Understanding the barriers and facilitators to using self-sampling packs for sexually transmitted infections and blood borne viruses: thematic analyses supporting intervention optimisation

Abstract

PurposeThis paper illustrates initial steps of an intervention optimisation process. Self-sampling packs for sexually transmitted infections (STIs) and blood borne viruses (BBVs) are widely offered within the UK, yet have problems with reach and sample return rates. They have arisen without any formal intervention development.MethodsEleven focus groups and seven interviews were conducted with convenience samples of patients recruited from sexual health clinics and members of the public in late 2017 (n=57). To enable intervention optimisation firstly we formulated initial programme theory situating the intervention. Secondly, we conducted an inductive appraisal of the behavioural system of using the pack to understand meaningful constituent behavioural domains. Subsequently we conducted a thematic analysis of barriers and facilitators to enacting each sequential behavioural domain in preparation for future behaviour change wheel analysis.ResultsOverall, we found that self-sampling packs were acceptable. Our participants understood their overall logic and value as a pragmatic intervention that simultaneously reduced barriers to, and facilitated, individuals being tested for STIs. However, at the level of each behavioural domain (e.g., reading leaflets, returning samples), problems with the pack were identified as well as a series of potential optimisations which might widen the reach of self-sampling and increase the return of viable samples.ConclusionsThis paper provides an example of a pragmatic approach to optimising an intervention already widely offered across the UK. The paper demonstrates the added value health psychological approaches make; systematically considering the context of the intervention, in addition to illuminating granular areas for improvement.What is already known on this subject?The use of self-sampling packs for sexually transmitted infections (STIs) and blood borne viruses (BBVs) has been widely implemented without in-depth assessment of user engagement or theorisationSome evidence suggests that the uptake of self-sampling packs, and the concomitant return of samples to enable diagnosis, are socially patternedDespite increasing and widespread use of self-sampling packs across the UK, relatively little is currently known about their acceptability, or how they could be improvedWhat does this study add?This study provides an illustrative example of using a preliminary programme theory to situate the problem to be addressed by intervention optimisationThe thematic analyses show that self-sampling packs offer a largely acceptable means to enabling STI and BBV testing and diagnosis; they remove many barriers to testing. However, several modifiable barriers to use endure, potentially reducing sample return and amplifying health inequalitiesThis study presents a range of barriers and facilitators to the various behavioural domains included within the use of self-sampling packs. It summarises the findings ready for subsequent behaviour change wheel analyses

Using the behaviour change wheel approach to optimise self-sampling packs for sexually transmitted infection and blood borne viruses

“…Reading horizontally, left to right, across the table it is possible to see the target behaviour (pitched at the level of the behavioural domains) at the heart of the BCW analysis that is to be changed (left hand column). Secondly, we present the specific barriers and facilitators to changing that behaviour summarising insights from our earlier qualitative work (Flowers et al, 2021, paper 3a). Thirdly, we show how these barriers and facilitators (as causal influences on the enactment of each behavioural domain) were coded in relation to theoretical domains specified by the TDF.…”

“…Details of the participants that generated the initial data that the current analyse can be found elsewhere (Flowers et al, 2021, paper 3a). Briefly, eleven focus groups and seven interviews with young heterosexual individuals and men who have sex with men (MSM) were conducted in Glasgow and London in late 2017.…”

“…The original thematic analysis is reported elsewhere (please see Flowers et al, 2021, paper 3a for details)…”

“…For us, as a pragmatic and applied interdisciplinary team, we have sought to attain the best balance of both behavioural specificity and parsimony. With regard to considering the behaviours at the heart of our behaviour change endeavour, having conducted inductive, participant-led thematic analysis detailing how our participants thought about the pack and what constituted pack use, we conceptualised using the self-sampling packs as a behavioural system structured by a series of inter-related and sequential behavioural domains (see Flowers et al, 2021, paper 3a). Although we could have analysed each behavioural domain in even more specific behavioural terms, we felt it was very likely that the number of shared antecedents for these highly-related specific behaviours would be high and that there could be a lot of effort for minimal reward.…”

“…Our previous exploratory qualitative insights (Flowers et al, 2021a) highlighted problems with the existing self-sampling pack. Through thematic analyses with diverse members of the public and those attending sexual health services, we showed that that use of the pack overall was sometimes experienced as overwhelming, that pack-level instructions were challenging to many, and that the poor overall pack-usability was likely to reduce pack use.…”