Shifting Grounds—Facilitating Self-Care in Testing for Sexually Transmitted Infections Through the Use of Self-Test Technology: Qualitative Study

Abstract

Background: Chlamydia remains prevalent worldwide and is considered a global public health problem. However, testing rates among young sexually active people remain low. Effective clinical management relies on screening asymptomatic patients. However, attending face-to-face consultations for testing for sexually transmitted infections is associated with stigmatization and anxiety. Self-testing technology allows patients to test themselves for chlamydia and gonorrhea without the presence of healthcare professionals. This may result in wider access to testing and to increase testing uptake. Therefore, the sexual health clinic a (blinded for review) has designed and developed a technology that allow patients to get tested at the clinic through selfcollected sampling without a face-to-face consultation. Objective:The aim of this study was twofold: 1) to pilot-test the STT in clinical practice and 2) to investigate the experiences of patients who have completed a self-test for chlamydia and gonorrhea. Methods:The study was conducted as a qualitative study inspired by the methodology of participatory design. Ethnographic methods were applied in the feasibility study and data analyzed was inspired by the action research spiral in iterative processes using the steps; plan, act, observe and reflect method. The qualitative evaluation study used semi-structured interviews and data were analyzed inspired by Ricoeur's theory of narrative and interpretation.Results: Findings from the feasibility study, such as lack of signposting and adequate information led to the final modifications of the self-test technology and made it possible to implement it in clinical practice. The qualitative evaluation study found that self-testing was seen as more appealing than testing at a face-to-face consultation because it was an easy solution that both saved time and allowed for freedom to plan the visit oneself. Security was experienced when the instructions balanced between being detail-oriented while also being simple and illustrative. The anonymity and discretion contributed to preserving privacy and removed the fear of an awkward conversation or being judged by health care professionals and thus, led to the reduction of intrusive feelings.Conclusions: Accessible healthcare services are crucial in preventing and reducing the impact of sexually transmitted infections and the self-testing technology may have the potential to increase testing up-take as it takes into account some of the barriers that exist. The pilot test and evaluation has resulted in a fully functioning implementation of the self-testing technology in clinical practice.