Recommendations for developing asynchronous online consultations for chlamydia treatment for underserved populations: A Behaviour Change Wheel analysis

Introduction

People from underserved groups experience disproportionately poor sexual health and challenges accessing care. Asynchronous online consultations (a user completes a health questionnaire online, which is reviewed by a clinician) are being used within sexual healthcare to prescribe chlamydia treatment. Users require sufficient health and digital literacy to access online services and use them safely.

Methods

We used the PROGRESS-Plus framework to guide purposive recruitment of 35 participants from diverse underserved groups, from community settings and sexual health services in contrasting areas of the UK (15/10/21-18/03/22). We conducted qualitative semi-structured interviews and thematic analyses to derive key barriers and facilitators to using asynchronous online consultations. We used the Behaviour Change Wheel to specify recommendations to address them.

Results

Over half of participants were from the most deprived areas and 40% were from minoritised ethnic groups. Key barriers included: lack of familiarity with online healthcare; perceived need to see a healthcare professional in person; privacy concerns; concerns about difficulty interpreting the questions; discomfort answering personal questions online. Key facilitators included: familiarity with online consultations; perceived low sexually transmitted infection (STI) risk; perceived increase in convenience, control, and privacy; simple wording and design; and support whilst completing them. Recommendations included: increasing awareness and familiarity by promoting them offline and online, and providing demonstrations and instructions on how to use them; encouraging people to choose them by highlighting available support, equivalence to in-person consultations, and privacy and convenience; and reducing attrition by using simple wording and design, providing additional explanations, and offering audio and visual alternatives to text.

Conclusions

Incorporating these evidence-based, theoretically informed recommendations could widen access to underserved groups, and increase the usability and safety of asynchronous online consultations for chlamydia treatment. Recommendations are likely to benefit all users and could be of use across health more broadly.

Main Messages

• Some sexual health services provide chlamydia treatment through asynchronous online consultations, where patients complete an online health questionnaire which is reviewed by a clinician before issuing a prescription, without the need for direct interaction with a healthcare professional.

• Safe and effective use of asynchronous online consultations requires adequate digital and health literacy but there is limited evidence on how to design these consultations inclusively, posing a risk of excluding underserved groups and exacerbating health inequalities.

• Among people from underserved groups, we found key barriers to using asynchronous online consultations included: a lack of familiarity with online healthcare; perceived need to see a healthcare professional in person; privacy concerns; concern about difficulty interpreting the questions; discomfort answering personal questions online.

• Key facilitators included: familiarity with online consultations; perceived low STI risk; perceived increase in convenience, control, and privacy; simplicity in consultation wording and design; and support whilst completing them.

• Recommendations include: increasing awareness and familiarity by promoting asynchronous online consultations offline (e.g. in GP practices) and online (e.g., social media), and providing demonstrations/instructions on how to use them; encouraging uptake by highlighting options for support, equivalence to in-person consultations, and privacy and convenience; and reducing attrition by using simple wording and design, providing additional explanations, and offering audio/visual alternatives to text.