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Original article
Using the eSexual Health Clinic to access chlamydia treatment and care via the internet: a qualitative interview study
  1. Catherine R H Aicken1,
  2. Lorna J Sutcliffe2,
  3. Jo Gibbs1,2,
  4. Laura J Tickle2,
  5. Kate Hone3,
  6. Emma M Harding-Esch4,5,
  7. Catherine H Mercer1,
  8. Pam Sonnenberg1,
  9. S Tariq Sadiq4,
  10. Claudia S Estcourt2,6,
  11. Maryam Shahmanesh1
  1. 1 Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
  2. 2 Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
  3. 3 College of Engineering, Design and Physical Sciences, Brunel University, London, UK
  4. 4 Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George’s University of London, London, UK
  5. 5 HIV/STI Department, National Infection Service, Public Health England, London, UK
  6. 6 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
  1. Correspondence to Catherine R H Aicken, Centre for Sexual Health and HIV Research - UCL, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK; c.aicken{at}ucl.ac.uk

Abstract

Objective We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention.

Methods Within exploratory studies of the eSHC (2014–2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18–35, 20 female, 16 male). Thematic analysis was conducted.

Results Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic access. They described completing the online consultation promptly, discreetly and with ease. The information provided online was considered comprehensive, reassuring and helpful, but some overlooked it in their haste to obtain treatment. Participants generally described being able to collect treatment from pharmacies discreetly and promptly, but for some, poor awareness of the eSHC by pharmacy staff undermined their ability to do this. Those unsuitable for remote management, who were directed to clinic, described frustration and concern about health implications and clinic attendance. However, the helpline was a highly valued source of information, assistance and support.

Conclusion The eSHC is a promising adjunct to traditional care. Its users have high expectations for convenience, speed and privacy, which may be compromised when transitioning from online to face-to-face elements of the eSHC. Managing expectations and improving implementation of the pharmacy process, could improve their experiences. Positive views on the helpline provide further support for embedding this ehealth intervention within a specialist clinical service.

  • chlamydia infection
  • sexual health
  • communication technologies
  • qualitative research
  • compex interventions

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors CRHA led the design of this qualitative study as part of her PhD research, conducted the interviews, led the analysis and wrote the first draft of the manuscript. LT, as the exploratory studies’ lead Research Health Adviser, enabled recruitment. LJS second-coded a selection of the interviews and, together with MS, informed definition of themes and interpretation. JG and LT provided detailed insights on the analysis and interpretation. CHM, MS and CSE provided guidance on all stages of the study as CRHA’s PhD supervisors and PS, STS, JG, LJS, LT, KH and EMH-E contributed to study design and interpretation of findings. CSE and PS led, and LJS managed, the exploratory studies from which interview participants were recruited. STS was the Principal Investigator of the eSTI2 Consortium, within which this programme of research took place. All authors contributed to drafting the manuscript and approved the final version.

  • Funding The Electronic Self-testing Instruments for Sexually Transmitted Infection (eSTI2) Consortium is funded under the UKCRC Translational Infection Research (TIR) Initiative supported by the Medical Research Council (Grant Number G0901608) with contributions to the Grant from the Biotechnology and Biological Sciences Research Council, the National Institute for Health Research on behalf of the Department of Health, the Chief Scientist Office of the Scottish Government Health Directorates and the Wellcome Trust. The funders had no role in the conduct or analysis of this research or the writing or decision to submit this article for publication.

  • Competing interests None declared.

  • Ethics approval Brighton & Sussex (NHS) Research Ethics Committee (ref:13/LO/1111).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data that support the findings of this study are available to researchers from the corresponding author, upon reasonable request. We will not share any data which could lead to the identification of research participants.

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