 100) were 66 (27) for understandability and 60 (55) for actionability. ConclusionsSDMs have a vital role in making decisions for people lacking decision-making capacity. Online resources are a potential source of information and support for SDMs in Australia. This study identified key gaps in availability, content and usability of existing SDM resources, highlighting the need for the further development of such resources. We suggest that future resource development include SDMs in the design and evaluation processes. What is known about the topic?An aging population and a greater need for decisions to be made on behalf of others who lack capacity means that health care substitute decision-making is occurring more frequently. Appointing one or more SDMs may occur as part of the advance care planning process. However, being a healthcare SDM can be difficult and stressful. People frequently use the Internet to search for health-related information. What does this paper add?This paper systematically examined the frequency, content and usability of existing Australian online resources with substitute decision-making content written for a consumer audience in English, and identified key gaps in online resources available to support SDMs. What are the implications for practitioners?Although there is a need for resources written for SDMs, authors of online resources need to pay careful attention to the purpose, content and usability of their resource. Future resource development should include input from SDMs and involve them in evaluation to assess whether the resources meet target audience needs.

BackgroundThere are few studies investigating group sex among female sex workers (FSWs). This study aimed to examine the typical number of group sex participants, sexual activities and condom use in group sex among FSWs attending a sexual health clinic in Melbourne, Australia.MethodsWe conducted a cross-sectional survey between May 1, 2019 and March 13, 2020 among FSWs in Melbourne. Participants were asked whether they had participated in group sex (sex involving more than two participants) within the past 3 months, the size of the most recent group sex event, sexual activities they engaged in and condom use. It is unknown whether this was a paid or unpaid event in our study.ResultsOf the 247 FSWs surveyed, the mean age was 28.9 years and 51.8% were born in Australia. More than a quarter (27.5%, n = 68) had had group sex in the past 3 months with the number of events ranging from 1 to 10 times. The median size of the group was 3 participants with one man and two women (including the FSW) being the most common combination. Kissing was the most common activity in group sex. Of 58 FSWs who had vaginal sex during group sex, 77.3% (51/58) reported their male partners always used condoms but 13.7% (7/51) of these did not change condoms between women.ConclusionThis study finds that group sex is common among FSWs. Although condoms are always used during group sex, one in six men did not change their condoms between partners, which may increase STI transmission between partners.

Studies suggest men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, implying primary anorectal lesions are likely to be missed. If men could detect anorectal lesions in the primary stage by regular anal self-examination (ASE), transmission could be reduced by early diagnosis and treatment. We aimed to explore the attitudes of MSM on performing ASE to detect primary anorectal syphilis. An online anonymous cross-sectional survey among MSM over 18 years of age living in Australia, was conducted between July and November 2020 and recruitment was from a sexual health clinic and social media. A total of 568 MSM completed the survey (median age: 34 [IQR 27–45]): 32% (183) had previously performed ASE. Among 66% (374) who had never performed ASE, 68% (250) would consider performing ASE in the future with a preferred median frequency of 2 times per 4 weeks (IQR 1–4), whilst men who were already performing ASE were performing it at median 1 per 4 weeks (IQR 0.2–3). Almost two-thirds of MSM who had never performed ASE were willing to adopt ASE practice in the future. Studies are required to determine the effectiveness of ASE for syphilis detection.

Background We aimed to examine the incidence of syphilis in men who have sex with men (MSM) and identify subgroups of MSM at a higher risk of syphilis infection. Methods We conducted a retrospective cohort study of MSM attending a sexual health clinic in Australia during 2013–2019, who had at least two syphilis serological tests during the study period. The incidence of syphilis was expressed as per 100 person-years. A cox regression analysis was conducted to identify risk factors for syphilis. Results A total of 24,391 individual MSM (75,086 consultations) were included. 1,404 new syphilis cases were diagnosed with an incidence of 3.7/100 person-years (95%CI:3.5–3.9). Syphilis incidence was higher in MSM living with HIV (9.3/100 person-years) than in MSM taking HIV pre-exposure prophylaxis (PrEP) (6.9/100 person-years) or HIV-negative MSM not taking PrEP (2.2/100 person-years). Risk factors associated with high incidence of syphilis included: MSM living with HIV (adjusted hazard ratio [aHR]:2.7), MSM taking HIV PrEP (aHR:2.1), past history of syphilis infection (aHR:2.4), injecting drug use (aHR:2.7), condomless anal sex (aHR:1.7), >4 sexual partners in the last 12 months (aHR:1.2), and concurrent STI (chlamydia and gonorrhoea) (aHR:1.6). Conclusion The incidence of syphilis remains high among MSM, particularly in subgroups with associated risk factors for syphilis infections. These data highlight the need for biomedical and behavioural interventions to be targeted to subgroups of MSM at the highest risk of syphilis infection.

Background. Few studies investigate group sex among heterosexuals. The aim of this study was to provide an exploration of characteristics and practices among heterosexual men and women who engage in group sex. Method. We conducted a cross-sectional survey between May 2019 and March 2020 among heterosexual men and women attending a sexual health clinic in Melbourne, Australia. Participants were asked whether they had participated in group sex (sex involving more than two participants) in the past 3 months, the size of the most recent event, sexual activities in which they engaged, and condom use. Results. Of 3277 heterosexuals surveyed (1509 women and 1768 men), the mean age was 29.9 years (s.d. 8.8) and more than half (56.0%, n = 1834) were born outside Australia. One in 20 participants (5.4%) had engaged in group sex in the past 3 months with the number of events ranging 1-10 times. Kissing was the most common activity in group sex, and women were significantly more likely to kiss a same-sex partner than men. Overall, of 165 participants who engaged in vaginal sex, 57 (34.5%) reported always using condoms and changing condoms between consecutive partners. Of the 100 men and women who had condomless vaginal sex, 79 (79.0%) received or performed fellatio after condomless vaginal sex. Conclusion. About two-thirds of heterosexuals who engaged in group sex neither used condoms nor changed condoms between partners in the most recent group sex event. Safe sex messages on changing condoms between partners and between sexual activities should be reinforced for sexually transmitted infections prevention.