Dr Julia Bailey, University College London eHealth Unit
The Covid-19 pandemic has prompted an unprecedented shift to remote health services as a response to social distancing for patient and practitioner safety. Sexual health clinic capacity has been cut as staff have been deployed to other parts of the health service, and patients are now asked to contact health services by phone or video-link, with clinic visits reserved for a small proportion of people who need to be seen (FSRH guidance). People can also access online sexual health services for STI testing (+/- contraception), in areas where this service is provided.
The shift to remote consultations is likely to make it more difficult to offer holistic healthcare and health promotion. For example, patients welcome opportunities to discuss sexual wellbeing beyond physical health (e.g. sexuality, sexual difficulties, sexual pleasure), but picking up on this will be more challenging with less opportunity to notice non-verbal cues and to establish trust (e.g. whilst examining).
Resources via the Internet and mobile phone can offer private, convenient access to information, which may be particularly welcome for topics which can be difficult to discuss (e.g. sex, sexuality, sexual difficulties). Online sexual health services can offer efficient STI testing and treatment, but do not usually offer evidence-based sexual health promotion. Interactive (i.e. tailored) digital interventions are effective for learning and sexual behaviour change, and could be incorporated into online sexual health pathways.
There is no nationally commissioned digital sexual health programme, and digital innovation varies widely across the UK. There are thousands of health apps and websites, but only a tiny minority have been rigorously evaluated and it is difficult to know which to recommend – the NHS apps library curates trustworthy resources.
Digital sexual health resources for patients – some suggestions:
Before (or instead of) appointments:
- Covid-19: Accessing sexual health services
- Websites for young people: e.g. Brook, BISH, SexEtc
- Online information and advice: Sex and sexuality; Relationships; Contraception; STIs and HIV; NHS sexual health information
- Symptom checker: NHS 111 Online; Patient Info
- Decision aids (e.g. Contraception choices; Hormone replacement therapy)
- Videos prior to appointments (e.g. Implant insertion and removal; IUD/IUS insertion; Cervical smear procedures)
- Mobile phone apps e.g. for sex and pleasure, alcohol harm reduction, smoking cessation.
- Interactive digital interventions e.g. for condom use; STI/HIV prevention; sexual difficulties
After a diagnosis/ongoing support:
- Trustworthy patient information (e.g. herpes; genital warts; Hepatitis B, Hepatitis C; HIV)
- Electronic partner notification
- Text message interventions: g. for safer sex, STI testing; support after acute STI diagnosis
- Online support groups (e.g. HIV support; + Support Groups; Health Unlocked forum)
- Email or text reminders (e.g. for contraception or HIV medication including PrEP)
Tips for writing patient materials
- Don’t reinvent the wheel! Check what’s already available
- Involve target users to make sure material meet their needs, priorities and preferences
- Draw on principles of evidence-based sexual health promotion
- Address barriers to access, e.g. audio and video formats; material in first languages
- Address groups whose needs are often overlooked (e.g. women who have sex with women, trans, non-binary, intersex, and disabled people).
The post-pandemic ‘new normal’ will include digital health. There are some excellent online sexual health information resources available, and there is currently an unprecedented opportunity to offer evidence-based, tailored sexual health promotion to complement online and clinician-delivered sexual health services.