Background Online postal self-sampling (OPSS) has been rapidly adopted as a method of STI testing in England, particularly since the COVID-19 pandemic. It now accounts for 43% of asymptomatic Chlamydia testing among young people and is recommended by national guidance. There has been little research on OPSS implementation or the contextual factors which affect its adoption and sustainability.
Methods ASSIST is a mixed-methods, realist evaluation of OPSS with a focus on three areas of England: Birmingham; London; and Sheffield. Semi-structured interviews, informed by Normalisation Process Theory (NPT), were undertaken with a range of staff and stakeholders – such as commissioners – on their views and experiences of OPSS. Interviews were supplemented with contextual observation and a document analysis. Data were analysed using a realist logic of analysis, informed by NPT.
Results We interviewed 55 participants and have sourced 57 relevant documents to date. Participants were widely supportive of OPSS in principle, but the context and relationships between stakeholder organisations affected staff buy-in to the implementation process in their setting. For example, in areas where relationships were more formalised, and OPSS was initiated by commissioners rather than services, staff were less engaged with implementation. However, these relationships appeared to be less important to the success of initial adoption, implementation and sustained use of OPSS than commissioning arrangements. Differences in commissioning and delivery models also affected the impact of COVID-19 on OPSS implementation; it advanced implementation in some services and reversed it in others.
Conclusion Implementation was found to be a continuous process which needs to respond to changes in context, even years after services have launched. The contextual factors identified, and their impact on implementation, will aid providers seeking to set up, or maintain, an OPSS service. Future research should explore implementation in countries and regions with different commissioning contexts and delivery models.
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