@Article{info:doi/10.2196/jmir.8101,
author="Turner, Katy ME
and Zienkiewicz, Adam K
and Syred, Jonathan
and Looker, Katharine J
and de Sa, Joia
and Brady, Michael
and Free, Caroline
and Holdsworth, Gillian
and Baraitser, Paula",
title="Web-Based Activity Within a Sexual Health Economy: Observational Study",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="07",
volume="20",
number="3",
pages="e74",
keywords="sexually transmitted diseases; testing; internet; self-sampling",
abstract="Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need. Objective: The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead. Methods: Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other. Results: Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47{\%} (from 36,373 to 43,091 in the same 6-month period---2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90{\%} (920/5443) to 12.25{\%} (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15{\%} (3764/5443) to 74.86{\%} (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62{\%}, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses. Conclusions: This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion. ",
issn="1438-8871",
doi="10.2196/jmir.8101",
url="https://www.jmir.org/2018/3/e74/",
url="https://doi.org/10.2196/jmir.8101",
url="http://www.ncbi.nlm.nih.gov/pubmed/29514776"
}