Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

Abstract

ObjectiveBehavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage individuals to these services.MethodsWe conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes.ResultsWe conducted 35 service user (15 heterosexual young people; 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users.ConclusionOverall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services.

Association between Psychological Factors and Condom Use with Regular and Nonregular Male Sexual Partners among Chinese MSM: A Quantitative Study Based on the Health Belief Model

“…The current behavior interventions or services for HIV prevention among MSM mainly focus on providing health packages, such as condoms and AIDS testing kits, videos, and digital interventions (e.g., using apps) [ 32 , 33 ]. However, if the scope of behavior interventions excluded the psychological factors, it would be difficult to achieve the intervention goals.…”

Modelling the impact of tailored behavioural interventions on chlamydia transmission

“…Our model results showed that targeting behavioural interventions at all tested high-risk individuals, including both individuals who tested chlamydia positive as well as those who tested negative, should be a part of STI management as well in order to reduce chlamydia prevalence most effectively. However, as sufficient resources to deliver behavioural interventions face-to-face to all tested individuals (e.g., during an STI test consultation) are often not available, online interventions might be a good alternative 34 , 59 , 60 . For example, a validated set of questions to assess certain psychological characteristics may be added to the process of making an appointment online (i.e., before testing).…”

“…For example, a validated set of questions to assess certain psychological characteristics may be added to the process of making an appointment online (i.e., before testing). This extra information could be used to deliver tailored online interventions at the SHC, such as a video-based intervention during the online intake assessment, or after retrieving the chlamydia test results online 34 , 59 , 60 .…”

“…Behavioural interventions are often STI clinic-based 32,34 , as individuals visiting the STI clinic at sexual health centers (SHC) tend to engage in higher risk sexual behaviour than the general population 35,36 , and potentially benefit the most from behavioural interventions 34 . It was previously shown that individuals who were diagnosed with a chlamydia infection engaged in more risk-reducing sexual behaviour after receiving the test results, whereas individuals who tested chlamydia negative did not change their sexual behaviour or even engaged in behaviours related to increased risk (i.e., decreased condom use) after testing 9,10,37 .…”

The invisible influence: impact of psychological mechanisms of sexual behaviour on chlamydia transmission

“…Primary prevention of chlamydia infection is usually aimed at achieving riskreducing behaviour, such as promotion of condom use [2], and behaviour change might be vital part of chlamydia control [43,44]. Extensive data on changes in sexual behaviour, psychosocial determinants, and STI/HIV infections over time have been collected in longitudinal cohort studies among men who have sex with men (MSM) [81][82][83][84][85][86][87][88]. However, among young heterosexual males and females, few published data are available on multiple psychological and behavioural characteristics, and chlamydia infections at more than one follow-up moment [20,39,85,89].…”