Utilizing Digital Health Technology to Increase Sexual Health Care Access: Youth Preferences on Self-Collect, Mail-In Sexually Transmitted Infection Testing in a High Sexually Transmitted Infection Prevalence Area

• Published in: Journal of adolescent health 2023-12, Vol.73 (6), p.1002-1009
• Main Authors: Sao, Saumya S., Yu, Ruoxi, Abboud, Sadie, Barre-Quick, Maclaine, Deshmukh, Sanyukta, Wang, Runzhi, Coleman, Jenell S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Digital health; Health Services Accessibility; Humans; Pandemics; Postal Service; Prevalence; Self-collect STI testing; Sexual health; Sexually Transmitted Diseases - diagnosis; STI testing; STIs; Young Adult; Youth
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2023.07.002

The COVID-19 pandemic highlighted the need for innovative approaches to delivering care. Self-collect, mail-in sexually transmitted infection (STI) testing could address barriers to in-person STI testing, particularly for youth, who bear a disproportionate burden of STIs. This study sought to obtain youth input on the development of a free self-collect, mail-in STI testing program. Focus group discussions (n = 5, 45–60 minutes each) were conducted with 28 youth ages 14–19 years old living in Baltimore, Maryland. Focus group discussions were based on a conceptual framework of patient-centered health-care access, and a prototype online program was discussed. Transcribed data were coded thematically. Memos were written to synthesize findings and identify representative quotes. Participants noted existing barriers to in-person STI testing barriers including individual-level (e.g., lack of knowledge), interpersonal-level (e.g., stigma), and structural-level (e.g., financial). Although participants expressed concerns about self-collect, mail-in STI testing (e.g., accuracy of self-swabbing), there was overall acceptance of the program, and many felt it would address current barriers to testing. Opportunities to improve the testing program included all four steps of testing process: kit ordering, receipt of the kit and swabbing, post-testing experience, and communication of results and treatment. Specifically, participants desired expanded shipping options to schools, and mail drop-off points such as lockers and local convenience stores; more transparency about testing and treatment; and hearing directly from health-care providers to assuage any concerns. Self-collect, mail-in STI testing was favorable among youth, and could be a viable option for increasing youth access to STI testing.