Using technology to provide choice in STI testing

Here at SH:24 we are always looking for ways to innovate and improve our service. Recently, we had a discussion with our partners in commissioned areas to discuss how to offer our users choice in what STIs they get tested for. As a result we’ve introduced selective testing in some of the areas we're commissioned in, and wanted to tell you a bit more about it.

What is selective STI testing?

Selective testing is where people are offered STI tests based on their risk profile with an option to request additional tests or deselect tests according to what the user wants.

How do you work out someone's risk profile?

SH:24 works out the user’s risk profile based on the questions that you answer during the order process. Based on your answers, you will then be offered STI tests that your local sexual health service thinks are most suited to your risk profile.

However, we know that our users are often very well-informed about their personal risk. Therefore you have the option to select more tests if you think you need them or deselect tests if you think you don’t need them.  

What does it look like?

As part of the order journey you will see a page that looks like the one below.

The recommended tests will be ticked already, but you can choose to untick any that you don’t want or choose more if you decide to. To help you decide, you can click on the ‘plus’ buttons on the side that give you more information.  

Where is it on offer?

At the moment, we are offering this for people living in Essex, Medway, Shropshire, Hillingdon and Telford and Wrekin.

What results are we seeing so far?

Over 16,000 people have used this new method of testing in the areas that it has been launched.

We are seeing that most of those who are offered all the tests (85%) are happy with the option and don’t deselect anything.

For those offered only genital chlamydia and gonorrhoea testing – well over half (60%) are opting in to test for HIV and Syphilis. Similarly, for those offered HIV, chlamydia & gonorrhoea, 67% opted-in for syphilis too.

What does this tell us?

It is hard to make firm conclusions without running this approach for longer and learning more, but it indicates that whilst people respond to the test options they are given as a result of completing our risk assessment, many people feel empowered to self-manage and test for other STIs too.

At the very least it shows many people do like to exercise choice about their own healthcare.

Another interesting finding was that we can see that people who opt-in to a blood test (HIV & syphilis) are about 6% more likely to complete it than those who received the blood test by default - indicating maybe that when you invest in a choice about testing you are more likely to complete the process.

What are the benefits?

Our commissioners are very positive about the scheme as it is encourages what is known as ‘shared decision-making’. This acknowledges the rights of people to be involved in their own health care.  

It’s really important to offer choice in healthcare and to engage with people who use our services in shared decision-making about their health. Offering choice means that users can think about what their risk might be, and if they are not sure, they can access information on our sexual health support pages or can request support from our in-house clinical team.

It is also an intelligence-led approach – helping to ensure testing is appropriately available for certain population groups but equally not claiming to know better than the service user by allowing them to self-manage by selecting into tests.

It feels like this might be moving to a ‘sweet spot’ - striking the balance between clinically informed and robust online assessments, empowering people to make their own choice, but simultaneously helping to use resources appropriately (by not testing people who don’t need certain tests). In a time where the $$ signs govern a great deal, selective testing seems like a good way to be financially responsible but not at the cost of quality or user experience.

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