Sante_HTA_Report_accepted manuscript 30April 2017.pdf (1.89 MB)
Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study
journal contribution
posted on 2023-06-09, 14:43 authored by Carina King, Carrie LlewellynCarrie Llewellyn, Maryam Shahmanesh, Charles Abraham, Julia Bailey, Fiona Burns, Laura Clark, Alison Howarth, Gwenda Hughes, Cath Mercer, Alec Miners, Alexander Pollard, Alison Rodger, Anupama Roy, Richard GilsonBackground: Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. Objectives: The study had two main objectives: 1. develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services; 2. assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. Design: The project was a multi-stage mixed methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review; analysis of national surveillance data, and development of a triage algorithm; interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. Setting: SH clinics in England. Participants: Young people (aged 16-25 years old) and men who have sex with men. Intervention: A three-part intervention package: 1. triage tool to score patients as high or low risk of STI infection using routine data; 2. a study-designed webpage with tailored sexual health information for all patients, regardless of risk; 3. a brief one-to-one session based on motivational interviewing for high risk patients. Main outcome measures: The three outcomes were: acceptability of the intervention to patients and SH providers; feasibility of delivering the interventions within existing resources; and feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). Results: We identified 33 relevant trials from the systematic review, including: videos, peer support, digital, and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% versus 46%). Limitations: Fewer clinics were included in the pilot than planned limiting the ability to make strong conclusions on RCT feasibility. Conclusion: We were unable to conclude whether a definitive RCT would be feasible due to challenges in implementation of a pilot, but have laid the groundwork for future research in the area.
History
Publication status
- Published
File Version
- Accepted version
Journal
Health Technology AssessmentISSN
2046-4924Publisher
NIHR Journals LibraryExternal DOI
Issue
12Volume
23Page range
1-121Department affiliated with
- Primary Care and Public Health Publications
Full text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2018-08-23First Open Access (FOA) Date
2018-11-22First Compliant Deposit (FCD) Date
2018-08-22Usage metrics
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