Abstract
We conducted an online survey to examine the preferences for receiving a text message with results of a test for sexually transmitted infections (STIs) as part of online self-sampling service at Solent NHS Trust. Findings showed that if all tests were negative, participants would prefer to receive one text message. However, in the event of a positive result, a large majority (86%) would prefer to receive a separate text with the name of the STI for which the test was positive. Similarly, three-quarters (74%) of participants would prefer to receive multiple texts indicating which test was inconclusive and required an additional sample. The results of this survey support a change of practice to sending multiple text messages with the results of online self-sampling that include the names of STIs.
Introduction
Mobile phone text messages with the results of screening for sexually transmitted infections (STIs) are an acceptable and effective method in reducing the time from screening to diagnosis, subsequent treatment and partner notification.1,2 Their wording is likely to vary between services, with some providing a simple text ‘No further action required’ and others indicating the names of specific STIs. The National Chlamydia Screening Programme in England, which conducted a survey exploring attitudes towards the wording of text results, found that there was a slight preference for the inclusion of the word ‘Chlamydia’. 3 Over 85% understood the wording of a ‘positive’ text and only 75% understood the wording of a ‘negative’ text, indicating a need for more comprehensible communication of screening outcomes.
Including the names of STIs within the text could benefit patients and services. Patients often worry about the results of screening and some may react with unnecessary anxiety after receiving texts indicating inconclusive results. Texts with the names of bacterial STIs are likely to decrease the number of calls being made to the clinic, producing substantial operational savings and reducing the waste related to the management of calls for incomplete tests. In the current study, we examined the attitudes of STI self-sampling service users of Solent NHS Trust towards the wording of text results containing the names of curable STIs such as Chlamydia and gonorrhoea (users with reactive HIV, hepatitis and syphilis tests are asked to contact the clinic).
An online survey with eight items was designed to determine the acceptability of new text messages including the names of STIs (see online Supplementary file). The survey explored how service users understood different formats of text messages and asked about their actions following a receipt of a new text message to estimate the actual impact on behaviour. Eight attitudinal questions with ‘strongly disagree’ to ‘strongly agree’ options explored users’ preferences for different formats of messages, sent either as a single or multiple texts. Finally, we presented three sets of new messages, so that the respondents could visually assess the proposed new format in comparison to the current format of text messages.
A text invitation to the online survey, with an URL link, was sent to service users who had used self-sampling in the past. The survey was anonymous and no patient identifiable information was collected. The data were analysed using descriptive statistics. This evaluation was approved by Solent NHS Trust Clinical Governance.
Results
In total, 115 users responded and 87% reported having received a text message with results of a sexual health test in the past. Thirteen per cent indicated that they did not understand its content, suggesting that although the current format is clear for the majority of service users, 1 in 10 might still have difficulty in comprehending the results.
There was a very good understanding of current text messages and generally good understanding of proposed text messages, which include the names of STIs (Table 1). In the case of positive results, most patients would ‘wait to be contacted by the clinic’, as instructed in the text, and only a quarter would call the sexual health clinic. Nine per cent of participants that received an inconclusive text message would proceed to order a new kit.
Users’ actions following the receipt of a text message. (Question: Below is the list of potential STI test results messages. Please read each message carefully and indicate what actions you would take if you receive it.)
STIs: sexually transmitted infections.
Over 86% of respondents would prefer to receive text messages that include the names of STIs (Table 2). Only 9% showed negative attitudes towards the proposed format. Sixty per cent of respondents would prefer to receive one text for negative results. The majority (65%) would not be concerned about other people reading the text if it includes the names of STIs. A small minority (15%) showed concerns about the inclusion of names and for 11% this would stop them from requesting the self-sampling kit.
Preferences for single and multiple text messages. (Question: Please read the following statements and decide to what extent you agree or disagree with each of them.)
STIs: sexually transmitted infections.
The analysis of the pictures displaying different formats of text messages, demonstrated that, if all test results were negative, 61% would prefer to receive one text with negative results, 86% would prefer multiple texts with the names of an STI for which they were positive (Chlamydia and gonorrhoea), and 74% would prefer to receive separate text messages indicating that inconclusive results required retesting.
Discussion
Multiple text messages that include the names of STIs for which patients test positive or negative are highly acceptable. Most self-sampling users would prefer a single text for negative results and multiple texts indicating a positive test result for a bacterial STI or incomplete samples. Users might need to be reminded to delete the text from their phone after receipt to minimise the risk of the text being visible to others. An additional phrase or clarification e.g. ‘you don’t need to order new kit yourself’ could reduce the number of unnecessary kit requests for inconclusive results. The findings are in line with the National Chlamydia Screening Programme’s recommendation to include the names of STIs. 3 These findings have international implications for sexual health services that use text messages to communicate self-sampling screening outcomes.
Supplemental Material
Supplemental material for Preferences for the format of text messages containing results of online screening for sexually transmitted infections: a service evaluation
Supplemental material for Preferences for the format of text messages containing results of online screening for sexually transmitted infections: a service evaluation by Tom Nadarzynski, Clare Scholfield, Ynez Symonds, Cynthia Graham and Sally Kidsley in International Journal of STD & AIDS
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
References
Supplementary Material
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