Opening the digital doorway to sexual healthcare: Recommendations from a behaviour change wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations.
Julie McLeod, Claudia S Estcourt, Jennifer MacDonald, Jo Gibbs, Melvina Woode Owusu, Fiona Mapp, Nuria Gallego Marquez, Amelia McInnes-Dean, John M Saunders, Ann Blandford, Paul Flowers
Author Information
Julie McLeod: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom. ORCID
Claudia S Estcourt: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
Jennifer MacDonald: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
Jo Gibbs: Institute for Global Health, University College London, London, England, United Kingdom.
Melvina Woode Owusu: Institute for Global Health, University College London, London, England, United Kingdom.
Fiona Mapp: Institute for Global Health, University College London, London, England, United Kingdom.
Nuria Gallego Marquez: Institute for Global Health, University College London, London, England, United Kingdom. ORCID
Amelia McInnes-Dean: Institute for Global Health, University College London, London, England, United Kingdom.
John M Saunders: Institute for Global Health, University College London, London, England, United Kingdom.
Ann Blandford: UCL Interaction Centre (UCLIC), University College London, London, England, United Kingdom. ORCID
Paul Flowers: Psychological Science and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom.
BACKGROUND: The ability to access and navigate online sexual health information and support is increasingly needed in order to engage with wider sexual healthcare. However, people from underserved populations may struggle to pass though this "digital doorway". Therefore, using a behavioural science approach, we first aimed to identify barriers and facilitators to i) seeking online sexual health information and ii) seeking online sexual health support. Subsequently, we aimed to generate theory-informed recommendations to improve these access points. METHODS: The PROGRESSPlus framework guided purposive recruitment (15.10.21-18.03.22) of 35 UK participants from diverse backgrounds, including 51% from the most deprived areas and 26% from minoritised ethnic groups. Using semi-structured interviews and thematic analysis, we identified barriers and facilitators to seeking online sexual health information and support. A Behaviour Change Wheel (BCW) analysis then identified recommendations to better meet the needs of underserved populations. RESULTS: We found diverse barriers and facilitators. Barriers included low awareness of and familiarity with online information and support; perceptions that online information and support were unlikely to meet the needs of underserved populations; overwhelming volume of information sources; lack of personal relevancy; chatbots/automated responses; and response wait times. Facilitators included clarity about credibility and quality; inclusive content; and in-person assistance. Recommendations included: Education and Persuasion e.g., online and offline promotion and endorsement by healthcare professionals and peers; Training and Modelling e.g., accessible training to enhance searching skills and credibility appraisal; and Environmental Restructuring and Enablement e.g., modifications to ensure online information and support are simple and easy to use, including video/audio options for content. CONCLUSIONS: Given that access to many sexual health services is now digital, our analyses produced recommendations pivotal to increasing access to wider sexual healthcare among underserved populations. Implementing these recommendations could reduce inequalities associated with accessing and using online sexual health service.
References
Br J Health Psychol. 2023 Feb;28(1):156-173
[PMID: 35918874]
