Digitalized sexual health services wouldn't be trusted by young people, finds study

Digital services, such as anonymous apps and texting services, could change how we engage with sexual health services, but young people wouldn't trust them, according to new research by Cardiff University.

Research has found that while digital sexual health services hold a lot of potential for helping young people feel more comfortable talking about sexual health, there are major issues with what young people expect and want from these services, and they currently wouldn't trust them.

"Young people under the age of 25 experience a disproportionate rate of STIs—because of this, young people's sexual health is considered a priority health issue," says Dr. Clare Bennett

"Internationally, health systems are shifting towards digitally-mediated care to meet the health needs of populations, and sexual health services have been at the forefront of these changes."

"Young people continue to underutilize sexual health care in both face-to-face and virtual services. We aimed to understand what could be done to increase engagement with sexual health services."

By working with sexual health nurses from across three English NHS Trusts in coastal, rural, and urban locations, as well as conducting research with 16 to 18-year-olds in full-time education in England and Wales, researchers from Cardiff University set out to understand perceptions of digital sexual health technologies and nurses' first-hand experience of providing these services.

The research found that while nurses thought that digitalizing sexual health services would help some young people overcome barriers to treatment, such as embarrassment, young people distrust online services and have unrealistic expectations about what they can provide.

"Young people expressed specific expectations and wanted choice—expressing a need for a service that was available 24 hours a day, seven days a week, with instant responses. They expressed that any system that involved a delayed response would be unacceptable to their age group," says Dr. Bennett.

The research also showed that digital services are limited in addressing inequalities of access to sexual health services due to a lack of access to technology among some young people.

"Although digital transformation has permeated into virtually every aspect of daily life, and especially for the lives of young people, we cannot assume digital literacy and access to digital technology. It's important to highlight, as services become more digital that there are risks of digital exclusion among those who have limited access, skills, and awareness of digital services."

"Our research demonstrates that digital platforms and services alone—as the young people in this study articulate—would be insufficient in addressing their needs. Instead, digital services need to form part of the system and not replace traditional face-to-face service provision," added Dr. Bennett.

Findings showed that young people need digital services to be accessible and user-friendly, and while digital sexual health services hold the potential to increase engagement from some young people, the services should be complementary to clinic visits but should not replace them.

"Working with nurses from sexual health clinics, we learned that digital services should act in addition to clinical visits, not replace them. In our research, we found that face-to-face assessment was often necessary, but digital engagement enabled the nurses to build trust to facilitate in-person attendance," says Dr. Bennett.

Before digital services can achieve their potential, trust needs to be addressed as does the expectations around what the service can deliver.

"Digital sexual health systems hold great potential—in both improving access to sexual health services for young people and breaking down some sexual health inequalities. But the issues of trust and expectation need to be addressed, and these technologies need to be integral to the wider systems otherwise there is a risk that their impact will be compromised," Dr. Bennett concludes.

The study is published in the journal BMJ Public Health.