The Department of Health has made reducing the rates of Sexually Transmitted Infections (STIs) a priority, particularly amongst young people (15-24 years), as larger numbers are affected in this age group.
The estimated annual cost to the NHS for STI treatment is £620 million. The best way for sexually active people to avoid STI’s is to use a condom but young people report inconsistent use.
In an effort to reduce the rate of one particularly widespread STI, chlamydia, young people aged 15-24 years old are able to access free testing from a number of clinical and community services, and also via a number of self-testing webistes.
On average 130,000 young people are tested via these websites every year and those tested are at high risk of future STIs and include groups which other services have found difficult to engage (e.g. young men and those from more deprived backgrounds). These websites provide a unique opportunity to intervene, but typically they provide little or no sexual health promotion to address how young people can protect themselves against future STIs. Furthermore, evidence suggests that the experience of testing doesn’t reliably translate into future prevention efforts. Preventx, who operate the self-testing website freetest.me, report high levels of repeat testing, at 40% based on all-time users. This statistic indicates a ‘revolving door’ use of the service and a failure to change condom-use behaviour.
The Chance2Change project involves the development of a digital intervention to increase condom use amongst those self-testing for chlamydia via online testing websites in order to prevent future STIs.
The digital intervention will be embedded within the existing user pathway of an online testing website (freetest.me) and delivered following a request for a self-test kit to users assessed as ‘at risk’. This has been identified as a potentially important ‘teachable moment’ when users are receptive to information about changing their sexual behaviour. The intervention will be brief and highly tailored to the each individual user, dependant on self-selected determinants of condom use (users will be asked to indicate from a list of options, what their main reasons for not using condoms are). Each individual will then receive a number of intervention components accordingly. If for example they report that purchasing condoms is embarrassing, they could be linked up to a scheme which posts out packs of condoms upon receipt of a text request.
The intervention will be co-created with a Young People’s Working Group, an Expert Group and the Innovation, Design and Technology Unit (IDTU, Coventry University). Over a number of stages, we will identify the main barriers to condom use for our target group and develop content to address each of these.
We will conduct a ‘think aloud’ study with young people before we finalise it to test usability, functionality and appeal. Further funding will be applied for at the end of the study to test whether the intervention is effective.
Ultimately we aim for our intervention to reduce the incidence of STIs. Whilst the intervention will initially be developed for freetest.me there is potential for it also to be adopted by other internet self-testing providers, and non-internet sexual health providers e.g. GUM patients could receive the intervention via an app whilst waiting in clinic for STI results. The intervention could also be embedded within the eSTI2 user pathway. Potential ‘reach’ is therefore high.