| Summary: | Background
Sexually transmitted infections (STI) are a major public health problem, with high social and economic costs. Condoms are effective for prevention of STI, but there are many barriers to successful use.
Men are less likely than women to visit health professionals, and can be reluctant to discuss their sexual health with practitioners, partners or friends. An online intervention offers an alternative way to reach men at risk of STI. Digital interventions are very suitable for sexual health promotion because access can be private, anonymous and self-paced. Interventions can be targeted for specific groups (e.g. by age, gender or sexuality), and content can be tailored for individuals. Digital interventions can be expensive to develop, but offer the advantages of intervention content fidelity and the potential to reach large audiences at relatively low dissemination costs. Interventions can improve sexual behaviour as well as increasing knowledge, self-efficacy and safer sex intention, but more evidence is needed to establish effects on biological outcomes such as STI.
The Men’s Safer Sex website (MenSS) is an interactive digital intervention (IDI) which provides information and tailored advice on sexual wellbeing and barriers to condom use. The website was offered to men in the waiting rooms of NHS sexual health clinics, with the aim of increasing condom use and reducing STI.
Aims:
To determine the feasibility and best design for a randomised controlled trial to test the effect of the Men’s Safer Sex website on condom use and STI amongst men attending sexual health clinics.
Methods:
Men aged 16 and over with female sexual partners and recent unprotected sex or suspected acute STI were recruited from three UK sexual health clinics (N = 159). Participants were randomised (using an automated computer algorithm) to the MenSS website in addition to usual clinic care, or to usual care only. Participants were invited via email to complete online follow-up questionnaires at 3, 6, and 12 months. The primary outcome was condom use at 3 months, with secondary outcomes of STI rates (self-reported and from clinical records). A total of £50 in online shopping vouchers was offered for completing online questionnaires.
Results:
Eighty-four men were allocated to receive the intervention, and 75 were randomised to the control arm. Clinical records were located for 94% of participants (for STI diagnoses over 12 months), but response rates for the online questionnaire were poor: 36% at 3 and 6 months, and 50% at 12 months. There was no detectable difference in condom use between groups, but the numbers were very small due to the low online questionnaire response rate. There were fewer clinical diagnoses of STI over one year in the intervention group who were offered the MenSS website, but the differences were non-significant (Incidence rate ratio 0.75, 95% CI 0.29 to 1.89). No harms or adverse events were identified.
Conclusions
The best way to assess the impact of the MenSS website was by recording STI diagnoses from clinical records. Response rates for the online questionnaire were poor despite offers of incentives. There were many challenges to conducting an online trial of a sexual health website including ethical committee concerns about email content, poor reliability of trial-related software, balancing data protection and security protocols against ease of access for participants, barriers to patient access to IT in NHS clinics, and trying to ensure that participants engage with a digital intervention for long enough. Whilst digital interventions have great potential for health promotion, we encountered significant obstacles to online research, and to implementation of an IDI in an NHS clinical setting.
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