Crh Aicken

Young people’s perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study

BackgroundControl 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 eSTI2 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.MethodsIn-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.ResultsNine 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.ConclusionsRemote 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.

O22.4 What Are Young People’s Perceptions of Using Electronic Self-Tests For STIs Linked to Mobile Technology For Diagnosis and Care (eSTI2)?

Background UK rates of sexually transmitted infections (STI) are sustained or rising, particularly among young people aged 16–24, despite decreases in patient waiting times within traditional services. Modern advances in communication and diagnostic technologies offers the potential of electronic self-testing and diagnosis for STIs (eSTI2), linked to Internet/mobile-App based clinical management and support, which could be accessed wherever people find convenient and safe. We aimed to explore opinions on using eSTI2 among a sample of potential users. Methods Twenty-five semi-structured interviews were conducted with a purposive sample of sexually active young people aged 16–24 years enrolled in London further education colleges. Analysis was based on the Framework method. Results Participants were 64% male (n = 16), 36% female (n = 9). Mean age was 19. They described their ethnicity as Black 84% (n = 21), mixed race 12% (n = 3), Asian 4% (n = 1). Including those screened via the National Chlamydia Screening Programme (NCSP), the majority of participants (92%, n = 23) had previously screened for STIs at least once. The young people in our sample were highly conversant in mobile technology but had limited experience of using it to access health-related services. Participants reported struggling between desire to access services out of concern for their sexual health and repercussions from being discovered by family and peers at testing centres. These barriers were seen to be mitigated by using eSTI2. Participants expressed the importance of eSTI2 being embedded within NHS services, incorporating personal support from clinicians when necessary. Conclusions Concern around long waits and lack of privacy within traditional settings created a barrier to STI testing for these young people. Electronic self-testing for STIs, linked to Internet/mobile-App based clinical management and support (eSTI2) and embedded within NHS services appears highly acceptable to this group of high-risk young people and could increase their access to STI testing and care.

Using the eSexual Health Clinic to access chlamydia treatment and care via the internet: a qualitative interview study.

Objective We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention. Methods Within exploratory studies of the eSHC (2014–2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18–35, 20 female, 16 male). Thematic analysis was conducted. Results Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic access. They described completing the online consultation promptly, discreetly and with ease. The information provided online was considered comprehensive, reassuring and helpful, but some overlooked it in their haste to obtain treatment. Participants generally described being able to collect treatment from pharmacies discreetly and promptly, but for some, poor awareness of the eSHC by pharmacy staff undermined their ability to do this. Those unsuitable for remote management, who were directed to clinic, described frustration and concern about health implications and clinic attendance. However, the helpline was a highly valued source of information, assistance and support. Conclusion The eSHC is a promising adjunct to traditional care. Its users have high expectations for convenience, speed and privacy, which may be compromised when transitioning from online to face-to-face elements of the eSHC. Managing expectations and improving implementation of the pharmacy process, could improve their experiences. Positive views on the helpline provide further support for embedding this ehealth intervention within a specialist clinical service.

Mixed-methods evaluation of a novel online STI results service

Objectives Evidence on optimal methods for providing STI test results is lacking. We evaluated an online results service, developed as part of an eSexual Health Clinic (eSHC). Methods We evaluated the online results service using a mixed-methods approach within large exploratory studies of the eSHC. Participants were chlamydia- positive and negative users of online postal self-sampling services in six National Chlamydia Screening Programme (NCSP) areas and chlamydia-positive patients from two genitourinary medicine (GUM) clinics between 21 July 2014 and 13 March 2015. Participants received a discreetly worded National Health Service ’NHS no-reply’ text message (SMS) informing them that their test results were ready and providing a weblink to a secure website. Participants logged in with their date of birth and mobile telephone or clinic number. Chlamydia-positive patients were offered online management. All interactions with the eSHC system were automatically logged and their timing recorded. Post-treatment, a service evaluation survey (n=152) and qualitative interviews (n=36) were conducted by telephone. Chlamydia-negative patients were offered a short online survey (n=274). Data were integrated. Results 92% (134/146) of NCSP chlamydia-positive patients, 82% (161/197) of GUM chlamydia-positive patients and 89% (1776/1997) of NCSP chlamydia-negative participants accessed test results within 7 days. 91% of chlamydia-positive patients were happy with the results service; 64% of those who had tested previously found the results service better or much better than previous experiences. 90% of chlamydia-negative survey participants agreed they would be happy to receive results this way in the future. Interviewees described accessing results with ease and appreciated the privacy and control the two-step process gave them. Conclusion A discreet SMS to alert users/patients that results are available, followed by provision of results via a secure website, was highly acceptable, irrespective of test result and testing history. The eSHC results service afforded users privacy and control over when they viewed results without compromising access.

OP34 Online care for sexually transmitted infections: using qualitative research in intervention development and evaluation

Background Sexually transmitted infections (STI) remain a major public health problem, despite widespread provision of STI testing and treatment through clinical services and chlamydia screening for young people in England. Early detection and treatment of these often asymptomatic infections is vital, but barriers to testing include embarrassment, privacy concerns, and inconvenience. Diagnostic technologies, which potentially enable STI self-testing within online care-pathways to treatment, are being developed; people could self-test and receive diagnoses and treatment ‘remote’ from health services, perhaps without interacting with health-professionals. Within a programme of research to develop this complex intervention, we qualitatively explored views and experiences, to inform its development and understand its acceptability. Methods In-depth interview study, with two phases (P1, P2). P1 explored, hypothetically, the acceptability of online care-pathways including STI self-testing, among 25 purposively-sampled college students, aged 16–24. P1’s findings informed development of the Online Chlamydia Pathway (OCP), which included an automated online consultation, treatment collection from community pharmacy, and a helpline for support and to facilitate clinic access where appropriate. P2: People diagnosed (following conventional testing) with chlamydia, were offered the OCP in an exploratory study. Interviews explored views and experiences of 40 purposively-sampled OCP users. Thematic analyses, using ‘Framework’ was used for data management. Results P1: 16 men and 9 women participated. Themes about speed, convenience and privacy (avoiding face-to-face consultations, concealing sexual healthcare use) were identified. Self-testing within online care-pathways was discussed as more convenient, private and quicker than existing services. Interviewees expressed concern about electronic ‘evidence’ of sexual healthcare use, and self-operation of novel technology. They valued the option of support from health-professionals. Association with NHS services conveyed trustworthiness. In response to these findings, the OCP was delivered as a web-app, text-messages were worded discreetly, NHS logos displayed, and a helpline and facilitated clinic access were included. P2: 19 men and 21 women, aged 18–35, participated. Themes about speed, convenience and privacy were further developed, but some described how these perceived advantages were compromised when they collected treatment in pharmacies. Interviewees expressed few, minor concerns about internet/‘technological’ privacy risks, and appreciated the OCP’s association with existing NHS services. They favoured the helpline’s presence, those using it gaining reassurance. Conclusion This novel intervention’s ongoing development has been iteratively informed by qualitative research. Although it was perceived as an acceptable alternative to conventional sexual healthcare, linkage with existing services and optional human support remained important. Further research is needed regarding other risk groups and infections, and the future self-test.

P2-S4.02 Don't look at your patients, look at their partners: Characteristics of sexual partnerships reported by people attending GUM clinics in England

Background Partnership characteristics, for example, their length, timing, and whether or not condoms are used, may be more important for assessing STI transmission risk than partnership numbers. However, data routinely collected by GUM clinics in the UK are limited in terms of such measures of partnership risk. We sought to measure this in a high-risk population and consider the implications for STI transmission and partner notification (PN). Methods Cross-sectional survey of 2203 people attending 4 sociodemographically and geographically contrasting GUM clinics in England in 2009. Attendees completed a questionnaire that was linked to their clinical records for data on acute STI diagnoses. Questions asked about their three most recent partnerships in the 3 months prior to attending GUM and the total number of partners in this period. We used a novel statistical approach to weight the data to represent the partnerships for which these questions were not asked. This enables us to describe the population of partnerships reported by GUM attendees, rather than the population of attendees. Results Most patients had few partners: median: 1 partner, IQRs: 1–3 (men) and 1–2 (women). However, the 1941 attendees reporting partners reported a total of 3576 partners: 1953 by 846 men, 1623 by 1095 women. Mens partnerships were shorter than womens: 73% vs 54% (p<0.01) were <3 months “old” (49% vs 27%, respectively, were one-off encounters), and were more likely to be considered as ended: 64% vs 41%, respectively, p<0.01, see Abstract P2-S4.02 figure 1 Inconsistent condom use was high, especially in womens partnerships: 81% vs 65% among mens partnerships, p=0.002. Men (but not women) were more likely to have acute STIs diagnosed if they had never used condoms with their partners than if they had at least once: 33% vs 27%, p=0.001. 24% of men vs 14% of women had recent concurrent partnerships based on the dates of their 3 most recent partners (p<0.01), but this was not associated with having acute STI diagnoses. Abstract P2-S4.02 Figure 1 Distribution of partnership length by partnership status and gender of GUM clinic attendee. Conclusions Despite low median partner numbers, GUM attendees have a large population of partnerships, of which only a small minority involve consistent condom use, thus the potential for STI transmission is high. These partnerships are often casual in nature being short in duration and unlikely to be ongoing. Research is needed to develop and test alternative methods for reaching such partners to ensure that PN achieves both individual and public health benefit.