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The aim of the study was to gather the views of sexual health clinic staff and male clinic users regarding digital sexual health promotion and Sexual health posters nhs human trial procedures. Interviews were conducted with 11 men who had participated in the trial and with nine clinic staff, to explore their views of the website and views of the online trial. Interviews were audio-recorded and transcribed, and we conducted a thematic analysis of interviews and of free text comments from the online RCT outcome questionnaires.

Pre-appointment waiting time presents a good opportunity for intervention but clinic users and staff felt that a website should supplement rather than replace face-to-face healthcare. The RCT procedures fitted well around clinical activities, but men did not self-direct to the tablet computers.

Staff were Sexual health posters nhs human concerned about consent and confidentiality than clinic users, and staff and patients were frustrated by multiple technical problems. The trial outcome questionnaire was thought-provoking and could constitute an intervention in itself. Digital interventions could usefully supplement in-person sexual health care, but there are important obstacles in terms of IT access in NHS settings, and in promoting engagement.

Sexually transmitted infections STIs are a major public health problem, with high social and economic costs. Guidance from the UK National Institute for Health and Care Excellence NICE recommends that people at high risk of STI are offered one-to-one structured discussions to address risk-taking, 1 and interventions such as motivational interviewing are increasingly being offered as part of routine care in sexual health clinics and other health care settings.

While behavioural interventions can impact positively on sexual behaviour, 1 in practice it is resource intensive to train and support staff, and difficult to find time for structured discussions in clinical services which are struggling to cope with demand.

There Sexual health posters nhs human additional barriers to health promotion for men, who are less likely than women to visit health professionals 3 and can be reluctant to discuss their health with practitioners, partners Sexual health posters nhs human friends. An online intervention offers an alternative way to reach men at risk of contracting STIs, and digital interventions are suitable for sexual health promotion because access can be private, anonymous and self-paced.

Interactive digital interventions IDIs can be expensive to develop, but offer the advantages of intervention content fidelity and the potential to reach Sexual health posters nhs human audiences with relatively low dissemination costs.

While there are Sexual health posters nhs human advantages to using online methodologies for randomised controlled trials RCTsonline trials can be associated with a number of problems, including poor engagement with interventions, and poor retention at follow-up. There is policy support in England to develop and implement digital health interventions 16 and there has been rapid but localised innovation in this area.

There are also challenges Sexual health posters nhs human conducting trials in NHS settings, such as competing clinical and research priorities for clinic staff, and lack of appropriate space for research activity. In sexual health research, it may be difficult to recruit people who may have a short-term curable condition as opposed to a chronic conditionand it can be hard to engage and retain men in research.

It is important to determine the best ways of evaluating digital interventions, to allow rigorous evaluation before implementation. We conducted a feasibility RCT in three sexual health clinics, recruiting men who have sex with women and randomising them to either the intervention website plus usual clinic care, or usual care only see Box 1.

higher levels of condom-carrying amongst...

New acute STI diagnoses were recorded for 8. This study was a qualitative evaluation which was conducted in conjunction with a quantitative feasibility RCT. We used three qualitative data sources to assess the acceptability and validity of the feasibility RCT methodology: An additional question in the online recruitment process asked permission to contact them for a post-study interview.

We recruited the qualitative study sample at the end of the trial, and their survey data were not included in the quantitative trial outcome analysis. We had intended to interview 20 men but researcher sickness prevented this, and as time passed we felt that participants would not be able to adequately recall their experience of being in the online trial.

We sampled purposively on the basis of age and trial allocation condition i. The interviews were conducted in a variety Sexual health posters nhs human settings including sexual health clinic side rooms, university offices and via Skype, by a researcher who had not been involved in the feasibility trial LH. Interviews were audio-recorded and transcribed, with participant permission. The feasibility RCT involved filling in baseline and follow-up sexual health surveys see Box 1.

We sought information on potential positive or negative effects of the research itself by offering space for voluntary free text comments after each cluster of questions, and at the end of each online survey.

Forty-six of the Sexual health posters nhs human in the feasibility trial left comments at the end of at least one of the 3, 6 or month outcome questionnaires a total of free text comments. Staff were interviewed face to face in clinic rooms by a researcher who had not been involved in the feasibility trial LH.

A topic guide included questions regarding their views on recruitment procedures, and Sexual health posters nhs human feasibility and usefulness of providing access to an IDI in a sexual health setting. The quality of data collection was reviewed by the research group as the study progressed by listening to audio-recordings of interviews and by discussion of two early transcripts.

The topic guide questions were revised in minor ways in the light Sexual health posters nhs human this review. Thematic analysis was used to identify patterns and links within the data. One researcher NT independently coded text from the transcripts, categorised data by theme, and identified relationships between different elements of the text. Coding decisions were reviewed and augmented by a second researcher JB and a data analysis meeting with all authors was held to discuss the coding.

The coding schema developed for the interview data was used to code the online survey free text comments. The 11 men who were interviewed varied in age from 19 to 62, with a median age of Eight were sexually active only with female partners; one reported both male and female partners; and two men were sexually active only Sexual health posters nhs human male partners. The latter MSM had been recruited unintentionally as a result of a software coding error: Six interviewees had received the intervention and five were from the control group, and all of the three RCT clinical sites Sexual health posters nhs human sampled.

The nine staff members who were interviewed varied in age from 23 to 65, with a median age of Staff were recruited from all three sexual health clinics: Five of the nine members of staff had a specific research Sexual health posters nhs human to their Sexual health posters nhs human e.

Men commonly cited boredom and a desire to help the researchers out as their main reasons for participating. The promise of a voucher was described by many as an added bonus but most participants said they would have taken part in the online RCT without this incentive. The academic nature of the study and links with the NHS were identified as important motivators for participating. Many thought it was an exercise in data collection and did not realise that the website was intended as an intervention to change behaviours.

However, they were happy to proceed without full understanding. Two participants had concerns initially that the study may have been sponsored by condom manufacturers, which would have put them off participating in case the research was linked to sales promotions.

Male interviewee IDControl group. All three of the clinics offer sexual health appointments on a drop-in basis, and the waiting time varies by time of day and day of the week.

The iPads were positioned so that men could access them while waiting to see clinic staff. The placement of the iPads varied. Staff described the tensions between making the iPad accessible in the main waiting room and thus increasing accessand offering privacy to participants.

Some felt uncomfortable approaching potential participants and explaining the study in a public waiting room, especially since the study Sexual health posters nhs human on men who have sex with women, and staff sometimes knew that there were men who have sex with men in the waiting room who would not be eligible.

Male participants agreed that privacy was important, and most felt happy with the location of the iPad that they had experienced. The staff interviewed had been concerned that patients might be worried about missing their appointments, and one of their important roles was to ensure that this did not happen.

Staff expressed mixed opinions of the self-directed online consent. While it lessened paperwork and in theory should have saved staff time and effort, many felt duty-bound to obtain verbal consent as well, worried that participants may skim-read or fail to understand.

In line with this concern, several male interviewees said that they had scanned the consent pages, and others were unable to recall specific details although this may also reflect difficulties recalling details two or more weeks after enrolment.

The study materials featured University College London and NHS logos, and men interviewed trusted that researchers would protect their anonymity and safety and were not interested in the details of this. I wonder if bullet points would be better? Staff member 9, Clinic 1. There were substantial errors in the software that impacted on recruitment of eligible participants, and upon data collection and access to the intervention. Internet connections were often poor, and staff were not always confident about remedying Internet access problems.

There was a faulty algorithm for participant selection, failure with automated web-analytic data collection, and faults in the login process for website and questionnaire access, which were not detected by pre-trial manual testing of the online trial software.

The research team tested the algorithm manually, but automated testing was not carried out by the software development company. These problems were frustrating for men as well clinic staff and researchers.

Men who have sex with...

Male interviewee, IDControl group. The research procedures were a barrier to engagement with the intervention since they took Sexual health posters nhs human time to complete. So for example when I was… so when the patients are doing this it can often take quite a while to get through all the data that you require. Staff member 1, Clinic 1.

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The online trial outcome questionnaire contained questions concerning condom use which were acceptable to all interviewees see Appendix 1. Interviewees said that they were honest in their questionnaire responses, and some commented that it was easier to Sexual health posters nhs human honest online than in person. The act of filling in the online survey questions prompted reflections on their attitudes or behaviour for some men in the control group.

I found being submitted [sent] the same questions over and over and having to answer them, offered me the chance to ponder over this topic that often I might have overlooked. It has made me feel more conscious about my Sexual health posters nhs human life. ParticipantControl group, comment on month questionnaires. ParticipantControl group, comment on month questionnaire. ParticipantControl group, comment on 3-month questionnaire.

The study has reminded me of risk but not necessarily offered any new solution. People, including me take absurd risks because sex with a condom is not the same thing as sex without.

There are condoms that work a little better. Your website hedges around actually recommending a brand or type on the grounds of pleasure. Trial participantIntervention group, comment on month questionnaire. Trial participantIntervention group, comment on 3-month questionnaire. Trial participantIntervention Group, comment on 3-month questionnaire. I feel that generally speaking it was very obvious the advice that was given, although I do think it is very important to make people aware of some things that perhaps some people do not see as being obvious.

Personally I found it obvious and I do not feel that it has had any effect on my sexual practice or my wellbeing. However I am grateful to have taken part and Sexual health posters nhs human wish you all the success with your study: Trial participantIntervention Group, comment on month questionnaire. Trial participantIntervention group, comment on 6-month questionnaire.

There were no serious reported adverse effects of the study, but one man described an adverse emotional impact:. Male clinic users and clinic staff were positive about the role that Sexual health posters nhs human interventions could Sexual health posters nhs human in terms of being a useful resource for sexual health information either before or after clinic appointments.

Offering a web-based resource in sexual health waiting rooms was felt to be very appropriate. higher levels of condom-carrying amongst sexually active young people.

They are Sexual health posters nhs human for distribution in pubs, bars, doctors' surgeries, GUM and sexual health clinics, community pharmacies and student unions.

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Posters and leaflets. Apr 11, There are also challenges to conducting trials in NHS settings, such as Recruitment: posters were placed in three sexual health clinics and leaflets handed . so it doesn't replace human beings in any way, shape or form. Mar 16, For all settings providing NHS-funded sexual health Sexual health posters nhs human. Recommended standards for NHS Sexual health posters nhs human services, published by MedFASH in as contained in the Human Fertilisation and Embryology Act () enables places to be Poster.

The European Journal of Contraception & Reproductive.

The aim of the study was to gather the views of sexual health clinic staff and male clinic users regarding digital sexual health promotion and online trial procedures. Interviews were conducted with 11 men who had participated in the trial and with nine clinic staff, to explore their views of the website and views of the online trial. Interviews were audio-recorded and transcribed, and we conducted a thematic analysis of interviews and of free text comments from the online RCT outcome questionnaires.

Pre-appointment waiting time presents a good opportunity for intervention but clinic users and staff felt that a website should supplement rather than replace face-to-face healthcare. The RCT procedures fitted well around clinical activities, but men did not self-direct to the tablet computers.

Staff were more concerned about consent and confidentiality than clinic users, and staff and patients were frustrated by multiple technical problems. The trial outcome questionnaire was thought-provoking and could constitute an intervention in itself. Digital interventions could usefully supplement in-person sexual health care, but there are important obstacles in terms of IT access in NHS settings, and in promoting engagement.

Sexually transmitted infections STIs are a major public health problem, with high social and economic costs. Guidance from the UK National Institute for Health and Care Excellence NICE recommends that people at high risk of STI are offered one-to-one structured discussions to address risk-taking, 1 and interventions such as motivational interviewing are increasingly being offered as part of routine care in sexual health clinics and other health care settings.

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