Background
GetCheckedOnline
The implementation context of GCO
Theoretical framework
Methods
Data collection
Topics | Questions |
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Knowledge of online sexual health services | Please tell me what you know about: a) the provision of online health care within and outside of Canada. b) online sexual health services within and outside of the country. c) the BCCDC’s Online Sexual Health Services. |
Perceived factors affecting the implementation of GCO | How feasible do you think the new GetCheckedOnline service will be with existing health human resource capacity in your health jurisdiction, clinic, or lab? |
What client populations do you think will benefit the most from the introduction of GCO? The least? Why? | |
Would you recommend GCO to people who access your organization’s services? Why/why not? | |
Tell me about any funding implications you think there might be for the new GetCheckedOnline service. | |
Perceived complementarity of GCO with current practices at STI/HIV testing clinics or labs | How well do you think the new GetCheckedOnline service might fit within your existing roles and responsibilities in the health jurisdiction, clinic, or lab where you work? |
How do you think GCO might affect the quality of care clinicians and lab technicians provide to clients seeking STI/HIV testing and treatment? | |
Perceived fit with extra-mural connections | How might GCO dovetail with (or clash with) clinical practice guidelines or accreditation requirements for clinics and labs in your health jurisdiction? |
Do you anticipate that GCO may identify a need to adapt or develop additional clinical practice guidelines or institutional regulations for STI/HIV testing services? | |
New training opportunities and other change management processes | What training opportunities do you think are needed in order to implement GCO in your health jurisdiction? |
How do you think this change to service provision can best be managed in your jurisdiction for you, your staff/co-workers, and clients? |
Data analysis
Results
Improving access to STBBI testing
It’s gonna stop people from having to sit in a waiting room with other people potentially that they don’t want to be around. … Even if it’s people they don’t know, people don’t like people to know about their sexual infections or that kind of thing. (‘Aidan’, administrator)
An emphasis on client confidentiality and privacy was regarded by some study participants as a factor that could encourage online testing as a ‘safer’ mode of testing (i.e., less risk of a confidentiality breach) than in-person testing.[T]hey’re being very cautious to protect the clients from [a privacy breach]. ‘Cause I think they just get [client code] numbers and such, like. So, I think, you know, I think the way they’re presenting it is done very well. Less privacy issues than just going to the clinic. (‘Elizabeth’, physician)
This comment reflects a common presumption that all young people and MSM are technologically savvy, have easy internet access, and are self-motivated to seek testing. This view was tempered slightly by some interview participants, who acknowledged that low-income individuals may not have affordable and reliable internet access, and some youth may not have private internet access. Most interviewees suggested that BC’s STBBI testing system will continue to need a diversity of approaches (GCO, clinics, outreach) in order to meet the overall population’s testing needs.This is going to be fantastic for MSM and youth! There’s not any question in my mind, because these are wider populations who are very comfortable being proactive and informed in their own care. (‘Marilyn’, administrator)
Impacts on STBBI service provision post-implementation
I think it’s great that we hear [public health] labs freaking out about these costs because you know what? This is the true cost of providing the care that we should have been providing all along. Yeah, it’s a problem, but the people who need to figure it out will figure it out. Our job is to provide care … according to the clinical guidelines. Are we being successful by rationing care and being afraid of success and motoring on with these same terrible uncontrolled epidemics? That’s the failure. (‘Phinn’, administrator)
These participants predicted that by encouraging routine testers and the ‘worried well’ to use GCO, it would reducing wait times for people seeking in-person testing at STBBI clinics.It allows people to get into testing but it also allows many of the worried well … the chance to get that reassurance that they want without necessarily impacting on a very limited resource in the system. (‘Marilyn’, administrator)
GCO developers always planned to eventually introduce swab tests but this was not immediately feasible during the pilot phase because the laboratory collection centres were not structured to support client self-collection of swabs.I think that there’s lots of people out there that we see, particularly in our gay male population, who don’t want to particularly talk to a nurse. They know the routine. … So they don’t really want to interface with us, right? They do it because they have to. …The only thing I worry about around GetCheckedOnline is that there are no swabs, there are no throat or rectal swabs, and so I know it says that all over the [web]site … but people will assume they have been really checked when they haven’t been checked, right? (‘Arthur’, clinician manager)
Some participants also asserted that GCO would not be able to match clinicians’ expert knowledge. These participants believed that face-to-face STBBI testing is the ‘gold standard’ and suggested it may be the preferred form of testing for some clients. One administrator stated:I think that it’s another tool that we can use to encourage people into normalized testing. I don’t see it as replacing a clinic visit, but enhancing or maybe introducing people to testing and maybe one day they feel comfortable coming in and seeing somebody for a full exam or a more thorough exam. (‘Chloe’, nurse)
[GCO is] meant to supplement and guide people into the system [and] make it more efficient. … And people also go where they know the quality is, so if it turns out that they’re not getting quality services online and they think they’ll get their needs met better by going to the clinic, they’ll go to the clinic. (‘Phillip’, administrator)
[GCO] has pros and cons compared to clinical practice but it fills a niche that needs to be filled, right? Some people need to test more frequently and it’s really around convenience or accessibility: people who can’t get into a clinic, or people who won’t come into a clinic and [GCO] is how they’ll get tested. So I definitely see that it’s sort of filling a void and being really complementary to clinical services. (‘Mike’, OSHS developer)
‘Marilyn’ supported GCO, in part, because she believed it would provide better quality of care than direct-to-consumer STBBI tests from outside of Canada. Moreover, she and a number of other study participants described GCO as having the potential to enhance the agency of people seeking testing by providing it online. However, GCO’s potential as a patient-centred form of healthcare created some uncertainty for some HCP who are accustomed to provider-controlled interventions. As previously noted, these clinicians regard provider-controlled interventions as providing the ‘gold standard’ of care. These clinicians asserted that the more detailed and nuanced nature of face-to-face, pre- and post-test counseling offers the highest standard of STBBI-related care and provides the added value of opening up discussions about other health issues, including referrals to other relevant services. Nonetheless, even though GCO was often not considered comparable to face-to-face testing, some regarded it as having the potential to empower users. As one GCO planner said:Either we make it available or people will just order it themselves. Like, this idea that we can control people the way we used to is ridiculous. I mean, they’ll order chlamydia kits from the UK. They’ll order gonorrhea kits from Mexico. It’s just gonna happen. So, my perspective is okay, let’s ensure some quality, opportunities for engagement, let’s monitor progress. … And that’s the perspective we need to take. (‘Marilyn’, administrator)
This perception that GCO has the potential to empower clients to take more proactive care of their sexual health gives the intervention significant symbolic value, which could be employed by its champions during its planned expansion to increase acceptance by HCP and uptake by users.[GCO] is a very self-directed approach, right? ... And I think there’s a sensibility out there, especially with young folks and what the internet can empower you to do. And you see this in the medical field. People think that they’re doctors because they, you know, googled something.... And so there’s that sometimes false belief that they know more than the doctor. But I think the good part of that, with [GCO], is that it puts their healthcare in their control and the feeling that comes with that is very powerful. You know, ‘I need to manage myself and I need to be in control of my own health. This is a tool that allows me to do that.’ I think that’s the crux of it. … It represents empowerment, I think, for health. (‘Rufus’, OSHS developer)