ObjectivesTo describe user experience of obtaining and uploading biometric measurements to a ‘digital-only’ contraceptive service prior to a prescription for the combined oral contraceptive (COC). To analyse this experience to inform the design of safe and acceptable ‘digital-only’ online contraceptive services.SettingAn online contraceptive service available free of charge to women in South East London, UK.ParticipantsTwenty participants who had ordered the combined oral contraceptive (COC) online. Our purposive sampling strategy ensured that we included participants from a wide range of ages and those who were and were not prescribed the COC.InterventionA ‘digital-only’ contraceptive service that prescribes the COCafter an online medical history and self-reported height, weight and blood pressure (BP) with pills prescribed by a GMC registered doctor, dispensed by an online pharmacy and posted to the user.DesignSemistructured interviews with a purposive sample of 20 participants who were already enrolled in a larger study of this service.AnalysisInductive, thematic analysis of the interviews assisted by NVivo qualitative analysis software.ResultsUsers valued the convenience of ‘digital-only care’ but experienced measuring BP but not height or weight as a significant barrier to service use. They actively engaged in work to understand and measure BP through a combination of recent/past measurements, borrowed machines, health service visits and online research. They negotiated tensions around maintaining a trusting relationship with the service, meeting its demands for accurate information while also obtaining the contraception that they needed.ConclusionDigital strategies to build trusting clinical relationships despite a lack of face-to-face contact are needed in ‘digital-only’ health services. This includes acknowledgement of work required, evidence of credible human support and a digital interface that communicates the health benefits of collaborating with an engaged clinical team.

BackgroundOnline contraception services increasingly provide information, clinical assessment and home-delivered oral contraceptives (OCs). Evidence is lacking on the effects of online contraceptive service use on short-term contraceptive continuation.MethodsCohort study comparing contraceptive continuation between new users of a free-to-access online OC service in South East London with those from other, face-to-face services in the same area. Online questionnaires collected data on participants’ sociodemographic characteristics, motivations for OC access, service ratings, OC knowledge and contraceptive use. Contraceptive use in the 4-month study period was measured using health service records. Unadjusted and multivariable logistic regression models compared outcomes between the online service group and those using other services.ResultsOnline service-users (n=138) were more likely to experience short-term continuation of OCs compared with participants using other services (n=98) after adjusting for sociodemographic and other characteristics (adjusted OR 2.94, 95% CI 1.52 to 5.70). Online service-users rated their service more highly (mean 25.22, SD 3.77) than the other services group (mean 22.70, SD 4.35; p<0.001), valuing convenience and speed of access. Among progestogen-only pill users, knowledge scores were higher for the online group (mean 4.83, SD 1.90) than the other services group (mean 3.87, SD 1.73; p=0.007). Among combined oral contraceptive users, knowledge scores were similar between groups.ConclusionsFree-to-access, online contraception has the potential to improve short-term continuation of OCs. Further research using a larger study population and analysis of longer-term outcomes are required to understand the impact of online services on unintended pregnancy.

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BackgroundYoung people in the UK are at high risk for sexually transmitted infections (STIs), despite STI testing being freely and confidentially available. Given multiple barriers they may face for attending sexual health clinics (SHCs), young people should be consulted regarding changes to care. Studies have shown that point-of-care tests (POCTs) for STIs, which can accurately diagnose and treat patients in one clinical visit, have potential for individual and public health benefits, yet patient opinions of changes to clinical practice associated with POCT implementation are less understood.MethodsThe Precise study explored patient experiences of UK SHC services and their opinions of POCT implementation plans; here we focus on young participants within the Precise study. Male and female attendees of three SHCs in England were purposively sampled and then invited to participate in a qualitative in-depth interview. Interviews were conducted one-on-one, in person or via telephone, were audio-recorded and transcribed. NVivo (V10) was used to organise data for our content-based analysis.ResultsTen young people aged 17-22 years, including: three women-who-have-sex-with-men, four men-who-have-sex-with-women and three men-who-have-sex-with-men were interviewed between June 2015 and February 2016. Participants reported SHCs as the best place to receive results because treatment could be stared immediately, with advice and information available. Participants discussed the potential for POCTs to reduce anxiety currently felt waiting for laboratory results. POCTs were found broadly acceptable, and were generally regarded as an innovation to improve SHC experiences. Participants with less previous SHC experience raised concerns that implementation of POCTs could negatively affect the amount and quality of time patients spend in consultations with clinicians and that changes to pathways may cause confusion in clinic.ConclusionsWe advise POCT implementation be accompanied by SHC staff communicating changes in clinical pathways to patients, including method and timeline for receiving results. Our participants valued face-to-face counselling and advice currently experienced in SHCs; these findings emphasise that POCT implementation plans safe-guard these aspects of care. Our findings suggest that POCT implementation in SHCs has potential to improve young people’s clinical experiences, which may facilitate attendance.