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

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.

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.