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d'Entremont-Harris M, MacNabb K, Wilby KJ, Ramsey TD. Pharmacy-based sexually transmitted infection service implementation considerations: A scoping review. J Am Pharm Assoc (2003) 2024; 64:186-196.e2. [PMID: 38453662 DOI: 10.1016/j.japh.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals affected by STIs demonstrates a gap in care. Pharmacy-based STI clinical services are a potential solution to improve care. OBJECTIVE To identify and summarize research about the implementation of pharmacy-based STI services, focusing on program characteristics, barriers, facilitators, and pharmacist and patient experiences. METHODS A search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted for papers evaluating STI expanded-scope clinical services performed by regulated pharmacists in an outpatient/community pharmacy setting. Study setting, design, data collection method, outcomes, target infection, services offered, patient population, and barriers and facilitators are reported. RESULTS Twelve studies, 11 cross-sectional and 1 randomized control trial, were identified in this review. All studies focused on chlamydia, and two included gonorrhea and trichomoniasis or syphilis. Eleven services investigated STI screening, with four also offering treatment, and two offering partner treatment. Overall, patients reported positive experiences, found the services accessible, and trusted pharmacists. Pharmacists recognized the importance of STI services, were keen, and felt comfortable performing clinical tasks. Patients described convenience as a key facilitator, and concerns about privacy, particularly at the pharmacy counter, and the stigma and fear of judgement associated with STIs as primary barriers. For facilitators, pharmacists reported increased job satisfaction and a sense of relieving the burden on traditional STI services; for barriers, pharmacists highlighted patient recruitment, communication challenges, and lack of remuneration. CONCLUSION Research on pharmacy-based STI services includes predominately small-scale, cross-sectional studies, and focuses on chlamydia screening. Both patients and pharmacists perceive these services to be acceptable and feasible, though strategies addressing patient privacy and recruitment, pharmacist competency, training, and remuneration must be considered to support the success of pharmacy-based STI services.
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Jiang TT, Han Y, Cao NX, Yin YP, Chen XS. Knowledge on Chlamydia trachomatis and Acceptance to Testing for It Among Young Students in China. Sex Transm Dis 2023; 50:236-240. [PMID: 36729091 DOI: 10.1097/olq.0000000000001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Actively screening for Chlamydia trachomatis (CT) is important for young people because of a high prevalence of asymptomatic infection in this population. This study aimed to investigate knowledge on CT and preference to the screening services for CT among young students in China. METHODS From June to July 2022, a web-based questionnaire survey was conducted to collect information on sociodemographic characteristics, sexual behaviors, knowledge of CT, previous testing for CT, and preference to platform of testing for CT among Chinese young students. An online home-based self-sampling test (HBSST) service was offered free of charge if the participant was willing to be tested for CT. Statistical analyses included descriptive analysis, χ 2 test, and multivariable logistic regression. RESULTS Of 520 participants, 419 (80.6%) were aged between 16 and 24 years, 235 (45.2%) reported having sexual experience in the past, and 27 (5.2%) being tested before for CT. Slightly higher than 10% (57/520) of students were knowledgeable about CT. About one-third (36.9%) expressed their willingness to have a testing for CT but majority of them (63.1%) preferred to a free testing. Having sexual experience was significantly associated with the willingness to take the HBSST service (adjusted odds ratio, 2.96; 95% confidence interval, 1.92-4.58). A total of 139 (26.7%) participants requested the HBSST service online and 43.2% (60/139) returned the specimen for testing, in which 2 positives (3.3%) were found. CONCLUSIONS The knowledge on CT and the previous uptake or current willingness to have a testing for CT was low among Chinese young students.
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Rea S, Zynda A, Allison B, Tolleson-Rinehart S. Adolescent Perceptions of Technology-Based Sexual and Reproductive Health Services: A Systematic Review. J Adolesc Health 2022; 71:533-544. [PMID: 35717326 DOI: 10.1016/j.jadohealth.2022.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/28/2022] [Accepted: 05/06/2022] [Indexed: 10/31/2022]
Abstract
Technology-based services, including telehealth, text messaging, and the internet are increasingly popular methods for adolescents and young adults (AYA) to access sexual and reproductive health (SRH) information and healthcare. This systematic review examined AYA perceptions of privacy and confidentiality of technology-based SRH services. The PubMed, Scopus, and PsycINFO were systematically searched in May 2021 to capture relevant qualitative or quantitative articles from the past 10 years. Included studies had AYA (i.e., mean age, 13-26-years with <10% of the sample outside this range), technology-based services for SRH, and outcomes of perceived privacy or confidentiality. Twenty-eight articles were included (N = 8638 AYA). Most studies utilized the internet and mobile apps to address human immunodeficiency virus infection (HIV), sexually transmitted infections, and general SRH topics. Most AYA reported that these services were private and confidential, with minimal differences across SRH topic addressed. More interactive services had greater concerns (e.g., family or friends seeing notifications). Most AYA considered technology-based SRH to be confidential and private. As technology will likely remain an integrated part of healthcare delivery, improving the privacy and confidentiality of these services can facilitate AYA's independent and autonomous engagement in SRH care, and potentially improve their SRH outcomes.
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Affiliation(s)
- Samantha Rea
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
| | - Aaron Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Bianca Allison
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Zimbile F, David S, Daemen M, Goossens A, Creemers J, Crutzen R. Introducing video consultations at public sexual health clinics in the Netherlands: a mixed-methods study. Health Promot Int 2022; 37:6730776. [PMID: 36173604 PMCID: PMC9521338 DOI: 10.1093/heapro/daac135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Video consultations (in combination with remote STI testing) can benefit both public sexual health clinics (SHCs) and their clients. The Dutch public SHCs explored the extent to which video consultations are accepted and appreciated—compared to face-to-face consultations—by both young clients (under 25 years) and nurses who normally carry out consultations. A mixed-methods study, using online questionnaires and telephone interviews with both young clients (aged under 25 years) and nurses (focus groups), was conducted to evaluate acceptance and appreciation of video and face-to-face consultations of the SHCs. Young clients evaluated 333 video consultations and 100 face-to-face consultations. Clients rated the VCs and F2F consultations as being of equal high level on five evaluation criteria (e.g. how it feels to talk about sex with a nurse, contact with the nurse). These positive results were confirmed in the interviews. Most important perceived advantages of VCs were time saving, ease, and feelings of comfort and safety. The nurses evaluated 422 VCs and 120 F2F consultations, rating the VCs and F2F consultations on an equal high level on three evaluation criteria (e.g., contact with the client, possibility to continue asking questions). Increasing accessibility of SHC consultations, getting faster to the point and saving time were mentioned as advantages of VCs during the focus group sessions with nurses. Video consultations are accepted and appreciated by young clients and nurses. They can be used for standard STI consultations that do not require a physical examination.
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Affiliation(s)
- Filippo Zimbile
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Aidsfonds - Soa Aids Nederland, Amsterdam, The Netherlands
| | - Silke David
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Maud Daemen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Anne Goossens
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Josien Creemers
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
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Uptake and effectiveness of a self-guided mobile app platform for college student mental health. Internet Interv 2021; 27:100493. [PMID: 35036331 PMCID: PMC8749061 DOI: 10.1016/j.invent.2021.100493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 12/20/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND College students endorse high rates of mental health problems. While many colleges offer on-campus services, many students who could benefit from mental health services do not receive care. Indeed, nearly half of students who screen positive for depression, for example, do not receive treatment. Digital mental health programs, such as those delivered via mobile apps, may help expand access to mental health care and resources. This mixed-methods study aims to examine the uptake and effectiveness of an implementation of IntelliCare for College Students, a self-guided app-based mental health platform, on two university campuses. METHODS Data on counseling center utilization was collected prior to the implementation of the app (pre-implementation phase) and while the app was available on campus (implementation phase). Data on app usage was collected throughout the implementation phase. A subset of participants (n = 20), along with counseling center staff members (n = 10), completed feedback interviews. RESULTS Overall, uptake of the app platform was low. A total of 117 participants downloaded the app and registered their study ID during the implementation phase. Approximately 24% (28/117) of participants used the app only once. The number of days between the first and last day of app use ranged from 0 to 299, with a mean of 35.01 days and a median of 14 days. A relatively small portion of the sample (26.5%; 31/117) downloaded one or more of the IntelliCare interactive apps. In examining counseling center utilization, there were no significant changes in intake appointments, individual therapy sessions, or crisis appointments observed from the pre-implementation phase to the implementation phase of the study. Feedback interviews highlighted the significant level of disruption caused by the COVID-19 pandemic and shift to remote learning, including challenges disseminating information to students and a preference to spend less time with digital devices outside of class time. CONCLUSIONS Findings from this study indicate that there is an ongoing need to identify ways to reach college students and support student mental health and wellness for the remainder of the COVID-19 pandemic and beyond.
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Ahmaro L, Lindsey L, Forrest S, Whittlesea C. Young people's perceptions of accessing a community pharmacy for a chlamydia testing kit: a qualitative study based in North East England. BMJ Open 2021; 11:e052228. [PMID: 34489295 PMCID: PMC8422476 DOI: 10.1136/bmjopen-2021-052228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/26/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Chlamydia testing among young people in community pharmacies in North East England has been low compared with other remote settings offering testing for the past few years. To understand why this may be, to maximise service provision, the perceptions of young men and women about pharmacy testing and possible chlamydia treatment were gathered and interpreted. DESIGN Indepth, semistructured interviews. SETTING Four youth centres in North East England. PARTICIPANTS The study included 26 young people aged 16-23. The sample of participants comprised those with a history of chlamydia testing as well as those never tested. INTERVIEWS Face-to-face interviews were conducted between October 2018 and May 2019. The interview schedule covered young people's perceptions of sexually transmitted infections, provision of pharmacy sexual and reproductive health and chlamydia testing, and potential chlamydia treatment. Data from the interviews were subjected to thematic analysis. RESULTS The geographical accessibility and long opening times of community pharmacies in North East England were perceived benefits of the service. However, young people had concerns about being judged by pharmacy staff or overheard by customers when requesting the test. Men did not want to be seen by their peers accessing the pharmacy. These barriers were associated with a perceived stigma of chlamydia. Despite this, young people thought that pharmacist advice on the test kit would be important to ensure they complete it correctly. Those never tested favoured how the kit could be taken home to complete the urine sample. The option of including chlamydia treatment was reported to be convenient and comforting. CONCLUSION Supporting pharmacies in North East England to offer a confidential chlamydia testing service is necessary to overcome young people's perceived barriers to testing. Delivering testing as an integrated sexual health package with other pharmacy services, together with treatment where suitable, will increase acceptance for testing and timely access to treatment.
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Affiliation(s)
- Lara Ahmaro
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Lindsey
- School of Pharmacy and Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Forrest
- College of St Hild & St Bede, and Sociology Department, Durham University, Durham, UK
| | - Cate Whittlesea
- Research Department of Practice and Policy, University College London, School of Pharmacy, London, UK
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Day S, Khan K, Kelly AM, Jones S, Kinsella R. Characteristics of newly diagnosed HIV-positive service users using a pan-London e-sexually transmitted infection screening service. Int J STD AIDS 2021; 32:1036-1042. [PMID: 33978539 DOI: 10.1177/09564624211014729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Maximising opportunities and removing barriers to HIV testing can help reduce the undiagnosed HIV population. Digital STI/HIV screening services have increased in availability and can improve access and testing coverage. We identified the characteristics of individuals who tested HIV positive using a regional, integrated, self-sampling STI service. The e-notes of service users with reactive HIV screening results were reviewed. Between 8 January 2018 and 31 December 2019, 0.097% (144/148,257) users received a reactive HIV result, 30/144 (20.8%) of whom had previously diagnosed HIV infection. All of the remaining 114 users were notified of their screening result, an estimated 109/114 (95.6%) received confirmatory testing (CT) at a sexual health clinic (SHC) and the confirmatory outcome was documented in 102/114 (89.5%) of cases: 34/114 (29.8%)were HIV positive, 68/114 (59.6%) HIV were negative and the result was unknown in 12/114 (10.5%). All new diagnoses transitioned to HIV outpatient care. These individuals were median age 28 years; 94.1% (32/34) male; 88.2% (30/34) men who have sex with men and 11.8% (4/34) heterosexual; 58.8% (20/34) of white/'white other' ethnicity and 42.2% of Black, Asian and minority ethnic group; 50%(17/34) had a concurrent STI; 9% and 21% had never tested for HIV or attended a SHC before. n HIV test reactivity rate of 0.1%(95% CI) was observed. Confirmed new HIV diagnoses comprised 0.023% of all HIV tests performed. All individuals where CT confirmed a new HIV diagnosis transitioned to HIV specialist care.
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Affiliation(s)
- Sara Day
- 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kaywaan Khan
- 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Adrian M Kelly
- Lead Commissioner Sexual Health e-Service, The City of London Corporation, Guildhall, London, UK
| | - Sophie Jones
- 9762Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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8
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Gasmelsid N, Moran BC, Nadarzynski T, Patel R, Foley E. Does online sexually transmitted infection screening compromise care? A service evaluation comparing the management of chlamydial infection diagnosed online and in clinic. Int J STD AIDS 2021; 32:528-532. [PMID: 33530888 DOI: 10.1177/0956462420980929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient demand on sexual health services in the United Kingdom is so high that many services have introduced online screening to accommodate more patients. There are concerns that these services may not be accessible to all. This service evaluation was undertaken to determine whether online screening is accessible by those patients most at need by comparing the demographics and number of asymptomatic chlamydial infections detected online and in clinic. No difference was found in the age nor level of deprivation, demonstrating that online services are an accessible way to screen for sexually transmitted infections without overburdening established services.
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Affiliation(s)
- Nur Gasmelsid
- Faculty of Medicine, 12211University of Southampton, Southampton, UK
| | - Benjamin Cb Moran
- Faculty of Medicine, 12211University of Southampton, Southampton, UK
| | - Tom Nadarzynski
- 247209University of Westminster School of Social sciences, London, UK
| | - Rajul Patel
- Faculty of Medicine, 12211University of Southampton, Southampton, UK
- Solent Sexual Health Services, 232267Solent NHS Trust, UK
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9
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Grandahl M, Larsson M, Herrmann B. 'To be on the safe side': a qualitative study regarding users' beliefs and experiences of internet-based self-sampling for Chlamydia trachomatis and Neisseria gonorrhoeae testing. BMJ Open 2020; 10:e041340. [PMID: 33376171 PMCID: PMC7778762 DOI: 10.1136/bmjopen-2020-041340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES In Sweden, an increasing number of tests for sexually transmitted infections are conducted. Self-sampling services are provided free of charge at the national eHealth website. Our aim was to obtain a deeper understanding of users' beliefs and experiences of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) self-sampling services. METHODS This qualitative study is part of the national project 'Internet-based chlamydia and gonorrhoea self-sampling test', conducted in Sweden. Individuals ordering a CT/NG self-sampling test at home from the eHealth website were invited to participate. Of the 114 individuals who agreed, a purposeful sample including 20 women and men aged 18-49 years (mean, 30.8 years) participated in a telephone interview in 2019. RESULTS The test service for CT/NG was highly appreciated by men and women of different ages. Round-the-clock accessibility, avoiding clinical visits, ease of use, confidentiality and a rapid test result were reasons for this appreciation. Language, uncertainty about the correct sampling procedure, unreliable postal services and concerns about handling of personal data were mentioned as barriers. Reasons for testing were checking after unprotected sex, symptoms, checking a partner's fidelity or a regular routine-'to be on the safe side'. Knowledge about the infections and their consequences was limited; some considered them severe, especially if they could threaten fertility, and others were less concerned. Disclosing an infection was described as emotionally stressful. Participants had high self-efficacy in relation to the test and would not hesitate to use the service again, even if it involved a cost. CONCLUSIONS Internet-based CT/NG self-sampling at home was highly appreciated and was used for individual health reasons, but also out of concern for others' health and for society as a whole. The benefits seem to outweigh the barriers, and the service may therefore continue to be widely offered.
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Affiliation(s)
- Maria Grandahl
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Björn Herrmann
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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10
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Day S, Singh GJ, Jones S, Kinsella R. Sexual assault reporting amongst users of online sexual health services. Int J STD AIDS 2020; 32:280-285. [DOI: 10.1177/0956462420963940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sexual assault (SA) survivors often attend sexual health clinics (SHC) for care relating to their assault. Reported rates of SA amongst SHC attendees can be high. Online sexual health services are becoming increasingly popular. Sexual Health London (SHL) is a large online sexual transmitted infection (STI) screening service. Between 1.1.20– 8.2.20, 0.5% (242/45841) (54% female, 45.6% male) of adults disclosed a recent SA when ordering an online STI testing kit. 79% (192/242) users engaged in a call back discussion initiated by the SHL team: 45% (87/192) users confirmed a SA had occurred and 53% (101/242) users denied an assault (particularly men) stating they had reported this in error. 18% (16/87) users had already reported their SA to the police/sexual assault centre, and one user accepted an onward referral. This study found a low reporting rate of SA amongst SHL users, but despite a high response rate to call backs, >50% cited they reported in error, 25% (22/87) didn’t want to discuss their SA and few accepted onward referrals. Using e-triage to screen for SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all. Further evaluation of ways to engage these individuals is required.
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Affiliation(s)
- Sara Day
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Sophie Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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11
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Wei Y, Zheng P, Deng H, Wang X, Li X, Fu H. Design Features for Improving Mobile Health Intervention User Engagement: Systematic Review and Thematic Analysis. J Med Internet Res 2020; 22:e21687. [PMID: 33295292 PMCID: PMC7758171 DOI: 10.2196/21687] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/30/2020] [Accepted: 10/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Well-designed mobile health (mHealth) interventions support a positive user experience; however, a high rate of disengagement has been reported as a common concern regarding mHealth interventions. To address this issue, it is necessary to summarize the design features that improve user engagement based on research over the past 10 years, during which time the popularity of mHealth interventions has rapidly increased due to the use of smartphones. Objective The aim of this review was to answer the question “Which design features improve user engagement with mHealth interventions?” by summarizing published literature with the purpose of guiding the design of future mHealth interventions. Methods This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Databases, namely, PubMed, Web of Science, Cochrane Library, Ovid EMBASE, and Ovid PsycINFO, were searched for English and Chinese language papers published from January 2009 to June 2019. Thematic analysis was undertaken to assess the design features in eligible studies. The Mixed Methods Appraisal Tool was used to assess study quality. Results A total of 35 articles were included. The investigated mHealth interventions were mainly used in unhealthy lifestyle (n=17) and chronic disease (n=10) prevention programs. Mobile phone apps (n=24) were the most common delivery method. Qualitative (n=22) and mixed methods (n=9) designs were widely represented. We identified the following 7 themes that influenced user engagement: personalization (n=29), reinforcement (n=23), communication (n=20), navigation (n=17), credibility (n=16), message presentation (n=16), and interface aesthetics (n=7). A checklist was developed that contained these 7 design features and 29 corresponding specific implementations derived from the studies. Conclusions This systematic review and thematic synthesis identified useful design features that make an mHealth intervention more user friendly. We generated a checklist with evidence-based items to enable developers to use our findings easily. Future evaluations should use more robust quantitative approaches to elucidate the relationships between design features and user engagement.
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Affiliation(s)
- Yanxia Wei
- School of Public Health, Fudan University, Shanghai, China
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai, China
| | - Hui Deng
- School of Public Health, Fudan University, Shanghai, China
| | - Xihui Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaomei Li
- School of Public Health, Fudan University, Shanghai, China
| | - Hua Fu
- School of Public Health, Fudan University, Shanghai, China
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12
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Day S, Kinsella R, Jones S, Tittle V, Suchak T, Forbes K. Safeguarding outcomes of 16 and 17-year-old service users of Sexual Health London (SHL.uk), a pan-London online sexual health service. Int J STD AIDS 2020; 31:1373-1379. [PMID: 33103583 DOI: 10.1177/0956462420933462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guidance around how to safeguard young people using online sexual health services (e-SHSs) is limited. Sexual Health London (SHL.uk) is an e-SHS, integrated with London's sexual health clinics (SHCs), offering users aged 16 years and above sexually transmitted infection (STI) testing. For a safeguarding risk assessment, under 18s must complete a safeguarding e-triage, and any concern raised results in a 'call back' (CB) by the SHL.uk team. The safeguarding outcomes of CBs between 8 January 2018 and 18 September 2018 were reviewed; 261/454 (57.5%) users never triggered a CB on their e-triage (non-CB group) and 193/454 (42.5%) users triggered one or more CB(s) (CB group). Safeguarding concerns disclosed predominantly related to drug/alcohol use and partner's age imbalance. Successful telephonic risk assessment took place in 84.5% CB cases. Safeguarding outcomes comprised referrals to: SHC in 35.5%; child protection team in 8.5%; social services in 7%. STI positivity was 16.4% and 15.2% in the CB and non-CB groups, respectively. Although a high number of safeguarding triggers were disclosed, only a small proportion warranted referral for further support/intervention. Using e-triage with telephony support to screen and safeguard adolescents accessing an e-SHS was acceptable to users and enabled their clinical and safeguarding needs to be safely met. e-SHS integration within a network of SHCs further supported this model.
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Affiliation(s)
- Sara Day
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Sophie Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Victoria Tittle
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tara Suchak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kimberley Forbes
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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13
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Spence T, Kander I, Walsh J, Griffiths F, Ross J. Perceptions and Experiences of Internet-Based Testing for Sexually Transmitted Infections: Systematic Review and Synthesis of Qualitative Research. J Med Internet Res 2020; 22:e17667. [PMID: 32663151 PMCID: PMC7481875 DOI: 10.2196/17667] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Internet-based testing for sexually transmitted infections (STIs) allows asymptomatic individuals to order a self-sampling kit online and receive their results electronically, reducing the need to attend a clinic unless for treatment. This approach has become increasingly common; however, there is evidence that barriers exist to accessing it, particularly among some high-risk populations. We review the qualitative evidence on this topic, as qualitative research is well-placed to identify the complex influences that relate to accessing testing. Objective This paper aims to explore perceptions and experiences of internet-based testing for STIs among users and potential users. Methods Searches were run through 5 electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and Web of Science) to identify peer-reviewed studies published between 2005 and 2018. Search terms were drawn from 4 categories: STIs, testing or screening, digital health, and qualitative methods. Included studies were conducted in high-income countries and explored patient perceptions or experiences of internet-based testing, and data underwent thematic synthesis. Results A total of 11 studies from the 1735 studies identified in the initial search were included in the review. The synthesis identified that internet-based testing is viewed widely as being acceptable and is preferred over clinic testing by many individuals due to perceived convenience and anonymity. However, a number of studies identified concerns relating to test accuracy and lack of communication with practitioners, particularly when receiving results. There was a lack of consensus on preferred media for results delivery, although convenience and confidentiality were again strong influencing factors. The majority of included studies were limited by the fact that they researched hypothetical services. Conclusions Internet-based testing providers may benefit from emphasizing this testing’s comparative convenience and privacy compared with face-to-face testing in order to improve uptake, as well as alleviating concerns about the self-sampling process. There is a clear need for further research exploring in depth the perceptions and experiences of people who have accessed internet-based testing and for research on internet-based testing that explicitly gathers the views of populations that are at high risk of STIs. Trial Registration PROSPERO CRD42019146938; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=146938
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Affiliation(s)
- Tommer Spence
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Inès Kander
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Julia Walsh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Ross
- Whittall Street Clinic, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
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14
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Mohiuddin S, Gardiner R, Crofts M, Muir P, Steer J, Turner J, Wheeler H, Hollingworth W, Horner PJ. Modelling patient flows and resource use within a sexual health clinic through discrete event simulation to inform service redesign. BMJ Open 2020; 10:e037084. [PMID: 32641336 PMCID: PMC7348479 DOI: 10.1136/bmjopen-2020-037084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Continuous improvement in the delivery of health services is increasingly being demanded in the UK at a time when budgets are being cut. Simulation is one approach used for understanding and assessing the likely impact of changes to the delivery of health services. However, little is known about the usefulness of simulation for analysing the delivery of sexual health services (SHSs). We propose a simulation method to model and evaluate patient flows and resource use within an SHS to inform service redesign. METHODS We developed a discrete event simulation (DES) model to identify the bottlenecks within the Unity SHS (Bristol, UK) and find possible routes for service improvement. Using the example of the introduction of an online service for sexually transmitted infection (STI) and HIV self-sampling for asymptomatic patients, the impact on patient waiting times was examined as the main outcome measure. The model included data such as patient arrival time, staff availability and duration of consultation, examination and treatment. We performed several sensitivity analyses to assess uncertainty in the model parameters. RESULTS We identified some bottlenecks under the current system, particularly in the consultation and treatment queues for male and female walk-in patients. Introducing the provision of STI and HIV self-sampling alongside existing services decreased the average waiting time (88 vs 128 min) for all patients and reduced the cost of staff time for managing each patient (£72.64 vs £88.74) compared with the current system without online-based self-sampling. CONCLUSIONS The provision of online-based STI and HIV self-sampling for asymptomatic patients could be beneficial in reducing patient waiting times and the model highlights the complexities of using this to cut costs. Attributing recognition for any improvement requires care, but DES modelling can provide valuable insights into the design of SHSs ensuing in quantifiable improvements. Extension of this method with the collection of additional data and the construction of more informed models seems worthwhile.
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Affiliation(s)
- Syed Mohiuddin
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rebecca Gardiner
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Peter Muir
- South West Regional Public Health Laboratory, Public Health England, Bristol, UK
| | - Jonathan Steer
- South West Regional Public Health Laboratory, Public Health England, Bristol, UK
| | - Jonathan Turner
- South West Regional Public Health Laboratory, Public Health England, Bristol, UK
| | - Helen Wheeler
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - William Hollingworth
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR CLAHRC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Paddy J Horner
- Population Health Sciences, University of Bristol, Bristol, UK
- Unity Sexual Health Clinic, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Health Protection Research Unit, University of Bristol, Bristol, UK
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15
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Dulai J, Salway T, Thomson K, Haag D, Lachowsky N, Grace D, Edward J, Grennan T, Trussler T, Gilbert M. Awareness of and intention to use an online sexually transmitted and blood-borne infection testing service among gay and bisexual men in British Columbia, two years after implementation. Canadian Journal of Public Health 2020; 112:78-88. [PMID: 32557285 PMCID: PMC7851227 DOI: 10.17269/s41997-020-00323-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Abstract
Objectives This study assessed gay, bisexual, and other men who have sex with men’s (GBMSM) awareness of and intention to use GetCheckedOnline, an online sexually transmitted and blood-borne infection (STBBI) testing service. Methods A cross-sectional study was conducted two years after launch among GBMSM > 18 years of age in British Columbia, Canada. Participants were recruited through community venues, clinics, websites, and apps. Results Of 1272 participants, 32% were aware of GetCheckedOnline. Gay identity, regularly testing at an STBBI clinic, being out to one’s healthcare provider, attending GBMSM community venues, and frequent social media use were associated with awareness. Among participants who were aware but had not used GetCheckedOnline, knowing GetCheckedOnline users, using social media, not knowing where else to test, and not wanting to see a doctor were associated with intention to use GetCheckedOnline. Conclusion Early promotion of GetCheckedOnline resulted in greater awareness among those connected to GBMSM.
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Affiliation(s)
- Joshun Dulai
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.,British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,Faculty of Health Sciences, Simon Fraser University, 888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kimberly Thomson
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Devon Haag
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Nathan Lachowsky
- School of Public Health & Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Daniel Grace
- Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Joshua Edward
- Health Initiative for Men, 1033 Davie Street, Vancouver, BC, V6E 1M5, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Terry Trussler
- Community-Based Research Centre, 808 Nelson Street, Vancouver, BC, V6Z 2H2, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,Faculty of Health Sciences, Simon Fraser University, 888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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16
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Söderqvist J, Gullsby K, Stark L, Wikman M, Karlsson R, Herrmann B. Internet-based self-sampling for Chlamydia trachomatis testing: a national evaluation in Sweden. Sex Transm Infect 2020; 96:160-165. [PMID: 31932359 PMCID: PMC7231453 DOI: 10.1136/sextrans-2019-054256] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Internet-based testing for Chlamydia trachomatis (CT) with self-sampling at home has gradually been implemented in Sweden since 2006 as a free-of-charge service within the public healthcare system. This study evaluated the national diagnostic outcome of this service. METHODS Requests for data on both self-sampling at home and clinic-based sampling for CT testing were sent to the laboratories in 18 of 21 counties. Four laboratories were also asked to provide data on testing patterns at the individual level for the years 2013-2017. RESULTS The proportion of self-sampling increased gradually from 2013, comprising 22.0% of all CT tests in Sweden in 2017. In an analysis of 14 counties (representing 83% of the population), self-sampling increased by 115% between 2013 and 2017 for women, compared with 71% for men, while test volumes for clinic-based sampling were fairly constant for both sexes (1.8% increase for women, 15% increase for men). In 2017 self-sampling accounted for 20.3% of all detected CT cases, and the detection rate was higher than, but similar to, clinic-based testing (5.5% vs 5.1%). The proportion of self-sampling men was also higher, but similar (33.7% vs 30.8%). Analysis of individual testing patterns in four counties over 5 years showed a higher proportion of men using self-sampling only (67%, n=10 533) compared with women (40%, n=8885). CONCLUSIONS Self-sampling has increased substantially in recent years, especially among women. This service is at least as beneficial as clinic-based screening for detection of CT, and self-sampling reaches men more than clinic-based testing.
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Affiliation(s)
- Joakim Söderqvist
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karolina Gullsby
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Lisa Stark
- Department of Laboratory Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Maria Wikman
- Department of Virology, University of Umeå, Umeå, Sweden
| | - Roger Karlsson
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - Bjőrn Herrmann
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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17
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de Wilt T, Versluis A, Goedhart A, Talboom-Kamp E, van Delft S. General practitioners attitude towards the use of eHealth and online testing in primary care. CLINICAL EHEALTH 2020. [DOI: 10.1016/j.ceh.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Wilson E, Leyrat C, Baraitser P, Free C. Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial. Sex Transm Infect 2019; 95:569-574. [PMID: 31175210 PMCID: PMC6902059 DOI: 10.1136/sextrans-2019-053992] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of an internet-accessed STI (e-STI) testing and results service on testing uptake among young adults (16-30 years) who have never tested for STIs in London, England. METHODS We conducted secondary analyses on data from a randomised controlled trial. In the trial, participants were randomly allocated to receive a text message with the web link of an e-STI testing and results service (intervention group) or a text message with the link of a website listing the locations, contact details and websites of seven local sexual health clinics (control group). We analysed a subsample of 528 trial participants who reported never testing for STIs at baseline. Outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and time from randomisation to completion of an STI test. RESULTS Uptake of STI testing among 'never testers' almost doubled. At 6 weeks, 45.3% of the intervention completed at least one test (chlamydia, gonorrhoea, syphilis and HIV), compared with 24.1% of the control (relative risk [RR] 1.88, 95% CI 1.47 to 2.40, p<0.001). For chlamydia and gonorrhoea testing combined, uptake was 44.3% in the intervention versus 24.1% in controls (RR 1.84, 95% CI 1.44 to 2.36, p<0.001). The intervention reduced time to any STI test (restricted mean survival time: 29.0 days vs 36.3 days, p<0.001) at a time horizon of 42 days. CONCLUSIONS : e-STI testing increased uptake of STI testing and reduced time to test among a young population of 'never testers' recruited in community settings. Although encouraging, questions remain on how best to manage the additional demand generated by e-STI testing in a challenging funding environment. Larger studies are required to assess the effects later in the cascade of care, including STI diagnoses and cases treated.
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Affiliation(s)
- Emma Wilson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clémence Leyrat
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paula Baraitser
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK.,School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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19
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Eaton S, Biggerstaff D, Petrou S, Osipenko L, Gibbs J, Estcourt CS, Sadiq T, Szczepura A. Young people's preferences for the use of emerging technologies for asymptomatic regular chlamydia testing and management: a discrete choice experiment in England. BMJ Open 2019; 9:e023663. [PMID: 30700477 PMCID: PMC6352830 DOI: 10.1136/bmjopen-2018-023663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To undertake a comprehensive assessment of the strength of preferences among young people for attributes of emerging technologies for testing and treatment of asymptomatic chlamydia. DESIGN Discrete choice experiment (DCE) with sequential mixed methods design. A staged approach to selection of attributes/levels included two literature reviews, focus groups with young people aged 16-24 years (n=21), experts' review (n=13) and narrative synthesis. Cognitive testing was undertaken to pilot and adapt the initial questionnaire. Online national panel was used for final DCE survey to maximise generalisability. Analysis of questionnaire responses used multinomial logit models and included validity checks. SETTING England. PARTICIPANTS 1230 young people aged 16-24 from a national online panel (completion rate 73%). OUTCOME MEASURES ORs for service attributes in relation to reference levels. RESULTS The strongest attribute influencing preferences was chlamydia test accuracy (OR 3.24, 95% CI 3.13 to 3.36), followed by time to result (OR 1.81, 95% CI 1.71 to 1.91). Respondents showed a preference for remote chlamydia testing options (self-testing, self-sampling and postal testing) over attendance at a testing location. For accessing treatment following a positive test result, there was a general preference for online (OR 1.21, 95% CI 1.15 to 1.28) versus traditional general practitioner (OR 1.18, 95% CI 1.12 to 1.24) or pharmacy (OR 1.15, 95% CI 1.10 to 1.22) over clinic services. For accessing a healthcare professional and receipt of antibiotics, there was little difference in preferences between options. CONCLUSIONS Both test accuracy and very short intervals between testing and results were important factors for young people when deciding whether to undergo a routine test for asymptomatic chlamydia, with test accuracy being more important. These findings should assist technology developers, policymakers, commissioners and service providers to optimise technology adoption in service redesign, although use of an online panel may limit generalisability of findings to other populations.
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Affiliation(s)
- Sue Eaton
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Leeza Osipenko
- Scientific Advice, National Institute for Health and Care Excellence, London, UK
| | - Jo Gibbs
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Ala Szczepura
- Enterprise and Innovation Group, Coventry University, Coventry, UK
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20
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Knight RE, Chabot C, Carson A, Thomson K, Haag D, Gilbert M, Shoveller J. Qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who use GetCheckedOnline.com: a comprehensive internet-based diagnostic service for HIV and other STIs. Sex Transm Infect 2019; 95:145-150. [PMID: 30636705 PMCID: PMC6580763 DOI: 10.1136/sextrans-2018-053645] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 11/07/2018] [Accepted: 11/25/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To describe the factors that influence gay, bisexual and other men who have sex with men’s (gbMSM) experiences with GetCheckedOnline.com (GCO) in British Columbia (BC), Canada. GCO clients complete an internet-based risk assessment and print a laboratory test requisition form for HIV and other STIs to take to a private laboratory for diagnostic services. Methods Drawing on a purposive stratified sampling framework, we conducted 37 in-depth semistructured interviews with gbMSM who had used GCO at least once between 2015 and 2017. Results Participants expressed a preference for GCO (instead of clinic-based testing) because of convenience, privacy and control over specimen collection (specifically with doing one’s own throat or anal swab). Participants preferred receiving their results online via GCO compared with phone or email follow-up by clinic staff. GCO was viewed positively because it offers gbMSM living outside of urban city centres easy access to diagnostic services, including access to pooled nucleic acid amplification testing. Many participants also continued to positively view the clinic-based services available for gbMSM in their community. These services were frequently described as highly competent, tailored and comprehensive in responding to more complex needs. For example, attending a clinic was viewed as preferential to GCO in instances where there was a desire to access services addressing co-occurring health issues (eg, mental health; substance use disorders). Almost all of the participants anticipated using both GCO and clinic-based services in the future. Conclusions gbMSM report positive experiences and perceptions of GCO; however, they do not view GCO as a panacea. The results of this study point to the need to ensure that a wide range of integrated service options (eg, online; clinic-based) are available to address the range of sexual health needs of gbMSM living in BC's diverse settings.
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Affiliation(s)
- Rod Eric Knight
- British Columbia Centre on Substance Use, Vancouver, Canada .,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Cathy Chabot
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Anna Carson
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kimberly Thomson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada.,Department of Psychology, Faculty of Health, Deakin University, Melbourne, Australia
| | - Devon Haag
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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21
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Gilbert M, Thomson K, Salway T, Haag D, Grennan T, Fairley CK, Buchner C, Krajden M, Kendall P, Shoveller J, Ogilvie G. Differences in experiences of barriers to STI testing between clients of the internet-based diagnostic testing service GetCheckedOnline.com and an STI clinic in Vancouver, Canada. Sex Transm Infect 2018; 95:151-156. [PMID: 29437984 PMCID: PMC6580770 DOI: 10.1136/sextrans-2017-053325] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 12/10/2017] [Accepted: 01/15/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Internet-based STI testing programmes may overcome barriers posed by in-clinic testing, though uptake could reflect social gradients. The role these services play in comparison to clinical testing services is unknown. We compared experiences of testing barriers between STI clinic clients to clients of GetCheckedOnline.com (GCO; where clients take a printed lab form to a lab). METHODS Our 10-month cross-sectional study was conducted after GCO was promoted to STI clinic clients and men who have sex with men (MSM). Clinic and GCO clients completed an online survey assessing testing barriers and facilitators; responses were compared using bivariate analysis (level of significance P<0.01; significant results below). RESULTS Compared with 321 clinic clients, the 73 GCO clients were more likely to be older (median 35 vs 30 years), MSM (45% vs 16%), be testing routinely (67% vs 39%), have delayed testing for any reason (76% vs 54%) and due to clinic distance (28% vs 9%), report delays due to wait times (50% vs 17%), embarrassment with testing (16% vs 6%), discomfort discussing sexual health where they usually go for testing (39% vs 22%), as well as discomfort discussing sexual history with (19% vs 5%) and fearing judgement from (30% vs 15%) any healthcare provider. GCO clients were less likely to have found clinic hours convenient (59% vs 77%) and clinic appointments easy to make (49% vs 66%), and more likely to report long wait times (50% vs 17%). We found no differences in technology skills/use. CONCLUSIONS In this urban setting, an internet-based testing service effectively engaged individuals experiencing testing barriers, with few social gradients in uptake. While some testing barriers could be addressed through increasing access to clinical services, others require social and structural changes, highlighting the importance of internet-based STI testing services to increasing test uptake.
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Affiliation(s)
- Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Thomson
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Devon Haag
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Chris Buchner
- Clinical Operations Communicable Disease & Harm Reduction, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Mel Krajden
- Division of Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,BC Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Perry Kendall
- Ministry of Health, Government of British Columbia, Victoria, British Columbia, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's and BC Women's Hospital, Vancouver, British Columbia, Canada
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22
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Barnard S, Free C, Bakolis I, Turner KME, Looker KJ, Baraitser P. Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis. Sex Transm Infect 2018; 94:377-383. [PMID: 29437985 PMCID: PMC6204942 DOI: 10.1136/sextrans-2017-053302] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/06/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Online services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services. Methods We conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users. Results 6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British. Conclusion Nearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups.
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Affiliation(s)
- Sharmani Barnard
- School of Population Health and Environmental Sciences, Centre for Global Health and Health Partnerships, King's College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Services Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katy M E Turner
- Department of Veterinary Sciences, Bristol Vet School, University of Bristol, Bath, UK
| | - Katharine J Looker
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paula Baraitser
- School of Population Health and Environmental Sciences, Centre for Global Health and Health Partnerships, King's College London, London, UK
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23
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Wilson E, Free C, Morris TP, Syred J, Ahamed I, Menon-Johansson AS, Palmer MJ, Barnard S, Rezel E, Baraitser P. Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial. PLoS Med 2017; 14:e1002479. [PMID: 29281628 PMCID: PMC5744909 DOI: 10.1371/journal.pmed.1002479] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Internet-accessed sexually transmitted infection testing (e-STI testing) is increasingly available as an alternative to testing in clinics. Typically this testing modality enables users to order a test kit from a virtual service (via a website or app), collect their own samples, return test samples to a laboratory, and be notified of their results by short message service (SMS) or telephone. e-STI testing is assumed to increase access to testing in comparison with face-to-face services, but the evidence is unclear. We conducted a randomised controlled trial to assess the effectiveness of an e-STI testing and results service (chlamydia, gonorrhoea, HIV, and syphilis) on STI testing uptake and STI cases diagnosed. METHODS AND FINDINGS The study took place in the London boroughs of Lambeth and Southwark. Between 24 November 2014 and 31 August 2015, we recruited 2,072 participants, aged 16-30 years, who were resident in these boroughs, had at least 1 sexual partner in the last 12 months, stated willingness to take an STI test, and had access to the internet. Those unable to provide consent and unable to read English were excluded. Participants were randomly allocated to receive 1 text message with the web link of an e-STI testing and results service (intervention group) or to receive 1 text message with the web link of a bespoke website listing the locations, contact details, and websites of 7 local sexual health clinics (control group). Participants were free to use any other services or interventions during the study period. The primary outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and self-reported STI diagnosis at 6 weeks, verified by patient record checks. Secondary outcomes were the proportion of participants prescribed treatment for an STI, time from randomisation to completion of an STI test, and time from randomisation to treatment of an STI. Participants were sent a £10 cash incentive on submission of self-reported data. We completed all follow-up, including patient record checks, by 17 June 2016. Uptake of STI testing was increased in the intervention group at 6 weeks (50.0% versus 26.6%, relative risk [RR] 1.87, 95% CI 1.63 to 2.15, P < 0.001). The proportion of participants diagnosed was 2.8% in the intervention group versus 1.4% in the control group (RR 2.10, 95% CI 0.94 to 4.70, P = 0.079). No evidence of heterogeneity was observed for any of the pre-specified subgroup analyses. The proportion of participants treated was 1.1% in the intervention group versus 0.7% in the control group (RR 1.72, 95% CI 0.71 to 4.16, P = 0.231). Time to test, was shorter in the intervention group compared to the control group (28.8 days versus 36.5 days, P < 0.001, test for difference in restricted mean survival time [RMST]), but no differences were observed for time to treatment (83.2 days versus 83.5 days, P = 0.51, test for difference in RMST). We were unable to recruit the planned 3,000 participants and therefore lacked power for the analyses of STI diagnoses and STI cases treated. CONCLUSIONS The e-STI testing service increased uptake of STI testing for all groups including high-risk groups. The intervention required people to attend clinic for treatment and did not reduce time to treatment. Service innovations to improve treatment rates for those diagnosed online are required and could include e-treatment and postal treatment services. e-STI testing services require long-term monitoring and evaluation. TRIAL REGISTRATION ISRCTN Registry ISRCTN13354298.
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Affiliation(s)
- Emma Wilson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tim P. Morris
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | - Jonathan Syred
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
| | - Irrfan Ahamed
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Melissa J. Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sharmani Barnard
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
| | - Emma Rezel
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
| | - Paula Baraitser
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
- Department of Sexual Health and HIV, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults' perceptions of this initiative. Br J Gen Pract 2017; 67:e490-e500. [PMID: 28533198 PMCID: PMC5565869 DOI: 10.3399/bjgp17x691325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/03/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Opportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013-2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines. AIM To determine young adults' opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice. DESIGN AND SETTING Qualitative interviews were conducted in a general practice setting in England between March and June 2013. METHOD Thirty interviews were conducted with nine male and 21 female patients aged 16-24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework. RESULTS Participants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation. CONCLUSION General practice staff should facilitate patients' preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way.
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Spencer-Hughes V, Syred J, Allison A, Holdsworth G, Baraitser P. Screening for Child Sexual Exploitation in Online Sexual Health Services: An Exploratory Study of Expert Views. J Med Internet Res 2017; 19:e30. [PMID: 28196790 PMCID: PMC5331185 DOI: 10.2196/jmir.5911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/03/2016] [Accepted: 10/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexual health services routinely screen for child sexual exploitation (CSE). Although sexual health services are increasingly provided online, there has been no research on the translation of the safeguarding function to online services. We studied expert practitioner views on safeguarding in this context. OBJECTIVE The aim was to document expert practitioner views on safeguarding in the context of an online sexual health service. METHODS We conducted semistructured interviews with lead professionals purposively sampled from local, regional, or national organizations with a direct influence over CSE protocols, child protection policies, and sexual health services. Interviews were analyzed by three researchers using a matrix-based analytic method. RESULTS Our respondents described two different approaches to safeguarding. The "information-providing" approach considers that young people experiencing CSE will ask for help when they are ready from someone they trust. The primary function of the service is to provide information, provoke reflection, generate trust, and respond reliably to disclosure. The approach values online services as an anonymous space to test out disclosure without commitment. The "information-gathering" approach considers that young people may withhold information about exploitation. Therefore, services should seek out information to assess risk and initiate disclosure. This approach values face-to-face opportunities for individualized questioning and immediate referral. CONCLUSIONS The information-providing approach is associated with confidential telephone support lines and the information-gathering approach with clinical services. The approach adopted online will depend on ethos and the range of services provided. Effective transition from online to clinic services after disclosure is an essential element of this process and further research is needed to understand and support this transition.
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Affiliation(s)
| | | | | | | | - Paula Baraitser
- King's College London, London, United Kingdom.,King's College Hospital NHS Foundation Trust, London, United Kingdom
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O’Connor S, Hanlon P, O’Donnell CA, Garcia S, Glanville J, Mair FS. Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Med Inform Decis Mak 2016; 16:120. [PMID: 27630020 PMCID: PMC5024516 DOI: 10.1186/s12911-016-0359-3] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/03/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. METHODS PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 - 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. 'telemedicine', 'mobile applications', 'personal health record', 'social networking'). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. RESULTS Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. CONCLUSION This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews CRD42015029846.
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Affiliation(s)
- Siobhan O’Connor
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| | - Catherine A. O’Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| | | | | | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
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Aicken CRH, Fuller SS, Sutcliffe LJ, Estcourt CS, Gkatzidou V, Oakeshott P, Hone K, Sadiq ST, Sonnenberg P, Shahmanesh M. Young people's perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study. BMC Public Health 2016; 16:974. [PMID: 27624633 PMCID: PMC5022229 DOI: 10.1186/s12889-016-3648-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 09/07/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Control of sexually transmitted infections (STI) is a global public health priority. Despite the UK's free, confidential sexual health clinical services, those at greatest risk of STIs, including young people, report barriers to use. These include: embarrassment regarding face-to-face consultations; the time-commitment needed to attend clinic; privacy concerns (e.g. being seen attending clinic); and issues related to confidentiality. A smartphone-enabled STI self-testing device, linked with online clinical care pathways for treatment, partner notification, and disease surveillance, is being developed by the eSTI(2) consortium. It is intended to benefit public health, and could do so by increasing testing among populations which underutilise existing services and/or by enabling rapid provision of effective treatment. We explored its acceptability among potential users. METHODS In-depth interviews were conducted in 2012 with 25 sexually-experienced 16-24 year olds, recruited from Further Education colleges in an urban, high STI prevalence area. Thematic analysis was undertaken. RESULTS Nine females and 16 males participated. 21 self-defined as Black; three, mixed ethnicity; and one, Muslim/Asian. 22 reported experience of STI testing, two reported previous STI diagnoses, and all had owned smartphones. Participants expressed enthusiasm about the proposed service, and suggested that they and their peers would use it and test more often if it were available. Utilizing sexual healthcare was perceived to be easier and faster with STI self-testing and online clinical care, which facilitated concealment of STI testing from peers/family, and avoided embarrassing face-to-face consultations. Despite these perceived advantages to privacy, new privacy concerns arose regarding communications technology: principally the risk inherent in having evidence of STI testing or diagnosis visible or retrievable on their phone. Some concerns arose regarding the proposed self-test's accuracy, related to self-operation and the technology's novelty. Several expressed anxiety around the possibility of being diagnosed and treated without any contact with healthcare professionals. CONCLUSIONS Remote STI self-testing and online care appealed to these young people. It addressed barriers they associated with conventional STI services, thus may benefit public health through earlier detection and treatment. Our findings underpin development of online care pathways, as part of ongoing research to create this complex e-health intervention.
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Affiliation(s)
- Catherine R. H. Aicken
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Sebastian S. Fuller
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lorna J. Sutcliffe
- Blizard Institute, Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claudia S. Estcourt
- Blizard Institute, Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - S. Tariq Sadiq
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Maryam Shahmanesh
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
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Wilson E, Free C, Morris TP, Kenward MG, Syred J, Baraitser P. Can Internet-Based Sexual Health Services Increase Diagnoses of Sexually Transmitted Infections (STI)? Protocol for a Randomized Evaluation of an Internet-Based STI Testing and Results Service. JMIR Res Protoc 2016; 5:e9. [PMID: 26772143 PMCID: PMC4733221 DOI: 10.2196/resprot.4094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/30/2015] [Accepted: 04/30/2015] [Indexed: 11/21/2022] Open
Abstract
Background Ensuring rapid access to high quality sexual health services is a key public health objective, both in the United Kingdom and internationally. Internet-based testing services for sexually transmitted infections (STIs) are considered to be a promising way to achieve this goal. This study will evaluate a nascent online STI testing and results service in South East London, delivered alongside standard face-to-face STI testing services. Objective The aim of this study is to establish whether an online testing and results services can (1) increase diagnoses of STIs and (2) increase uptake of STI testing, when delivered alongside standard face-to-face STI testing services. Methods This is a single-blind randomized controlled trial. We will recruit 3000 participants who meet the following eligibility criteria: 16-30 years of age, resident in the London boroughs of Lambeth and Southwark, having at least one sexual partner in the last 12 months, having access to the Internet and willing to take an STI test. People unable to provide informed consent and unable to read and understand English (the websites will be in English) will be excluded.
Baseline data will be collected at enrolment. This includes participant contact details, demographic data (date of birth, gender, ethnicity, and sexual orientation), and sexual health behaviors (last STI test, service used at last STI test and number of sexual partners in the last 12 months).
Once enrolled, participants will be randomly allocated either (1) to an online STI testing and results service (Sexual Health 24) offering postal self-administered STI kits for chlamydia, gonorrhoea, syphilis, and HIV; results via text message (short message service, SMS), except positive results for HIV, which will be delivered by phone; and direct referrals to local clinics for treatment or (2) to a conventional sexual health information website with signposting to local clinic-based sexual health services. Participants will be free to use any other interventions or services during the trial period.
At 6 weeks from randomization we will collect self-reported follow-up data on service use, STI tests and results, treatment prescribed, and acceptability of STI testing services. We will also collect objective data from participating STI testing services on uptake of STI testing, STI diagnoses and treatment.
We hypothesise that uptake of STI testing and STI diagnoses will be higher in the intervention arm. Our hypothesis is based on the assumption that the intervention is less time-consuming, more convenient, more private, and incur less stigma and embarrassment than face-to-face STI testing pathways.
The primary outcome measure is diagnosis of any STI at 6 weeks from randomization and our co-primary outcome is completion of any STI test at 6 weeks from randomization. We define completion of a test, as samples returned, processed, and results delivered to the intervention and/or clinic settings. We will use risk ratios to calculate the effect of the intervention on our primary outcomes with 95% confidence intervals. All analyses will be based on the intention-to-treat (ITT) principle. Results This study is funded by Guy’s and St Thomas’ Charity and it has received ethical approval from NRES Committee London-Camberwell St Giles (Ref 14/LO/1477). Research and Development approval has been obtained from Kings College Hospital NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust. Results are expected in June 2016. Conclusions This study will provide evidence on the effectiveness of an online STI testing and results service in South East London. Our findings may also be generalizable to similar populations in the United Kingdom. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 13354298; http://www.isrctn.com/ISRCTN13354298 (Archived by WebCite at http://www.webcitation.org/6d9xT2bPj)
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Affiliation(s)
- Emma Wilson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Baraitser P, Syred J, Spencer-Hughes V, Howroyd C, Free C, Holdsworth G. How online sexual health services could work; generating theory to support development. BMC Health Serv Res 2015; 15:540. [PMID: 26637295 PMCID: PMC4670497 DOI: 10.1186/s12913-015-1200-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Online sexual health services are an emerging area of service delivery. Theory of change critically analyses programmes by specifying planned inputs and articulating the causal pathways that link these to anticipated outcomes. It acknowledges the changing and contested nature of these relationships. Methods We developed two versions of a theory of change for an online sexual health service. The first articulated the theory presented in the original programme proposal and the second documented its development in the early stages of implementation through interviews with key programme stakeholders. Results The programme proposal described an autonomous and empowered user completing a sexual health check using a more convenient, accessible and discreet online service and a shift from clinic based to online care. The stakeholder interviews confirmed this and described new and more complex patterns of service use as the online service creates opportunities for providers to contact users outside of the traditional clinic visit and users move between online and clinic based care. They described new types of user/provider relationships which we categorised as: those influenced by an online retail culture; those influenced by health promotion outreach and surveillance and those acknowledging the need for supported access. Conclusions This analysis of stakeholder views on the likely the impacts of online sexual health services suggests three areas for further thinking and research.Co-development of clinic and online services to support complex patterns of service use. Developing access to online services for those who could use them with support. Understanding user experience of sexual health services as increasing user autonomy and choice in some situations; creating exclusion and a need for support in others and intrusiveness and a lack of control in still others.
This work has influenced the evaluation of this programme which will focus on; mapping patterns of use to understand how users move between the online and clinic based services; barriers to use of online services among some populations and how to overcome these; understanding user perceptions of autonomy in relation to online services.
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Affiliation(s)
- Paula Baraitser
- Kings Centre for Global Health, Kings College London, London, UK. .,Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust, London, UK.
| | - Jonathan Syred
- Kings Centre for Global Health, Kings College London, London, UK
| | | | | | - Caroline Free
- Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
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Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72. [PMID: 26307056 PMCID: PMC4549868 DOI: 10.1186/s12911-015-0197-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 08/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing pervasiveness of mobile technologies has given potential to transform healthcare by facilitating clinical management using software applications. These technologies may provide valuable tools in sexual health care and potentially overcome existing practical and cultural barriers to routine testing for sexually transmitted infections. In order to inform the design of a mobile health application for STIs that supports self-testing and self-management by linking diagnosis with online care pathways, we aimed to identify the dimensions and range of preferences for user interface design features among young people. METHODS Nine focus group discussions were conducted (n = 49) with two age-stratified samples (16 to 18 and 19 to 24 year olds) of young people from Further Education colleges and Higher Education establishments. Discussions explored young people's views with regard to: the software interface; the presentation of information; and the ordering of interaction steps. Discussions were audio recorded and transcribed verbatim. Interview transcripts were analysed using thematic analysis. RESULTS Four over-arching themes emerged: privacy and security; credibility; user journey support; and the task-technology-context fit. From these themes, 20 user interface design recommendations for mobile health applications are proposed. For participants, although privacy was a major concern, security was not perceived as a major potential barrier as participants were generally unaware of potential security threats and inherently trusted new technology. Customisation also emerged as a key design preference to increase attractiveness and acceptability. CONCLUSIONS Considerable effort should be focused on designing healthcare applications from the patient's perspective to maximise acceptability. The design recommendations proposed in this paper provide a valuable point of reference for the health design community to inform development of mobile-based health interventions for the diagnosis and treatment of a number of other conditions for this target group, while stimulating conversation across multidisciplinary communities.
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Affiliation(s)
- Voula Gkatzidou
- Department of Computer Science, Brunel University, Uxbridge, UK.
| | - Kate Hone
- Department of Computer Science, Brunel University, Uxbridge, UK
| | - Lorna Sutcliffe
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Jo Gibbs
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Syed Tariq Sadiq
- Institute for Infection and Immunity, St. Georges, University of London, London, UK
| | - Ala Szczepura
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, UK
| | - Claudia Estcourt
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Moore Z, Angel D, Bjerregaard J, O'Connor T, McGuiness W, Kröger K, Rasmussen BSB, Yderstrœde KB. eHealth in Wound Care: from conception to implementation. J Wound Care 2015; 24:S1-S44. [DOI: 10.12968/jowc.2015.24.sup5.s1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Zena Moore
- Professor, Head of School, Previous President of the European Wound Management Association, School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Donna Angel
- Nurse Practitioner, Secretary of the Australian Wound Management Association, Royal Perth Hospital, 197 Wellington Street, Perth WA 6000, Australia
| | - Julie Bjerregaard
- The European Wound Management Association, Nordre Fasanvej 113, Frederiksberg, Denmark
| | - Tom O'Connor
- Deputy Head of School/Director of Academic Affairs, Senior Lecturer, School of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - William McGuiness
- Associate Professor, Previous President of the Australian Wound Management Association, Monash Health, 246 Clayton Rd, ClaytonVIC 3168, Australia
| | - Knut Kröger
- Director, Vice President of the Initiative Chronic Wounds e.V., Germany, Department of Angiology, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | | | - Knud Bonnet Yderstrœde
- Associate professor, Consultant Medical Endocrinology and Internal Medicine, Odense University Hospital, Region of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C
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Lohan M, Aventin Á, Oliffe JL, Han CS, Bottorff JL. Knowledge translation in men's health research: development and delivery of content for use online. J Med Internet Res 2015; 17:e31. [PMID: 25642787 PMCID: PMC4327186 DOI: 10.2196/jmir.3881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/04/2014] [Accepted: 11/23/2014] [Indexed: 02/04/2023] Open
Abstract
Background Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men’s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation. Objective Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men’s health. Methods We present experiences of KT across two case studies of men’s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men’s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men’s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled “If I Were Jack”. Results For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men’s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset. Conclusions The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom.
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Fuller SS, Mercer CH, Copas AJ, Saunders J, Sutcliffe LJ, Cassell JA, Hart G, Johnson AM, Roberts TE, Jackson LJ, Muniina P, Estcourt CS. The SPORTSMART study: a pilot randomised controlled trial of sexually transmitted infection screening interventions targeting men in football club settings. Sex Transm Infect 2014; 91:106-10. [PMID: 25512674 PMCID: PMC4345976 DOI: 10.1136/sextrans-2014-051719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Uptake of chlamydia screening by men in England has been substantially lower than by women. Non-traditional settings such as sports clubs offer opportunities to widen access. Involving people who are not medically trained to promote screening could optimise acceptability. Methods We developed two interventions to explore the acceptability and feasibility of urine-based sexually transmitted infection (STI) screening interventions targeting men in football clubs. We tested these interventions in a pilot cluster randomised control trial. Six clubs were randomly allocated, two to each of three trial arms: team captain-led and poster STI screening promotion; sexual health adviser-led and poster STI screening promotion; and poster-only STI screening promotion (control/comparator). Primary outcome was test uptake. Results Across the three arms, 153 men participated in the trial and 90 accepted the offer of screening (59%, 95% CI 35% to 79%). Acceptance rates were broadly comparable across the arms: captain-led: 28/56 (50%); health professional-led: 31/46 (67%); and control: 31/51 (61%). However, rates varied appreciably by club, precluding formal comparison of arms. No infections were identified. Process evaluation confirmed that interventions were delivered in a standardised way but the control arm was unintentionally ‘enhanced’ by some team captains actively publicising screening events. Conclusions Compared with other UK-based community screening models, uptake was high but gaining access to clubs was not always easy. Use of sexual health advisers and team captains to promote screening did not appear to confer additional benefit over a poster-promoted approach. Although the interventions show potential, the broader implications of this strategy for UK male STI screening policy require further investigation.
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Affiliation(s)
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Andrew J Copas
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - John Saunders
- Blizard Institute of Cell and Molecular Science, Queen Mary, University of London, London, UK
| | - Lorna J Sutcliffe
- Blizard Institute of Cell and Molecular Science, Queen Mary, University of London, London, UK
| | - Jackie A Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Graham Hart
- Faculty of Population Health Sciences, University College London, London, UK
| | - Anne M Johnson
- Department of Infection & Population Health, University College London, London, UK
| | - Tracy E Roberts
- Department of Health Economics Facility, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Department of Health Economics Facility, University of Birmingham, Birmingham, UK
| | - Pamela Muniina
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Claudia S Estcourt
- Blizard Institute of Cell and Molecular Science, Queen Mary, University of London, London, UK
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van Liere GAFS, Dukers-Muijrers NHTM, van Bergen JEAM, Götz HM, Stals F, Hoebe CJPA. The added value of chlamydia screening between 2008-2010 in reaching young people in addition to chlamydia testing in regular care; an observational study. BMC Infect Dis 2014; 14:612. [PMID: 25403312 PMCID: PMC4239384 DOI: 10.1186/s12879-014-0612-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background Internet-based Chlamydia Screening Implementation (chlamydia screening programme) was introduced in the Netherlands in 2008-2010 to detect and treat asymptomatic infections and to limit ongoing transmission through annual testing and treatment of Chlamydia trachomatis in young people (16-29 years). This population-based screening may be less effective when addressing individuals who are already covered by regular care, instead of addressing a hidden key population without chlamydia testing experience in regular care. This study had two aims: (1) to assess the rate and determinants of newly reached (i.e. not previously tested in 2006-2010) participants in the chlamydia screening programme, and (2) to assess the chlamydia positivity in these newly reached participants. Methods This observational matching study included all chlamydia tests performed in subjects aged 16-29 years in eastern South Limburg in the Netherlands (population 16-29 years:41,000) between 2006-2010. Testing was conducted during the systematic chlamydia screening programme (2008-2010), at a sexually transmitted infections clinic (STI clinic), by general practitioners (GPs), and by medical specialists as reported by the medical laboratory serving the region. Data were matched between testing services on individual level. The study population included all participants who were tested at least once for chlamydia by the chlamydia screening programme. Participants were included at their first chlamydia screening participation. Results In the chlamydia screening programme, 80.7% (4298/5323) of participants were newly reached, others were previously tested by the STI clinic (5.7%, n=304), GPs (6.2%, n=328), medical specialists (3.5%, n=187) or a combination of providers (3.9%, n=206). Chlamydia prevalence was similar in newly reached participants (4.8%, 204/4298) and participants previously tested (4.5%, 46/1025, P=0.82). Independent determinants for being a newly reached participant were male gender (men OR 2.9; 95% CI 2.5-3.4) and young age <21 years (versus 25-29 years OR 1.8; 95% CI 1.5-2.2). Conclusions The majority of the chlamydia screening programme participants have not been tested by regular care, and show similar chlamydia prevalence as those previously tested. Thereby population-based chlamydia screening adds to the existing regular care by testing young individuals hidden to current regular care. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0612-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geneviève A F S van Liere
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, Netherlands. .,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), P.O. Box 5800, 6202 AZ, Maastricht, Netherlands.
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, Netherlands. .,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), P.O. Box 5800, 6202 AZ, Maastricht, Netherlands.
| | | | - Hannelore M Götz
- Department of Infectious Diseases Control, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, 3000 LP, Rotterdam, Netherlands.
| | - Frans Stals
- Department of Medical Microbiology, Atrium Medical Centre Parkstad, P.O. Box 4446, 6401 CX, Heerlen, Netherlands.
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, Netherlands. .,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), P.O. Box 5800, 6202 AZ, Maastricht, Netherlands.
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The views of general practitioners and practice nurses towards the barriers and facilitators of proactive, internet-based chlamydia screening for reaching young heterosexual men. BMC FAMILY PRACTICE 2014; 15:127. [PMID: 24972919 PMCID: PMC4096584 DOI: 10.1186/1471-2296-15-127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chlamydia trachomatis is a common bacterial sexually transmitted infection (STI), which disproportionately affects young people under 25 years. Commonly, more women are offered screening than men. This study obtained the views of general practitioners and practice nurses towards Internet-based screening and assessed levels of support for the development of proactive screening targeting young heterosexual men via the Internet. METHODS Semi-structured telephone interviews with 10 general practitioners and 8 practice nurses, across Central Scotland. Topics covered: experience of screening heterosexual men for chlamydia, views on the use of the Internet as a way to reach young men for chlamydia screening, beliefs about the potential barriers and facilitators to Internet-based screening. Transcripts from audio recordings were analysed with Framework Analysis, using QSR NVivo10. RESULTS Experiences of chlamydia screening were almost exclusively with women, driven by the nature of consultations and ease of raising sexual health issues with female patients; few practice nurses reported seeing men during consultations. All participants spoke in favour of Internet-based screening for young men. Participants reported ease of access and convenience as potential facilitators of an Internet-based approach but anonymity and confidentiality could be potential barriers and facilitators to the success of an Internet approach to screening. Concerns over practical issues as well as those pertaining to gender and socio-cultural issues were raised. CONCLUSIONS Awareness of key barriers and facilitators, such as confidentiality, practicality and socio-cultural influences, will inform the development of an Internet-based approach to screening. However, this approach may have its limits in terms of being able to tackle wider social and cultural barriers, along with shifts in young people's and health professionals' attitudes towards screening. Nevertheless, employing innovative efforts as part of a multi-faceted approach is required to ensure effective interventions reach the policy agenda.
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