Development of a digital intervention to increase condom use amongst those selftesting for chlamydia

Lead Research Organisation: Coventry University
Department Name: Ctr for Advances in Behavioural Science

Abstract

The Department of Health has made reducing the rates of Sexually Transmitted Infections (STIs) a priority. This is particularly so amongst young people, as larger numbers are affected in this age group compared to others. STIs can lead to serious health consequences for individuals, and the cost to the NHS of treatment is high. The best way for sexually active people to avoid STIs is to use a condom but young people report inconsistent use.

In an effort to reduce the rate of one particularly widespread STI called chlamydia, young people aged 15-24 years old are able to access free testing from a number of clinical and community services. As part of this initiative, self-testing for this group is available online via a number of internet providers. After inputting some basic personal information, users of this service receive a small unmarked box in the post containing a testing kit. After taking a sample - urine (males and females) or vaginal swab (females only) - and returning this in the box, users with a negative result receive a text or email message to this effect within 2-5 days. Those with a positive result receive an email or text asking them to contact their local chlamydia screening coordinator who discusses the result with them and arranges treatment.

On average 130,000 young people are tested via this route every year. Those tested are at high risk of future STIs and include groups which other services have found difficult to engage, such as young men and those from deprived backgrounds. These websites typically provide little or no advice to users about protecting themselves against future STIs. Furthermore, information from one of the internet testing providers (freetest.me) indicates that approximately 40% of those testing have used the service before. This suggests that the experience of testing in itself does not lead to a change in behaviour.

This study will develop a digital intervention to increase condom use amongst users of internet testing websites in order to prevent future STIs. It will be shown to users in between sending off their sample and receiving their test results. This has been identified as a potentially important 'teachable moment' when users are receptive to information about changing their sexual behaviour. It will be brief and highly tailored to the individual user. At the start of the intervention users will be asked to indicate from a list of options, what their main reasons for not using condoms are. They will then receive a number of relevant 'chunks' of the intervention. If for example they report that purchasing condoms is embarrassing, they could be linked up to a scheme which posts out packs of condoms upon receipt of a text request.

We will be developing the intervention with young people. Over a number of stages, we will identify the main barriers to condom use for our target group and develop content to address each of these. We will test our intervention with young people before we finalise it to make sure that it is simple, easy to use and engaging. Changes will be made accordingly if necessary. At the end of this study we will apply for further funding to test whether the intervention works.

Technical Summary

The Department of Health has made reducing the rates of Sexually Transmitted Infections (STIs) a priority, particularly amongst young people who are disproportionately affected [1]. The best way for sexually active people to avoid STIs is to use a condom [1] but young people report inconsistent use [2, 3]. A missed opportunity to intervene to increase condom use is when they access self-testing kits for STIs via the internet.
Due to the National Chlamydia Screening programme, there are a number of websites offering free selftesting kits to young people for the STI Chlamydia. On average 130,000 young people are tested via this route every year [4]. Those tested are at high risk of future STIs [4] and include groups which other services have found difficult to engage, such as young men and those from deprived backgrounds [4, 5]. Typically however, these websites provide little or no sexual health promotion [4]. This study will develop a theory-based, tailored intervention to increase condom use for this priority/hard-to-reach group, embedded within the existing user pathway of the chlamydia self-testing website freetest.me. Co-design with young people will maximise future appeal and use by the target audience. In line with MRC guidance [6], we will 1) identify important determinants of condom use and evidence of their 'changeability' using computer/digital interventions, 2) identify suitable Behaviour Change Techniques (BCTs), and engaging methods of delivery, to target these determinants , 3) design the tailored intervention ensuring fidelity to theoretical basis and high levels of appeal/usability, 4) test usability using a think-aloud study and then refine prior to finalisation, 5) produce an intervention manual, and protocol for future feasibility study and trial.
 
Title Condom carrier 
Description A product for discretely carrying condoms when out and about. This is a small headphone case with a discrete, hidden compartment for up to two condoms, or one condom and a sachet of lube. 
Type Of Art Artefact (including digital) 
Year Produced 2016 
Impact The condom carrier forms part of the Wrapped intervention. This has not as yet been made publically available. 
 
Title Condom sample pack 
Description This is a box containing twelve types of condoms (different brands, sizes, textures, thickness), and two types of lube for users to try out. It contains step-by-step instructions on how to correctly apply condoms. The box is also designed to be a permanent store for condoms at home. 
Type Of Art Artefact (including digital) 
Year Produced 2016 
Impact This pack will form part of the Wrapped intervention. It has not as yet been made publically available. 
 
Title Condom use demo 
Description This is a video providing step-by-step instructions on how to put a condom on (using a demonstrator). It features a number of young people all giving their tips and tricks on how to do this (correctly, with ease, conducive with pleasure) so that enjoyable/pleasurable for self and partner and part of the flow of sex. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact The condom demo forms part of the Wrapped intervention. This has not as yet been made publically available. 
 
Title Real Life videos 
Description A series of three videos showing three couples talking about and demonstrating condom use. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact These videos will form part of the Wrapped intervention. It has not as yet been made publically available. 
 
Title Talking heads videos 
Description This is a series of seven videos in which young people talk about ways in which they have brought up condom use with partners in the past and introduced them into sex. They talk about how this went, what worked, what didn't etc. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact These videos will form part of the Wrapped intervention. It has not as yet been made publically available. 
 
Description Advisor to the World Health Organization (Dept of Reproductive Health and Research)
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
 
Description Public Involvement Fund
Amount £200 (GBP)
Funding ID 2318 
Organisation Research Design Service, West Midlands 
Sector Public
Country United Kingdom
Start 10/2017 
End 01/2018
 
Description Coventry and Warwickshire Partnership Trust (CWPT) 
Organisation Coventry and Warwickshire Partnership NHS Trust
Country United Kingdom 
Sector Public 
PI Contribution CWPT run Coventry and Warwickshire's Integrated Sexual Health Service (ISSH) offering care and advice on STIs. One of our collaborators on the project, Dr Satyajit Das, is Medical Lead Consultant Physician for HIV and GU Medicine working within the (ISSH). We have throughout the project being mindful of the potential for the intervention under development to be of benefit to ISSH patients seeking STI testing. We have met regularly to ensure its continued suitability for this. Dr Das has kept the ISSH team up to date on project progress. Maintaining this relationship continues to be important as there is the potential to 1) apply for funding with CWPT to evaluate the efficacy of Chance2Change within this context, and 2) to generate considerable future impact of the Chance2Change intervention should it be implemented within existing sexual health services.
Collaborator Contribution Dr Das has provided updates on ISSH practice throughout the Chance2Change project. This has enabled the Chance2Change team to maintain this relationship and to ensure the continued suitability of the developing intervention for integration within ISSH services.
Impact No specific outputs/outcomes. The ISSH is operated by HIV/GUM physicians and specialist nurses.
Start Year 2015
 
Description Preventx 
Organisation Preventx Limited
Country United Kingdom 
Sector Private 
PI Contribution The intervention funded by this project is being developed within sufficient flexibility that it will be possible for the final version to be embedded within a number of different contexts. However, the team is first working with Preventx to create a version that can be embedded within their chlamydia self-testing website freetest.me. Throughout the Chance2Change project, regular updates on progress have been sent to the Preventx. This has enabled the team to keep abreast of progress on the Chance2Change project, and the type of emerging intervention, to ensure its continued suitability for embedding within the freetest.me digital pathway in the future. Maintaining this relationship continues to be important as there is the potential to 1) apply for funding with Preventx to evaluate the efficacy of Chance2Change within this context, and 2) to generate considerable future impact of the Chance2Change intervention should it be embedded within the freetest.me pathway
Collaborator Contribution Tim Alston (Technical Director at Preventx) is a collaborator on the Chance2Change project. Tim has provided updates on Preventx work throughout the Chance2Change project. This has enabled the Chance2Change team to maintain this relationship and to ensure the continued suitability of the developing intervention for the freetest.me pathway.
Impact No specific outputs or outcomes. The collaboration is with experts in remote diagnostics.
Start Year 2015
 
Description World Health Organization 
Organisation World Health Organization (WHO)
Department Department of Reproductive Health and Research
Country Global 
Sector Academic/University 
PI Contribution The WHO are developing a feasibility study protocol for brief sexual health interventions. On the basis of this MRC funded work (to develop a brief digital sexual health intervention), Dr Newby was asked to be an advisor. Dr Newby has attended two meetings (Budapest and Geneva) to present on her work and to contribute towards discussions. Dr Newby has also reviewed and commented on a number of iterations of the protocol and intervention manual they have developed.
Collaborator Contribution The Department of Reproductive Health & Research (WHO) has requested updates on project progress as they are keen to support its future implementation - possibly using component parts within their own planned brief sexual health intervention. Additionally, the WHO invited Dr Newby to present on this work as part of a WHO symposium at the International Union against STI (IUSTI) conference.
Impact Protocol for a Feasibility Study of a Brief Intervention to Prevent STIs and Unintended Pregnancies Brief Sexuality Communication Intervention Manual Presentation at IUSTI conference Collaboration is multi-disciplinary - the team of advisors include psychologists, sociologists, physicians, and anthropologists.
Start Year 2016
 
Title Trademark of Wrapped (UK00003209574) 
Description 'Wrapped' is the name given to the intervention developed from the MRC PHIND funding. 
IP Reference  
Protection Trade Mark
Year Protection Granted 2017
Licensed No
Impact None. We are seeking funding to evaluate Wrapped - impact will be realised upon implementation should the intervention be proven effective.
 
Title Wrapped intervention 
Description The Chance2Change project has developed the Wrapped intervention. This is a tailored digital intervention aiming to increase condom use amongst young people using online chlamydia self-testing services. There are six components to the intervention. Users are directed to one or more of these depending on their responses to initial tailoring questions. Five of the six components have been developed. Component six is currently under development (estimated completion May 2017). The Wrapped intervention is funded by MRC PHIND. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2017
Development Status Actively seeking support
Impact None yet - impact will be realised on implementation if proven to be effective. 
 
Description Chance2Change Twitter account 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact The Chance2Change project has a Twitter account associated with its website. There are currently 67 followers.
Year(s) Of Engagement Activity 2015,2016,2017
URL https://twitter.com/CovUni_C2C
 
Description Chance2Change Website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact The Chance2Change website was developed at the beginning of the project as a source of information and updates on the project. It is aimed at academics, practitioners and the general public. An email address for contact with the team is provided. In October 2016 we received a considerable amount of press interest in the project. There was a spike in views of the website at this time. Media reporting included that we were seeking young people to participate in video content being developed for the intervention. Approximately 100 young people contacted us via the email address provided on the website (and considerably more via other channels).
Year(s) Of Engagement Activity 2015,2016,2017
URL http://c2c.coventry.ac.uk
 
Description Development and specification of an intervention to increase condom use amongst young people accessing chlamydia self-testing websites. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Wrapped: Development and specification of an intervention to increase condom use amongst young people accessing chlamydia self-testing websites. West Midlands Health Informatics Network (WIN) Conference, Warwick, January 2017.
Year(s) Of Engagement Activity 2017
 
Description IUSTI Conference Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact As part of a symposium organised by the World Health Organization, Dr Newby presented at the International Union Against STI (IUSTI) conference in Budapest on the Chance2Change project.
Year(s) Of Engagement Activity 2016
 
Description Media interest in Chance2Change project 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact In October 2016 we had considerable media interest in the project. This was sparked by our attempts to recruit young people to participate in the filming of (sexually explicit) video content for the intervention. Most UK newspapers ran a story in print and on their websites. A number of media outlets outside of the UK also ran the story online. Coventry University gave two press statements. Dr Newby gave two interviews - one to a local newspaper (Coventry Telegraph) and one to Radio Five Live (this was not aired). As a result of this we estimate receiving 1000 contacts from young people wishing to take part.
Year(s) Of Engagement Activity 2016
 
Description Presentation at West Midlands Health Informatics (WIN) conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other audiences
Results and Impact Conference presentation by Dr Newby to highlight innovation in the development of digital behaviour change interventions. This triggered discussion afterwards with companies providing STI self-testing services.
Year(s) Of Engagement Activity 2017
 
Description Presentation at the 8th Conference on Supporting Health by Technology, Enschede, the Netherlands 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact This was a conference presentation at 'Supporting Health by Technology'. Presentation entitled 'Wrapped: Development of an intervention to increase condom use amongst users of online chlamydia self-testing services'. The purpose of the conference is to demonstrate and discuss progress in development of eHealth interventions and introduce new methods and models for behaviour change using monitoring technologies. Approx 100 people attended the presentation. The audience was largely made up of academics working in the field of eHealth. A number of questions were asked at the end.
Year(s) Of Engagement Activity 2018