Objectives Partner notification (PN) is important for sexually transmitted infection (STI) control. With developments in technology, such as text messaging, contacting partners is now easier. This study investigates the frequency and acceptability of text messaging in UK sexual health clinics for STI provider-led PN.
Methods A questionnaire was distributed to health advisers (HAs), cascaded by the Society of Sexual Health Advisers and posted on their website.
Results 65 questionnaires were returned. Most HAs use telephone for the first and second provider-led PN attempt (61, 94% and 51, 78%, respectively) with text messaging as preferred second choice (19, 29% and 32, 49%, respectively). Overall, 56 clinics (86%) used text messaging at some stage, even if not the preferred option. 29 (52%) clinics had text messaging guidelines and 31 (55%) used messaging templates. Messages varied; 33 (59%) request partner make contact, 11 (20%) mention risk of infection, 9 (16%) name the infection and 20 (36%) use a combination of messages. Six (10%) had contact with their Caldicott Guardian about text messaging. No confidentiality concerns were reported and no complaints were reported from partners about receiving unsolicited text messages.
Conclusions Text messaging is widely used and is an important and acceptable tool for STI provider-led PN. It is the second preferred method for contacting partners after telephone for first and second provider-led PN attempts. A small number of clinics never use it. Message content varied; few named the infection. Concerns about confidentiality or negative impact for the partner were not reported. National guidance for the use of text messaging for provider-led PN is needed.
- PARTNER NOTIFICATION
- SEXUAL HEALTH
- PUBLIC HEALTH
- HEALTH PROMOTION
- GENITOURINARY MEDICINE SERVICES
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Partner notification (PN) plays an important role in the management and control of sexually transmitted infections (STIs).1 ,2 There are three methods of PN: patient referral, where the index patient informs the partner themselves; provider-led referral where a health adviser (HA) contacts the partner directly without disclosing the identity of the patient or a combination of both approaches called contract or negotiated referral where the index patient agrees to contact their partner, and if this is not done within an agreed time period, then the HA initiates provider-led referral. Informing partners at risk of STIs has become easier with developments in PN approaches, including voicemail, text messaging, email and web-based social networking sites.3–6
Although text messaging is widely used in most sexual health clinics as an efficient way for conveying STI results to patients, little is known about the use of this method for provider-led PN. Public Health England sought to investigate the use of text messaging by HAs conducting provider-led PN for all STIs (including Hepatitis), but excluding HIV infection. HIV was excluded because we were keen to understand the ‘usual approach’ clinics used regarding text messaging for provider-led PN for the more prevalent STIs, and we believed HIV PN may vary from usual practice.
A project team was established and developed a questionnaire about the use of text messaging for provider-led PN. Questions in the questionnaire (web supplementary questionnaire S1) included frequency of text messaging and the type of text messages used when sending a text message. HAs were asked to select from four options to describe the content of the message sent and these were (a) mention there is a risk of infection (do not specify), (b) name the infection, (c) ask them to contact you as you need to speak to them and (d) combination depending on circumstances. Questions also included Caldicott Guardian involvement in implementation and whether the clinic had guidance for text messaging partners. The questionnaire was piloted within the team and with wider sexual health colleagues.
The questionnaire and accompanying information letter were distributed by email to an initial network of 36 HAs from across the UK known to the project group. The Society of Sexual Health Advisers (SSHA) also cascaded the questionnaire and information letter to their members and posted the documents on their website. This was a service evaluation exercise and was undertaken between September and October 2011. All respondents were reassured concerning confidentiality. Completed questionnaires were returned by post or email. Survey results were analysed using Microsoft Excel.
Sixty-five questionnaires were returned. The majority (56, 86%) of clinics used text messaging at some stage for provider-led PN. Nine (14%) never used this method. A few clinics wanted to use text messaging for provider-led PN but encountered restrictions with clinic software. For the initial provider-led PN contact attempt, the majority made contact by telephone, with 61 clinics (94%) always or usually using this method. Text messaging was the second most used approach with 19 clinics (29%) using this method. Letter, email and other forms of contact were used but infrequently. For the second attempt at provider-led PN, the telephone remained the preferred method with 51 clinics (75%) using this method. Text messaging was used more often for the second than first attempt with 32 clinics (49%) using this approach always or usually for the second attempt. The use of letters also increased for the second attempt, with 15 clinics (23%) using this method always or usually (table 1).
One HA commented that some younger people, often with limited funds on their phones, choose not to answer calls from unknown callers or pick up voice messages, as charges can occur. They therefore always follow an attempted call with a text message. Others commented that messages without a National Health Service logo or from software without sufficient message space were sometimes perceived as pranks.
Thirty-one (55%) of the 56 clinics who used text messaging for provider-led PN had a text message template for sending messages and 29 clinics (52%) had text message clinic guidelines. Thirty-three (59%) requested the partner make contact, 11 (20%) mentioned a risk of infection, 9 (16%) named the infection and 20 (36%) used a combination of messages depending on the circumstances.
Six clinics reported Caldicott Guardian involvement, mostly to help develop the guidelines and text message templates. Two clinics that reported naming the infection in the text message received assistance from their Caldicott Guardian. No confidentiality concerns were raised. No complaints or confidentiality breaches were reported from partners receiving an unsolicited text message for provider-led PN. Complaints, if received, were associated with the index patient identity being withheld or thinking their telephone number was given in error.
Text messaging is widely used for STI provider-led PN. It is a quick and efficient way to convey key information to partners about a possible STI risk compared with other traditional methods such as letters; it is also cheaper. Text messaging has been shown to be acceptable to patients3 ,4 and was acceptable to the majority of clinics who took part in this study; either as a preferred option for contacting partners or as a last resort when other methods failed. It was also acceptable to partners and no adverse events were reported.
Only half of the clinics using text messaging for provider-led PN had specific local guidelines and further guidance was requested. The SSHA Manual for Sexual Health Advisers provides guidance for provider-led PN, but this is limited for text messaging7; if updated, it will assist with standardising PN approaches using text messaging nationally. Training is also key for HAs involved in making PN decisions and services providing PN should have written guidance that is easily accessible.2 ,8
With higher rates of STIs in younger adults,9 a combined approach of following a voicemail with a text message should be considered, as it provides an efficient method for delivering timely PN to younger adults where there may be cost implications for accessing voice messages; this approach was reported in Canada.10
Consideration should be given to the content of the text message and if naming the infection, awareness that a breach of confidentiality could occur if the text message is read by others. In one study, patients asked about text message content responded that they would prefer that the message requested them to contact the clinic, rather than informing them they may have an STI.4
With new PN technological tools now available, including the growth of social networking sites and the development of enhanced, accelerated and electronic methods for delivering PN and treatment,1 whichever PN method is chosen, there should be no reason for delays in conveying the required messages and ensuring partners are promptly informed and treated. Timely informing and treatment of partners are essential for reducing onward transmission of infection and reducing reinfection, and for the wider public health interest, in the prevention of STIs. Where clinic software does not facilitate sending text messages to non-registered patients, alternatives should be considered, such as a dedicated office mobile phone. Of note is that a small number of clinics choose never to use this method; further studies could investigate the reason for this.
This study has several limitations, including potential selection and participation biases and a relatively small sample size; this was a convenience sample and the findings can relate only to those HAs working in sexual health who returned the questionnaire. Provider-led PN approaches may differ depending on the STI; we did not differentiate. With the current approach of normalising HIV and the importance of HIV PN,2 it would be helpful to know whether HAs think this method appropriate for HIV. When patients were asked about this in an earlier study, 60% believed a text message for HIV PN was inappropriate, although the majority considered it acceptable for other STIs.3 Although there were no reported complaints in this study about partners receiving an unsolicited text message, little is known about the acceptability of this method to them and further investigation would be valuable. Finally, HAs using text messaging as part of their routine provider-led PN practice may have been more motivated to complete the questionnaire and return it than those who did not. Nevertheless, the 65 HAs who returned completed questionnaires were from clinics widely distributed throughout the UK.
Our findings indicate that text messaging for STI provider-led PN is widely used and is acceptable within the clinic setting, for HAs and for partners receiving a text message. Possible concerns about confidentiality issues or negative impact for partner have not been realised. These findings, in addition to highlighting the need for provider-led PN guidance on text messaging and improved software for some clinics, have enhanced our understanding of the use and acceptability of text messaging for STI provider-led PN, identified areas for further research, given invaluable insights into provider-led PN methods and will be a useful reference for those involved in this area.
We thank Martin Murchie (president of SSHA), HAs who participated in the provider-led partner notification study and Alan Darbin (HIV&STI Dept., Public Health England).
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Files in this Data Supplement:
- Data supplement 1 - Online supplement
Handling editor Jackie A Cassell
Contributors VLG and CML planned the study. VLG developed the questions, implemented the survey and collected the data. Initial analysis undertaken by VLG with KT performing main analysis. VLG and KT interpreted the findings and wrote the manuscript. CML contributed to survey design, further interpretation of the findings and provided critical review of the manuscript.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.