Supporting access to sexual healthcare and consultations
Research type
Research Study
Full title
Supporting access to sexual healthcare and consultations: A research study
IRAS ID
281107
Contact name
Claire Farrow
Contact email
Sponsor organisation
Aston University
Duration of Study in the UK
0 years, 11 months, 3 days
Research summary
Summary of Research
The aim of this study is to understand what makes it easy or difficult for people to attend sexual health clinic appointments, what would help people to overcome any barriers to accessing sexual health services and the impact of such services delivered in a variety of modalities (e.g. face-to-face; telephone; video call) due to changes in delivery caused by Covid-19. Through gathering the views of people who have attended or missed a sexual health consultation/appointment, or those who may attend one in the future, we will be able to identify factors associated with missed appointments. This information will inform recommendations for improving access to, and attendance at sexual health services as well as the satisfaction with different modes of delivery. This study will involve interviewing people who have used, missed or might use a sexual health service. Information will be elicited on the experience of accessing and any associated views on barriers to accessing these appointments. Participants will be approximately 20 service-users and 5 potential service-users and 15 health professionals. Service-user participants will be identified and recruited through the Umbrella sexual health service in Birmingham, UK. Potential users will be identified via advertisement on social media and within local universities, community groups. Due to restrictions related to Covid-19, interviews will be conducted via telephone/internet call with or without video (according to participant preference). Participants will also be offered an alternative, online qualitative questionnaire if they do not wish to participate in an interview. Informed consent will be obtained from all participants prior to data collection. With permission, interviews will be recorded and the recordings transcribed and analysed using a thematic framework approach. Findings will be synthesised with those of a systematic literature review and used to make recommendations regarding effective interventions to reduce non-attendance at sexual health appointments and consultations.
Summary of Results
i. Systematic review of the factors influencing missed appointments at sexual health clinics (SHC): twenty-six papers were included in the review. Findings indicated that interventions targeting missed appointments at SHCs need to take steps to increase individuals’ positive evaluations of attendance (e.g. positive health outcomes) and decrease negative evaluations (e.g. fear of examination), improve perceptions of social acceptance of SHC attendance (e.g. sexual health appointment attendance as a normal healthcare behaviour) and enhance perceived attendance ease (e.g. availability of appointments; mode of appointment delivery).
ii. Qualitative study with sexual health clinic service-users/potential users and healthcare professionals to explore why people miss appointments for sexual health consultations which they have pre-booked. Findings highlighted perceptual and practical factors influencing missed appointments for sexual health care. These included beliefs about appointment necessity (related to perceptions of symptom severity and risky behaviour); beliefs about outcomes or value of attending; sense of responsibility to self and others; concerns about privacy and security and concerns about what might happen during the appointment. Practical factors included competing demands and disruption to daily life (related to perceptions of necessity); ability to attend; and forgetting. There were also service delivery barriers including mode of appointment delivery and convenience/availability of appointments. While remote consultations were thought to reduce missed appointments by increasing convenience and mitigating some concerns (e.g. being seen attending), tele-healthcare also created barriers such as finding an appropriate time/space for consultations away from the clinic. Recommendations made by participants to reduce missed appointments included: appointment reminders; increasing service-user responsibility to attend; increasing perceptions of necessity to attend (importance); dispelling concerns about attending through information provision; improving clinic efficiency.
iii. Systematic review to identify the range and type of interventions designed to reduce missed appointments at sexual health clinics: thirteen studies were included from across three countries; eight non-randomised before-after study designs and five randomised controlled trials. Text messages were the most frequently used mode of intervention delivery. A total of 19 behaviour change techniques (BCTs) were identified as being used within interventions. The most used BCTs in effective interventions were credible sources, prompts/cues and the provision of information about health consequences. Only three studies mentioned behaviour change theory within their intervention design.
iv. Synthesis and recommendations: Data collected from i, ii and iii were synthesised using a series of frameworks and models, to develop recommendations for interventions that are likely to be effective, acceptable and deliverable in practice to reduce missed appointments at sexual health clinics in Birmingham, delivered by any modality. Findings from the synthesis indicated that underlying factors influencing why people miss pre-booked sexual health clinic appointments include: forgetting; beliefs about the outcomes of attending appointments; perceived appointment need; sense of personal and social responsibility; perceptions of value and fear and uncertainty regarding procedures; Perceptions of privacy and confidentiality; convenience and competing demands; time from appointment booking to attendance. Interventions are recommended to implement “reminder-plus” messaging systems which target the practical barrier of forgetting an appointment together with perceptual barriers of beliefs about outcomes and perceived need of the appointment. Providing options for mode of appointment delivery and reducing time between booking and offering appointment are also recommended.REC name
North of Scotland Research Ethics Committee 1
REC reference
20/NS/0092
Date of REC Opinion
31 Aug 2020
REC opinion
Favourable Opinion