Risk reconsidered: insights from a data saturation analysis of sexual health research amongst gay, bisexual and other men who have sex with men

This study explored how risk in the context of sexual health is conceptualised in research related to gay, bisexual, and other men who have sex with men during a period of major biomedical change, including the scale-up of pre-exposure prophylaxis (PrEP) and the Undetectable = Untransmittable (U = U) campaign, prior to the COVID-19 pandemic. A systematic search across Medline (OVID), CINAHL, and Scopus identified studies published and/or with data collected between 2015 and 2020, from high-income countries in the Global North. A novel saturation-based approach, adapted from qualitative research, was used to determine when no new implicit or explicit conceptualisations of risk were evident. Ten initial papers were reviewed, followed by sets of three, stopping after saturation was reached at 24 papers. The word 'risk' appeared 722 times across included studies. Hundreds of distinct implicit and explicit conceptualisations were identified and grouped according to five interconnected dimensions: health outcomes, and their focus on biomedical, behavioural, interpersonal, and individual factors. Findings highlight the pervasive yet variable use of 'risk' in the sexual health literature, which may hinder clear communication between researchers, clinicians, and service users. Study findings support calls for the use of more precise language.